Author Topic: How long can we wait while flattening the curve?  (Read 248300 times)

Buffaloski Boris

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Re: How long can we wait while flattening the curve?
« Reply #300 on: March 29, 2020, 08:38:04 AM »

And while everyone here in Australia is unemployed, anxious and fearful, and domestic violence is increasing... we are going to close playgrounds, but... keep bottle shops open.

Really?

'Straya! Trying to be as dumb as America since 1962.

This is not a dumb move. We see this with hurricanes*. Alcohol is a vital supply used to keep (most) people calm. Same thing with pot stores where that's now legal. 

State liquor stores are open here with breweries and distilleries now allowed to offer home delivery! And I for one am glad that this public service will continue.

*(for the hurricane challenged, imagine winds howling for 12 hours or more. It's like listening to a freight train for hours. You're holed up, the electricity is usually out, you can't sleep, and are hoping that a tree doesn't fall on you. It sucks.) 

secondcor521

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Re: How long can we wait while flattening the curve?
« Reply #301 on: March 29, 2020, 08:38:29 AM »
Well me might have an actual answer now that we have some data. I much prefer math over stories just trying to get clicks.

https://covid19.healthdata.org/projections

Very interesting to see the how some states are much further along than others, and how some states have accomplished a flattening of the curve.

I cannot speak to their methods, data, or assumptions. But its a start.

I appreciate their effort.  I can say two things about the site:

1.  For my state (Idaho), they show that we have not implemented the first three items at the top, when in fact we have.  Perhaps their information is out of date.

2.  If ventilators = invasive ventilators, then the number of ventilators predicted to be needed does not square with Governor Cuomo's estimates.  The site says NY will need 4,141 ventilators.  Governor Cuomo stated he needed a minimum of 30,000 additional ventilators on 3/24 per https://www.worldometers.info/coronavirus/country/us.

Ffs. Does it matter if you over supply in the current climate? Nope. Does it matter if you undersupply? YEP.

Of course, and I agree with your point completely.

My point, which you may have missed or ignored, is that the data at the site is not one I would rely on because it appears to me to be inaccurate in major ways based on personal experience which is readily fact-checkable (point 1) and on recent published statements by an elected governor based on health experts which are also readily fact-checkable (point 2).

KBecks

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Re: How long can we wait while flattening the curve?
« Reply #302 on: March 29, 2020, 08:48:56 AM »
Here is a study on using a combination of two drugs to combat COVID-19.  I am not accustomed to reading research papers but those of you who are may be interested.

https://www.mediterranee-infection.com/wp-content/uploads/2020/03/COVID-IHU-2-1.pdf

It seems that this drug combination may help reduce the impacts of the virus.  It also sounds like New York started its own use/trials of this combination on Tuesday.

bmjohnson35

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Re: How long can we wait while flattening the curve?
« Reply #303 on: March 29, 2020, 08:56:27 AM »

Another interesting article..........it's a long read and more of an opinion and speculation article, but it raises a lot to think about as we live through this thing and try to forecast our future.

https://www.theatlantic.com/health/archive/2020/03/how-will-coronavirus-end/608719/

BJ

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Re: How long can we wait while flattening the curve?
« Reply #304 on: March 29, 2020, 09:19:43 AM »
Here is a study on using a combination of two drugs to combat COVID-19.  I am not accustomed to reading research papers but those of you who are may be interested.

https://www.mediterranee-infection.com/wp-content/uploads/2020/03/COVID-IHU-2-1.pdf

It seems that this drug combination may help reduce the impacts of the virus.  It also sounds like New York started its own use/trials of this combination on Tuesday.

This report doesnt seem to have included a control group, which is essential in determining treatment efficacy. The purported efficacy in treatment resulted in a decrease in both viral load and time to hospital discharge. One wonders if a placebo control group would have exhibited identical outcomes. The authors do compare their findings to (recent) historical viral loads and discharge rates and make the claim that the treatment was effective. The conclusion hinges on this comparison, which is to be honest, weak, BUT encouraging as the (historic) control group data from other countries, patient demographics, etc.  may not necessarily be reflective of the control data that should have been obtained empirically in this study. I get it, one cant always generate such data internally, but without that comparison, claims of efficacy are limited in confidence. What we need, and are currently conducting, are fully controlled preclinical and clinical studies. We will know soon.

Hirondelle

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Re: How long can we wait while flattening the curve?
« Reply #305 on: March 29, 2020, 09:54:14 AM »

Due to the lack of testing, we are flying blind with this outbreak. More Tests Equal More Confirmed Cases. Less confirmed cases does not mean less cases!
Deaths are deaths, though, they're a bit harder to hide: https://www.nytimes.com/interactive/2020/03/21/upshot/coronavirus-deaths-by-country.html

yeah but to be useful number of deaths reallly needs to be normalized. its not useful to compare number of deaths in us (350m people) to italy (60m people).

also, are we really testing everyone that dies with covid symptoms? without a test, cause of death could be pneumonia, heart failure or something else. when tests are so limited why waste a test on someone that is dead or going to die anyway? especially when that test could be used to test a health care worker or someone who lived in a group setting, potentially infecting many others.

Are all corpses tested for coronavirus?  If they're not, you might not know the real numbers.

In my country corpses are not tested. Can't speak for other places.

It does look like there's an underreporting of COVID-related deaths though. Look at this and this link where they compare the number of 'expected' deaths to the number of actual deaths and the number of deaths attributed to COVID in some areas in Italy and Spain. There's a huge gap of unexplained deaths.

