7 ms·

If Covid-19 does end up being a dud, then we are in real trouble if/when an actual pandemic arrives -- because by then everyone will say the CDC is Crying Wolf.

hellofunk 7y ago
It’s already proven not to be a dud — healthcare systems stretched to beyond 200% capacity is solid evidence of something no one has seen in recent memory. When youngish healthcare workers are dying, something is going on.
- huffmsa 7y ago
  Not necessarily. If it's already in a sizable portion of the population but mostly undetected, it will kill some seemingly healthy young people. They may have some unknown underlying condition, may have the genetics to trigger a lung destroying cytokinin storm, or may just have gotten unlucky.
  - nradov 7y ago
    Here's some more information about cytokine storm syndrome treatment in COVID-19 patients. https://www.uab.edu/news/research/item/11176-covid-19-do-not-forget-the-host-in-treating-this-disease https://www.uab.edu/news/research/item/11176-covid-19-do-not...
- thu2111 7y ago
  Where did you get that number from? A report from Lombardy yesterday says so far everyone with any reasonable chance of recovery has been treated: https://www.reuters.com/article/us-health-coronavirus-italy-ethics-speci/all-is-well-in-italy-triage-and-lies-for-virus-patients-idUSKBN2133KG https://www.reuters.com/article/us-health-coronavirus-italy-... As far as I can tell so far, no hospital systems have collapsed due to this, even in the most extreme hot zones. The fear is that they will, and that sounds totally reasonable. But we also are basing that fear on data that's not robust. So we don't really know yet what will happen.
  - hellofunk 7y ago
    This has been so widely reported, not sure where to start. Operating rooms at many Italian hospitals have been closed and turned into ICUs to handle the demand, which means that surgeries in many places are no longer possible. You can read about this in any of hundreds of media outlets. Here's one: https://www.dailymail.co.uk/news/article-8095835/Overwhelmed-Italian-hospitals-running-200-cent-capacity.html https://www.dailymail.co.uk/news/article-8095835/Overwhelmed...
    - thu2111 7y ago
      You don't seem to be contradicting me. I'm not saying everything is normal or other operations weren't cancelled. I'm saying that at this time, Italy is saying they have not run out of capacity to treat CV patients. And they definitely aren't 200% over capacity (for CV) as claimed.
      - jfkebwjsbx 7y ago
        They have not enough ICU beds. That is pretty much the definition of running out of capacity.
        thu2111 7y ago
        OK, so I read the Daily Mail article. I think there are a couple of things going on here. Firstly, hellofunk made a claim of "health care systems stretched to beyond 200% capacity". I asked where that number came from because it contradicted what I'd read. S/he's provided a source, which is this quote from the DM: Another medic in northern Italy told a friend in the UK that hospitals were running at '200 per cent capacity' with operating theatres hurriedly converted into intensive care units. So this is a snippet from a private conversation with a friend repeated on Twitter, and it grew in the telling ("at 200%" became "at over 200%"): it's not a formal claim by someone with all the data. It's a claim that's painting a picture of what it looks like inside a hospital where one person works. Secondly the report I cited has this: "Over three weeks, 1,135 people have needed intensive care in Lombardy, but the region has only 800 intensive care beds, according to Giacomo Grasselli ... Grasselli coordinates all the state-run intensive care units across Lombardy." When I read this the first time I thought, OK, so then they've surely run out of beds and are turning away people they could save. Confusion followed when I read this: Lombardy intensive care coordinator Grasselli said he believed that, so far, all patients with a reasonable chance of recovering and living an acceptable quality of life had been treated. But he added that this approach is under strain. “Previously, for some people we would have said, ‘let’s give them a chance for a few days.’ Now we have to be more stringent.” The first quote doesn't actually say they've run out of beds. That would be true if everyone needed to stay 3 weeks. If the average recovery time is 14.7 days then 1135 people could be treated with 800 ICU beds without anyone being turned away, whilst being at full capacity. In the DM article the anonymous doctor claims Lombardy's healthcare system is one of the best in the world (sometimes this is phrased as most efficient, which isn't quite the same thing: you'd expect a highly efficient healthcare system to run out of capacity earlier than a less efficient one, I suppose). The Reuters article says: Intubating can be taxing on the body, especially for older patients, says Grasselli ... adding that he would never intubate his 84-year old father. Before the coronavirus broke, “we more often had the luxury to try to intubate patients who were at the limit,” said Mario Riccio, head of anaesthesiology at the Oglio Po hospital near Cremona. Now that’s changed. So some of this notion of rationing of healthcare is that before, Lombardy could afford to try extreme and risky measures to extend every life even in cases where the likely outcome was severe damage to the body from the procedure. Now they can't afford to take such measures anymore. Medical systems don't have a hard notion of capacity. Total capacity is flexible: when under stress doctors are forced to triage more aggressively and drop the most extreme treatments. It may not make sense to talk about running out of capacity in a world where medical systems can keep otherwise terminal patients alive indefinitely; there is always triage even in quiet times. I'm not sure how best to measure it but it may be unduly alarming to say Lombardy has run out of beds.
