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The way things are described make the doctors sound powerless. I've been frustrated by the lack the information on the usefulness of hospitals. The impression I

The way things are described make the doctors sound powerless. I've been frustrated by the lack the information on the usefulness of hospitals. The impression I've gotten is that they cannot do much, and if they would go as far as intubation, you're highly likely to die even with intubation.

ketanmaheshwari 6y ago
I have never admitted to a hospital in the US but have heard stories of other folks who have been. I just get a feeling that once you are admitted in a hospital nobody has any power including yourself. Everything is taken over by the "system". This is my biggest fear why I would never want to be hospitalized.
- klmadfejno 6y ago
  That may be true, but I meant powerless to meaningfully improve someone's medical outcome due to COVID, regardless of bureaucratic barriers.
  - koheripbal 6y ago
    ...which is not correct.
- nashashmi 6y ago
  It actually benefits you to have a doctor in the family who is there navigating and talking to the doctors. The doctors are more receptive to each other and listen carefully. Otherwise you are just a number. And the doctors won't try so hard on patients who really don't have any understanding of medicine in the first place.
  - bsder 6y ago
    > And the doctors won't try so hard on patients who really don't have any understanding of medicine in the first place. I have never found this to be the case. Generally, if I was fighting with a doctor, it was because he was trying to be too aggressive and do too much, not too little.
    - nashashmi 6y ago
      Clarification : Doctors won't try so hard to do thorough testing of the patient nor would they take a deep look to assess all symptoms. But if they feel you know medicine or are capable of understanding medicine or have a drive to learn more about your condition, then they will try harder, do more tests, ask more questions, etc.
  - isolli 6y ago
    My wife went to the ER (in Manhattan) with septicemia a week after giving birth. She was left lying on a stretcher for 17 hours without as much as water to drink before they finally "found" a room for her. (Thankfully she recovered.) A few months later, a friend who works at the hospital told me: I wish you had called me, I could have gotten you a room. And I thought: this is just like a third world country, where you need connections to get basic care.
    - koheripbal 6y ago
      You are lucky. People in Quebec hospitals are left in hallways permanently, due to space issues - even before covid.
- bsder 6y ago
  > I just get a feeling that once you are admitted in a hospital nobody has any power including yourself. Everything is taken over by the "system". This is my biggest fear why I would never want to be hospitalized. Well, I was admitted and personally walked out with a gall bladder about to explode. Yeah, I was back in the hospital 24 hours later ... not my finest hour. So, I can absolutely confirm that you can be stubborn and buck the system. I will absolutely defend your ability to spend time and research your treatment when dealing with doctors normally--especially for chronic conditions. Doctors page fault on every patient and if you are being responsible you may very well be better informed than your general practitioner about what is going on with your body. However, if you are actually admitted to a hospital with something acute, do you really have the wherewithal to diagnose and manage it? By the time I hit the hospital, I was probably on 72 hours with very little sleep and pain that took hydromorphone to even dent. I guarantee I wasn't thinking clearly by then. The biggest problem with hospitals is that you need an advocate for you, personally. Without someone in the room with you, you won't know if the nurse missed that medication round, isn't paying attention to your increasing temperature, didn't bring you your lunch, etc. The problem isn't when the system works. The problem is that without someone else there you don't have someone to watch for if the system hiccups.
screye 6y ago
Yeah, the odds of death if you have to be put on a ventilator is 88%. It is similar to CPR, in that it works but statistically has a very low chance of success since it is only administered once the situation has deteriorated to near certain death.
- joshgel 6y ago
  88% is definitely not true. That paper retracted that claim.
  - screye 6y ago
    Thanks a lot for correcting that. I was going off the stat NYC reported at the peak of the pandemic. Just checked and it is quite the stark difference. https://www.npr.org/sections/health-shots/2020/05/15/856768020/new-evidence-suggests-covid-19-patients-on-ventilators-usually-survive https://www.npr.org/sections/health-shots/2020/05/15/8567680... Quote from the article Old information: Early reports from China, the United Kingdom and Seattle found mortality rates as high as 90% among patients on ventilators. And more recently, a study of some New York hospitals seemed to show a mortality rate of 88%. New information: The mortality rate among 165 COVID-19 patients placed on a ventilator at Emory was just under *30%* . And unlike the New York study, only a few patients were still on a ventilator when the data were collected.
    - jrib 6y ago
      For others having a hard time reading those quotes on mobile: Old information: Early reports from China, the United Kingdom and Seattle found mortality rates as high as 90% among patients on ventilators. And more recently, a study of some New York hospitals seemed to show a mortality rate of 88%. New information: The mortality rate among 165 COVID-19 patients placed on a ventilator at Emory was just under 30% . And unlike the New York study, only a few patients were still on a ventilator when the data were collected.
bsder 6y ago
> The impression I've gotten is that they cannot do much, and if they would go as far as intubation, you're highly likely to die even with intubation. Anecdotal evidence seems to be that the doctors are getting better at treating the worst Covid patients. It's still not something you want to get, but it's not quite the death sentence it was. Apparently, high-flow ventilation is a big improvement over intubation, but until everybody had enough/proper protective equipment it simply wasn't on the table (it aerosolizes the virus). Which drug cocktails help and how to administer them is also improving. We're not getting a good treatment until monoclonal antibodies or a vaccine, but were not simply standing still, either.
nradov 6y ago
There is a lot that doctors can do short of intubation. Take a look at this care protocol. https://www.evms.edu/covid-19/covid_care_for_clinicians/#d.en.140202 https://www.evms.edu/covid-19/covid_care_for_clinicians/#d.e...
davycro 6y ago
We can put a patient on oxygen without intubating them. High flow oxygen can provide up to 60 liters per minute. We can prone patients, and provide them with nutrition to help support their immune system. We save many patients with supportive care. We can’t however cure the virus. And if it progresses far enough then no amount of oxygen will save a patient. These cases are hard because we have to watch someone die without any means to save them. Doing cpr on a patient with covid can feel pointless. If the lungs do work then no amount of chest compressions, oxygen, and cardiac drugs will save that person.
- klmadfejno 6y ago
  I'm hoping this doesn't come off as snarky but, why can't / don't we tell people to prone at home? As I understand, it's literally just lying down on your stomach. I first encountered the concept in a new york times article where the interviewed nurse was saying the problem was people got bored and stopped doing it. That sounded... dumb. And as though being prone should be plastered all over the public health recommendations.
  - davycro 6y ago
    Good question. Proned patients are too sick to survive at home. As soon as the roll onto their back or sit upright they start suffocating and must work for their breath. Because of this they need help caring for themselves. They also are at risk of becoming much worse and needing more oxygen.
    - klmadfejno 6y ago
      > Proned patients are too sick to survive at home. Proned patients are just people lying on their stomachs, are they not? I get that its something you would recommend to someone who is really low on oxygen, but why aren't people who aren't too sick to survive at home being told to do this also? Is there a downside? Like if your pulse oximeter starts readying 88 and slowly dropping, its probably a good idea to start proning, in the very least at night while sleeping?