This is probably a combination of non-diagnosed COVID deaths and collateral damage as ERs report to see few people with heart issues, appendix issues, liver failure etc (like, ER visits that you don't expect to plummet overnight) as people don't dare to go to the ER, either due to fear of catching COVID or because they think they're too busy there. So the damage of the lack of testing, the overrun medical systems and the folks that are too scared to go to ER even if they have severe complaints is probably much, much worse than the actual deaths reported. 

wenchsenior

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Re: How long can we wait while flattening the curve?
« Reply #306 on: March 29, 2020, 10:05:13 AM »

And while everyone here in Australia is unemployed, anxious and fearful, and domestic violence is increasing... we are going to close playgrounds, but... keep bottle shops open.

Really?

'Straya! Trying to be as dumb as America since 1962.

This is not a dumb move. We see this with hurricanes*. Alcohol is a vital supply used to keep (most) people calm. Same thing with pot stores where that's now legal. 

State liquor stores are open here with breweries and distilleries now allowed to offer home delivery! And I for one am glad that this public service will continue.

*(for the hurricane challenged, imagine winds howling for 12 hours or more. It's like listening to a freight train for hours. You're holed up, the electricity is usually out, you can't sleep, and are hoping that a tree doesn't fall on you. It sucks.)

I think it's mostly psychological...one certainly doesn't need booze to get through hurricanes (speaking from experience riding out 2 category 3s). And I certainly wouldn't want to face the next day hungover. Jesus, what a nightmare that would be.

However, for the many MANY members of the population who are physically addicted to alcohol, sudden withdrawal can certainly kill you, so I suspect part of the reason for keeping liquor stores open is to reduce both fatalities and also the addicts roaming around outside either drunk or withdrawing, panicking from lack of access.

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Re: How long can we wait while flattening the curve?
« Reply #307 on: March 29, 2020, 12:20:32 PM »
Well me might have an actual answer now that we have some data. I much prefer math over stories just trying to get clicks.

https://covid19.healthdata.org/projections

Very interesting to see the how some states are much further along than others, and how some states have accomplished a flattening of the curve.

I cannot speak to their methods, data, or assumptions. But its a start.

I appreciate their effort.  I can say two things about the site:

1.  For my state (Idaho), they show that we have not implemented the first three items at the top, when in fact we have.  Perhaps their information is out of date.

2.  If ventilators = invasive ventilators, then the number of ventilators predicted to be needed does not square with Governor Cuomo's estimates.  The site says NY will need 4,141 ventilators.  Governor Cuomo stated he needed a minimum of 30,000 additional ventilators on 3/24 per https://www.worldometers.info/coronavirus/country/us.

Ffs. Does it matter if you over supply in the current climate? Nope. Does it matter if you undersupply? YEP.

Of course, and I agree with your point completely.

My point, which you may have missed or ignored, is that the data at the site is not one I would rely on because it appears to me to be inaccurate in major ways based on personal experience which is readily fact-checkable (point 1) and on recent published statements by an elected governor based on health experts which are also readily fact-checkable (point 2).
Just in case anyone thinks that having an adequate supply of ventilators solves the problems, current UK information is that 50% of covid-19 sufferers who need ventilation die in any case (and forum member and doctor Abe posted figures of 60%+ out of NY).

KBecks

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Re: How long can we wait while flattening the curve?
« Reply #308 on: March 29, 2020, 12:22:21 PM »

BostonBrit

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Re: How long can we wait while flattening the curve?
« Reply #309 on: March 29, 2020, 12:44:41 PM »
Well me might have an actual answer now that we have some data. I much prefer math over stories just trying to get clicks.

https://covid19.healthdata.org/projections

Very interesting to see the how some states are much further along than others, and how some states have accomplished a flattening of the curve.

I cannot speak to their methods, data, or assumptions. But its a start.

I appreciate their effort.  I can say two things about the site:

1.  For my state (Idaho), they show that we have not implemented the first three items at the top, when in fact we have.  Perhaps their information is out of date.

2.  If ventilators = invasive ventilators, then the number of ventilators predicted to be needed does not square with Governor Cuomo's estimates.  The site says NY will need 4,141 ventilators.  Governor Cuomo stated he needed a minimum of 30,000 additional ventilators on 3/24 per https://www.worldometers.info/coronavirus/country/us.

Ffs. Does it matter if you over supply in the current climate? Nope. Does it matter if you undersupply? YEP.

Of course, and I agree with your point completely.

My point, which you may have missed or ignored, is that the data at the site is not one I would rely on because it appears to me to be inaccurate in major ways based on personal experience which is readily fact-checkable (point 1) and on recent published statements by an elected governor based on health experts which are also readily fact-checkable (point 2).
Just in case anyone thinks that having an adequate supply of ventilators solves the problems, current UK information is that 50% of covid-19 sufferers who need ventilation die in any case (and forum member and doctor Abe posted figures of 60%+ out of NY).

Very true...   BUT 100% of ventilators that need ventilation who don't get a ventilation die.

On the original trajectory of the virus (pre- flattening), the numbers needing ventilators was 8x the number of ventilators.

So continuing your point, 8.5/9 so 94% who need ventilators would die vs 50%.. and there is a hope that as medical knowledge improves that 50% rate decreases as does the % needing ventilation.

