Can we finally agree NYC hospitals were overly dramatic? There were no bed, ventilator, or staffing issues.

Given this

"So it has transpired. In the wake of the testing disaster has come the personal protective equipment (PPE) disaster, the hospital bed disaster, and now the ventilator disaster.

Ventilators, literal life preservers, are in dire short supply across the country. When governors begged Trump to unleash the full might of the US government on this critical problem, he gave his answer on 16 March."

I question the whole story. At best there was a projected dire short supply based upon projections that turned out to be very wrong. I must have missed the disaster.

FastTuohy wrote:

Given this

"So it has transpired. In the wake of the testing disaster has come the personal protective equipment (PPE) disaster, the hospital bed disaster, and now the ventilator disaster.

Ventilators, literal life preservers, are in dire short supply across the country. When governors begged Trump to unleash the full might of the US government on this critical problem, he gave his answer on 16 March."

I question the whole story. At best there was a projected dire short supply based upon projections that turned out to be very wrong. I must have missed the disaster.

Correct.

I do work in a hospital. Level 1 trauma center.

The poster I was replying to called him or herself an “ER manager”.

Let’s continue to discuss the obvious trend though that the areas hardest hit are those with poor track records. Italy’s mortality rates for flu have been catastrophic for a decade (journal link added below). And New York’s track record regarding patient safety specifically puts them 47th out of 50 states. (See links in posts above) While we were preparing on a governmental level with social distancing and on a hospital system level with supply and bed management procedures, NYC had millions still riding the subway and poor hospital administrations who are used to delivering patient safety as the 47th out of 50 states. The news keeps suggesting that the New York and Italy issues are purely covid related, but it’s clear when comparing to other parts of the world that their issues are administrative. So the nyc hospital administrations are happy to support a narrative which suggests that despite their top notch efforts, this virus is too deadly for anyone to handle. I honestly believe most NY physicians and administrators think they typical are the best, but the data shows they are among the worst. And when the final mortality rates are calculated, NYC should be held accountable for their past and current abysmal performance.

Here is the Italy link https://www.sciencedirect.com/science/article/pii/S1201971219303285

Cool story bro.

You replied to me, I said I work in emergency management. Your reading comprehension is typical of most physicians, but I still doubt that you are one.

Ok. Thanks for clarifying your title. Now do you have anything constructive to add? Any response to the concern that nyc hospital management administrators a system which is 47th out of 50 states with regards to patients safety?

You and I can discuss titles, but people have suffered in nyc under poorly managed hospitals too long. Not the wealthy from other countries who pay cash for cancer treatments and knee replacements, but New Yorkers who work and aren’t aware of the documented poor quality of their local health care administrators including those in emergency management.

another fact wrote:

Ok. Thanks for clarifying your title. Now do you have anything constructive to add? Any response to the concern that nyc hospital management administrators a system which is 47th out of 50 states with regards to patients safety?

You and I can discuss titles, but people have suffered in nyc under poorly managed hospitals too long. Not the wealthy from other countries who pay cash for cancer treatments and knee replacements, but New Yorkers who work and aren’t aware of the documented poor quality of their local health care administrators including those in emergency management.

I’m not sure you understand my role, but that’s ok. I’m not an administrator, we beg administrators for money.

I brought up a bunch of good points, pointed out where you were wrong and you addressed none of it.

I’m not defending hospital preparation. There is a lot that could have been better from the local level all the way up. That said, hospitals can’t control how many patients walk through their doors. At the peak (like 2 days ago), we had 19,000 inpatients for COVID. Were we supposed to have 20,000 beds on standby? Were we supposed to have 2,000 ICU beds on standby?

It’s fun to throw random nonsense out there the way you have been, but when it comes time to address you realities, you have nothing to say in response.

Germany. Not very hard at all.

I am curious if there are any estimates of how many patients are saved by being hospitalized as opposed to if a bed was not available. My sense is that the difference is miniscule. Patients may be made more comfortable and many are saved but most of those would have recovered at home anyway.

stats guru wrote:

I am curious if there are any estimates of how many patients are saved by being hospitalized as opposed to if a bed was not available. My sense is that the difference is miniscule. Patients may be made more comfortable and many are saved but most of those would have recovered at home anyway.

That is a fantastic question. Obviously we can’t have a firm answer on that yet, especially because so many deaths at home and in nursing homes are yet to be counted, but we do have some insight on the stats. It’s a bit much for me to type up right now, but I definitely will tomorrow. The very brief answer is that even the simple act of delivering oxygen has saved thousands of lives. If you get to where you need mechanical ventilation...you might survive, and you definitely wouldn’t have survived without it.

stats guru wrote:

I am curious if there are any estimates of how many patients are saved by being hospitalized as opposed to if a bed was not available. My sense is that the difference is miniscule. Patients may be made more comfortable and many are saved but most of those would have recovered at home anyway.

Alright, so I'm going to preface this with the fact that I'm obviously not a clinician of any kind, but my education is in public health and epidemiology and I've worked in healthcare for 12 years.