ketanmaheshwari 6y ago

I have never admitted to a hospital in the US but have heard stories of other folks who have been. I just get a feeling that once you are admitted in a hospital nobody has any power including yourself. Everything is taken over by the "system". This is my biggest fear why I would never want to be hospitalized.

klmadfejno 6y ago
That may be true, but I meant powerless to meaningfully improve someone's medical outcome due to COVID, regardless of bureaucratic barriers.
- koheripbal 6y ago
  ...which is not correct.
nashashmi 6y ago
It actually benefits you to have a doctor in the family who is there navigating and talking to the doctors. The doctors are more receptive to each other and listen carefully. Otherwise you are just a number. And the doctors won't try so hard on patients who really don't have any understanding of medicine in the first place.
- bsder 6y ago
  > And the doctors won't try so hard on patients who really don't have any understanding of medicine in the first place. I have never found this to be the case. Generally, if I was fighting with a doctor, it was because he was trying to be too aggressive and do too much, not too little.
  - nashashmi 6y ago
    Clarification : Doctors won't try so hard to do thorough testing of the patient nor would they take a deep look to assess all symptoms. But if they feel you know medicine or are capable of understanding medicine or have a drive to learn more about your condition, then they will try harder, do more tests, ask more questions, etc.
- isolli 6y ago
  My wife went to the ER (in Manhattan) with septicemia a week after giving birth. She was left lying on a stretcher for 17 hours without as much as water to drink before they finally "found" a room for her. (Thankfully she recovered.) A few months later, a friend who works at the hospital told me: I wish you had called me, I could have gotten you a room. And I thought: this is just like a third world country, where you need connections to get basic care.
  - koheripbal 6y ago
    You are lucky. People in Quebec hospitals are left in hallways permanently, due to space issues - even before covid.
bsder 6y ago
> I just get a feeling that once you are admitted in a hospital nobody has any power including yourself. Everything is taken over by the "system". This is my biggest fear why I would never want to be hospitalized. Well, I was admitted and personally walked out with a gall bladder about to explode. Yeah, I was back in the hospital 24 hours later ... not my finest hour. So, I can absolutely confirm that you can be stubborn and buck the system. I will absolutely defend your ability to spend time and research your treatment when dealing with doctors normally--especially for chronic conditions. Doctors page fault on every patient and if you are being responsible you may very well be better informed than your general practitioner about what is going on with your body. However, if you are actually admitted to a hospital with something acute, do you really have the wherewithal to diagnose and manage it? By the time I hit the hospital, I was probably on 72 hours with very little sleep and pain that took hydromorphone to even dent. I guarantee I wasn't thinking clearly by then. The biggest problem with hospitals is that you need an advocate for you, personally. Without someone in the room with you, you won't know if the nurse missed that medication round, isn't paying attention to your increasing temperature, didn't bring you your lunch, etc. The problem isn't when the system works. The problem is that without someone else there you don't have someone to watch for if the system hiccups.

