4 ms·

Before say 1 in 100 went into hospital, meaning 100k infections means 1000 hospitalisations Now 1 in 1000 go into hospital, that's great from an individual bas

Before say 1 in 100 went into hospital, meaning 100k infections means 1000 hospitalisations Now 1 in 1000 go into hospital, that's great from an individual basis and a population basis. Still means that 1 million infections leads to 1,000 hospitalisations.

qwerty456127 5y ago
This reminds me of a broader question: why our health systems are so incapacitate they can't handle every 1 in 1000 (or whatever the number actually is) being hospitalized?
- franga2000 5y ago
  Being prepared for such an increase necessary means having that much capacity unused for the rest of the time. The private sector sure as hell isn't going to do it and the public sector is beholden to the general population, which won't stand for "inefficient spending". What politician would dare run on a platform of "we'll build 50% more hospital capacity and hire 50% more doctors, then have them sit idle just in case a global pandemic hits". Two years ago, they would've gotten laughed out of the room.
  - eru 5y ago
    The private sector could totally build the extra capacity. Look at 'peaker plants' for electricity generation. It's worth quoting Wikipedia here https://en.wikipedia.org/wiki/Peaking_power_plant https://en.wikipedia.org/wiki/Peaking_power_plant > Peaking power plants, also known as peaker plants, and occasionally just "peakers", are power plants that generally run only when there is a high demand, known as peak demand, for electricity.[1][2][3][4] Because they supply power only occasionally, the power supplied commands a much higher price per kilowatt hour than base load power. Peak load power plants are dispatched in combination with base load power plants, which supply a dependable and consistent amount of electricity, to meet the minimum demand. > Although historically peaking power plants were frequently used in conjunction with coal baseload plants, peaking plants are now used less commonly. Combined cycle gas turbine plants have two or more cycles, the first of which is very similar to a peaking plant, with the second running on the waste heat of the first. That type of plant is often capable of rapidly starting up, albeit at reduced efficiency, and then over some hours transitioning to a more efficient baseload generation mode. Combined cycle plants have similar capital cost per watt to peaking plants, but run for much longer periods, and use less fuel overall, and hence give cheaper electricity. > As of 2020, open cycle gas turbines give an electricity cost of around $151-198/MWh. The issues is that the natural mechanism that incentivises the private sector to provide peak capacity is what some people call 'price gauging'. And that's a big taboo for 'sacred values' like anything to do with medicine or health.
    - bildung 5y ago
      The problem isn't the qualified beds but the personnel. In contrast to gas turbines, which are small standalone plants where an operator already there essentially just presses the power button.
      - sterlind 5y ago
        We've had to massively scale up the number of doctors and nurses before - in WWII. Learning was substantially accelerated and abridged, and the population was being drafted so being a doctor might sound better than being a combat soldier. I don't think this would work here though, since enlisting to work in a covid ward is a hard sell when you're not being drafted, and standard of care would suffer with all the inexperience. Substantially raising nursing pay and increasing the powers of nurse practitioners would be a good idea though.
      - eru 5y ago
        Why? The economics are exactly the same. Many people would happily do some courses (and plenty of refreshers) to be a stand-by nurse or doctor who only gets activated for a few weeks every few years, if they get a few tens of thousands of dollars for that trouble.
    - franga2000 5y ago
      The main cost of operating a power plant is fuel, which costs you nothing if not used. Keeping a bunch of doctors (like, thousands) trained and ready to handle an emergency at any moment is a huge ongoing cost with a by definition low probability for a payout each year. Let's do some napkin math for my area: if you started such a company in 2008 and paid your doctors minimum wage to stand by and keep themselves trained, but not actually do any work, one such doctor would've cost you around 100k € until the start of the pandemic. I remember hearing some official on the TV saying we'd need another 300 doctors to keep everything running smoothly. Let's half that. Congratulations: your company is 15 million € in debt. Let's call it 20M € because obviously you need to make yourself at least a little rich too. So that's the bill you need to give the government in order to break even: 20M € for 150 under-trained medical personnel with basically zero work experience. Not a good business model, imo
  - qwerty456127 5y ago
    > then have them sit idle Can't they do research when idle?
