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I agree - I am worried about taking hospital capacity claims at face value though. From what I've seen, it was common for hospitals to report being overwhelmed

I agree - I am worried about taking hospital capacity claims at face value though. From what I've seen, it was common for hospitals to report being overwhelmed even during flu seasons pre-covid. I wouldn't classify that level of 'overwhelmed' worthy of mandates upon society. I don't doubt that during these periods of time hospital resources are strained in some way, but there's a difference between this routine level of being overwhelmed and a level where freedoms should be restricted from the general public. I don't have a good model for where the line should be drawn, but I lean towards not imposing restrictions unless massive benefit can be shown beyond a reasonable doubt.

walterbell 5y ago
There are operations research PhD's who use decades of aggregate demand data in dynamic pricing algorithms for the purpose of revenue and queue management in perishable services, e.g. software for pricing of airline seats, rental cars and hotel rooms. In countries with universal healthcare, price cannot be used for queue management, but the US isn't one of those countries. Did any hospital use queue management software to adjust pricing as a mechanism for demand throttling, due to limited capacity in 2020-2021? In any case, if supply-vs-demand is both a policy driver and metric of intervention performance, we need public, detailed hospital capacity data for analysis and optimization of net societal costs vs benefits. Utilization of space and skills is eminently quantifiable and software already exists for demand mgmt.
- zrail 5y ago
  > Did any hospital use queue management software to adjust pricing as a mechanism for demand throttling, due to limited capacity in 2020-2021 No one shops for healthcare in the US based on price, for three reasons. First, prices are unknowable in advance. Second, if you have insurance the insurance will fulfill their end of the bargain if you need to be admitted (i.e. they will pay as agreed upon in the insurance contract). Third, emergency rooms in the US are required by law to stabilize any emergent patient that walks in the door, which means anyone can go to any ER anywhere and get treatment.
  - depereo 5y ago
    Isn't there a new law, partially rolled out, that requires US hospitals to disclose the cost for a procedure or treatment in advance?
    - abduhl 5y ago
      Hospitals don't comply with it. What is the government going to do, shut them down or fine them into closing during a pandemic? Private companies have coopted the power over our government during this pandemic, and we have gladly given it to them in fear.
    - vel0city 5y ago
      They're required to publish their prices, which results in giant PDF documents with thousands of different charge codes and prices. Its almost incomprehensible to analyze unless you're in healthcare billing. Plus, you'd need to know what services/medications/equipment you'll need before you even get to the hospital, which is pretty dang tricky unless you're a doctor yourself. I was recently in the hospital for abdominal issues. How would I know what drugs they would give me? How would I know if they were going to give me some kind of scan? If they were going to give me a scan, are they going to use a portable machine or use a stationary machine? Are they going to need to use some kind of endoscopic scope? Will I need other things to assist with those scans (sedatives, contrast materials, etc)? Which blood work tests is the doctor going to order? Which urine tests is the doctor going to order? Are they going to order stool samples? How many samples are they going to need, how many times are they going to need to re-run tests? What if I get there and determine I need surgery? How should I have known I needed that ahead of time? What kind of surgery is it going to be? What drugs are involved in that? Its not like you can walk up and see a board that says "INTESTIONAL DISTRESS -- $175"
      - brimble 5y ago
        > Its almost incomprehensible to analyze unless you're in healthcare billing. Considering that hospitals seem (anecdotal evidence only) to fuck up their own billing codes like 20% of the time, I'm not even sure that's enough.
- nradov 5y ago
  Pricing is mostly fixed for at least a year at a time by contracts with payers (insurance companies), or by Medicare fee schedules. Hospitals have almost no legal flexibility to dynamically adjust prices based on demand.
Tade0 5y ago
A few of my friends are doctors. When it hits, it's hell. Here in Poland 300h of work during the month the infections are at their peak is not unheard of.
sib301 5y ago
Dude go to a hospital in a populated area during this surge. My wife sat in the waiting room for 3 hours with SEVERE abdominal pain, DURING A PREGNANCY and was unable to be seen. We went home. If she’d had an ectopic pregnancy, she would probably not be here anymore.
- lowercased 5y ago
  My mom had to wait for ~ 5 hrs in ER waiting room in relatively severe pain. Was another 8-9 hours 'inside' just to be sent home. Years ago she'd had been admitted and stayed overnight to be on the safe side (older adult, known health issues, etc) but ... no room, over capacity, stretched way too thin.
- Lammy 5y ago
  To be fair I had exactly that same experience at the UCSF Emergency Room in 2017. Four hours in the waiting room, and then the only bed they could give me was against one wall of a busy hallway.
  - saiya-jin 5y ago
