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Germany is pretty well equipped with ICU beds and they've increased the capacity even further in preparation for Corona. I'm not worried about Germany really. I

by est31 7y ago

Germany is pretty well equipped with ICU beds and they've increased the capacity even further in preparation for Corona. I'm not worried about Germany really. I'm more worried about other parts of Europe like eastern europe. A Czech friend told me they have barely any respirators in the country.

cosmodisk 7y ago
I think western countries have it worse: https://en.m.wikipedia.org/wiki/List_of_countries_by_hospital_beds https://en.m.wikipedia.org/wiki/List_of_countries_by_hospita...
- est31 7y ago
  From that list, Germany has more ICU beds per 100k inhabitants than any other country in that list except for the US, so it confirms that at least. Italy, France, Belgium, etc all have > 11, while Poland, Slovakia, Slovenia, Russia etc. have less than 10 each. Hungary and Czech republic have really good numbers, opposite to the trend and Netherlands, Portugal, Sweden, Denmark have really low numbers, also opposite to the trend. So it's pretty mixed actually. Only gives me more countries to be worried about :(
- pkaye 7y ago
  Some countries seem to have high bed utilization rates despite high number of beds. Is it due to more elderly population?
  - Someone 7y ago
    Part of it is cultural. For hospital beds, do you keep patients one extra night ‘just in case’, or do you send them home as soon as possible? For IC beds, do you give patients the choice between going home to die a week later and a bed in IC that will make them live a bit longer, but with a less comfort and less contact with their loved ones, or do you always go for “all life is sacred”? Some countries discus this with patients, even if the IC option has a chance of survival. That may sound unethical, but survival, for many patients, will be with much lower quality of life. They may have to move to a care home, stay on medication with severe side effects, may have to train hard for months to even be able to walk again. Patients that already have a low life expectancy may choose to stay out of IC.
adventured 7y ago
I agree with your concerns about Eastern Europe. I have many friends there and their respective countries are not prepared at all in terms of resources. Turkey has me the most worried at the moment. Turkey is maxing out its testing capacity every day, with cases rising by 4k like clockwork; 47k cases with very few recovered and it's accelerating. Their infrastructure can't handle the existing cases much less another 50k+ in the coming 7-10 days. And then Russia. I wish there was a clearer picture of what was going on there. For example: "Suifenhe in China’s far northeastern Heilongjiang province has seen an influx of Chinese people returning home, many infected with the virus, travelling by road from the Russian far eastern city of Vladivostok after flying there from Moscow." https://www.reuters.com/article/us-health-coronavirus-china-border/on-russian-border-china-scrambles-to-contain-coronavirus-influx-idUSKCN21S0TI https://www.reuters.com/article/us-health-coronavirus-china-...
DoreenMichele 7y ago
If it's any comfort, the death rate is so high with ventilators (80%+, which is bad even for ventilators) that some doctors are trying to avoid using them, if possible, because they are concerned the ventilators are actually killing people. https://news.ycombinator.com/item?id=22819580 https://news.ycombinator.com/item?id=22819580 I previously suggested that ventilators were problematic and I wasn't happy with the rush to create more of them instead of promoting less invasive treatments. I'm glad some doctors are looking for alternatives, but we really need to be a lot more aggressive about that angle.
- est31 7y ago
  Interesting points, thank you. I previously mostly had the death rate for "ordinary" ICU admissions in mind, which were 50%. Didn't know that once you are you are connected a ventilator, you have a 80% death rate. To compare the effect of ventilators vs none, one needs good studies with randomized groups where one gets ventilators and the other doesn't. But I guess those aren't available and doing them is probably not possible due to moral issues. I wonder if there are statistics that are the next best thing, death rate of people who doctors would have wanted to connect to ventilators but there were none available. You shouldn't compare it to the death rate of people with ventilators in places where there is ventilator shortage because then obviously there is some element of choice in who gets the ventilator and who doesn't, e.g. they choose the patients with the worst symptoms, or the patients with the largest chances of survival. Most places probably have/had shortages, so the data we have are all pretty bad to judge whether ventilators help, and if yes how much.
  - DoreenMichele 7y ago
    I have a really serious lung condition. I used to use mechanical intervention to treat my condition. I have found other methods and no longer do that, in part because such interventions are hard to keep adequately sterile and are known to increase risk of antibiotic resistant infections because of that element. It's really not good to think of this problem space in terms of finding some group without ventilators at all. I get your point about the data, but the problem is that lungs are a critical system. If you have lung issues, you are a priority admit at an ER because that whole not breathing thing can kill within minutes. Inability to breathe is one of the quicker ways to die. What I was previously suggesting was non invasive airway clearance methods and management techniques like being mindful of better positions to sleep in (which is apparently at least part of what some doctors are now doing according to the article I linked above). I got hounded and attacked as "practicing medicine without a license" for talking about my first-hand experience with managing my very deadly condition using such techniques. You really can't just not treat patients experiencing lung distress and hope they live. That's a good way to kill people. But I have looked at a little info on ARDS (the process that actually kills people with Coronavirus) and how ventilators work and I'm quite horrified that the world rushed to create more ventilators rather than rushing to say "We must do everything possible to intervene effectively without ventilators. Ventilators must be an absolute last ditch effort after every other possible intervention has been exhausted." They aren't doing that. They are too quick to put people on ventilators and the fact that doctors are now coming up with non invasive alternatives tells you they haven't been sufficiently aggressive in exhausting all other treatment modalities first. I have substantial first-hand experience with staying alive in the face of having routine lung distress that could kill me. I knew from the outset that they were putting people on ventilators too quickly, that ventilators are quite dangerous in their own right and that there are, in fact, other options available. I'm quite frustrated by the whole thing. This absolutely never needed to be this ugly. I'm certainly not the only person on the planet who knew ahead of time that ventilators are problematic and that there are myriad other options available that can be tried first, especially before it gets that severe in hopes of not letting it get to that point.
m4rtink 7y ago
I would say the respirator situation here in Czech Republic stabilized since the - the awrial bridge is still running and medical personel shoukd be stocked now by PPE & some buffer is being built. As for normal people - everyone uses hand made cloth masks & that seems to work fine. You can even buy the cloth masks easily online now if you don't have sewing skills and don't know someone who does.
perf1 7y ago
I read somewhere that they have difficulties getting medication and might running out of sedatives in the next weeks to take out people who have to be ventilated. Edit: found the Article: https://www.spiegel.de/wirtschaft/corona-krise-lieferengpass-bei-narkosemedikamenten-a-00000000-0002-0001-0000-000170435637# https://www.spiegel.de/wirtschaft/corona-krise-lieferengpass...
alkonaut 7y ago
I wonder why they have such extreme numbers of ICU beds. Are they reporting them differently, e.g. disaster wards that are normally not operating unless there is a disaster are counted? Or do they really run with a tiny fraction of beds occupied, in the years between wars and pandemics? It seems a bit wasteful to have that low usage, instead of having the capability stored for a rainy day.