- igorkraw 5y ago
  Because usually, we have less than that hospitalized, and capital efficiency demands elimination of redundant capacity. In the US shareholder value of private hospitals, in my homecountry of Germany, political pressure to remove "inefficiencies" from the system.
- 3np 5y ago
  Optimizing a system for increased efficiency comes with a corresponding increase in fragility. Health systems in many places are optimized for efficiency, and on top of that were at or over capacity even pre-pandemic. I find it shameful that this is still not addressed properly and publicly. If enough resources had been spent on addressing this issue, and doing everything we can to overprovision capacity (double healthcare worker compensation could be one part of that, for example), we should be able to handle this by now. If, under normal condition, healthcare workers had a lot of slack, facilities were underused, and pay was higher, the situation wouldn’t be so grave. (wasn’t there an Ask HN thread the other day where many self-reported reviving cushy pay for only doing 2-8h of actual work in a given week, and others responding with how that’s all good?)
- johnchristopher 5y ago
  It's not a broader question. It's a question mainly used in a form or another by covid deniers to first shift the blame for hospitals saturation from the covid infection rate to government's downsizing of our health infrastructure and then to claim this downsizing is the main and only reason for hospitals saturation “so covid is not responsible for hospital saturation, see ? so let's stop the vaccine madness". Whatever our hospital capacity is or should be or was it's not enough now to handle the situation. If it was enough 2 years ago then we'd still be facing health worker's fatigue.
- iso1210 5y ago
  Scaling up healthcare is not a matter of spinning up a new EC2 instance. We run health care at a level that can cope with normal situations, but would fail instantly in the case of say civil war or alien invasion. That's a choice, as a society we'd rather spend the resources on youtube videos of rich people yelling at the camera than on more doctors, and that's fine, freedom. It gets worse though, you can 'overclock' your healthcare system in a time of crisis, but that leads to burning out your machines, and thus ending up with less capacity afterwards. Generally the west has run our healthcare systems beyond 100% for nearly 2 years, and that means capacity has actually decreased. All the money in the world won't fix that in a short time - indeed it can make it worse in some cases (If you gave a nurse $1m to work 16 hour shifts for the 30 days, he would, and then he'd likely quit) If you want to improve your healthcare situation, you need to go back in time 10 years and get more people training to work in healthcare. That means fewer people working in advertising or other key parts of the economy.
  - johnchristopher 5y ago
    > That means fewer people working in advertising or other key parts of the economy. I see what you did there :). Anyway, ~10 years ago I considered moving back to school for a nurse degree. I didn't and one of the reason was that I had not enough energy in me to fight for the degree and to fight the social and welfare system for the right to do it. Edit: It's a key part of the society and the promise of fulfilling rewards is great but the system doesn't like you. It glorifies your pain. That's why I don't believe most nurses and health care workers who got out will ever get back as nurses. Maybe as medical secretaries or logistics but they won't get back in the trenches.
  - gus_massa 5y ago
    One of the reasons why you can't overclock the health system is that medical doctors and nurses are doing insane long shift, like 12 hours or even 24 hours. The official reason is that they must be used to long shift, so in case of a big emergency they can work long shifts. The problem is that once the big emergency arrives, you don't have spared professionals, because you don't need them because they are overclocked in normal times. Another reason is that the shift change is dangerous because they have a lot of info in their mind that is not transmitted to the member of the next shift. This can be solved if they log all the data in some common system, but it's difficult to convince the doctors to follow a checklist during surgery. (Pilots following checklist avoid a lot of plane crashes.) (Each time a new doctor arrives, remember to tell him/her all the relevant info, don't assume the last doctor passed the info.) If you want to be prepared for the next pandemic, make 6 hours shift mandatory. They will have an easy time fpr the next 90 years. Health care will be more expensive. Make a good shift change procedure. Once the next pandemic arrive, you can easily overclock the staff x2, increase the pay x3 to keep them happy, and call the heroes too.

