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The good news: we flattened the curve enough that most of these field hospitals weren’t needed. The bad news: bureaucracy and mismanagement prevented hospitals

The good news: we flattened the curve enough that most of these field hospitals weren’t needed. The bad news: bureaucracy and mismanagement prevented hospitals who did need more space from using them. The awful news: NY recommended people to stay home from the hospital even if they needed care, probably causing extra deaths and complications.

IG_Semmelweiss 6y ago
ER admissions are down 50% or more depending in county. People did not magically recover from heart conditions during lockdown Those people died, or skipped on critical treatment that would have made their condition improve. One cannot help but wonder if those missing people are going to be swept under the COVID rug... Meanwhile, field hospitals sit empty...
- lurquer 6y ago
  >ER admissions are down 50% or more depending in county. This isn't as significant as you might think... There is a large (very large in some communities) percentage of ER visits that aren't for real emergencies; rather, they are used for routine stuff, for which people with good insurance would go to their pediatrician or Urgent Care Clinic. If you are broke, have crappy or no insurance, and can't afford a scrip of antibiotics, when your kid gets a fever or sore throat, you go to the ER. That's routine for -- I would bet -- hundreds of thousands of people throughout the year.
  - taurath 6y ago
    OTOH, if I have a really nasty cold which doesn't share symptoms of coronavirus, I am absolutely NOT going to the ER or urgent care even though I normally would. The urgent care center near my house is full hazmat suits and a tent outside to do front line covid screening. I think the effect you're describing does exist, but its certainly not the whole story. The fact is as well there's PLENTY of actual data available on this so we need not even be extrapolating based on our assumptions. The problem is any data that doesn't line up with our assumptions gets discarded because we don't know which datasets are good and reliable.
    - neversmiling 6y ago
      "I am absolutely NOT going to the ER or urgent care even though I normally would" That's a very dangerous assumption to make. Most hospitals in US are not overwhelmed. People should not be scared to receive necessary healthcare. The public messaging from authorities (and the media) should reflect that. At the very least, contact ER or urgent care (or better yet, your primary care physician if you have one), and follow their direction.
      - deleted 6y ago
        [deleted]
  - _-___________-_ 6y ago
    As far as I've seen, this is only routine in the USA. Everywhere else, people would go to their GP for this sort of thing.
deedub 6y ago
The awful news - This isn't just NY. This is around me too, where our hospitals have been damn near completely empty with next to 0 infections. I know very specifically of one death where the individual was told to stay home vs going into the empty hospital. He eventually got to the hospital, but it was too late.
malandrew 6y ago
I'm unsure why IG_Semmelweiss sibling comment is dead and why I can't vouch or reply to it, but even NPR is reporting on the exact same phenomena: https://www.npr.org/sections/health-shots/2020/05/06/850454989/eerie-emptiness-of-ers-worries-doctors-where-are-the-heart-attacks-and-strokes https://www.npr.org/sections/health-shots/2020/05/06/8504549... This concerns me because my dad has congestive heart failure and can't get proper medical support right now. What we should be doing is segregating hospitals, keeping some focused on COVID and others focused on non-COVID medical emergencies.
- djsumdog 6y ago
  I've heard of some people getting stuff scheduled way out at suburban hospitals, often out of network, and clearing out their health savings accounts to get essential surgery. That's fucked up.
- the-dude 6y ago
  Click the timestamp.
  - malandrew 6y ago
    That's what I did. Vouch didn't work nor was there a reply link.
    - zaroth 6y ago
      Just worked for me.
- carapace 6y ago
  I just downvoted that comment because it opens with a fact (as reported by some news agencies): > ER admissions are down 50% or more depending in county. But then spins it into some kind of conspiracy BS: > ...missing people... ...swept under the COVID rug...
djsumdog 6y ago
The great irony is that, in trying to prevent hospitals from being overwhelmed leading to unnecessary deaths, we cleared out hospitals too soon, to prepare for a surge that never happened, and lead some people to unnecessary suffering and maybe death. People without jobs had to get surgery now, before their CORBA ran out.
lostlogin 6y ago
I can’t tell if you are joking - that NY curve was one of the least flat curves achieved anywhere. What am I missing?
- pensatoio 6y ago
  The point isn’t that the curve didn’t exist or that it’s relative magnitude wasn’t higher in some cities. The point is that hospitals generally weren’t overrun, therefore, the measures we took effectively flattened the curve enough that all these overflow medical resources weren’t put to use.
  - ryankemper 6y ago
    And yet, a large part of the reason we weren't overrun is because our initial estimates of hospital beds and ventilators needed were far too high on a per-infected-person basis. So yes, we definitely cut down transmission, but it's not clear that we would have incurred excess deaths due to capacity overrun. The biggest botteleneck is the presence of people on invasive ventilation; other clinical outcomes result in either the individual dying quite quickly (imagine a nursing home patient with multiple comorbidities), or in the patient recovering in 1-2 weeks. But there's that uncanny valley of people healthy enough to not immediately die but in bad enough shape that they need these aggressive interventions. This is a big part of why I think we could have exposed much more people to the virus with only marginal increase in hospitalizations, by encouraging those who are not at risk to live as normally. It also makes it easier to centralize the resources where you do need it. For example it's much more feasible for government programs to handle food delivery, grocery delivery, and all these other logistical concerns when you only need to provide it for 10-40% of the country as opposed to 80% of it. Serology in NY has shown us that we have maybe 1/8 of the population with antibodies as of a few weeks ago, which does mean that there was room for another doubling or too before transmission started naturally slowing down to a noticeable extent. So we absolutely could have had a lot more patient volume, but again the # of hospitalizations/invasive ventilation cases is much more related to the # of vulnerable people infected as opposed to the number overall. (The classic argument here is that by fighting transmission in all members of the population, that the at-risk are better protected. For a number of reasons I think such an approach is misguided but I won't go into the full argument against that here)