by est31 7y ago

cosmodisk 7y ago

I think western countries have it worse: https://en.m.wikipedia.org/wiki/List_of_countries_by_hospital_beds https://en.m.wikipedia.org/wiki/List_of_countries_by_hospita...

est31 7y ago
From that list, Germany has more ICU beds per 100k inhabitants than any other country in that list except for the US, so it confirms that at least. Italy, France, Belgium, etc all have > 11, while Poland, Slovakia, Slovenia, Russia etc. have less than 10 each. Hungary and Czech republic have really good numbers, opposite to the trend and Netherlands, Portugal, Sweden, Denmark have really low numbers, also opposite to the trend. So it's pretty mixed actually. Only gives me more countries to be worried about :(
pkaye 7y ago
Some countries seem to have high bed utilization rates despite high number of beds. Is it due to more elderly population?
- Someone 7y ago
  Part of it is cultural. For hospital beds, do you keep patients one extra night ‘just in case’, or do you send them home as soon as possible? For IC beds, do you give patients the choice between going home to die a week later and a bed in IC that will make them live a bit longer, but with a less comfort and less contact with their loved ones, or do you always go for “all life is sacred”? Some countries discus this with patients, even if the IC option has a chance of survival. That may sound unethical, but survival, for many patients, will be with much lower quality of life. They may have to move to a care home, stay on medication with severe side effects, may have to train hard for months to even be able to walk again. Patients that already have a low life expectancy may choose to stay out of IC.

adventured 7y ago

I agree with your concerns about Eastern Europe. I have many friends there and their respective countries are not prepared at all in terms of resources. Turkey has me the most worried at the moment. Turkey is maxing out its testing capacity every day, with cases rising by 4k like clockwork; 47k cases with very few recovered and it's accelerating. Their infrastructure can't handle the existing cases much less another 50k+ in the coming 7-10 days. And then Russia. I wish there was a clearer picture of what was going on there. For example: "Suifenhe in China’s far northeastern Heilongjiang province has seen an influx of Chinese people returning home, many infected with the virus, travelling by road from the Russian far eastern city of Vladivostok after flying there from Moscow." https://www.reuters.com/article/us-health-coronavirus-china-border/on-russian-border-china-scrambles-to-contain-coronavirus-influx-idUSKCN21S0TI https://www.reuters.com/article/us-health-coronavirus-china-...

