I'm not sure about the articles, but my SO had worked nights in the ICU just outside of NYC for the past two months. Notes from her:

- They quadrupled ICU capacity, taking over empty hospital beds from elsewhere in the hospital. At one point the only patients were COVID. No other admissions.

- Out-of-work doctors like cardiologists, soldiers, out-of-state nurses came in to help. They didn't know what to do in the ICU, so they mostly got in the way.

- At the peak they needed about double the normal number of beds.

- Most 12-hours shifts were done without sitting or having time to go to the bathroom.

So they overestimated the flood of COVID patients and were able to deal with it, possibly because they over-prepared, and there were essentially no non-COVID patients. At least that's n=1 ICU physician's perspective. Her friends in difference cities seem to have had similar experience (all east coast doctors, though), but the only overwhelmed ones are in NYC metro.

So, they were not overwhelmed?

Completing 12 hour shifts without a moments break isn’t overwhelmed?

Read this article about two of the nurses in NY that committed suicide due to the stress of watching patients die and not having the resources to help them, then tell me those people were not overwhelmed.

https://www.wsws.org/en/articles/2020/04/28/emts-a28.html

Waving people's deaths around like this is crass and offensive. It's very sad that these nurses died, but when people say "overwhelmed" in this context they mean that people cannot obtain healthcare.

> when people say "overwhelmed" in this context they mean that people cannot obtain healthcare.

The “no non-COVID patients” part didn't happen because suddenly no one needed ICU care or other hospitalization for non-COVID reasons, it happened because people were systematically excluded starting with methods from soft (discouragement to seek care) to hard (bans on classes of procedures, triage prioritization, etc.) from hospital care for non-COVID reasons.

Hospitals in and around NYC were, like those in Italy at the peak of the crisis, using criteria beyond medical need to allocate ventilators because medical need exceeded supply. That's overwhelmed, and ant standard which suggests it isn't is a dumbass standard.

Oh I see, the human cost to health care workers doesn’t count. Got it.

Maybe your threshold for what counts as ‘getting health care’ is different from mine. For me it amounts to more up than just being physically in a hospital. If the people described below were your family, would you be satisfied with their health care?

"Some of them, bless their souls, can't do anything for themselves," she said. "How can I take care of 14 people when I have one tech and they have 30 patients. It's so bad here you guys."

https://www.independent.co.uk/news/world/americas/coronaviru...

You know you're being dishonest here and I'm not going to engage.

That’s a real shame. I just don’t understand at all where you’re coming from, or in what way I’m being dishonest.

To me is seems straightforward to say that a system that is no longer able to provide an acceptable standard of care to a majority, or large minority if it’s patients, has been pushed beyond its capacity.

I’m under the impression that this is in fact what an overwhelmed health care system looks like. That the people in the system would rather die than continue being in it. This is also how we measure the despair of poverty.

That specific hospital wasn't. But, again:

> At the peak they needed about double the normal number of beds.

If they had not been able to annex a portion of the hospital for more beds, they probably would've been overwhelmed. Most of the people with normal things (heart attacks, severe diabetes-related issues, alcohol withdraw, etc.) stayed home, so they were able to create more capacity. I think every hospital did the same, so there's no good control group.

In the beginning of March Mayo Clinic circulated a COVID ICU protocol which virtually everybody implemented. Cleveland Clinic had something similar though NYC, Philadelphia and Baltimore hospital systems went with Mayo. It had metrics and trigger points at which point different units at hospitals were converted into COVID ICUs. Such protocols are absolutely standard for any large scale disaster scenarios. "Overwhelmed" means "handling of this event is not in a protocol". That has never happened. 2x the normal ICU beds was would not have triggered even the 2nd implementation of a second phase.

To me, overwhelmed means not able to provide the expected standard of care to a majority, or large minority of patients. In many cases the patient to nurse ratios went up to 3 or 4 times higher than would normally be considered acceptable, and patients dying before the nurses can even get to them. Simply having a bed isn’t enough.

That is an insane redefinition and goal post moving.

It is not. It is exactly the same as event one's AWS installation has a capacity problem. You do sort of have that plan, don't you?

If I attempt at AWS load balancing was “cut down all other services for the purpose of this particular services up to and including the full shut down of other services to divert to this service” I would definitely say this instance is wildly out of hand and an unacceptable state and that we may need to evaluate if this is temporary or if we need to grab more AWS $$$.

You just described the plan. That's exactly what it is.

This definition you have concocted isn't real. Just because everyone stops what they are doing and starts bailing water out of a boat doesn't mean the boat isn't flooded.

You can't hallucinate some new definition for being overwhelmed and then say New York hospitals weren't overwhelmed. That is not rational.

New York came distressingly close to capacity, but indeed didn't hit a saturation point like Madrid or Milan.

But that's, quite frankly, just dumb luck. At the rate of growth we were seeing in the early epidemic, their safety margin comes out to something like two days. The lockdown almost missed the target.

Quite frankly, a very large number of New Yorkers probably owe their lives to the other early movers in the US that enabled the NYC lockdown: Washington State was a big one. Also when the history is written, the NBA cancelling its season is probably going to be one of the biggest heroes.

Milan didn't hit saturation either, I believe, you may be thinking of Bergamo.

But the saturation was not reached because of lockdown, clearing hospital beds from electives, adding more beds, recruiting new sanitary personnel from all over the country.

If all of italy had kept going "business as usual" we'd likely count deaths at a 30x rate.

I 100% agree with you. Also don’t forget the mayor of SF. I don’t like her politics but objectively she had the courage to make a very hard choice and locked down the SF Bay Area much sooner than anywhere else. She saved thousands of lives right here.

The lockdown order wasn’t her doing. It was supposed to have been orchestrated by Santa Clara county’s health director , Sara Cody. Also, SF has no power over the other counties. It was a joint health order.

It’s remarkable the amount of just plain wrong information that people believe in.

Lock down + ramp up capacity sounds like something that would result in having excess capacity.

It's a better result than if the lockdown hadn't worked and they hadn't ramped up capacity, or if they'd ramped up without the lockdown