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Why did they not extend capacity with field hospitals weeks ago? They’ve been telling us it was going to get bad, then it did and they’re not prepared for it? W

Why did they not extend capacity with field hospitals weeks ago? They’ve been telling us it was going to get bad, then it did and they’re not prepared for it? What is going on here?

dhnajsjdnd 6y ago
There are tent hospitals in the parking lots. It seems like they have been trying.
dangero 6y ago
This is a really good question —- earlier this year we had setup unused overflow facilities and those were taken down. Why were they dismantled?
- CydeWeys 6y ago
  They weren't ultimately needed then and you couldn't staff them now that the pandemic is countrywide rather than restricted to NYC. The real limiting factor here is availability of trained medical personnel and there is no surplus of them anywhere.
- dragonwriter 6y ago
  > earlier this year we had setup unused overflow facilities and those were taken down. No, they mostly weren't. > Why were they dismantled? They have largely been activated, including ones which while prepared stood empty in the initial, far lower, peak, and many additional ones were set up for this surge.
diogenescynic 6y ago
Most hospitals are maxed out and nurses are quitting and calling out. We just don’t have resources to fall on, the bench isn’t that deep.
- deleted 6y ago
  [deleted]
dragontamer 6y ago
When cases grow exponentially, no amount of preparation will be sufficient.
- alacombe 6y ago
  That's bullshit, China grew hospitals in a matter of weeks. Though, they are not restricted with all the regulations going on the US.
  - kortilla 6y ago
    Did they grow doctors and nurses too?
    - alacombe 6y ago
      They probably teach more than the US do per-capita, so most likely yes. You don't need a 10 years general practitioner to attend everybody.
    - dragonwriter 6y ago
      China has a localized crisis and could move surplus doctors and nurses from other places (they also have a system of government that lets them do that without political and partisan friction, which is bad for lots of reasons but useful for this specific situation.) While California is worse off, the US has a national problem and no region to ship surplus from, even leaving aside the political problems which would add friction if the capacity existed.
  - dragontamer 6y ago
    China was able to get a clamp down by becoming more authoritarian and literally wielding doors shut of people suspected of COVID19. The hospital growth thing is a red herring. Gaining +2000 hospital beds (or 20% growth for a lot of areas) means jack diddly squat against a Virus that replicates into the millions. Its far easier to stay home for Thanksgiving and cut down on the spread, rather than grow hospitals. But of course, we're growing hospitals where we can (moving Navy Hospital Ships, hiring student nurses before they graduate, etc. etc.) But the USA already had a nurse shortage BEFORE COVID19 came around. There comes a point where there's no point building Hospital beds: we simply don't have enough nurses / doctors in this country to staff them. Even if we include student nurses / doctors. ---------- In either case: China has the right idea. You stop the spread before it becomes a million cases. You can't just magically grow hospitals and create expert nurses out of thin air. Free Liberal countries like New Zealand got to stop the exponential growth because their society was more unified and rational about things. Authoritarian wasn't necessary, but its clearly a good cudgel to use in this situation.
longdefeat 6y ago