Either way - grim

ice_beard

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Re: How long can we wait while flattening the curve?
« Reply #310 on: March 29, 2020, 02:13:20 PM »
Everyone keeps talking about ventilators as some sort of cure all.  I have news for you all...it takes a TEAM of medical professionals to take care of ventilated patients.  Respiratory therapists, nurses, nursing assistants and MDs to oversee the care of these ventilated patients.  The typical ratio for ventilated patients to nurses is 2:1.  Given these are atypical times, 3:1 and possibly even higher ratios could be a possibility I don't doubt.  So if you need 20,000 ventilators, they'd better come with 10,000 trained nurses who know how to care for vented patients. 
Source: ICU RN

wanderlustNW

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Re: How long can we wait while flattening the curve?
« Reply #311 on: March 29, 2020, 02:29:23 PM »
Everyone keeps talking about ventilators as some sort of cure all.  I have news for you all...it takes a TEAM of medical professionals to take care of ventilated patients.  Respiratory therapists, nurses, nursing assistants and MDs to oversee the care of these ventilated patients.  The typical ratio for ventilated patients to nurses is 2:1.  Given these are atypical times, 3:1 and possibly even higher ratios could be a possibility I don't doubt.  So if you need 20,000 ventilators, they'd better come with 10,000 trained nurses who know how to care for vented patients. 
Source: ICU RN

Thank you! I'm a radiation therapist and was trying to explain this to friends. They thought you just hook people up to these and any ol' person can just run it. It takes specialized people who know what they are doing to take care of these patients. The patients also need to be under anesthesia.

They thought I could also explain to someone in a matter of a few weeks how to do my job. Uh....if you wanna irradiate the wrong part of the body go for it.

BostonBrit

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Re: How long can we wait while flattening the curve?
« Reply #312 on: March 29, 2020, 05:37:51 PM »
Everyone keeps talking about ventilators as some sort of cure all.  I have news for you all...it takes a TEAM of medical professionals to take care of ventilated patients.  Respiratory therapists, nurses, nursing assistants and MDs to oversee the care of these ventilated patients.  The typical ratio for ventilated patients to nurses is 2:1.  Given these are atypical times, 3:1 and possibly even higher ratios could be a possibility I don't doubt.  So if you need 20,000 ventilators, they'd better come with 10,000 trained nurses who know how to care for vented patients. 
Source: ICU RN

Couldn't agree more

dandarc

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Re: How long can we wait while flattening the curve?
« Reply #313 on: March 30, 2020, 07:39:21 AM »
Everyone keeps talking about ventilators as some sort of cure all.  I have news for you all...it takes a TEAM of medical professionals to take care of ventilated patients.  Respiratory therapists, nurses, nursing assistants and MDs to oversee the care of these ventilated patients.  The typical ratio for ventilated patients to nurses is 2:1.  Given these are atypical times, 3:1 and possibly even higher ratios could be a possibility I don't doubt.  So if you need 20,000 ventilators, they'd better come with 10,000 trained nurses who know how to care for vented patients. 
Source: ICU RN

Couldn't agree more
Yes this. And also another factor as to why we normal folks need to do everything we can to slow this thing down.

GettingClose

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Re: How long can we wait while flattening the curve?
« Reply #314 on: March 30, 2020, 03:10:38 PM »
Quote
So if you need 20,000 ventilators, they'd better come with 10,000 trained nurses

Really more like 30,000 trained nurses, since you need a nurse for each 12-hour shift each day, and most nurses work 3 shifts a week.

My sister is a certified nurse midwife, working in a New England hospital, and she just worked 84 hours in 9 days (many labor and delivery nurses and midwives out with COVID-19 or conditions like pregnancy, cancer treatment, etc. that make it unwise to come in).  It's impossible to keep that up for more a couple of weeks.

Sibley

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Re: How long can we wait while flattening the curve?
« Reply #315 on: March 30, 2020, 04:57:51 PM »
Here is a study on using a combination of two drugs to combat COVID-19.  I am not accustomed to reading research papers but those of you who are may be interested.

https://www.mediterranee-infection.com/wp-content/uploads/2020/03/COVID-IHU-2-1.pdf

It seems that this drug combination may help reduce the impacts of the virus.  It also sounds like New York started its own use/trials of this combination on Tuesday.

This report doesnt seem to have included a control group, which is essential in determining treatment efficacy. The purported efficacy in treatment resulted in a decrease in both viral load and time to hospital discharge. One wonders if a placebo control group would have exhibited identical outcomes. The authors do compare their findings to (recent) historical viral loads and discharge rates and make the claim that the treatment was effective. The conclusion hinges on this comparison, which is to be honest, weak, BUT encouraging as the (historic) control group data from other countries, patient demographics, etc.  may not necessarily be reflective of the control data that should have been obtained empirically in this study. I get it, one cant always generate such data internally, but without that comparison, claims of efficacy are limited in confidence. What we need, and are currently conducting, are fully controlled preclinical and clinical studies. We will know soon.

The other piece of that puzzle is supply. If the medications appear to be effective, every hospital across the world is going to be trying to get ahold of those drugs. And it doesn't matter how common they are, the supply is finite. Sure, manufacturers could try to increase production, but I'm guessing that it's actually that easy - shifting whatever is needed physically in the factory, getting raw ingredients, etc is going to take time. There's also a finite supply of the raw ingredients.