    Yes its very common even in richest places. Case point #2 - Geneva, Switzerland has the biggest public hospital in whole country (HUG). They employ around 10k personnel overall, and Geneva is relatively small city (they call it the smallest metropole for a reason). There is no shortage of money or high tech equipment. But if you came pre-covid during say weekend night and you were not clearly about to die, 10+h waiting time in emergency was not unheard of (wife was serving there for some time as doctor, those folks deserve some proper respect). Simply overwhelmed, not enough staff comprised mostly by junior doctors. Now they are properly good in diagnosing whether your excruciating pain is life-threatening or not, but it must suck big time to be on patient's side. This is by far the biggest emergency in whole canton. Any private clinic or smaller medical centre will send serious cases straight there. Its not something discussed frequently but that's just how things are, in one of the richest and well-organized countries in whole world. Don't expect much better experience if you have bad luck with timing.
AnthonyMouse 5y ago
The thing they don't always mention is that hospital capacity is always close to being overwhelmed, by design, because otherwise you're sitting around with a large amount of extraordinarily expensive idle hospital capacity. A small change is enough to go from "almost full" to "over capacity." The seemingly obvious thing to do would be to build some temporary capacity specifically for COVID patients. We've had quite a long time to do this now so I'm not sure what's preventing it. Maybe it's caught up in that thing where captured regulators are gatekeeping medical certifications to maintain labor scarcity or some such thing?
- cma 5y ago
- hutzlibu 5y ago
  This is a hard problem, because you do not only need beds, but also humans tending to the patients. And while you can just build another hospital if you have the cash - you cannot just build another doctor, if you need one.
  - jstarfish 5y ago
    > you cannot just build another doctor, if you need one. So take your pool of existing NPs and give them a temporary promotion.
    - spookthesunset 5y ago
      Or anything like that. It's an emergency, right? So what about people in medical school who have yet to be licensed? Grab them and have them do stuff. Retired doctors? Go get them. Whatever. It's an emergency. Get creative. You don't need things perfect. You need things to work. It's an emergency. Every second you aren't focused on solving overwhelmed healthcare is a second you are stealing from people through lockdowns. I really don't understand why people are completely incapable of using their imagination to solve "hospitals over capacity". The only thing I can think of is perhaps hospitals have never actually been overwhelmed because if they were... we'd have fixed the problem already.
mrcrumb1 5y ago
Can you give me an example of a scenario where you would be in favor of restriction like the ones that have been implemented?
nradov 5y ago
2018: "Hospitals Overwhelmed by Flu Patients Are Treating Them in Tents" https://time.com/5107984/hospitals-handling-burden-flu-patients/ https://time.com/5107984/hospitals-handling-burden-flu-patie... This pandemic has been extremely hard on many healthcare providers. But hospitals in many areas were routinely overwhelmed during winter respiratory virus season in previous years. They dealt with it as best they could, and we didn't impose mandates or restrictions on the rest of society. https://peterattiamd.com/covid-19-current-state-omicron/ https://peterattiamd.com/covid-19-current-state-omicron/
- frickinLasers 5y ago
  Covid has been something like ten times as deadly as the flu. I imagine those hospital beds put way more strain on the system as a whole than a bad flu season (see: ventilator sharing). I think any human with a shred of empathy for their tribe would agree, that this level of misery warranted collective action on the level of our response to measles, mumps, rubella, tuberculosis, diphtheria, pertussis... And though I really hope it's the case, I've heard no news yet that Omicron will be the last significant variant.
  - nradov 5y ago
    Did you actually listen to that panel discussion I linked where several leading physicians explain what's been happening and the mistakes that have been made?
    - frickinLasers 5y ago
      Given the amount of time between when you posted and when I replied, it's safe to say I hadn't listened to the three-hour conversation between two physicians and a professor. Initially I scrolled down, was put off by the stack of text and images/embeds with no clear organization, skimmed the Cliff's notes, and failed to understand how it correlated with "we didn't impose mandates or restrictions on the rest of society." They make several good points about policy moving forward and vaccinating children, but they were disregarding Omicron before we even knew much about it. Their general position aged like milk, now that there are more people in the hospital with Covid than at any point in the pandemic. They complain about Fauci holding rigid positions, while my science-illiterate family complain that the rules keep changing/are confusing. None of this addresses the fact that masks and vaccines are consistent with past policy in America and have been more effective than nothing, at least as far as people complied, or that comparisons to the flu are a bit of a stretch.
Fomite 5y ago
I work with a lot of clinicians. Normal flu seasons don't leave them with 1000 yard stares.