From what I understand, space isn't the only limiting issue. You might find more space with some difficulty but you cannot suddenly produce more nurses and doctors, many of whom are overwhelmed or themselves ill and out of commission.
- blaisio 6y ago
  Yeah space really isn't the problem at all. It is nurses and doctors and oxygen. They have nurses - who are supposed to treat 2, maybe 3 at a time - treating 30 people at a time.
- listless 6y ago
  That makes sense, but then I think about the military. Don’t they have a massive medical force? They are not _all_ doctors and nurses (although many are) but all are highly trained and could serve here. Why not deploy them to the current battlefield?
  - gremlinsinc 6y ago
    Many of your reserve nurses/doctors work as doctors in local E.Rs so they're basically already taken.
bsder 6y ago
ICU patients require a significant amount of highly-trained personnel 24/7. You quickly burn through those people. And, since the Federal government never stepped up to fund anything, no one is going to bother training personnel that they'll just get rid of in 12 months.
- alacombe 6y ago
  > And, since the Federal government never stepped up to fund anything This is California, aren't people happy to pay 50% taxes there ? Why would they depends from the feds...
  - belltaco 6y ago
    Because only the feds can print money, the states cannot. Covid put a huge hole in state budgets.
- unishark 6y ago
  What do you mean? There's been a bunch of emergency funding bills passed.
- ashtonkem 6y ago
  > And, since the Federal government never stepped up to fund anything I'm not sure where this idea came from, but I really wish people would start arguing about what Congress actually did rather than making it up, because Congress did step up to fund medical care. The CARES act appropriated $130B for health care providers, including hospitals. The followup appropriations bill allocates $69B for vaccines, testing, health care providers, and mental health. One might argue that that's not enough money, but at least make the argument that they should have spent more rather than falsely claiming they spent nothing. Congress' direct payments to the healthcare providers in these two bills totaled $199B. Broken down by department, only two agencies are allocated more than $199B next year, the DOD ($695B) and the VA ($243B). And that's just looking at direct payments to medical providers, I didn't even mention the remaining $2.1T from the CARES act.
  - 6y ago
jpollock 6y ago
With these growth rates (doubling every 10-15 days), _doubling_ the number of beds available in an area will only buy two weeks. Santa Clara's hospitalization growth rate is running at 2-3 weeks. This isn't something the health system can grow to solve.
dragonwriter 6y ago
> Why did they not extend capacity with field hospitals weeks ago? They...did. There is a limit to the ability to magic up staffed medical facilities on short notice ex nihilo, however. > They’ve been telling us it was going to get bad, then it did and they’re not prepared for it? Had it not been predicted that it would exceed the potential to boost capacity, they would not have implemented the capacity-cobtingent statewide stay at home order (which is undermined by county sheriffs widespread and public non-enforcement stance.)
messick 6y ago
In California, the rules say a ICU nurse can handle max two patients, and that the person monitoring telemetry can have at max four patients. Hospitals have obviously gotten waivers for these limits, but eventually you just start killing people by adding beds without the appropriate amounts of additional staff.

