And people go to hospital with other conditions. If hospitals are 100% overwhelmed with Covid-19 cases, then they may struggle to treat strokes, heart attacks, car crash victims, cancer patients, etc...
Flattening the curve will save lives.
I've never actually heard anybody discuss any treatments besides ventilators, so I have no idea what's feasible.
The issue is when they deteriorate, what do you do then. There are hundreds of ways for people in hospital to "go wrong" knowing when where and how to intervene requires both nurses and doctors. All of which take 3-9 years to train
That said, oxygen and heparin at home could be good for a lot of patients. Improvements in prognostication may help distinguish that group in the future.
Currently the lockdown makes sense for one reason, to get something that at least makes it seasonal flu-deadly (about 5-10 times less than currently).
https://www.statnews.com/2020/04/23/data-on-gileads-remdesiv...
Maybe the data wasn't ready for release, and the final version will show some benefit, but it's likely that remdesivir has little benefit.
(Genuinely confused about why this got downvotes.)
(I have no idea who would downvote your comment.)
Yes, but how many lives will it save? The answer is unclear but it seems to be lower than what most people would expect.
The basic assumptions were not well supported when the decisions were made. All the models we had were based on a very, very low level of testing and unreliable information from other countries.
If ventilators are a scarce resource/bottleneck and ventilation is applied by prioritisation then I could see the mortality rate skewing up as a function of treatment being applied too late.
It is worth bearing in mind the mortality rate of non-swamped health care systems.
For every NYC/Paris/Lombardy/Wuhan there is a South Korea/Taiwan/Hong Kong with very different data profiles.
I would love to see the mortality rate for ventilation support in these countries/cities...
That's an easy thing to say if the cost you pay is working from home and not going out on the town.
Not so easy when the cost is the end of a small business you worked years to build.
We make arbitrage like this when setting pollution laws, or speed limits. The issue here is that we don't know the cost of flattening the curve. We know that GDP is strongly correlated with life expectancy, and the loss of GDP worldwide will have important sanitary impact, but it's hard to quantify this.
That being said, I'm not saying we shouldn't try to flatten the curve. Considering we don't have the data to make the right decision, we use a greedy algorithm. But I'm quite convinced that we'll be worse off in the long term. Incidentally, we choosing to save old people over poor people.
http://www.igmchicago.org/surveys/policy-for-the-covid-19-cr...
Which is a shame.
It’s like the one example where some back of the envelope yet informed numbers might improve public policy vs the status quo..blind panic and a livelihood crippling total lockdown.
To put it in perspective, approximately 37,000 people die per YEAR from automobile accidents in the USA
With all the measures already in place, and strong possibilities of under counting COVID19 has already killed more than 50,000 people in less than 4 months.
A better argument would be banning obesity. ~300,000 people die from obesity related diseases every year
From cities? You'll find that many will agree with that.
I do agree with your general point though.
In California it looks like more than 200 jobs could have been lost per life saved and that's a lot of human suffering. https://marginalrevolution.com/marginalrevolution/2020/04/ca...
Allowing it to spread kill many more people and overwhelm our healthcare system would result in a worse economy in the medium term
http://www.igmchicago.org/surveys/policy-for-the-covid-19-cr...
On one side - we cannot stop the economy to contain the virus, because that would turn into every person having to grow their own food and carry their own water with a bucket from the river. Many many people would also die.
On the other side - we also cannot ignore the pandemic and carry as if nothing is happening because that would over-burden the hospitals to the point that they will not be able to treat people with other issues. Many many people would die as well.
So there indeed has to be a balance. And the question "what price are we willing to pay for saving a life" seems to be on point.
I'm not convinced that such deaths outweigh the lives saved through these measures, but they're still worth mentioning if we want a full picture of the impact.
Also; por qué no los dos? The USA has enough money and resources (and billionaires) to save the lives + not have the suffering (basic income/welfare). That they choose not to might not be the concern of the people who voted for those things but got Trump; they don't want their lives or loved ones to be chosen over 'jobs/economy' just because the people in power are overly greedy and short-sighted.
The lives being saved by flattening are not limited to covid-19 patients requiring intubation.
It's also about saving the lives of people who aren't covid-19 infected at all, but require emergency hospital care, which there's a constant supply of on any given day in a major city.
Frankly I'm surprised we're even having to clarify this at this late stage, sigh.
It's not even about just saving lives if the thing I saw recently about the effects of COVID-19 on survivors is accurate - diminished lung capacity, impaired liver function, possible cardiac issues, possible neurological issues, blood clots that may lead to strokes later, etc.
Currently 750k survivors - health systems could possibly be looking at a generation or more of strain coping with them.
Or we can flatten the curve and reduce the number of infections and thence the number of infected survivors.
Flattening the curve is only about spreading the same number of infections over time, so that at a given time, the health system is not overwhelmed. It will not reduce the number of infections, and will likely augment the number of survivors, who might have to deal with hard long term consequences.
[1] Excepting places like Taiwan, etc., who clearly did learn.
It got into ridiculous situations where a friend who is an urology doctor was on paid leave for last few weeks, simply no work for them under these rules. Another friend, radiologist in a hospital heavily hit by covid, worked only 4 hours/day shifts, instead of usual 10-12 ones.
So no, hospitals definitely don't treat everybody they used to, only those that would literally die if postponed. And even there sometimes they don't, ie they stopped resuscitating severe heart attacks here few weeks ago, because its too equipment-intense and uncertain. Equipment is +-same as that used for covid patients.