DoreenMichele 7y ago

If it's any comfort, the death rate is so high with ventilators (80%+, which is bad even for ventilators) that some doctors are trying to avoid using them, if possible, because they are concerned the ventilators are actually killing people. https://news.ycombinator.com/item?id=22819580 https://news.ycombinator.com/item?id=22819580 I previously suggested that ventilators were problematic and I wasn't happy with the rush to create more of them instead of promoting less invasive treatments. I'm glad some doctors are looking for alternatives, but we really need to be a lot more aggressive about that angle.

est31 7y ago
Interesting points, thank you. I previously mostly had the death rate for "ordinary" ICU admissions in mind, which were 50%. Didn't know that once you are you are connected a ventilator, you have a 80% death rate. To compare the effect of ventilators vs none, one needs good studies with randomized groups where one gets ventilators and the other doesn't. But I guess those aren't available and doing them is probably not possible due to moral issues. I wonder if there are statistics that are the next best thing, death rate of people who doctors would have wanted to connect to ventilators but there were none available. You shouldn't compare it to the death rate of people with ventilators in places where there is ventilator shortage because then obviously there is some element of choice in who gets the ventilator and who doesn't, e.g. they choose the patients with the worst symptoms, or the patients with the largest chances of survival. Most places probably have/had shortages, so the data we have are all pretty bad to judge whether ventilators help, and if yes how much.
- DoreenMichele 7y ago
  I have a really serious lung condition. I used to use mechanical intervention to treat my condition. I have found other methods and no longer do that, in part because such interventions are hard to keep adequately sterile and are known to increase risk of antibiotic resistant infections because of that element. It's really not good to think of this problem space in terms of finding some group without ventilators at all. I get your point about the data, but the problem is that lungs are a critical system. If you have lung issues, you are a priority admit at an ER because that whole not breathing thing can kill within minutes. Inability to breathe is one of the quicker ways to die. What I was previously suggesting was non invasive airway clearance methods and management techniques like being mindful of better positions to sleep in (which is apparently at least part of what some doctors are now doing according to the article I linked above). I got hounded and attacked as "practicing medicine without a license" for talking about my first-hand experience with managing my very deadly condition using such techniques. You really can't just not treat patients experiencing lung distress and hope they live. That's a good way to kill people. But I have looked at a little info on ARDS (the process that actually kills people with Coronavirus) and how ventilators work and I'm quite horrified that the world rushed to create more ventilators rather than rushing to say "We must do everything possible to intervene effectively without ventilators. Ventilators must be an absolute last ditch effort after every other possible intervention has been exhausted." They aren't doing that. They are too quick to put people on ventilators and the fact that doctors are now coming up with non invasive alternatives tells you they haven't been sufficiently aggressive in exhausting all other treatment modalities first. I have substantial first-hand experience with staying alive in the face of having routine lung distress that could kill me. I knew from the outset that they were putting people on ventilators too quickly, that ventilators are quite dangerous in their own right and that there are, in fact, other options available. I'm quite frustrated by the whole thing. This absolutely never needed to be this ugly. I'm certainly not the only person on the planet who knew ahead of time that ventilators are problematic and that there are myriad other options available that can be tried first, especially before it gets that severe in hopes of not letting it get to that point.

m4rtink 7y ago

I would say the respirator situation here in Czech Republic stabilized since the - the awrial bridge is still running and medical personel shoukd be stocked now by PPE & some buffer is being built. As for normal people - everyone uses hand made cloth masks & that seems to work fine. You can even buy the cloth masks easily online now if you don't have sewing skills and don't know someone who does.

perf1 7y ago

I read somewhere that they have difficulties getting medication and might running out of sedatives in the next weeks to take out people who have to be ventilated. Edit: found the Article: https://www.spiegel.de/wirtschaft/corona-krise-lieferengpass-bei-narkosemedikamenten-a-00000000-0002-0001-0000-000170435637# https://www.spiegel.de/wirtschaft/corona-krise-lieferengpass...

alkonaut 7y ago

I wonder why they have such extreme numbers of ICU beds. Are they reporting them differently, e.g. disaster wards that are normally not operating unless there is a disaster are counted? Or do they really run with a tiny fraction of beds occupied, in the years between wars and pandemics? It seems a bit wasteful to have that low usage, instead of having the capability stored for a rainy day.