To those who are brushing off corona concerns

amother

Sun, Mar 08 2020, 7:04 pm

Please read this article: http://www.israelnationalnews......25338

And to highlight the main point:

"We are at this point, we have to decide who will live and who will die, who will be cured and who will not. The doctors of the Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care (Siaarti) have written in a document that, in the face of the current epidemic and in the event of further worsening, the sacrifice of dozens of people will be inevitable due to their age and fragility.

We read: “It may be necessary to set an age limit when entering the intensive care unit. It is not a question of making purely valuable choices, but of reserving resources that may be very scarce for those who are more likely to survive and secondly for those who may have more years of life saved, with a view to maximizing the benefits for the greatest number of people”.

Read these words again. Then read them again. And do it again. And you will understand the potential tragedy Italy is facing. Civilization is regressing."

There aren't enough medical resources to go around so elderly people might just be left to die. (Though I guess some on this board have been vocal proponents of such practices lately.) Let that sink it before dismissing the concerns and calling this all hype. This puts us in a way more serious situation than the seasonal flu.

amother

Plum ↓

Sun, Mar 08 2020, 7:09 pm

Is this fact checked?

If so, it’s terrifying.

elisheva25 ↓

Sun, Mar 08 2020, 7:10 pm

That is super duper scary.
What will be here ?

mamma llama ↓

Sun, Mar 08 2020, 7:18 pm

That is so not okay.
Why do they get to decide who has lived a long enough life vs. who is worth treating?
Sounds to me like somebody has a gd complex... Mad

amother

↑ Plum

Sun, Mar 08 2020, 7:20 pm

mamma llama wrote:

That is so not okay.
Why do they get to decide who has lived a long enough life vs. who is worth treating?
Sounds to me like somebody has a gd complex... Mad

Because they lack the resources to save everyone. They have to decide who will get the available beds and treatment.

amother

Pearl

Sun, Mar 08 2020, 7:22 pm

This is medical ethics 101.

Amarante ↓

Sun, Mar 08 2020, 7:25 pm

It’s not so different from triage which is done in all medical crisis situations.

You can’t save everybody so how do you determine how to allocate medical resources so they go to those who will most benefit. Typically you allocate limited resources to those most likely to be saved with the resources at hand and don’t treat those who will recover without intervention and those who are likely to die even with intervention.

Last edited by Amarante on Sun, Mar 08 2020, 8:04 pm; edited 1 time in total

↑ mamma llama ↓

Sun, Mar 08 2020, 7:25 pm

amother [ Plum ] wrote:

Because they lack the resources to save everyone. They have to decide who will get the available beds and treatment.

I hear that, but it rubs me the wrong way to think that they can decide that someone lived long enough.
I feel like they should be trying to gather more resources instead of "sacrificing" the elderly.

↑ elisheva25 ↓

Sun, Mar 08 2020, 7:27 pm

I didn’t write this, copied from Facebook page: For those that are into numbers, you will understand and appreciate it .
Repost @LizSpecht

I think most people aren’t aware of the risk of systemic healthcare failure due to #COVID19 because they simply haven’t run the numbers yet. Let’s talk math.

Let’s conservatively assume that there are 2,000 current cases in the US today, March 6th. This is about 8x the number of confirmed (lab-diagnosed) cases. We know there is substantial under-Dx due to lack of test kits; I’ll address implications later of under-/over-estimate.

We can expect that we’ll continue to see a doubling of cases every 6 days (this is a typical doubling time across several epidemiological studies). Here I mean *actual* cases. Confirmed cases may appear to rise faster in the short term due to new test kit rollouts.

We’re looking at about 1M US cases by the end of April, 2M by ~May 5, 4M by ~May 11, and so on. Exponentials are hard to grasp, but this is how they go.

As the healthcare system begins to saturate under this case load, it will become increasingly hard to detect, track, and contain new transmission chains. In absence of extreme interventions, this likely won’t slow significantly until hitting >>1% of susceptible population.

What does a case load of this size mean for healthcare system? We’ll examine just two factors — hospital beds and masks — among many, many other things that will be impacted.

The US has about 2.8 hospital beds per 1000 people. With a population of 330M, this is ~1M beds. At any given time, 65% of those beds are already occupied. That leaves about 330k beds available nationwide (perhaps a bit fewer this time of year with regular flu season, etc).

Let’s trust Italy’s numbers and assume that about 10% of cases are serious enough to require hospitalization. (Keep in mind that for many patients, hospitalization lasts for *weeks* — in other words, turnover will be *very* slow as beds fill with COVID19 patients).

By this estimate, by about May 8th, all open hospital beds in the US will be filled. (This says nothing, of course, about whether these beds are suitable for isolation of patients with a highly infectious virus.)