arthur5005 7y ago
This is my biggest concern. I don’t even think this is “the big one”
- beatgammit 7y ago
  Oh, it's absolutely not "the big one", which is why I'm so frustrated at all of the panic buying. It was pretty clear early on that this isn't that deadly and that the main issue with it is filling up hospitals. We later learned that the whole process from infection to recovery (well, enough to be released from a hospital) is about 2 weeks, maybe less. This isn't some society-collapsing event, but it does require containment so our medical infrastructure doesn't get overwhelmed. If you get it, you'll most likely live, even without medical attention. That being said, we do need to treat it seriously. It isn't just a dress rehearsal for something worse, but it is telling in how people react. I'm worried about what will happen if something worse comes along. What I have learned, however, is that my general strategy is always keeping 1-2 months of basic essentials on hand is a good idea, and that I need to be more vigilant about it because people overreact.
  - soggy-assistant 7y ago
    I lived in the Tampa Bay area for 7 years. Twice a year (despite the fact that TB has been very much sparred from impact) hurricane panic ramps up and the region is CLEARED out of wood, petro, water, and canned goods. Hurricane Irma results in a complete wipeout of supplies 2 weeks before landfall. The initial landfall target was Miami and all hell broke loose anyway.
  - senordevnyc 7y ago
    So when you get 1-2 months of essentials just in case, it’s a good idea, but when other people do it, it’s panic buying and overreaction?
    - collinmanderson 7y ago
      The trick is to already have 1-2 months of essentials before hand. The issue is when everyone tries to get 1-2 months of essentials all at the same time.
tqkxzugoaupvwqr 7y ago
Hospitals in Italy are over capacity. People are prioritized based on chance of survival. Anyone unlucky is left to die because there is not enough equipment.
- 8fingerlouie 7y ago
  Yesterday the news was that anybody over 80 is not treated. They simply don't have the capacity for it, and survival chances are better for people under 80.
  - thu2111 7y ago
    Are you sure? https://www.reuters.com/article/us-health-coronavirus-italy-ethics-speci/all-is-well-in-italy-triage-and-lies-for-virus-patients-idUSKBN2133KG https://www.reuters.com/article/us-health-coronavirus-italy-... Lombardy intensive care coordinator Grasselli said he believed that, so far, all patients with a reasonable chance of recovering and living an acceptable quality of life had been treated. I wonder if we're getting mixed messages here; that is, it's inevitable doctors give up on some cases and unplug them from the ICU but that is always a risk in ICU for any reason to be there.
    - bob33212 7y ago
      Doctors "Give Up" on people all the time. If you have advanced pancreatic cancer, are 85 and a heavy smoker, most doctors are going to suggest you go home and spend your last few days with loved ones.
      - thu2111 7y ago
        Yeah, that's what I'm getting at. What I see at the moment on HN and elsewhere is a lot of people who seem to believe that in Italy the hospitals are already overrun and people are being turned away in large numbers because all the beds are gone already days ago. But this doesn't match what is actually happening there, according to the Italian government. What they're saying is so far they've had to turn away noone; that everyone who needs treatment is getting it. I think this mismatch is coming from a couple of places. One is mis-interpreting doctors switching off life support for patients who can theoretically be kept alive using e.g. ECMO but for whom their lungs are destroyed and they wouldn't really have a life afterwards. That's terribly sad but isn't the same thing as patients who are in the middle of making a full recovery being switched off, or people who could be saved being denied beds because there just aren't enough. Another is a confusion between "we're about to run out of beds" and "we think we're about to run out of beds". I'm not trying to downplay the seriousness of the situation here, but we have also have to keep our heads and double check things being claimed about that seriousness, as it's always tempting in times of crisis to lose our heads and go full sandwich-board. Maybe by tomorrow Italy will actually be there, but as of yesterday at least, it seems they aren't.
marvin 7y ago
This is not a dud, and it will prime whole generations in different countries to have respect for new diseases. If the United States just delays a little longer in its response, it will also be on the list of those countries. Don't know if one should count that as a success or not.
- 8fingerlouie 7y ago
  >If the United States just delays a little longer in its response You'd think following the trend of Italy was scary enough. https://www.vox.com/policy-and-politics/2020/3/13/21178289/confirmed-coronavirus-cases-us-countries-italy-iran-singapore-hong-kong https://www.vox.com/policy-and-politics/2020/3/13/21178289/c...