IG_Semmelweiss 6y ago

ER admissions are down 50% or more depending in county. People did not magically recover from heart conditions during lockdown Those people died, or skipped on critical treatment that would have made their condition improve. One cannot help but wonder if those missing people are going to be swept under the COVID rug... Meanwhile, field hospitals sit empty...

lurquer 6y ago
>ER admissions are down 50% or more depending in county. This isn't as significant as you might think... There is a large (very large in some communities) percentage of ER visits that aren't for real emergencies; rather, they are used for routine stuff, for which people with good insurance would go to their pediatrician or Urgent Care Clinic. If you are broke, have crappy or no insurance, and can't afford a scrip of antibiotics, when your kid gets a fever or sore throat, you go to the ER. That's routine for -- I would bet -- hundreds of thousands of people throughout the year.
- taurath 6y ago
  OTOH, if I have a really nasty cold which doesn't share symptoms of coronavirus, I am absolutely NOT going to the ER or urgent care even though I normally would. The urgent care center near my house is full hazmat suits and a tent outside to do front line covid screening. I think the effect you're describing does exist, but its certainly not the whole story. The fact is as well there's PLENTY of actual data available on this so we need not even be extrapolating based on our assumptions. The problem is any data that doesn't line up with our assumptions gets discarded because we don't know which datasets are good and reliable.
  - neversmiling 6y ago
    "I am absolutely NOT going to the ER or urgent care even though I normally would" That's a very dangerous assumption to make. Most hospitals in US are not overwhelmed. People should not be scared to receive necessary healthcare. The public messaging from authorities (and the media) should reflect that. At the very least, contact ER or urgent care (or better yet, your primary care physician if you have one), and follow their direction.
    - deleted 6y ago
      [deleted]
- _-___________-_ 6y ago
  As far as I've seen, this is only routine in the USA. Everywhere else, people would go to their GP for this sort of thing.

deedub 6y ago

The awful news - This isn't just NY. This is around me too, where our hospitals have been damn near completely empty with next to 0 infections. I know very specifically of one death where the individual was told to stay home vs going into the empty hospital. He eventually got to the hospital, but it was too late.

malandrew 6y ago

I'm unsure why IG_Semmelweiss sibling comment is dead and why I can't vouch or reply to it, but even NPR is reporting on the exact same phenomena: https://www.npr.org/sections/health-shots/2020/05/06/850454989/eerie-emptiness-of-ers-worries-doctors-where-are-the-heart-attacks-and-strokes https://www.npr.org/sections/health-shots/2020/05/06/8504549... This concerns me because my dad has congestive heart failure and can't get proper medical support right now. What we should be doing is segregating hospitals, keeping some focused on COVID and others focused on non-COVID medical emergencies.

djsumdog 6y ago
I've heard of some people getting stuff scheduled way out at suburban hospitals, often out of network, and clearing out their health savings accounts to get essential surgery. That's fucked up.
the-dude 6y ago
Click the timestamp.
- malandrew 6y ago
  That's what I did. Vouch didn't work nor was there a reply link.
  - zaroth 6y ago
    Just worked for me.
carapace 6y ago
I just downvoted that comment because it opens with a fact (as reported by some news agencies): > ER admissions are down 50% or more depending in county. But then spins it into some kind of conspiracy BS: > ...missing people... ...swept under the COVID rug...

djsumdog 6y ago

The great irony is that, in trying to prevent hospitals from being overwhelmed leading to unnecessary deaths, we cleared out hospitals too soon, to prepare for a surge that never happened, and lead some people to unnecessary suffering and maybe death. People without jobs had to get surgery now, before their CORBA ran out.

lostlogin 6y ago

I can’t tell if you are joking - that NY curve was one of the least flat curves achieved anywhere. What am I missing?

pensatoio 6y ago
The point isn’t that the curve didn’t exist or that it’s relative magnitude wasn’t higher in some cities. The point is that hospitals generally weren’t overrun, therefore, the measures we took effectively flattened the curve enough that all these overflow medical resources weren’t put to use.
- ryankemper 6y ago
  And yet, a large part of the reason we weren't overrun is because our initial estimates of hospital beds and ventilators needed were far too high on a per-infected-person basis. So yes, we definitely cut down transmission, but it's not clear that we would have incurred excess deaths due to capacity overrun. The biggest botteleneck is the presence of people on invasive ventilation; other clinical outcomes result in either the individual dying quite quickly (imagine a nursing home patient with multiple comorbidities), or in the patient recovering in 1-2 weeks. But there's that uncanny valley of people healthy enough to not immediately die but in bad enough shape that they need these aggressive interventions. This is a big part of why I think we could have exposed much more people to the virus with only marginal increase in hospitalizations, by encouraging those who are not at risk to live as normally. It also makes it easier to centralize the resources where you do need it. For example it's much more feasible for government programs to handle food delivery, grocery delivery, and all these other logistical concerns when you only need to provide it for 10-40% of the country as opposed to 80% of it. Serology in NY has shown us that we have maybe 1/8 of the population with antibodies as of a few weeks ago, which does mean that there was room for another doubling or too before transmission started naturally slowing down to a noticeable extent. So we absolutely could have had a lot more patient volume, but again the # of hospitalizations/invasive ventilation cases is much more related to the # of vulnerable people infected as opposed to the number overall. (The classic argument here is that by fighting transmission in all members of the population, that the at-risk are better protected. For a number of reasons I think such an approach is misguided but I won't go into the full argument against that here)