If we’re wrong by a factor of two regarding the fraction of severe cases, that only changes the timeline of bed saturation by 6 days in either direction. If 20% of cases require hospitalization, we run out of beds by ~May 2nd.

If only 5% of cases require it, we can make it until ~May 14th. 2.5% gets us to May 20th. This, of course, assumes that there is no uptick in demand for beds from *other* (non-COVID19) causes, which seems like a dubious assumption.

As healthcare system becomes increasingly burdened, Rx shortages, etc, people w/ chronic conditions that are normally well-managed may find themselves slipping into severe states of medical distress requiring intensive care & hospitalization. But let’s ignore that for now.

Alright, so that’s beds. Now masks. Feds say we have a national stockpile of 12M N95 masks and 30M surgical masks (which are not ideal, but better than nothing).

There are about 18M healthcare workers in the US. Let’s assume only 6M HCW are working on any given day. (This is likely an underestimate as most people work most days of the week, but again, I’m playing conservative at every turn.)

As COVID19 cases saturate virtually every state and county, which seems likely to happen any day now, it will soon be irresponsible for all HCWs to not wear a mask. These HCWs would burn through N95 stockpile in 2 days if each HCW only got ONE mask per day.

One per day would be neither sanitary nor pragmatic, though this is indeed what we saw in Wuhan, with HCWs collapsing on their shift from dehydration because they were trying to avoid changing their PPE suits as they cannot be reused.

How quickly could we ramp up production of new masks? Not very fast at all. The vast majority are manufactured overseas, almost all in China. Even when manufactured here in US, the raw materials are predominantly from overseas... again, predominantly from China.

Keep in mind that all countries globally will be going through the exact same crises and shortages simultaneously. We can’t force trade in our favor.

Now consider how these 2 factors – bed and mask shortages – compound each other’s severity. Full hospitals + few masks + HCWs running around between beds without proper PPE = very bad mix.

HCWs are already getting infected even w/ access to full PPE. In the face of PPE limitations this severe, it’s only a matter of time. HCWs will start dropping from the workforce for weeks at a time, leading to a shortage of HCWs that then further compounds both issues above.

We could go on and on about thousands of factors – # of ventilators, or even simple things like saline drip bags. You see where this is going.

Importantly, I cannot stress this enough: even if I’m wrong – even VERY wrong – about core assumptions like % of severe cases or current case #, it only changes the timeline by days or weeks. This is how exponential growth in an immunologically naïve population works.

Undeserved panic does no one any good. But neither does ill-informed complacency. It’s wrong to assuage the public by saying “only 2% will die.” People aren’t adequately grasping the national and global systemic burden wrought by this swift-moving of a disease.

I’m an engineer. This is what my mind does all day: I run back-of-the-envelope calculations to try to estimate order-of-magnitude impacts. I’ve been on high alarm about this disease since ~Jan 19 after reading clinical indicators in the first papers emerging from Wuhan.

Nothing in the last 6 weeks has dampened my alarm in the slightest. To the contrary, we’re seeing abject refusal of many countries to adequately respond or prepare. Of course some of these estimates will be wrong, even substantially wrong.

But I have no reason to think they’ll be orders-of-magnitude wrong. Even if your personal risk of death is very, very low, don’t mock decisions like canceling events or closing workplaces as undue “panic”.

These measures are the bare minimum we should be doing to try to shift the peak – to slow the rise in cases so that healthcare systems are less overwhelmed. Each day that we can delay an extra case is a big win for the HC system.

And yes, you really should prepare to buckle down for a bit. All services and supply chains will be impacted. Why risk the stress of being ill-prepared?

Worst case, I’m massively wrong and you now have a huge bag of rice and black beans to burn through over the next few months and enough Robitussin to trip out.

One more thought: you’ve probably seen multiple respected epidemiologists have estimated that 20-70% of world will be infected within the next year. If you use 6-day doubling rate I mentioned above, we land at ~2-6 billion infected by sometime in July of this year.

Obviously I think the doubling time will start to slow once a sizeable fraction of the population has been infected, simply because of herd immunity and a smaller susceptible population.

But take the scenarios above (full beds, no PPE, etc, at just 1% of the US population infected) and stretch them out over just a couple extra months.

That timeline roughly fits with consensus end-game numbers from these highly esteemed epidemiologists. Again, we’re talking about discrepancies of mere days or weeks one direction or another, but not disagreements in the overall magnitude of the challenge.

This is not some hypothetical, fear-mongering, worst-case scenario. This is reality, as far as anyone can tell with the current available data.

That’s all for now. Standard disclaimers apply: I’m a PhD biologist but *not* an epidemiologist. Thoughts my own. Yadda yadda. Stay safe out there.

amother

Puce

Sun, Mar 08 2020, 7:58 pm

Thanks for posting this article.