hellofunk 7y ago

It’s already proven not to be a dud — healthcare systems stretched to beyond 200% capacity is solid evidence of something no one has seen in recent memory. When youngish healthcare workers are dying, something is going on.

huffmsa 7y ago
Not necessarily. If it's already in a sizable portion of the population but mostly undetected, it will kill some seemingly healthy young people. They may have some unknown underlying condition, may have the genetics to trigger a lung destroying cytokinin storm, or may just have gotten unlucky.
- nradov 7y ago
  Here's some more information about cytokine storm syndrome treatment in COVID-19 patients. https://www.uab.edu/news/research/item/11176-covid-19-do-not-forget-the-host-in-treating-this-disease https://www.uab.edu/news/research/item/11176-covid-19-do-not...
thu2111 7y ago
Where did you get that number from? A report from Lombardy yesterday says so far everyone with any reasonable chance of recovery has been treated: https://www.reuters.com/article/us-health-coronavirus-italy-ethics-speci/all-is-well-in-italy-triage-and-lies-for-virus-patients-idUSKBN2133KG https://www.reuters.com/article/us-health-coronavirus-italy-... As far as I can tell so far, no hospital systems have collapsed due to this, even in the most extreme hot zones. The fear is that they will, and that sounds totally reasonable. But we also are basing that fear on data that's not robust. So we don't really know yet what will happen.
- hellofunk 7y ago
  This has been so widely reported, not sure where to start. Operating rooms at many Italian hospitals have been closed and turned into ICUs to handle the demand, which means that surgeries in many places are no longer possible. You can read about this in any of hundreds of media outlets. Here's one: https://www.dailymail.co.uk/news/article-8095835/Overwhelmed-Italian-hospitals-running-200-cent-capacity.html https://www.dailymail.co.uk/news/article-8095835/Overwhelmed...
  - thu2111 7y ago
    You don't seem to be contradicting me. I'm not saying everything is normal or other operations weren't cancelled. I'm saying that at this time, Italy is saying they have not run out of capacity to treat CV patients. And they definitely aren't 200% over capacity (for CV) as claimed.
    - jfkebwjsbx 7y ago
      They have not enough ICU beds. That is pretty much the definition of running out of capacity.
      - thu2111 7y ago
        OK, so I read the Daily Mail article. I think there are a couple of things going on here. Firstly, hellofunk made a claim of "health care systems stretched to beyond 200% capacity". I asked where that number came from because it contradicted what I'd read. S/he's provided a source, which is this quote from the DM: Another medic in northern Italy told a friend in the UK that hospitals were running at '200 per cent capacity' with operating theatres hurriedly converted into intensive care units. So this is a snippet from a private conversation with a friend repeated on Twitter, and it grew in the telling ("at 200%" became "at over 200%"): it's not a formal claim by someone with all the data. It's a claim that's painting a picture of what it looks like inside a hospital where one person works. Secondly the report I cited has this: "Over three weeks, 1,135 people have needed intensive care in Lombardy, but the region has only 800 intensive care beds, according to Giacomo Grasselli ... Grasselli coordinates all the state-run intensive care units across Lombardy." When I read this the first time I thought, OK, so then they've surely run out of beds and are turning away people they could save. Confusion followed when I read this: Lombardy intensive care coordinator Grasselli said he believed that, so far, all patients with a reasonable chance of recovering and living an acceptable quality of life had been treated. But he added that this approach is under strain. “Previously, for some people we would have said, ‘let’s give them a chance for a few days.’ Now we have to be more stringent.” The first quote doesn't actually say they've run out of beds. That would be true if everyone needed to stay 3 weeks. If the average recovery time is 14.7 days then 1135 people could be treated with 800 ICU beds without anyone being turned away, whilst being at full capacity. In the DM article the anonymous doctor claims Lombardy's healthcare system is one of the best in the world (sometimes this is phrased as most efficient, which isn't quite the same thing: you'd expect a highly efficient healthcare system to run out of capacity earlier than a less efficient one, I suppose). The Reuters article says: Intubating can be taxing on the body, especially for older patients, says Grasselli ... adding that he would never intubate his 84-year old father. Before the coronavirus broke, “we more often had the luxury to try to intubate patients who were at the limit,” said Mario Riccio, head of anaesthesiology at the Oglio Po hospital near Cremona. Now that’s changed. So some of this notion of rationing of healthcare is that before, Lombardy could afford to try extreme and risky measures to extend every life even in cases where the likely outcome was severe damage to the body from the procedure. Now they can't afford to take such measures anymore. Medical systems don't have a hard notion of capacity. Total capacity is flexible: when under stress doctors are forced to triage more aggressively and drop the most extreme treatments. It may not make sense to talk about running out of capacity in a world where medical systems can keep otherwise terminal patients alive indefinitely; there is always triage even in quiet times. I'm not sure how best to measure it but it may be unduly alarming to say Lombardy has run out of beds.