qwerty456127 5y ago

This reminds me of a broader question: why our health systems are so incapacitate they can't handle every 1 in 1000 (or whatever the number actually is) being hospitalized?

franga2000 5y ago
Being prepared for such an increase necessary means having that much capacity unused for the rest of the time. The private sector sure as hell isn't going to do it and the public sector is beholden to the general population, which won't stand for "inefficient spending". What politician would dare run on a platform of "we'll build 50% more hospital capacity and hire 50% more doctors, then have them sit idle just in case a global pandemic hits". Two years ago, they would've gotten laughed out of the room.
- eru 5y ago
  The private sector could totally build the extra capacity. Look at 'peaker plants' for electricity generation. It's worth quoting Wikipedia here https://en.wikipedia.org/wiki/Peaking_power_plant https://en.wikipedia.org/wiki/Peaking_power_plant > Peaking power plants, also known as peaker plants, and occasionally just "peakers", are power plants that generally run only when there is a high demand, known as peak demand, for electricity.[1][2][3][4] Because they supply power only occasionally, the power supplied commands a much higher price per kilowatt hour than base load power. Peak load power plants are dispatched in combination with base load power plants, which supply a dependable and consistent amount of electricity, to meet the minimum demand. > Although historically peaking power plants were frequently used in conjunction with coal baseload plants, peaking plants are now used less commonly. Combined cycle gas turbine plants have two or more cycles, the first of which is very similar to a peaking plant, with the second running on the waste heat of the first. That type of plant is often capable of rapidly starting up, albeit at reduced efficiency, and then over some hours transitioning to a more efficient baseload generation mode. Combined cycle plants have similar capital cost per watt to peaking plants, but run for much longer periods, and use less fuel overall, and hence give cheaper electricity. > As of 2020, open cycle gas turbines give an electricity cost of around $151-198/MWh. The issues is that the natural mechanism that incentivises the private sector to provide peak capacity is what some people call 'price gauging'. And that's a big taboo for 'sacred values' like anything to do with medicine or health.
  - bildung 5y ago
    The problem isn't the qualified beds but the personnel. In contrast to gas turbines, which are small standalone plants where an operator already there essentially just presses the power button.
    - sterlind 5y ago
      We've had to massively scale up the number of doctors and nurses before - in WWII. Learning was substantially accelerated and abridged, and the population was being drafted so being a doctor might sound better than being a combat soldier. I don't think this would work here though, since enlisting to work in a covid ward is a hard sell when you're not being drafted, and standard of care would suffer with all the inexperience. Substantially raising nursing pay and increasing the powers of nurse practitioners would be a good idea though.
    - eru 5y ago
      Why? The economics are exactly the same. Many people would happily do some courses (and plenty of refreshers) to be a stand-by nurse or doctor who only gets activated for a few weeks every few years, if they get a few tens of thousands of dollars for that trouble.
  - franga2000 5y ago
    The main cost of operating a power plant is fuel, which costs you nothing if not used. Keeping a bunch of doctors (like, thousands) trained and ready to handle an emergency at any moment is a huge ongoing cost with a by definition low probability for a payout each year. Let's do some napkin math for my area: if you started such a company in 2008 and paid your doctors minimum wage to stand by and keep themselves trained, but not actually do any work, one such doctor would've cost you around 100k € until the start of the pandemic. I remember hearing some official on the TV saying we'd need another 300 doctors to keep everything running smoothly. Let's half that. Congratulations: your company is 15 million € in debt. Let's call it 20M € because obviously you need to make yourself at least a little rich too. So that's the bill you need to give the government in order to break even: 20M € for 150 under-trained medical personnel with basically zero work experience. Not a good business model, imo
- qwerty456127 5y ago
  > then have them sit idle Can't they do research when idle?
igorkraw 5y ago
Because usually, we have less than that hospitalized, and capital efficiency demands elimination of redundant capacity. In the US shareholder value of private hospitals, in my homecountry of Germany, political pressure to remove "inefficiencies" from the system.