So a while back in the news when this was all still new in the USA, it was reported - and this is still true - that there is no cure for COVID and all we can do is treat symptoms. This is not the same as just making patients comfortable. There are actual therapies being delivered that lead to better outcomes than no therapies at all. Many of the patients that become seriously or critically ill have underlying illness, whether its cardiovascular, renal, whatever. For example, a patient with chronic kidney disease will have a higher chance of being critically ill from COVID. The infection will hinder respiratory efficiency and lead to lower blood oxygen saturation which will impair kidney function further which will lead to a buildup of fluid in the heart and lungs which will further impair respiratory efficiency, which will further impair kidney function...you get the idea. For someone like that, the simple act of delivering oxygen and managing fluids could save their life. Same as folks with diabetes or any number of other common illnesses. The other benefit to hospitalization is that many patients seem to be doing reasonably well, and then crash very sharply in a very short amount of time. Already being in a hospital and being able to be quickly transferred to an ICU is huge in those situations.

I'm not sure if you're a stats guru or if that's just your name, but either way, the specific numbers are obviously still a little fuzzy right now. We can be reasonably confident that the hospital reported deaths are in the ballpark. What we have no idea about is the number of deaths at home or in nursing homes. On average, pre-COVID, 145 people die per day in NYC. About 25 people per day die at home. In late March, it was up to 125 per day dying at home. This past week there have been days were over 250 people died at home. For the most part, these deaths are not counted in the COVID totals. That will all have to be counted later. Not all of the increase in deaths is directly COVID related. There are people who aren't taking their medications because they're afraid or unable to go out. People who normally have help taking care of themselves who no longer are getting that help. People who don't go to the ER for a heart attack because they're afraid of getting COVID. But let's assume that many of them are directly COVID related. That's thousands of additional deaths from COVID that as of right now are unreported. Once we get a handle on the number of people who were infected but not hospitalized, we'll be able to calculate a death rate for people who were hospitalized vs people who were hospitalized.

Another set of numbers relevant to your question is the number of folks that are hospitalized that require serious medical care, vs the ones who do not. It's pretty safe to assume that most of the folks who require serious medical interventions would die without them and would not have recovered at home. Around 20% of those hospitalized end up in the ICU for some length of time.

A final thing to look at in the value of hospitalization, is the outcomes between total recovery and death. There's a whole spectrum there. It's not just "oh you recovered, you're fine" or "sorry, you're dead". There are degrees of lung damage, of organ damage, of neurological damage. When you're in a hospital, you're constantly having your blood analyzed and having your care catered to your specific situation at any given time. There are signals that a doctor might see in your lab results or other monitoring that indicate that it's time to start a certain intervention, or that you're experiencing a cytokine storm, or that your immune system is or is not doing well. If you're at home, you don't get any of that. Your care at the hospital may have determined whether you make a full recovery or whether you can't walk up the stairs without taking a breather.

All of that said, if you're not sick enough to need those interventions, which is true for that vast majority of people, then the hospital doesn't have much to offer other than a bed less comfortable than the one you have at home. You might get oxygen and and electrolytes, but you're probably better off at home. If you show up to the hospital and you don't need the hospital, they'll send you home.

not a good answer wrote:

THOUGHTSLEADER wrote:

Making a lot of excuses for Trump. The point is he did not have the country ready for a pandemic in February. He left everything to the States and didn’t get anything in preparation to address crisis areas. That did cost lives, and deepen the crisis in NYC. Sure he couldn’t have known all the mitigation that was necessary but he could’ve stocked up so hospitals were ready and locked things down and with more authority as opposed to leaving everything to the states’ discretion.

Name one country that was prepared for a pandemic.

Waiting...

Waiting...

Thought so

Taiwan

Kyzer Sozenator wrote:

not a good answer wrote:

Name one country that was prepared for a pandemic.

Waiting...

Waiting...

Thought so

Taiwan

When did they prep for an unknown virus and what special actions did they take?

I will say this. The delay in getting testing going was bad. I think a new test had been developed by mid February except it did not work. But this seemed to be a combination of bureaucratic problems between agencies and missteps as opposed to a decision to not get going. But this is worth looking into and understanding.

Adrenochrome wrote:

THOUGHTSLEADER wrote:

Germany. Not very hard at all.

43 deaths per million. Nothing special when compared to red states of the USA, which are using chloroquine to easily and instantly cure the virus, instead of following Democrat orders to let as many people die as possible and list every death as from the virus, to try and steal the 2020 election and force everyone to take Bill Gates' vaccine/digital-ID.

Honest question. If democratic states let their residents die, but all of the republican states cure their residents...How would democrats win the election? Wouldn't all of their voters be dead?

A cynical view is the D base is younger and less likely to die so allowing the older people to die would help the D candidates. But I am NOT saying that I think is what happened.

The guy already proved his original assertion to be false. Don’t waste your keystrokes with him.

another fact wrote:

This is officially looking like a normal flu season even including covid deaths.

Yeah in a normal flu season we have 2400 people die in 1 day and and 15k in a week. And this is after social distancing for almost a month. It must be that for the past 40+ years we have only had mild flu season and not a single normal one. Or you are blind.