Buffaloski Boris

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Re: How long can we wait while flattening the curve?
« Reply #316 on: March 30, 2020, 05:22:40 PM »
Everyone keeps talking about ventilators as some sort of cure all.  I have news for you all...it takes a TEAM of medical professionals to take care of ventilated patients.  Respiratory therapists, nurses, nursing assistants and MDs to oversee the care of these ventilated patients.  The typical ratio for ventilated patients to nurses is 2:1.  Given these are atypical times, 3:1 and possibly even higher ratios could be a possibility I don't doubt.  So if you need 20,000 ventilators, they'd better come with 10,000 trained nurses who know how to care for vented patients. 
Source: ICU RN
Bingo. The problem isnít just the ventilators.  Itís the doctors and nurses and other health professionals. How many weeks of sheer hell do we expect them to be able endure?

bacchi

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Re: How long can we wait while flattening the curve?
« Reply #317 on: March 30, 2020, 05:33:47 PM »
Everyone keeps talking about ventilators as some sort of cure all.  I have news for you all...it takes a TEAM of medical professionals to take care of ventilated patients.  Respiratory therapists, nurses, nursing assistants and MDs to oversee the care of these ventilated patients.  The typical ratio for ventilated patients to nurses is 2:1.  Given these are atypical times, 3:1 and possibly even higher ratios could be a possibility I don't doubt.  So if you need 20,000 ventilators, they'd better come with 10,000 trained nurses who know how to care for vented patients. 
Source: ICU RN
Bingo. The problem isnít just the ventilators.  Itís the doctors and nurses and other health professionals. How many weeks of sheer hell do we expect them to be able endure?

How would removing social distancing guidelines fix this? Wouldn't that mean overwhelmed hospitals? Is it the idea that it's more pain over a shorter time vs spreading out the pain over a longer time?

Kyle Schuant

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Re: How long can we wait while flattening the curve?
« Reply #318 on: March 30, 2020, 06:29:53 PM »

This is not a dumb move. We see this with hurricanes*. Alcohol is a vital supply used to keep (most) people calm. Same thing with pot stores where that's now legal. 

Increasing accessibility of alcohol increases violence and suicide. Reducing it reduces those.

Keeping people calm? Well...


"Alcohol abuse is a means of easing oneís psychological stress but, at the same time, impacts on all other factors, rendering suicide more likely."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2872355

"the repeal of Sunday alcohol-sales restrictions may increase crime in poor urban areas."
https://www.sciencedaily.com/releases/2016/04/160425100417.htm

"Harmful use of alcohol is a major contributor to violence. Studies have shown that
violence can be cut by reducing the availability of alcohol through regulating sales outlets
and hours and prices; by providing brief interventions and longer-term treatment for
problem drinkers; and by improving the management of environments in which alcohol is
served."
https://www.who.int/violence_injury_prevention/violence/alcohol.pdf




WaterproofBanjo

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Re: How long can we wait while flattening the curve?
« Reply #319 on: March 30, 2020, 06:54:18 PM »
Realizing that the original post was on March 17... a lot has happened since then. 
  • There's currently 45 refrigerated trailers parked in NYC for dealing with COVID-19 deaths.
  • I work in the medical-industrial complex, and my industry is scrambling to figure out how to supply hundreds of thousands of ventilators to keep people alive.
  • Medical professionals are scared, overwhelmed, but still showing up (thank you).
  • In general, you're better off the younger you are, but there's also plenty of counter-examples who that hasn't worked out for.

As painful as it is to shut everything down, I'm not really seeing the alternative.

PDXTabs

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Re: How long can we wait while flattening the curve?
« Reply #320 on: March 30, 2020, 07:45:12 PM »
How many weeks of sheer hell do we expect them to be able endure?

I would like to flatten the curve and save lives, and hopefully avoid too many medical professionals with PTSD. With that said, every nurse and doctor in the country knew when they signed up that they might get to see a war or epidemic or otherwise witness years of pure hell. That's part of the job.

MoseyingAlong

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Re: How long can we wait while flattening the curve?
« Reply #321 on: March 30, 2020, 08:12:01 PM »
How many weeks of sheer hell do we expect them to be able endure?

I would like to flatten the curve and save lives, and hopefully avoid too many medical professionals with PTSD. With that said, every nurse and doctor in the country knew when they signed up that they might get to see a war or epidemic or otherwise witness years of pure hell. That's part of the job.

Yeah....no.
I, and I'd guess all my nursing school classmates, anticipated rough shifts and busy months but "years of pure hell"...no.

Abe

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Re: How long can we wait while flattening the curve?
« Reply #322 on: March 30, 2020, 08:29:51 PM »
 Yeah there's nothing in any civilian healthcare workforce contract expecting to be drafted into a war or years of pure hell anymore than anyone else. Epidemic, maybe. I've seen more death than pretty much anyone on this forum other than active duty military, veterans or ICU workers. Let's just say I wouldn't be so flippant about its effects.
« Last Edit: March 30, 2020, 08:33:20 PM by Abe »

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Re: How long can we wait while flattening the curve?
« Reply #323 on: March 30, 2020, 08:40:59 PM »
How many weeks of sheer hell do we expect them to be able endure?

I would like to flatten the curve and save lives, and hopefully avoid too many medical professionals with PTSD. With that said, every nurse and doctor in the country knew when they signed up that they might get to see a war or epidemic or otherwise witness years of pure hell. That's part of the job.

I went to Haiti after the earthquake.