3np 5y ago
Optimizing a system for increased efficiency comes with a corresponding increase in fragility. Health systems in many places are optimized for efficiency, and on top of that were at or over capacity even pre-pandemic. I find it shameful that this is still not addressed properly and publicly. If enough resources had been spent on addressing this issue, and doing everything we can to overprovision capacity (double healthcare worker compensation could be one part of that, for example), we should be able to handle this by now. If, under normal condition, healthcare workers had a lot of slack, facilities were underused, and pay was higher, the situation wouldn’t be so grave. (wasn’t there an Ask HN thread the other day where many self-reported reviving cushy pay for only doing 2-8h of actual work in a given week, and others responding with how that’s all good?)
johnchristopher 5y ago
It's not a broader question. It's a question mainly used in a form or another by covid deniers to first shift the blame for hospitals saturation from the covid infection rate to government's downsizing of our health infrastructure and then to claim this downsizing is the main and only reason for hospitals saturation “so covid is not responsible for hospital saturation, see ? so let's stop the vaccine madness". Whatever our hospital capacity is or should be or was it's not enough now to handle the situation. If it was enough 2 years ago then we'd still be facing health worker's fatigue.
iso1210 5y ago
Scaling up healthcare is not a matter of spinning up a new EC2 instance. We run health care at a level that can cope with normal situations, but would fail instantly in the case of say civil war or alien invasion. That's a choice, as a society we'd rather spend the resources on youtube videos of rich people yelling at the camera than on more doctors, and that's fine, freedom. It gets worse though, you can 'overclock' your healthcare system in a time of crisis, but that leads to burning out your machines, and thus ending up with less capacity afterwards. Generally the west has run our healthcare systems beyond 100% for nearly 2 years, and that means capacity has actually decreased. All the money in the world won't fix that in a short time - indeed it can make it worse in some cases (If you gave a nurse $1m to work 16 hour shifts for the 30 days, he would, and then he'd likely quit) If you want to improve your healthcare situation, you need to go back in time 10 years and get more people training to work in healthcare. That means fewer people working in advertising or other key parts of the economy.
- johnchristopher 5y ago
  > That means fewer people working in advertising or other key parts of the economy. I see what you did there :). Anyway, ~10 years ago I considered moving back to school for a nurse degree. I didn't and one of the reason was that I had not enough energy in me to fight for the degree and to fight the social and welfare system for the right to do it. Edit: It's a key part of the society and the promise of fulfilling rewards is great but the system doesn't like you. It glorifies your pain. That's why I don't believe most nurses and health care workers who got out will ever get back as nurses. Maybe as medical secretaries or logistics but they won't get back in the trenches.
- gus_massa 5y ago
  One of the reasons why you can't overclock the health system is that medical doctors and nurses are doing insane long shift, like 12 hours or even 24 hours. The official reason is that they must be used to long shift, so in case of a big emergency they can work long shifts. The problem is that once the big emergency arrives, you don't have spared professionals, because you don't need them because they are overclocked in normal times. Another reason is that the shift change is dangerous because they have a lot of info in their mind that is not transmitted to the member of the next shift. This can be solved if they log all the data in some common system, but it's difficult to convince the doctors to follow a checklist during surgery. (Pilots following checklist avoid a lot of plane crashes.) (Each time a new doctor arrives, remember to tell him/her all the relevant info, don't assume the last doctor passed the info.) If you want to be prepared for the next pandemic, make 6 hours shift mandatory. They will have an easy time fpr the next 90 years. Health care will be more expensive. Make a good shift change procedure. Once the next pandemic arrive, you can easily overclock the staff x2, increase the pay x3 to keep them happy, and call the heroes too.