walterbell 5y ago

There are operations research PhD's who use decades of aggregate demand data in dynamic pricing algorithms for the purpose of revenue and queue management in perishable services, e.g. software for pricing of airline seats, rental cars and hotel rooms. In countries with universal healthcare, price cannot be used for queue management, but the US isn't one of those countries. Did any hospital use queue management software to adjust pricing as a mechanism for demand throttling, due to limited capacity in 2020-2021? In any case, if supply-vs-demand is both a policy driver and metric of intervention performance, we need public, detailed hospital capacity data for analysis and optimization of net societal costs vs benefits. Utilization of space and skills is eminently quantifiable and software already exists for demand mgmt.

zrail 5y ago
> Did any hospital use queue management software to adjust pricing as a mechanism for demand throttling, due to limited capacity in 2020-2021 No one shops for healthcare in the US based on price, for three reasons. First, prices are unknowable in advance. Second, if you have insurance the insurance will fulfill their end of the bargain if you need to be admitted (i.e. they will pay as agreed upon in the insurance contract). Third, emergency rooms in the US are required by law to stabilize any emergent patient that walks in the door, which means anyone can go to any ER anywhere and get treatment.
- depereo 5y ago
  Isn't there a new law, partially rolled out, that requires US hospitals to disclose the cost for a procedure or treatment in advance?
  - abduhl 5y ago
    Hospitals don't comply with it. What is the government going to do, shut them down or fine them into closing during a pandemic? Private companies have coopted the power over our government during this pandemic, and we have gladly given it to them in fear.
  - vel0city 5y ago
    They're required to publish their prices, which results in giant PDF documents with thousands of different charge codes and prices. Its almost incomprehensible to analyze unless you're in healthcare billing. Plus, you'd need to know what services/medications/equipment you'll need before you even get to the hospital, which is pretty dang tricky unless you're a doctor yourself. I was recently in the hospital for abdominal issues. How would I know what drugs they would give me? How would I know if they were going to give me some kind of scan? If they were going to give me a scan, are they going to use a portable machine or use a stationary machine? Are they going to need to use some kind of endoscopic scope? Will I need other things to assist with those scans (sedatives, contrast materials, etc)? Which blood work tests is the doctor going to order? Which urine tests is the doctor going to order? Are they going to order stool samples? How many samples are they going to need, how many times are they going to need to re-run tests? What if I get there and determine I need surgery? How should I have known I needed that ahead of time? What kind of surgery is it going to be? What drugs are involved in that? Its not like you can walk up and see a board that says "INTESTIONAL DISTRESS -- $175"
    - brimble 5y ago
      > Its almost incomprehensible to analyze unless you're in healthcare billing. Considering that hospitals seem (anecdotal evidence only) to fuck up their own billing codes like 20% of the time, I'm not even sure that's enough.
nradov 5y ago
Pricing is mostly fixed for at least a year at a time by contracts with payers (insurance companies), or by Medicare fee schedules. Hospitals have almost no legal flexibility to dynamically adjust prices based on demand.

Tade0 5y ago

A few of my friends are doctors. When it hits, it's hell. Here in Poland 300h of work during the month the infections are at their peak is not unheard of.

sib301 5y ago

Dude go to a hospital in a populated area during this surge. My wife sat in the waiting room for 3 hours with SEVERE abdominal pain, DURING A PREGNANCY and was unable to be seen. We went home. If she’d had an ectopic pregnancy, she would probably not be here anymore.