Why did they not extend capacity with field hospitals weeks ago? They’ve been telling us it was going to get bad, then it did and they’re not prepared for it? What is going on here?

dhnajsjdnd 6y ago

There are tent hospitals in the parking lots. It seems like they have been trying.

dangero 6y ago

This is a really good question —- earlier this year we had setup unused overflow facilities and those were taken down. Why were they dismantled?

CydeWeys 6y ago
They weren't ultimately needed then and you couldn't staff them now that the pandemic is countrywide rather than restricted to NYC. The real limiting factor here is availability of trained medical personnel and there is no surplus of them anywhere.
dragonwriter 6y ago
> earlier this year we had setup unused overflow facilities and those were taken down. No, they mostly weren't. > Why were they dismantled? They have largely been activated, including ones which while prepared stood empty in the initial, far lower, peak, and many additional ones were set up for this surge.

diogenescynic 6y ago

Most hospitals are maxed out and nurses are quitting and calling out. We just don’t have resources to fall on, the bench isn’t that deep.

deleted 6y ago
[deleted]

dragontamer 6y ago

When cases grow exponentially, no amount of preparation will be sufficient.

alacombe 6y ago
That's bullshit, China grew hospitals in a matter of weeks. Though, they are not restricted with all the regulations going on the US.
- kortilla 6y ago
  Did they grow doctors and nurses too?
  - alacombe 6y ago
    They probably teach more than the US do per-capita, so most likely yes. You don't need a 10 years general practitioner to attend everybody.
  - dragonwriter 6y ago
    China has a localized crisis and could move surplus doctors and nurses from other places (they also have a system of government that lets them do that without political and partisan friction, which is bad for lots of reasons but useful for this specific situation.) While California is worse off, the US has a national problem and no region to ship surplus from, even leaving aside the political problems which would add friction if the capacity existed.
- dragontamer 6y ago
  China was able to get a clamp down by becoming more authoritarian and literally wielding doors shut of people suspected of COVID19. The hospital growth thing is a red herring. Gaining +2000 hospital beds (or 20% growth for a lot of areas) means jack diddly squat against a Virus that replicates into the millions. Its far easier to stay home for Thanksgiving and cut down on the spread, rather than grow hospitals. But of course, we're growing hospitals where we can (moving Navy Hospital Ships, hiring student nurses before they graduate, etc. etc.) But the USA already had a nurse shortage BEFORE COVID19 came around. There comes a point where there's no point building Hospital beds: we simply don't have enough nurses / doctors in this country to staff them. Even if we include student nurses / doctors. ---------- In either case: China has the right idea. You stop the spread before it becomes a million cases. You can't just magically grow hospitals and create expert nurses out of thin air. Free Liberal countries like New Zealand got to stop the exponential growth because their society was more unified and rational about things. Authoritarian wasn't necessary, but its clearly a good cudgel to use in this situation.

longdefeat 6y ago

From what I understand, space isn't the only limiting issue. You might find more space with some difficulty but you cannot suddenly produce more nurses and doctors, many of whom are overwhelmed or themselves ill and out of commission.

blaisio 6y ago
Yeah space really isn't the problem at all. It is nurses and doctors and oxygen. They have nurses - who are supposed to treat 2, maybe 3 at a time - treating 30 people at a time.
listless 6y ago
That makes sense, but then I think about the military. Don’t they have a massive medical force? They are not _all_ doctors and nurses (although many are) but all are highly trained and could serve here. Why not deploy them to the current battlefield?
- gremlinsinc 6y ago
  Many of your reserve nurses/doctors work as doctors in local E.Rs so they're basically already taken.

bsder 6y ago

ICU patients require a significant amount of highly-trained personnel 24/7. You quickly burn through those people. And, since the Federal government never stepped up to fund anything, no one is going to bother training personnel that they'll just get rid of in 12 months.

alacombe 6y ago
> And, since the Federal government never stepped up to fund anything This is California, aren't people happy to pay 50% taxes there ? Why would they depends from the feds...
- belltaco 6y ago
  Because only the feds can print money, the states cannot. Covid put a huge hole in state budgets.
unishark 6y ago
What do you mean? There's been a bunch of emergency funding bills passed.
ashtonkem 6y ago
> And, since the Federal government never stepped up to fund anything I'm not sure where this idea came from, but I really wish people would start arguing about what Congress actually did rather than making it up, because Congress did step up to fund medical care. The CARES act appropriated $130B for health care providers, including hospitals. The followup appropriations bill allocates $69B for vaccines, testing, health care providers, and mental health. One might argue that that's not enough money, but at least make the argument that they should have spent more rather than falsely claiming they spent nothing. Congress' direct payments to the healthcare providers in these two bills totaled $199B. Broken down by department, only two agencies are allocated more than $199B next year, the DOD ($695B) and the VA ($243B). And that's just looking at direct payments to medical providers, I didn't even mention the remaining $2.1T from the CARES act.
- 6y ago

jpollock 6y ago

With these growth rates (doubling every 10-15 days), _doubling_ the number of beds available in an area will only buy two weeks. Santa Clara's hospitalization growth rate is running at 2-3 weeks. This isn't something the health system can grow to solve.

dragonwriter 6y ago

> Why did they not extend capacity with field hospitals weeks ago? They...did. There is a limit to the ability to magic up staffed medical facilities on short notice ex nihilo, however. > They’ve been telling us it was going to get bad, then it did and they’re not prepared for it? Had it not been predicted that it would exceed the potential to boost capacity, they would not have implemented the capacity-cobtingent statewide stay at home order (which is undermined by county sheriffs widespread and public non-enforcement stance.)

messick 6y ago

In California, the rules say a ICU nurse can handle max two patients, and that the person monitoring telemetry can have at max four patients. Hospitals have obviously gotten waivers for these limits, but eventually you just start killing people by adding beds without the appropriate amounts of additional staff.