They may have some unknown underlying condition, may have the genetics to trigger a lung destroying cytokinin storm, or may just have gotten unlucky.
https://www.uab.edu/news/research/item/11176-covid-19-do-not...
A report from Lombardy yesterday says so far everyone with any reasonable chance of recovery has been treated:
https://www.reuters.com/article/us-health-coronavirus-italy-...
As far as I can tell so far, no hospital systems have collapsed due to this, even in the most extreme hot zones. The fear is that they will, and that sounds totally reasonable. But we also are basing that fear on data that's not robust. So we don't really know yet what will happen.
You can read about this in any of hundreds of media outlets. Here's one:
https://www.dailymail.co.uk/news/article-8095835/Overwhelmed...
The original claim was that people over the age of 80 aren't being treated because they don't have the capacity for it. I queried if they were sure about that, because the Italian government was saying that's not true. An Italian has now replied to that same post also stating it's not true and the international media has exaggerated a comment by a single doctor.
That's the factual world.
In another thread a guy claimed the Italian system was "at over 200% capacity". This turned out to be an exaggeration of another claim by a single doctor, not a real statistic.
I've been querying these sorts of claims by directly citing detailed testimony from the guy who literally runs all of ICU in Lombardy, the worst struck place in the whole world. He is saying, as clear as can be, he doesn't believe people with a chance of recovery have been turned away due to lack of beds. This doesn't mean they haven't increased beds via drastic measures or taken other actions to increase capacity. It means that as of the time that report was made, he didn't believe they'd run out of at-present capacity and had to turn people away at the hospital entrance.
Maybe he's wrong and not living in the same factual world as the rest of us. I don't know. But I'd hope he understands the state of his own hospitals given his job.
That is pretty much the definition of running out of capacity.
Firstly, hellofunk made a claim of "health care systems stretched to beyond 200% capacity". I asked where that number came from because it contradicted what I'd read. S/he's provided a source, which is this quote from the DM:
Another medic in northern Italy told a friend in the UK that hospitals were running at '200 per cent capacity' with operating theatres hurriedly converted into intensive care units.
So this is a snippet from a private conversation with a friend repeated on Twitter, and it grew in the telling ("at 200%" became "at over 200%"): it's not a formal claim by someone with all the data. It's a claim that's painting a picture of what it looks like inside a hospital where one person works.
Secondly the report I cited has this:
"Over three weeks, 1,135 people have needed intensive care in Lombardy, but the region has only 800 intensive care beds, according to Giacomo Grasselli ... Grasselli coordinates all the state-run intensive care units across Lombardy."
When I read this the first time I thought, OK, so then they've surely run out of beds and are turning away people they could save. Confusion followed when I read this:
Lombardy intensive care coordinator Grasselli said he believed that, so far, all patients with a reasonable chance of recovering and living an acceptable quality of life had been treated. But he added that this approach is under strain. “Previously, for some people we would have said, ‘let’s give them a chance for a few days.’ Now we have to be more stringent.”
The first quote doesn't actually say they've run out of beds. That would be true if everyone needed to stay 3 weeks. If the average recovery time is 14.7 days then 1135 people could be treated with 800 ICU beds without anyone being turned away, whilst being at full capacity.
In the DM article the anonymous doctor claims Lombardy's healthcare system is one of the best in the world (sometimes this is phrased as most efficient, which isn't quite the same thing: you'd expect a highly efficient healthcare system to run out of capacity earlier than a less efficient one, I suppose). The Reuters article says:
Intubating can be taxing on the body, especially for older patients, says Grasselli ... adding that he would never intubate his 84-year old father. Before the coronavirus broke, “we more often had the luxury to try to intubate patients who were at the limit,” said Mario Riccio, head of anaesthesiology at the Oglio Po hospital near Cremona. Now that’s changed.
So some of this notion of rationing of healthcare is that before, Lombardy could afford to try extreme and risky measures to extend every life even in cases where the likely outcome was severe damage to the body from the procedure. Now they can't afford to take such measures anymore.