I remember that some neighbourhoods protested the slowness of Hatian emergency response by piling their beloved dead like cordons. I remember a man tossing dead children, cartwheeling them through the air, out of a school gymnasium. He was certainly a standard human being, who cared the standard human amount about his fellow man, and he'd reached a capacity where he was tossing broken, crushed, dead children like sacks of grain. One of the kids has his brains spilling out the side of his head. He looked so odd - a little black kid so covered in dust he was tan, with a grey jelly leaking down his face.

I think about that man a fair amount. Is that just part of my job?

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #324 on: March 30, 2020, 10:20:53 PM »
Realizing that the original post was on March 17... a lot has happened since then. 
  • There's currently 45 refrigerated trailers parked in NYC for dealing with COVID-19 deaths.
  • I work in the medical-industrial complex, and my industry is scrambling to figure out how to supply hundreds of thousands of ventilators to keep people alive.
  • Medical professionals are scared, overwhelmed, but still showing up (thank you).
  • In general, you're better off the younger you are, but there's also plenty of counter-examples who that hasn't worked out for.

As painful as it is to shut everything down, I'm not really seeing the alternative.

Yes. And:

https://www.nytimes.com/2020/03/30/us/coronavirus-funeral-albany-georgia.html?action=click&module=Spotlight&pgtype=Homepage
and
https://www.google.com/amp/s/www.latimes.com/world-nation/story/2020-03-29/coronavirus-choir-outbreak%3f_amp=true

Too often, we don't know that someone in the room is infected until it's too late. Stay the fuck home.

PDXTabs

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Re: How long can we wait while flattening the curve?
« Reply #325 on: March 30, 2020, 10:34:10 PM »
Yeah....no.
I, and I'd guess all my nursing school classmates, anticipated rough shifts and busy months but "years of pure hell"...no.

Did they miss the last 300 years of history in high-school and college? Because I had to take a full year of history for my BS.*

My family lost people in the 1918 pandemic. Other parts of my family lived through the western front of WWII and the Chinese civil war. I reject the premise that today's generations could have reasonably expected to not have to live through any similar events.

EDITed to add: * - that might not be fair. I think that technically I could have taken a different social science and I chose to take history, including a graduate level course on the French Revolution. Shit can get real bad real fast, and I promise you that we are not immune. 
« Last Edit: March 30, 2020, 10:53:40 PM by PDXTabs »

PDXTabs

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Re: How long can we wait while flattening the curve?
« Reply #326 on: March 30, 2020, 10:38:18 PM »
I think about that man a fair amount. Is that just part of my job?

I grew up with stories of the bodies stacked up in North Dakota in 1918 because the ground was still frozen, and this was before anyone had heavy equipment to dig graves. I think that Americans are good at forgetting history, but one of those bodies was my great grandfather and my grandfather made sure that I knew it.

Maybe I should put it another way: no cop deserves to have to shoot someone, but they all know that they might have to. They made that choice when they took the job, which is a hell of a lot better than being a conscript during WWI.
« Last Edit: March 30, 2020, 10:43:40 PM by PDXTabs »

MoseyingAlong

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Re: How long can we wait while flattening the curve?
« Reply #327 on: March 30, 2020, 11:10:33 PM »
Yeah....no.
I, and I'd guess all my nursing school classmates, anticipated rough shifts and busy months but "years of pure hell"...no.

Did they miss the last 300 years of history in high-school and college? Because I had to take a full year of history for my BS.*

My family lost people in the 1918 pandemic. Other parts of my family lived through the western front of WWII and the Chinese civil war. I reject the premise that today's generations could have reasonably expected to not have to live through any similar events.


When we were in the military, sure, bring it on.
Civilian healthcare, not government, yeah...no.

There's a difference between a society going thru something and expecting individuals to go thru a specific type of hell. 

Sailor Sam

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Re: How long can we wait while flattening the curve?
« Reply #328 on: March 30, 2020, 11:15:25 PM »
Of course people know bad things are coming.

Over the course of a 15 year career, Iíve responded to six hurricanes, and one earthquake. Haiti, Katrina, Maria, Michael, Florence, Dorian. Each response left me with something that will never leave my brain. Haiti above all. The saving grace is that Iíve been able to spread those moments out across 15 years, with gaps in between.

Youíre asking medical workers to live disaster response day, after day, after day, for an untold amount of time. To use your analogy: itís asking a LEO to shoot someone in the line of duty every day, and telling them itís just part of their job. Itís an astonishing lack of compassion.

@Abe has ďFirst Do No Harm.Ē @MoseyingAlong has a vocation that stretches back as far as humans. I have ďHonor, Respect, Devotion to Duty.Ē Iím not exactly certain what you have, beyond stories that donít even involve your own suffering.

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Re: How long can we wait while flattening the curve?
« Reply #329 on: March 30, 2020, 11:23:25 PM »
Iím not exactly certain what you have, beyond stories that donít even involve your own suffering.

I have an insistence that we flatten the curve and fund healthcare like a first world country.

As for my own suffering, I didn't choose to be a cop, a soldier, or a nurse; but give me 18 months and I might have some stories of my own, or I might be dead, or I might have permanent lung damage. Because as MoseyingAlong pointed out, all of society is going through this right now.

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Re: How long can we wait while flattening the curve?
« Reply #330 on: March 31, 2020, 01:15:42 AM »
Yeah....no.
I, and I'd guess all my nursing school classmates, anticipated rough shifts and busy months but "years of pure hell"...no.