lowercased 5y ago
My mom had to wait for ~ 5 hrs in ER waiting room in relatively severe pain. Was another 8-9 hours 'inside' just to be sent home. Years ago she'd had been admitted and stayed overnight to be on the safe side (older adult, known health issues, etc) but ... no room, over capacity, stretched way too thin.
Lammy 5y ago
To be fair I had exactly that same experience at the UCSF Emergency Room in 2017. Four hours in the waiting room, and then the only bed they could give me was against one wall of a busy hallway.
- saiya-jin 5y ago
  Yes its very common even in richest places. Case point #2 - Geneva, Switzerland has the biggest public hospital in whole country (HUG). They employ around 10k personnel overall, and Geneva is relatively small city (they call it the smallest metropole for a reason). There is no shortage of money or high tech equipment. But if you came pre-covid during say weekend night and you were not clearly about to die, 10+h waiting time in emergency was not unheard of (wife was serving there for some time as doctor, those folks deserve some proper respect). Simply overwhelmed, not enough staff comprised mostly by junior doctors. Now they are properly good in diagnosing whether your excruciating pain is life-threatening or not, but it must suck big time to be on patient's side. This is by far the biggest emergency in whole canton. Any private clinic or smaller medical centre will send serious cases straight there. Its not something discussed frequently but that's just how things are, in one of the richest and well-organized countries in whole world. Don't expect much better experience if you have bad luck with timing.

AnthonyMouse 5y ago

The thing they don't always mention is that hospital capacity is always close to being overwhelmed, by design, because otherwise you're sitting around with a large amount of extraordinarily expensive idle hospital capacity. A small change is enough to go from "almost full" to "over capacity." The seemingly obvious thing to do would be to build some temporary capacity specifically for COVID patients. We've had quite a long time to do this now so I'm not sure what's preventing it. Maybe it's caught up in that thing where captured regulators are gatekeeping medical certifications to maintain labor scarcity or some such thing?

cma 5y ago
hutzlibu 5y ago
This is a hard problem, because you do not only need beds, but also humans tending to the patients. And while you can just build another hospital if you have the cash - you cannot just build another doctor, if you need one.
- jstarfish 5y ago
  > you cannot just build another doctor, if you need one. So take your pool of existing NPs and give them a temporary promotion.
  - spookthesunset 5y ago
    Or anything like that. It's an emergency, right? So what about people in medical school who have yet to be licensed? Grab them and have them do stuff. Retired doctors? Go get them. Whatever. It's an emergency. Get creative. You don't need things perfect. You need things to work. It's an emergency. Every second you aren't focused on solving overwhelmed healthcare is a second you are stealing from people through lockdowns. I really don't understand why people are completely incapable of using their imagination to solve "hospitals over capacity". The only thing I can think of is perhaps hospitals have never actually been overwhelmed because if they were... we'd have fixed the problem already.

mrcrumb1 5y ago

Can you give me an example of a scenario where you would be in favor of restriction like the ones that have been implemented?

nradov 5y ago

2018: "Hospitals Overwhelmed by Flu Patients Are Treating Them in Tents" https://time.com/5107984/hospitals-handling-burden-flu-patients/ https://time.com/5107984/hospitals-handling-burden-flu-patie... This pandemic has been extremely hard on many healthcare providers. But hospitals in many areas were routinely overwhelmed during winter respiratory virus season in previous years. They dealt with it as best they could, and we didn't impose mandates or restrictions on the rest of society. https://peterattiamd.com/covid-19-current-state-omicron/ https://peterattiamd.com/covid-19-current-state-omicron/

frickinLasers 5y ago
Covid has been something like ten times as deadly as the flu. I imagine those hospital beds put way more strain on the system as a whole than a bad flu season (see: ventilator sharing). I think any human with a shred of empathy for their tribe would agree, that this level of misery warranted collective action on the level of our response to measles, mumps, rubella, tuberculosis, diphtheria, pertussis... And though I really hope it's the case, I've heard no news yet that Omicron will be the last significant variant.
- nradov 5y ago
  Did you actually listen to that panel discussion I linked where several leading physicians explain what's been happening and the mistakes that have been made?
  - frickinLasers 5y ago
    Given the amount of time between when you posted and when I replied, it's safe to say I hadn't listened to the three-hour conversation between two physicians and a professor. Initially I scrolled down, was put off by the stack of text and images/embeds with no clear organization, skimmed the Cliff's notes, and failed to understand how it correlated with "we didn't impose mandates or restrictions on the rest of society." They make several good points about policy moving forward and vaccinating children, but they were disregarding Omicron before we even knew much about it. Their general position aged like milk, now that there are more people in the hospital with Covid than at any point in the pandemic. They complain about Fauci holding rigid positions, while my science-illiterate family complain that the rules keep changing/are confusing. None of this addresses the fact that masks and vaccines are consistent with past policy in America and have been more effective than nothing, at least as far as people complied, or that comparisons to the flu are a bit of a stretch.

Fomite 5y ago

I work with a lot of clinicians. Normal flu seasons don't leave them with 1000 yard stares.