Medical systems don't have a hard notion of capacity. Total capacity is flexible: when under stress doctors are forced to triage more aggressively and drop the most extreme treatments. It may not make sense to talk about running out of capacity in a world where medical systems can keep otherwise terminal patients alive indefinitely; there is always triage even in quiet times. I'm not sure how best to measure it but it may be unduly alarming to say Lombardy has run out of beds.
It does. It literally says people without much chances to live had not been treated.
If you had 25% chance of living, and are told you will be dead anyway, I am sure you would understand the quote perfectly at that moment.
And you are not even taking into account the amount of psychological stress to health professionals (and the families of victims) that have to tell people that or, worse, that they will disconnect someone even if it still had chances to live. There are nurses breaking down, and I expect a wave of PTSD cases in health professionals when this is over.
This is the caveat of what you said. The West, and especially Americans, doesn't take kindly to the realities of triaging. See the arguments on "death panels" regarding the Affordable Care Act.
As Italy is "3 weeks" ahead of us, news from there is being monitored closely as it could signal what might happen here.
https://www.reuters.com/article/us-health-coronavirus-italy-...
Lombardy intensive care coordinator Grasselli said he believed that, so far, all patients with a reasonable chance of recovering and living an acceptable quality of life had been treated.
I wonder if we're getting mixed messages here; that is, it's inevitable doctors give up on some cases and unplug them from the ICU but that is always a risk in ICU for any reason to be there.
What I see at the moment on HN and elsewhere is a lot of people who seem to believe that in Italy the hospitals are already overrun and people are being turned away in large numbers because all the beds are gone already days ago.
But this doesn't match what is actually happening there, according to the Italian government. What they're saying is so far they've had to turn away noone; that everyone who needs treatment is getting it.
I think this mismatch is coming from a couple of places. One is mis-interpreting doctors switching off life support for patients who can theoretically be kept alive using e.g. ECMO but for whom their lungs are destroyed and they wouldn't really have a life afterwards. That's terribly sad but isn't the same thing as patients who are in the middle of making a full recovery being switched off, or people who could be saved being denied beds because there just aren't enough. Another is a confusion between "we're about to run out of beds" and "we think we're about to run out of beds".
I'm not trying to downplay the seriousness of the situation here, but we have also have to keep our heads and double check things being claimed about that seriousness, as it's always tempting in times of crisis to lose our heads and go full sandwich-board. Maybe by tomorrow Italy will actually be there, but as of yesterday at least, it seems they aren't.
> all patients with a reasonable chance of recovering and living an acceptable quality of life had been treated.
These two quotes from you are mutually contradictory.
I think reading the Reuters article I'm citing in full is the best way to understand what's going on. I've also tried to summarise it here:
https://news.ycombinator.com/item?id=22607485
The confusion probably comes from the definition of treatment. It's possible for simultaneously nobody to be turned away due to lack of a bed, whilst terminal cases they know they can't save are now being turned off quicker i.e. less aggressive intervention than before. That's what Grasselli is saying:
Lombardy intensive care coordinator Grasselli said he believed that, so far, all patients with a reasonable chance of recovering and living an acceptable quality of life had been treated. But he added that this approach is under strain. “Previously, for some people we would have said, ‘let’s give them a chance for a few days.’ Now we have to be more stringent.”
The next part is "living an acceptable" quality of life. This probably means anyone not brain damaged and anyone they think won't require oxygen later. Might mean people not currently on oxygen when they get covid-19.
And despite all of that he says that this system is under strain.
Read between the lines.
You wrote yourself a quote in another comment where it is claimed that has happened. I am confused...
We now live in an age where you can dig up facts to confirm whatever you want to confirm. Information overload is a real thing.
You'd think following the trend of Italy was scary enough.
https://www.vox.com/policy-and-politics/2020/3/13/21178289/c...
This isn't some society-collapsing event, but it does require containment so our medical infrastructure doesn't get overwhelmed. If you get it, you'll most likely live, even without medical attention.
That being said, we do need to treat it seriously. It isn't just a dress rehearsal for something worse, but it is telling in how people react. I'm worried about what will happen if something worse comes along.
What I have learned, however, is that my general strategy is always keeping 1-2 months of basic essentials on hand is a good idea, and that I need to be more vigilant about it because people overreact.