Most of the normal workload for hospital isn't emergency, but all those non-severe treatments like dermatology, arthritis, broken bones etc. That's maybe 80% of the staff.
I'm assuming specialists ain't allowed to work as generalists, then? I'd imagine that specialized doctors (like urologists) should be able to double as PCPs should the need arise (like, you know, a global pandemic). I ain't a doctor, though, so I'm perfectly willing to accept "specialist and generalist practice are too different from one another" as the answer here.
BUT:we know there are long term effects on your organs and lungs from corona. Would giving ventilators to not critical or semi critical people reduce the long term effects and damage?
So, a hospital at, lets say 70 percent might still be netter longterm for infected people than close to the edge. (not to mention heart strokes etc)
If there aren't enough, you give them to the best of the worst.
But as i said, i have no idea if a vent would reduce long term effects.
If a patient can't breathe independently, they are by definition a "worst of the worst case". Regardless of whether they contracted corona or something else.
Putting someone on a ventilator is not a cure. It's a last ditch aid that buys the patient a bit of extra time for their body to pull through. However, that's in no way or shape a guarantee that a patient will actually pull through.
When doctors decide to hook a patient to a ventilator, they already accept that that their patient might not make it.
However, that's not an argument to not deploy ventilators or let patients die.
Ventilators are used to give any patient a maximal chance to pull through. The upshot is that ventilators gives a percentage of patients a second chance.
The moral question then is to what lengths society is willing to go to provide that chance to as many patients who are hit hardest by this virus. Understanding that some patients are less likely to pull through then others. That's where you end up with ethical questions about who gets to live and who doesn't and what criteria medical staff is using to make that decision.
> we know there are long term effects on your organs and lungs from corona.
We know that there is damage to organs and lungs. However, this is a novel virus. It's unclear what the actual impact of that damage will be in a general population over a longer period of time.
> Would giving ventilators to not critical or semi critical people reduce the long term effects and damage?
Putting someone on a ventilator is a Hail Mary and it's a delicate operation. It's literally shoving a tube down a patient's windpipe and hooking up an advanced air compressor. Do it wrong, and the patient dies or is left with debilitating complications for life (i.e. damaged vocal cords, overextending the lungs when pushing air,...).
It's also a traumatizing event: patients who are put on a ventilator are put in an induced coma for an extended amount of time which comes with it's own trade offs and potential complications.
> So, a hospital at, lets say 70 percent might still be netter longterm for infected people than close to the edge. (not to mention heart strokes etc)
It's important to understand that maintaining an ICU in normal times is extremely cost intensive. An ICU unit is, after all, intended for patients who are at the edge between life and death. It's a place where life is generally counted in minutes or hours. And above all, despite the fancy technology and the expertise, it's a place where fate, luck and chance determine in which way the scales tips.
The 'shortage' of ICU beds all over the world isn't just a reflection of how ill-prepared we were for a pandemic, it's above all a testament of the deadliness of this pathogen, of it's ability to ravage a human body.
While increasing the ICU capacity of hospitals is absolutely tantamount to save as many lives as possible, I think humanity also might want to show a due sense of humility to a complex force of nature that we don't really control. For all our technological capabilities, we tend to forget in our daily existence that life is very much fragile and that living to see another year is less self granted then we may have come to assume. For many, that might come as a very stark and uncomfortable truth.
2. The high death rate might mean that they are at the point of only intubating hopeless cases, who otherwise have a 0% chance of survival.
3. If you don't flatten the curve, you're going to be killing doctors.
edit - to the downvoters who refuse to read anything before downvoting, here you go:
Boston 25 News: "According to a story in The Washington Post, autopsies are showing that many people who died from the COVID-19 virus have hundreds of microclots present in their lungs at the time they die. The autopsies were not revealing pneumonia as was expected, but lung damage from blood clots and the damage was appearing in the kidneys, liver, heart, intestines and brain, the Post story reported."
This is the death rate of people being incorrectly treated. If you treat patients thinking that pneumonia is their primary problem, putting them on ventilators, when the primary problem is that they have microclots in their lungs and you fail to treat the clots (which has been the case until very recently), you're going to kill a large percentage of those patients.
Tens of thousands of patients have died because the medical system somehow didn't notice the large volume of blood clots in patients.
It's the blood clots causing the high mortality rates, sudden deaths that are difficult to account for, and the oxygen problems re the lungs. They're finally beginning to address this by immediately treating patients with blood thinners. The virus causes an extreme increase in inflammation, which is causing blood clots including in the lungs which is causing oxygen deprivation.
A horrific mistake has been made over the past few months of just ventilating everyone with breathing problems, when it was the blood clots in the lungs causing the problem. They tried to solve the wrong problem.
https://www.reuters.com/article/us-health-coronavirus-usa-bl...
https://www.livescience.com/coronavirus-blood-clots.html
https://www.boston25news.com/news/trending/coronavirus-are-b...
About a thousand articles are out there over the last week about this.
https://www.reuters.com/article/uk-factcheck-covid-infects-t...
If that is the death rate for people who need ventilators then a lot of the arguments for "flattening the curve" are less compelling.
The whole idea of "flattening the curve" was to preserve hospital capacity in order to save lives. If most of the people who need ventilators are likely to die whether or not hospital capacity is available, then the trade-off between saving lives and saving the economy has not turned out the way we expected.