Did they miss the last 300 years of history in high-school and college? Because I had to take a full year of history for my BS.*

My family lost people in the 1918 pandemic. Other parts of my family lived through the western front of WWII and the Chinese civil war. I reject the premise that today's generations could have reasonably expected to not have to live through any similar events.


When we were in the military, sure, bring it on.
Civilian healthcare, not government, yeah...no.

There's a difference between a society going thru something and expecting individuals to go thru a specific type of hell.

I don't think there is. You pay a price for living in a society, but the pay offs are huge. The price is that you have to moderate your behaviour for the sake of everyone. We do it all the time - by not stealing and murdering, by queuing in a socially agreed fashion, by being courteous when it comes to how/where we cough, spit, sneeze, pee etc etc. Quarantine is really no different.

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Re: How long can we wait while flattening the curve?
« Reply #331 on: March 31, 2020, 02:21:09 AM »
"Suck it up, you knew going in that we might suffer a generation-defining pandemic that would probably leave you with PTSD and kill a sizeable minority of your colleagues" seems like a great way to make sure you have a recruitment crisis in your healthcare system for the next thirty years.

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Re: How long can we wait while flattening the curve?
« Reply #332 on: March 31, 2020, 06:55:14 AM »
Of course people know bad things are coming.

Over the course of a 15 year career, Iíve responded to six hurricanes, and one earthquake. Haiti, Katrina, Maria, Michael, Florence, Dorian. Each response left me with something that will never leave my brain. Haiti above all. The saving grace is that Iíve been able to spread those moments out across 15 years, with gaps in between.

Youíre asking medical workers to live disaster response day, after day, after day, for an untold amount of time. To use your analogy: itís asking a LEO to shoot someone in the line of duty every day, and telling them itís just part of their job. Itís an astonishing lack of compassion.

@Abe has ďFirst Do No Harm.Ē @MoseyingAlong has a vocation that stretches back as far as humans. I have ďHonor, Respect, Devotion to Duty.Ē Iím not exactly certain what you have, beyond stories that donít even involve your own suffering.

Just wanted to voice publicly that I'm grateful we've had you out there @Sailor Sam doing what you do for the past decade and a half.
~n~

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Re: How long can we wait while flattening the curve?
« Reply #333 on: March 31, 2020, 08:33:28 AM »
"Suck it up, you knew going in that we might suffer a generation-defining pandemic that would probably leave you with PTSD and kill a sizeable minority of your colleagues" seems like a great way to make sure you have a recruitment crisis in your healthcare system for the next thirty years.

That's what I said on page 3:

Some of those people who will die will be healthcare professionals. If the hospitals are overrun there will be MDs and RNs with PTSD and the ones that have the resources to retire early will. People are already talking about a major healthcare professional shortage a year from now.

But other than flattening the curve, getting them supplies, paying them well, and treating the PTSD what do you want me to do? Self immolate at home so that they don't need to see me?

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Re: How long can we wait while flattening the curve?
« Reply #334 on: March 31, 2020, 08:43:09 AM »
I'm surprised how much excess in the system people think there is for handling people getting sick and/or dying.

It doesn't take much to upset systems that have slowly gone to equilibrium over many years. It's not like funeral homes and mortuaries have built out a massive amount of additional capability that sits idle for 99% of the time.  Or hospitals for that matter.

Quickly Googling suggests that NYC sees around 420 deaths a day on average. This article says they had a total of 900 morgue spaces in the entire city. As best I can tell, over 100 people died from Sunday to Monday - even if it's "just" 100 people day dying from covid-19, that's still 25% more deaths and bodies to deal with than normal.

I highly doubt all the systems like funeral homes/etc have 25%+ unused capacity.

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Re: How long can we wait while flattening the curve?
« Reply #335 on: March 31, 2020, 08:52:34 AM »
Yeah....no.
I, and I'd guess all my nursing school classmates, anticipated rough shifts and busy months but "years of pure hell"...no.

Did they miss the last 300 years of history in high-school and college? Because I had to take a full year of history for my BS.*

My family lost people in the 1918 pandemic. Other parts of my family lived through the western front of WWII and the Chinese civil war. I reject the premise that today's generations could have reasonably expected to not have to live through any similar events.


When we were in the military, sure, bring it on.
Civilian healthcare, not government, yeah...no.

There's a difference between a society going thru something and expecting individuals to go thru a specific type of hell.

I don't think there is. You pay a price for living in a society, but the pay offs are huge. The price is that you have to moderate your behaviour for the sake of everyone. We do it all the time - by not stealing and murdering, by queuing in a socially agreed fashion, by being courteous when it comes to how/where we cough, spit, sneeze, pee etc etc. Quarantine is really no different.

This reply seems to miss the point -- that MEDICALLY TRAINED individuals are being expected to go thru a specific type of hell.

For my family, self-isolation/quarantine is inconvenient but a far cry from hell.

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Re: How long can we wait while flattening the curve?
« Reply #336 on: March 31, 2020, 09:25:56 AM »
I highly doubt all the systems like funeral homes/etc have 25%+ unused capacity.

We're lucky that we have refrigeration trucks. There were no refrigeration trucks in 1918. In Italy the military is driving bodies to the crematoriums that still have capacity and has banned funerals.

