4 ms·

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

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.
- snapetom 7y ago
  > reasonable chance of recovery has been treated This is the caveat of what you said. The West, and especially Americans, doesn't take kindly to the realities of triaging. See the arguments on "death panels" regarding the Affordable Care Act.

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.
snapetom 7y ago
> reasonable chance of recovery has been treated This is the caveat of what you said. The West, and especially Americans, doesn't take kindly to the realities of triaging. See the arguments on "death panels" regarding the Affordable Care Act.