I'm generally an optimist so instead of predicting doom and gloom for corona I thought it would be better to try and figure out why some places with outbreaks are doing so much better than others and why some places aren't getting the outbreaks.
Seems to me that South Korea is having a very different experience with Corona than Italy. Same with Hong Kong. Well Hong Kong is a different situation as the virus just isn't spreading very fast there.
Are there things we can learn from these places?
Why is Italy so much worse? Or is it just a matter of the testing being better in Korea than Italy so mild cases are being detected in Korea and not Italy?
But I've heard anything from kissing on the cheeks in Italy, to an older population, to the flu killing more people in Italy nearly every year.
As far as I understand it, S. Korea did an amazing job with extremely high #s of testing and quarantining/social distancing.
Italy did not.
The US is more similar to Italy; our testing is abysmal. We are about 12 days behind them so we can see them for our future if we don't change things.
I'm in NYC and there are huge changes happening now, with self-quarantining and being encouraged to work from home.
The whole argument of 'it's only killed 4,000 people vs the flu which such-and-such amount' is REALLY missing the point: This is a NEW virus. It hasn't reached everywhere yet. And it is multiplying x10 every 15-20 days. If we let it continue unabated, it will be a disaster for healthcare systems. At this point, the beginning of May will have hundreds of millions of cases.
Personally, I'd rather extreme quarantining measures be taken preemptively and we say 'that was over reacting' than we suffer massive losses and look back and say 'we under reacted.'
Heard a U.S. doctor interviewed on the radio this morning. He had experience in Italy and was familiar with their hospitals. He said they are set up completely different than Western based Hospitals and that he's not surprised that they are having greater difficulties than others in controlling this. He made it sound like Italy was not a great place to be hospitalized in.
Hong Kong and Taiwan were the hardest hit when SARs broke out 17 years ago with high mortality rates close to 20%. I think that experience gave them planning on what to do next time something like that hit...Now they seem to have it under control which is quite the feat considering how close proximity people in HK live.
The west never really got hit that bad back then and now it's all new
Posting from another thread. Below is why. Also, in your spare time look into the Heathcare systems in HK and SK (are they "pure free market" systems"? or perhaps something else...).
^This is very accurate. I will add that part of the reason we are where we are right now with lab testing has to do with the corporations, MBAs, and the "unscrupulous" (to use your word) non-laboratory based physicians often run clinical labs with skeleton crews to maximize their profits. This inhibits the ability to ramp up in times of crisis. This profit over patient mentality actually puts peoples lives at risk everyday but most of the time it goes un-nocticed....until the sh!t really hits the fan as it is right now.
Your point re: the education of physicians--well all physicians with the exception of pathologists--about laboratory testing is spot on though. The level of understanding of basic laboratory medicine by most medical specialties is analgous to what most LRCers say docs know about sports injuries and nutrition--they know almost nothing.
It is shocking because, as you accurately state, most treatment decisions in medicine are based on lab results. But basic science and--lab science specifically--have been de-emphasized in medical school curriculum for the past 20 years or so. FFS, they just decided to make the USMLE step I pass / fail--this is f@#king medical school not elementry school. The dumbing down of medical education in the US is truly appaling. Ultimately, this has resulted in a YUGE knowledge gap for most docs, marginalization and commoditization of laboratory services / practicioners, and concomitant decrease in people pursuing medical lab sceinces as a career.
This COVID-19 situation makes all of this very apparent to anyone in medicine paying attention. It is also why companies like Theranos can get a 9 billion dollar valuation and Holmes can appear in TED talks and on the cover of TIME--because the people who knew she was full of sh!t are now so marginalized in medicine that they are ignored (read Bad Blood for more details) partially because people want to make $$$ and partially because most docs don't really understand how basic labs work.
Finally, this crisis and Theranos are not the only medical laboratory atrocties being levied on the population--molecular testing in oncology is a HUGE scam right now. Listen to Vinay Prasad's podcast (UCSF Oncologist) about such topics. The FDA has been approving very, very expensive drugs based on very, very expensive tests left and right partially based on misinterpretation (or misue) of these tests and bad statistical analysis / bogus endpoints (like progression free survival rather than overall survival). See the recent JCO article about oncotype testing in prostate cancer as an example--that test costs ~$3000, has been in use for years, and they *just* figured out it doesn't work at all....but it is still on the market and be ordered ALL the time by Urologist. Heck given the male predominance on this site I wouldn't be surprised if some LRCers haven't been conned into getting this test done.
So basically, the root cause of this IS the idea that free market principles should be applied to any aspect of medicine--here it is laboratory services and tests. When one does that one gets fragmented, understaffed, poorly run labs that cannot handle a public health crisis.
In my country the government believe Italia got out of control because so few got tested compared to South Korea and other countries. They didn't start testing BEFORE patients came to the hospital. Also people in Italy doesn't have as much trust in healthcare as some other countries and have few respirators compared to how many people are there.
The whole argument of 'it's only killed 4,000 people vs the flu which such-and-such amount' is REALLY missing the point: This is a NEW virus.
Actually that's wrong. It's been around since at least 2003. Researchers in Iowa injected the virus into mice prior to 2008, which is when they found out that injecting the virus into people could kill them. The SARS outbreak was recently discovered to actually have been the corona virus. It is not a new virus.
I'm not concerned with the virus, but I'm concerned about the many over reactions and responses.