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Re: How long can we wait while flattening the curve?
« Reply #337 on: March 31, 2020, 10:11:32 AM »
just tossing two things out there.  File under: Procedural Uncertainties

1) my sister (physician) has been redirected from her normal medical duties to assessing possible COVID patients in their cars in a parking garage 2x/week and handing overflow patients remotely the remaining days. Like much of the medical profession, her pay is normally tied to how many patients she sees in office and clinic hours.  Now that she's outside that normal billing schedule no one in her practice has any idea how or what they will be paid this coming period.  Meanwhile, her workload, risk-exposure and stress-level has gone through the roof.

2) my father (physican, retired several years ago) might be "recalled" to treat 'everyday' patients while younger, current doctors take care of suspected COVID patients.  There's no modern precedent for this in his career.  While he's confident in his ability to practice medicine, there's a lot of legal uncertainty here -- he no longer carries malpractice insurance and as he retired several years ago his board certification is no longer up to date.  So where does that leave him (and patients) who come in with a sprained ankle or complications from chronic illnesses... what happens when the person treating and potentially prescribing medicine is an uninsured former doctor?

...uncertain times.

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Re: How long can we wait while flattening the curve?
« Reply #338 on: March 31, 2020, 11:20:03 AM »
Realizing that the original post was on March 17... a lot has happened since then. 
  • There's currently 45 refrigerated trailers parked in NYC for dealing with COVID-19 deaths.
  • I work in the medical-industrial complex, and my industry is scrambling to figure out how to supply hundreds of thousands of ventilators to keep people alive.
  • Medical professionals are scared, overwhelmed, but still showing up (thank you).
  • In general, you're better off the younger you are, but there's also plenty of counter-examples who that hasn't worked out for.

As painful as it is to shut everything down, I'm not really seeing the alternative.

I think the alternative is long gone and at this point, it's really the only option.

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Re: How long can we wait while flattening the curve?
« Reply #339 on: March 31, 2020, 11:42:17 AM »
But we haven't shut everything down. Does anyone live someplace where everything is shut down? NYC didnt look shutdown yesterday with the crowds watching the navy hospital ship arrive.

Where I live we have a "stay at home order" but there are so many exceptions that virtually the only people affected are restaurant servers, massager, and hair stylists. pretty much everything else is deemed "essential".

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Re: How long can we wait while flattening the curve?
« Reply #340 on: March 31, 2020, 11:48:23 AM »
But we haven't shut everything down. Does anyone live someplace where everything is shut down? NYC didnt look shutdown yesterday with the crowds watching the navy hospital ship arrive.

Where I live we have a "stay at home order" but there are so many exceptions that virtually the only people affected are restaurant servers, massager, and hair stylists. pretty much everything else is deemed "essential".

There's "shut down" and then there's "forced isolation" (akin to home arrest). Here in the US we haven't gone towards the latter, at least not yet.
Still, with almost all front-facing businesses closed, as well as schools and (most) daycare the number of person-to-person interactions have plummeted for most people.  My wife and have gone for a full week without ever coming within 6' of another person, even though we still go for long walks every day.

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Re: How long can we wait while flattening the curve?
« Reply #341 on: March 31, 2020, 11:56:54 AM »
Iím not exactly certain what you have, beyond stories that donít even involve your own suffering.

I have an insistence that we flatten the curve and fund healthcare like a first world country.

As for my own suffering, I didn't choose to be a cop, a soldier, or a nurse; but give me 18 months and I might have some stories of my own, or I might be dead, or I might have permanent lung damage. Because as MoseyingAlong pointed out, all of society is going through this right now.

I'm not sure what you're trying to get at with all of this, but the only thing that's coming off to me is a complete lack of any attempt at empathy. These people didn't enlist in an army. They went and got a college degree and took jobs with the desire to help people. What they've been put in is far worse than anyone would have expected. My spouse is in the medical field working in a hospital. Things aren't bad here yet, but even with that, the tension is high. I don't really care if they "should have known" it was a possibility or not, the least you can do with people who are literally giving their lives to help others is try to not come off like you are.... In 18 months, you might have some stories of your own, and if you do, I'll try to empathize with you about them.

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Re: How long can we wait while flattening the curve?
« Reply #342 on: March 31, 2020, 12:11:56 PM »
The way modern forced indenture works is you set up the rules so that people have to work or they die.

For example grocery worker needs the money from the job for food and shelter and the health insurance. Only those who get fired can get unployment benefits. Healthcare workers are no different, I'm sure many of them would change careers right now if they could.


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Re: How long can we wait while flattening the curve?
« Reply #343 on: March 31, 2020, 12:12:17 PM »
2) my father (physican, retired several years ago) might be "recalled" to treat 'everyday' patients while younger, current doctors take care of suspected COVID patients.  There's no modern precedent for this in his career.  While he's confident in his ability to practice medicine, there's a lot of legal uncertainty here -- he no longer carries malpractice insurance and as he retired several years ago his board certification is no longer up to date.  So where does that leave him (and patients) who come in with a sprained ankle or complications from chronic illnesses... what happens when the person treating and potentially prescribing medicine is an uninsured former doctor?

...uncertain times.

Would problems here be covered by some sort of Good Samaritan law?

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Re: How long can we wait while flattening the curve?
« Reply #344 on: March 31, 2020, 12:19:50 PM »
2) my father (physican, retired several years ago) might be "recalled" to treat 'everyday' patients while younger, current doctors take care of suspected COVID patients.  There's no modern precedent for this in his career.  While he's confident in his ability to practice medicine, there's a lot of legal uncertainty here -- he no longer carries malpractice insurance and as he retired several years ago his board certification is no longer up to date.  So where does that leave him (and patients) who come in with a sprained ankle or complications from chronic illnesses... what happens when the person treating and potentially prescribing medicine is an uninsured former doctor?