arthur5005 7y ago

This is my biggest concern. I don’t even think this is “the big one”

beatgammit 7y ago
Oh, it's absolutely not "the big one", which is why I'm so frustrated at all of the panic buying. It was pretty clear early on that this isn't that deadly and that the main issue with it is filling up hospitals. We later learned that the whole process from infection to recovery (well, enough to be released from a hospital) is about 2 weeks, maybe less. This isn't some society-collapsing event, but it does require containment so our medical infrastructure doesn't get overwhelmed. If you get it, you'll most likely live, even without medical attention. That being said, we do need to treat it seriously. It isn't just a dress rehearsal for something worse, but it is telling in how people react. I'm worried about what will happen if something worse comes along. What I have learned, however, is that my general strategy is always keeping 1-2 months of basic essentials on hand is a good idea, and that I need to be more vigilant about it because people overreact.
- soggy-assistant 7y ago
  I lived in the Tampa Bay area for 7 years. Twice a year (despite the fact that TB has been very much sparred from impact) hurricane panic ramps up and the region is CLEARED out of wood, petro, water, and canned goods. Hurricane Irma results in a complete wipeout of supplies 2 weeks before landfall. The initial landfall target was Miami and all hell broke loose anyway.
- senordevnyc 7y ago
  So when you get 1-2 months of essentials just in case, it’s a good idea, but when other people do it, it’s panic buying and overreaction?
  - collinmanderson 7y ago
    The trick is to already have 1-2 months of essentials before hand. The issue is when everyone tries to get 1-2 months of essentials all at the same time.

tqkxzugoaupvwqr 7y ago

Hospitals in Italy are over capacity. People are prioritized based on chance of survival. Anyone unlucky is left to die because there is not enough equipment.

8fingerlouie 7y ago
Yesterday the news was that anybody over 80 is not treated. They simply don't have the capacity for it, and survival chances are better for people under 80.
- thu2111 7y ago
  Are you sure? https://www.reuters.com/article/us-health-coronavirus-italy-ethics-speci/all-is-well-in-italy-triage-and-lies-for-virus-patients-idUSKBN2133KG https://www.reuters.com/article/us-health-coronavirus-italy-... Lombardy intensive care coordinator Grasselli said he believed that, so far, all patients with a reasonable chance of recovering and living an acceptable quality of life had been treated. I wonder if we're getting mixed messages here; that is, it's inevitable doctors give up on some cases and unplug them from the ICU but that is always a risk in ICU for any reason to be there.
  - bob33212 7y ago
    Doctors "Give Up" on people all the time. If you have advanced pancreatic cancer, are 85 and a heavy smoker, most doctors are going to suggest you go home and spend your last few days with loved ones.
    - thu2111 7y ago
      Yeah, that's what I'm getting at. What I see at the moment on HN and elsewhere is a lot of people who seem to believe that in Italy the hospitals are already overrun and people are being turned away in large numbers because all the beds are gone already days ago. But this doesn't match what is actually happening there, according to the Italian government. What they're saying is so far they've had to turn away noone; that everyone who needs treatment is getting it. I think this mismatch is coming from a couple of places. One is mis-interpreting doctors switching off life support for patients who can theoretically be kept alive using e.g. ECMO but for whom their lungs are destroyed and they wouldn't really have a life afterwards. That's terribly sad but isn't the same thing as patients who are in the middle of making a full recovery being switched off, or people who could be saved being denied beds because there just aren't enough. Another is a confusion between "we're about to run out of beds" and "we think we're about to run out of beds". I'm not trying to downplay the seriousness of the situation here, but we have also have to keep our heads and double check things being claimed about that seriousness, as it's always tempting in times of crisis to lose our heads and go full sandwich-board. Maybe by tomorrow Italy will actually be there, but as of yesterday at least, it seems they aren't.

marvin 7y ago

This is not a dud, and it will prime whole generations in different countries to have respect for new diseases. If the United States just delays a little longer in its response, it will also be on the list of those countries. Don't know if one should count that as a success or not.

8fingerlouie 7y ago
>If the United States just delays a little longer in its response You'd think following the trend of Italy was scary enough. https://www.vox.com/policy-and-politics/2020/3/13/21178289/confirmed-coronavirus-cases-us-countries-italy-iran-singapore-hong-kong https://www.vox.com/policy-and-politics/2020/3/13/21178289/c...