screye 6y ago

Yeah, the odds of death if you have to be put on a ventilator is 88%. It is similar to CPR, in that it works but statistically has a very low chance of success since it is only administered once the situation has deteriorated to near certain death.

joshgel 6y ago
88% is definitely not true. That paper retracted that claim.
- screye 6y ago
  Thanks a lot for correcting that. I was going off the stat NYC reported at the peak of the pandemic. Just checked and it is quite the stark difference. https://www.npr.org/sections/health-shots/2020/05/15/856768020/new-evidence-suggests-covid-19-patients-on-ventilators-usually-survive https://www.npr.org/sections/health-shots/2020/05/15/8567680... Quote from the article Old information: Early reports from China, the United Kingdom and Seattle found mortality rates as high as 90% among patients on ventilators. And more recently, a study of some New York hospitals seemed to show a mortality rate of 88%. New information: The mortality rate among 165 COVID-19 patients placed on a ventilator at Emory was just under *30%* . And unlike the New York study, only a few patients were still on a ventilator when the data were collected.
  - jrib 6y ago
    For others having a hard time reading those quotes on mobile: Old information: Early reports from China, the United Kingdom and Seattle found mortality rates as high as 90% among patients on ventilators. And more recently, a study of some New York hospitals seemed to show a mortality rate of 88%. New information: The mortality rate among 165 COVID-19 patients placed on a ventilator at Emory was just under 30% . And unlike the New York study, only a few patients were still on a ventilator when the data were collected.

bsder 6y ago

> The impression I've gotten is that they cannot do much, and if they would go as far as intubation, you're highly likely to die even with intubation. Anecdotal evidence seems to be that the doctors are getting better at treating the worst Covid patients. It's still not something you want to get, but it's not quite the death sentence it was. Apparently, high-flow ventilation is a big improvement over intubation, but until everybody had enough/proper protective equipment it simply wasn't on the table (it aerosolizes the virus). Which drug cocktails help and how to administer them is also improving. We're not getting a good treatment until monoclonal antibodies or a vaccine, but were not simply standing still, either.

nradov 6y ago

There is a lot that doctors can do short of intubation. Take a look at this care protocol. https://www.evms.edu/covid-19/covid_care_for_clinicians/#d.en.140202 https://www.evms.edu/covid-19/covid_care_for_clinicians/#d.e...

davycro 6y ago

We can put a patient on oxygen without intubating them. High flow oxygen can provide up to 60 liters per minute. We can prone patients, and provide them with nutrition to help support their immune system. We save many patients with supportive care. We can’t however cure the virus. And if it progresses far enough then no amount of oxygen will save a patient. These cases are hard because we have to watch someone die without any means to save them. Doing cpr on a patient with covid can feel pointless. If the lungs do work then no amount of chest compressions, oxygen, and cardiac drugs will save that person.

klmadfejno 6y ago
I'm hoping this doesn't come off as snarky but, why can't / don't we tell people to prone at home? As I understand, it's literally just lying down on your stomach. I first encountered the concept in a new york times article where the interviewed nurse was saying the problem was people got bored and stopped doing it. That sounded... dumb. And as though being prone should be plastered all over the public health recommendations.
- davycro 6y ago
  Good question. Proned patients are too sick to survive at home. As soon as the roll onto their back or sit upright they start suffocating and must work for their breath. Because of this they need help caring for themselves. They also are at risk of becoming much worse and needing more oxygen.
  - klmadfejno 6y ago
    > Proned patients are too sick to survive at home. Proned patients are just people lying on their stomachs, are they not? I get that its something you would recommend to someone who is really low on oxygen, but why aren't people who aren't too sick to survive at home being told to do this also? Is there a downside? Like if your pulse oximeter starts readying 88 and slowly dropping, its probably a good idea to start proning, in the very least at night while sleeping?