How Helpful Hospitals?

[sengsational]

Many books will be written once all of this is history, and I wonder what they'll say about the effectiveness of our healthcare system in this first wave, when our healthcare's arsenal against the virus is pretty much empty.

To be clear, I don't see anyone or any group is doing anything "wrong". Everyone is doing what they can, and I honor them for it. It seems to me that they simply don't have highly effective tools at their disposal at the moment.

I haven't even researched the current standard treatments and protocols used at hospitals around the world, but just going by what I read on this board, it sounds like hospitals are trying that hydroxychloroquine + azithromycin thing, maybe they're giving IV fluids, and, of course, they can knock you out and put you on a ventilator (which basically means you've likely lost the battle). There are other things being done at various hospitals, even using fomentation, but right now, hospitals don't seem to have any "really good" remedies.

This is not to take anything away from our brave hospital workers; it's essential for people to have somewhere to go and to have someone to take care for you if you get very sick. But I wonder, when this is in the history books, what they'll say about the effectiveness of the healthcare systems around the world during this span of time of the pandemic, before a really effective treatment is available.

I see some 'natural experiments' cropping up when a certain geography has more cases than hospitals can manage. The hospitals do triage between cases and take the ones they think they can help the most, but there's probably going to be situations where a certain uniform cohort is too large to admit all of them, so they take a subset. I haven't paid too much attention to specific cases where the curve wasn't flat enough and this kind of selective application of hospital care had to be undertaken, but I imagine the data is already collected. Not that anybody wants or needs to talk about it now, in the midst of the crisis, which is why I'm not sure this is even a good thing to talk about right now.

What I wonder is "How much more survivable is the disease if admitted to a hospital when compared to staying at home". The numbers, as reflected upon in the future, will show this. Obviously, it will vary, hospital to hospital. But I wonder about it today. Am I twice as likely to survive if I get admitted vs getting turned away. Ten times? Or is it even odds? I really have no clue, but my feeling is that it's closer to even odds than it is to ten times.

 

[LOL!]

One thing is that treatment has evolved in the past two weeks at hospitals. Certainly, one is unlikely to get oxygen gas at home. One can get a home blood oximeter, but hospitals already have them. Difficulty breathing / blood oxygen level seems to be the dividing line now for whether to go to a hospital or not.

 

[braumeister]

What I wonder is "How much more survivable is the disease if admitted to a hospital when compared to staying at home".

There's no question that you're right about many books being written about this time in the future, but my guess is that it will be a long time before any real consensus is reached on the big picture.

As to hospitals, I've been in them in this country, Europe, and South America. No experience with Asia or Africa, but what I've seen has been remarkably similar from one continent to another. I think it's very unlikely that you would be admitted if you were able to be cared for at home. So if you were admitted you would be in the best hands available.

Personally, I will always do everything possible to stay far away from hospitals, but I'm extremely glad they're around when I need one.

 

[sengsational]

Thanks for the reminder, LOL! about oxygen. Of course that's a big advantage of a hospital. We'll see how much of a survivability advantage that has, but I imagine it's non-zero. That got me thinking...I wonder how many oxygen concentrators are sitting around at ole Aunt Bess' house (and the others like that), long after she passed. Those should be put to use!


I'm also glad to have a hospital when I need one, but am really glad I haven't needed one, especially since they've been struggling with super bugs. That gets me thinking again... I wonder if processes from viral containment will be adopted to help control super bugs.

 

[Sunset]

One thing is that treatment has evolved in the past two weeks at hospitals. Certainly, one is unlikely to get oxygen gas at home. One can get a home blood oximeter, but hospitals already have them. Difficulty breathing / blood oxygen level seems to be the dividing line now for whether to go to a hospital or not.

Another reason a hospital is handy is for events like cardiac arrest time, the defibrillators are nice to have around.

 

[Just_Steve]

Just a little clarification, don't assume difficulty breathing / blood oxygen level are one and the same as people can and often do have one without the other. I have shortness of breath/difficulty breathing everyday but my pulse ox is just fine and dandy.

"The difference between being short of breath and being hypoxic"

https://copd.net/clinical/breathlessness-vs-oxygen-saturation/

 

[Rianne]

Just a little clarification, don't assume difficulty breathing / blood oxygen level are one and the same as people can and often do have one without the other. I have shortness of breath/difficulty breathing everyday but my pulse ox is just fine and dandy.