In my opinion, Trump should declare that in 3 days, all people of the us will have to be in their homes for 3 weeks like a long holiday but everyone must stay in their homes.

Doing this sooner will save from greater damage later ( human lives, economy, Trump's popularity etc)

amother

Mustard ↓

Sun, Mar 08 2020, 8:59 pm

amother [ Puce ] wrote:

We need ppl to work.
Grocery stores
Home health aides
Dr
Nurses
Govt workers
Police
Fireman
Required services (electric, water, gas)
It’s impossible to have everyone quarantined.

And it can take longer then 3 weeks. If it is traveling through a family a few weeks after one gets it someone can still be contagious. When does everyone stop catching it and being contagious.

It’s best if the sick can be staggered so there is room in the hospital. But what isn’t clear is how long ppl require hospitalization. If it’s a long time the beds just don’t clear.

amother

Floralwhite

Sun, Mar 08 2020, 9:22 pm

I have an even better idea why don’t we just realize that we have a Hashem in this world and just like this started He can make it stop and we don’t need to rely on statistics and fear mongering but we should rely on Him. Purim is coming up let’s take the day to daven and ask of Him to take this gezrah away.
And no I don’t mean that we shouldn’t do our proper hishtadlus I’m saying instead of talking about worst case scenarios let’s talk to Hashem

Ravenclaw

Sun, Mar 08 2020, 9:24 pm

2% might not seem like a lot out of 100. But considering how fast this is spreading, 2% of millions and billions... is millions.

amother

Jade ↓

Sun, Mar 08 2020, 10:20 pm

What do we gain from this?

If we say that indeed it is a doomsday scenario, and thousands of seniors are going to be left to die, what do we gain?

Are we going to impose more quarantines? We're already doing that!
Get more people to stockpile masks, Purell, and toilet paper? Who does that help?
Get everyone to listen to the CDC? We're doing that too.

Follow instructions? Of course. But how does the panic BENEFIT anyone?

WhatFor ↓

Sun, Mar 08 2020, 10:35 pm

Amarante wrote:

I was thinking of exactly this week I saw the OP. No one wants to think about the real life decisions that those in the medical field can face. In a mass casualty situation, ER people have to show up and decide who they're going to focus their energy on. There are multiple people in front of them and they literally cannot be attending to all those people at once.

It's an uncomfortable distasteful question to think about. No one's life is worth more than another's. But sometimes the productiveness of resources are maximized when put toward one person over another.

I don't envy the people who have to make these decisions but I don't judge them either. Would you give the one respirator to someone highly likely to pass away, so now you have two people who didn't make it (Person A who didn't survive even with the respirator, and Person B who likely would've survived with the respirator but didn't because the respirator went to Person A.)?

amother

Blue

Mon, Mar 09 2020, 1:39 am

actually why think about it? For the very reason that seemingly some people are reluctant to take it seriously, or think mistakenly that it does not affect them and their families, and quarantine and put in place other recommended hygiene practices!

not to panic but to WAKE UP and do our hishtadlus b'gashmius and b'ruchnius!

southernbubby ↓

Mon, Mar 09 2020, 5:14 am

mamma llama wrote:

That's what it would seem but I live in Monsey where everyone is scrambling to find Purel and Clorox wipes and you would think that a community this size would solve this simple problem but it remains a shortage day after day. I did find some house brand cleaning wipes and apparently Amazing Savings now has pocket sized sanitizer for $1.99 but that's as good as it gets.
Walmart looked ransacked (my insurance wants me to use the pharmacy there) but at least they got in a shipment of toilet paper.
What I am trying to say is that if we can't even supply one household size Purel or Clorox wipes per family, how do we come up with enough medical equipment?
My sister in Louisville finally found toilet paper at Lowe's. These products are basic for sanitation today and the biggest businesses in the community can't provide them. And then, of course, when a shipment comes, people are buying ridiculously large amounts.

amother

Ruby

Mon, Mar 09 2020, 5:23 am

The question is whether this is actually true or not??? There are plenty of American media outlets that have the most preposterous, nonsensical doomsday scenarios all the time. Scary if it's true, but might be entirely made up. Please realize this.

amother

↑ Jade ↓

Mon, Mar 09 2020, 8:42 am

amother [ Blue ] wrote:

Maybe this should be a spin-off, but what exactly do you think people are not doing?

Are there really people who were placed in quarantine but are not obeying? What hygiene practices do you think people are avoiding?

What is the hishtadlus that you expect people to do, that you think they are not doing?

↑ Amarante ↓

Mon, Mar 09 2020, 8:51 am

amother [ Jade ] wrote:

Actually there is at least one documented case of a HEALTH WORKER who refused to self quarantine but went to a musical event exposing others.

At this point the issue is the uncertainty because coherent messages are not coming from the top. It's one of the reasons why the stock market declined so precipitously that markets were closed for awhile.