...uncertain times.

Would problems here be covered by some sort of Good Samaritan law?

No idea.  Typically (as I've learned in first-responder training) good Samaritan laws are applicable up to your current standard of training.  So if I'm trained in CPR and I see someone who I think might need CPR  and I administer CPR I'm covered, even if "bad things happen" as a result of my actions.  But if I try to perform a tracheostomy but have no surgical training... then I'm in big legal trouble.

As someone who practiced medicine for almost 40 years, my father knows that you aren't supposed to practice medicine unless you are current with your training (e.g. boards).  So... he's being asked to do something he was trained for, but for which he knows under normal circumstances he should not do anymore. 

Love to hear a legal opinion on this though...

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Re: How long can we wait while flattening the curve?
« Reply #345 on: March 31, 2020, 12:34:53 PM »
Neeeo, surely this would be voluntarily on your Dadís part. He is older so in a high risk group. What a dilemma. My heart aches for the medical staff and the least we all can do is keep our asses home.

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Re: How long can we wait while flattening the curve?
« Reply #346 on: March 31, 2020, 12:39:49 PM »
@nereo, in normal times I doubt any physician would practice medicine without adequate malpractice insurance, and in normal times I think all malpractice insurance requires the doctor to be current on boards, state licensure, and any other sort of requirements like that.

In non-normal times, I don't know what the answer is, but the malpractice aspect is something that I think most doctors would insist on being addressed before moving forward.  Some sort of blanket law protecting them might work (like the Volunteer Protection Act or similar).

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Re: How long can we wait while flattening the curve?
« Reply #347 on: March 31, 2020, 12:46:38 PM »
Neeeo, surely this would be voluntarily on your Dadís part. He is older so in a high risk group. What a dilemma. My heart aches for the medical staff and the least we all can do is keep our asses home.

To be clear, it seems that they want these recently retired physicians to take non-COVID cases, freeing up the younger doctors and health care professionals to deal with the very infectious stuff.  He'd basically be handling the caseload of patients that need weekly/monthly appointments for chronic conditions, as well as seeing acute, non-infectious patients (e.g. "I fell off a ladder yesterday and now my chest hurts").

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Re: How long can we wait while flattening the curve?
« Reply #348 on: March 31, 2020, 01:14:11 PM »
Neeeo, surely this would be voluntarily on your Dad’s part. He is older so in a high risk group. What a dilemma. My heart aches for the medical staff and the least we all can do is keep our asses home.

To be clear, it seems that they want these recently retired physicians to take non-COVID cases, freeing up the younger doctors and health care professionals to deal with the very infectious stuff.  He'd basically be handling the caseload of patients that need weekly/monthly appointments for chronic conditions, as well as seeing acute, non-infectious patients (e.g. "I fell off a ladder yesterday and now my chest hurts").

I'm a nurse and just throwing this idea out.  I wonder if people like your father who are no longer credentialed, with no malpractice insurance, could function like a NP or PA, under the supervision of a credentialed MD.
I'm an ICU nurse.  My facility is planning for an onslaught of vent patients with not enough ICU staff by  training our stepdown nurses in basic vent management and ICU skills. Most of them have already been taking chronic stable vent patients.  We've been training them over the last month while our census is low instead of calling people off.  Obviously they aren't going to know everything they need to know, but the plan is to have them take the vented covid patients under the supervision of an ICU nurse.  Each med surg/ step down nurse can handle 2 or 3 patients.   And 3 of them will be supervised by ICU nurses. 

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Re: How long can we wait while flattening the curve?
« Reply #349 on: March 31, 2020, 02:40:57 PM »
Yeah....no.
I, and I'd guess all my nursing school classmates, anticipated rough shifts and busy months but "years of pure hell"...no.

Did they miss the last 300 years of history in high-school and college? Because I had to take a full year of history for my BS.*

My family lost people in the 1918 pandemic. Other parts of my family lived through the western front of WWII and the Chinese civil war. I reject the premise that today's generations could have reasonably expected to not have to live through any similar events.


When we were in the military, sure, bring it on.
Civilian healthcare, not government, yeah...no.

There's a difference between a society going thru something and expecting individuals to go thru a specific type of hell.

I don't think there is. You pay a price for living in a society, but the pay offs are huge. The price is that you have to moderate your behaviour for the sake of everyone. We do it all the time - by not stealing and murdering, by queuing in a socially agreed fashion, by being courteous when it comes to how/where we cough, spit, sneeze, pee etc etc. Quarantine is really no different.

This reply seems to miss the point -- that MEDICALLY TRAINED individuals are being expected to go thru a specific type of hell.

For my family, self-isolation/quarantine is inconvenient but a far cry from hell.

Isolation might well become your personal hell if you had family members that died and you were unable to see them or say goodbye before they did. Or if you had to give birth without a support person. Or a hundred other circumstances. We are all being asked to give something up. Medical staff are obviously on the front line and their struggle is much more immediate and obvious - and we know they're heroes to do this for us all. Luckily for the rest of us, most medical staff are the giver/helper type who run towards these situations rather than away. Yes, there's an expectation that they do their bit. The same expectation is on all of us. Our bit is just a lot smaller.