"The difference between being short of breath and being hypoxic"

https://copd.net/clinical/breathlessness-vs-oxygen-saturation/

Very important distinction. This stated in multiple Medscape articles and completely alters the treatment given.

 

[sengsational]

One thing is that treatment has evolved in the past two weeks at hospitals. Certainly, one is unlikely to get oxygen gas at home. One can get a home blood oximeter, but hospitals already have them. Difficulty breathing / blood oxygen level seems to be the dividing line now for whether to go to a hospital or not.

I learned something new today, or maybe just reminded me, because this is the second time I watched this doc talk about this topic, but if the disease has blocked alvioli (shunt physiology), giving pure oxygen benefits very little.

https://youtu.be/nO4xgcIaPeA?t=1031

 

[LOL!]

I learned something new today, or maybe just reminded me, because this is the second time I watched this doc talk about this topic, but if the disease has blocked alvioli (shunt physiology), giving pure oxygen benefits very little.

I don't think you are arguing that at such a point, one would not be better off in a hospital than at home.

 

[CaptTom]

I saw a headline which suggested that people are not being sent/going to the hospital lately, even for serious things like heart attacks. I didn't read it because it's not really news to me. I wouldn't go now unless there was clearly no alternative.

Also, doctors seem to be much more liberal about diagnosing over the phone and calling in prescriptions, instead of insisting on an office visit. I got an antibiotic for a potential Lyme disease tick bite this way. My doc is pretty good about that sort of thing anyway. Back when my kids were little we often did the ear infection diagnosis together over the phone. But many doctors would historically refuse to diagnose or prescribe anything unless you come in. I think that may be changing.

 

[sengsational]

I don't think you are arguing that at such a point, one would not be better off in a hospital than at home.

The question is how much better a hospital would be compared to home and to understand that, I'm interested in exploring the effectiveness of the tools they have, that I don't have.

One tool I don't have at home is oxygen, which, according to the video, can be helpful in some cases, but apparently not helpful in other cases.

Another tool is hydroxychloroquine + azithromycin. I'm not hearing glowing reports from that tool.

Another tool is getting put on a ventilator. Another thread here is filled with people saying 'nope' to that as a treatment, presumably because the treatment is unlikely to work.

What else do the hospitals have to offer? That's what I'm here to try and better understand.

 

[Sarah S]

There is emerging evidence that this affects much more than the respiratory system including clotting disorders. A well known actor apparently had his leg amputated due to this but there are other reports. This isn’t the blood clots from immobility you might expect but profound derangement of normal function. Also metabolic imbalances

 

[daylatedollarshort]

There is emerging evidence that this affects much more than the respiratory system including clotting disorders. A well known actor apparently had his leg amputated due to this but there are other reports. This isn’t the blood clots from immobility you might expect but profound derangement of normal function. Also metabolic imbalances

I've been reading the links to blood clots as well. There are many foods like garlic, berries, and ginger that thin the blood. COVID19 is also linked to cancer. Cancer is also linked to blood clots. Many of the foods recommended for cancer prevention also are natural blood thinners.

There aren't any published studies on diets for COVID19, but there's tons of published articles on food and diets for the prevention and treatment of the co-existing conditions like heart disease, diabetes, cancer and high blood pressure. I can't say I'm surprised there isn't much press about the virus and nutrition, but that seems like a really logical area to explore.

 

[MRG]

I saw a headline which suggested that people are not being sent/going to the hospital lately, even for serious things like heart attacks. I didn't read it because it's not really news to me. I wouldn't go now unless there was clearly no alternative.

Also, doctors seem to be much more liberal about diagnosing over the phone and calling in prescriptions, instead of insisting on an office visit. I got an antibiotic for a potential Lyme disease tick bite this way. My doc is pretty good about that sort of thing anyway. Back when my kids were little we often did the ear infection diagnosis together over the phone. But many doctors would historically refuse to diagnose or prescribe anything unless you come in. I think that may be changing.

+1
I'm not changing my decision on the current situation.

I've had one telemed conference and I had to go off my BP med post phlebotomy. I just sent my PCP a note, she was fine with me monitoring myself at home.