Who’s Really At Risk of Dying From Covid-19

[Midpack]

Quote:

Originally Posted by PatrickA5 As was expected (hoped?), in most places the critical hospital's being overwhelmed never happened (at least not yet). Some will think it's because of the programs put in place. Some will think it never was going to be overwhelmed in the first place. I doubt we'll ever know for sure. Pick whatever side you'd like. Personally, I just don't know.

Some NYC, NJ, New Orleans and Atlanta hospitals were reportedly overwhelmed - but I don't know of others. So many were not - thanks to the lockdown. As you say, we'll never know how many would have been overwhelmed, though we may learn more if/when the second waves begin. At least they will be better prepared for the second wave but that doesn't mean they won't be forced into triage.

[audreyh1]

Quote:

Originally Posted by youbet It will be interesting to see how people cope with this (bold mine). Adult children who have no one available to be with elderly/sick mom or dad 24X7 will be at a loss as to how to handle it. Elderly/sick folks who have no friends or family able/willing to care for them might have no place to be housed and cared for. This could be particularly tough on folks counting on Medicaid to foot their LTC needs since Medicaid payments may increase more slowly than NH costs. NH's will be motivated to take only private pay clients. And as escalating gov't rules and regs designed to make NH's COVID-19 safer push up costs, how will LTCI polices and the companies that wrote them make out? Yes, as you say, the NH industry may be "one the ropes," but if the industry struggles and shrinks, or becomes substantially more expensive than it already is, we're the ones that will be on the ropes. Maybe we're on the brink of an industry that will have to be nationalized. Interesting times.

I don’t see alternatives to nursing homes or group care homes for the elderly for many folks. If someone is cared for at their home they are still vulnerable as other people have to come into their home to help care for them.

So I don’t think the NH business going to shrink much. I’m hoping they get much better at infection control.

[6miths]

In our area it is not just that workers in LTC facilities are going from patient to patient, it is that they are also going from facility to facility as the business model is to employ many workers PT or OPT rather than a full compliment of full time staff. This served to spread the virus even more quickly in this setting.

It seems to me that one thing people are not picking up on is the time sequence of the epidemic in local places, its natural history. There is a significant time lag between the introduction of the virus into a locale, its spread to a critical number of people, cases getting ill and people starting to die. I will not be surprised if the experience of New York, Detroit and New Orleans is shared by other cities but not until after the restrictions are lifted and people become complacent. Again, IMHO much of what is being done is seat of the pants because this is such a novel situation with a virus that behaves very badly. There is just not enough known to know what the right call is. The good news is that barring a significant mutation, children and people under 40 are not at large risk when looking at populations.

[USGrant1962]

Quote:

Originally Posted by Midpack Some NYC, NJ, New Orleans and Atlanta hospitals were reportedly overwhelmed - but I don't know of others. So many were not - thanks to the lockdown. As you say, we'll never know how many would have been overwhelmed, though we may learn more if/when the second waves begin. At least they will be better prepared for the second wave but that doesn't mean they won't be forced into triage.

So back when this started "hospitals overwhelmed" generally meant not enough ICU beds and/or ventilators. That's what all the models were forecasting, with Imperial College of London being the worst. Taking into consideration the various Federal, State and local actions to expand capacity, I haven't heard that actually happened anywhere. Cuomo said it did not in NYC.

Hospital workers did have to work extra hours and there were lots of stories about that. While that is unfortunate, it is hardly the same as not enough ICU/ventilators. I think the press is running with human interest stories on the difficult time hospital workers are having (true) and people are extrapolating that to whole systems being overwhelmed.

[Midpack]

Quote:

Originally Posted by USGrant1962 So back when this started "hospitals overwhelmed" generally meant not enough ICU beds and/or ventilators. That's what all the models were forecasting, with Imperial College of London being the worst. Taking into consideration the various Federal, State and local actions to expand capacity, I haven't heard that actually happened anywhere. Cuomo said it did not in NYC.

You can Google and decide for yourself. Might be in how you define overwhelmed. I'm able to find articles (one below) stating Brookdale, NYU Langone Health, New York-Presbyterian’s Brooklyn Methodist and an unnamed Queens hospital resorted to triage and stopped reviving patients to accommodate others with a better outlook - why do that if you weren't out of capacity? It was reported one hospital was bullying patients into signing DNR's - I'd call that overwhelmed. There could be others, but I don't feel a need to research further. The good news is most hospitals were not overwhelmed, thanks to lockdown, other measures or what we didn't/don't know about Covid-19.

https://www.forbes.com/sites/lisette.../#4b7c39b33146

[6miths]

Definitely there were hospitals that were overwhelmed. When caregivers are using single machines to ventilate more than one person then you are overwhelmed.

[USGrant1962]

Quote:

Originally Posted by 6miths Definitely there were hospitals that were overwhelmed. When caregivers are using single machines to ventilate more than one person then you are overwhelmed.

Source? I find tons of articles about the concept, nothing about it actually happening.

[N02L84ER]

Quote:

Originally Posted by USGrant1962 Source? I find tons of articles about the concept, nothing about it actually happening.

Look at the second graph on this page for New York. Note the curves exceeding the Number of Beds and Number of ICU Beds.


https://covid19.healthdata.org/unite...erica/new-york

[Oz investor]

my definition of overwhelmed ( with Covid ) is not enough personal protection gear to go around for ALL the staff , considering all the medical staff infected ALL the other staff face extra risks as well , the infected will not show signs for days ( if any signs at all ) so any frontline staff might easily infect the support staff , even to the folks in the canteen .. who might infect ...

closing borders to international travel slowly was a key ingredient to the rapid spread everything else just made things worse

hopefully nations will be wiser for the next wave or pandemic

[USGrant1962]

Quote:

Originally Posted by N02L84ER Look at the second graph on this page for New York. Note the curves exceeding the Number of Beds and Number of ICU Beds. https://covid19.healthdata.org/unite...erica/new-york

It does not say what you think it says - the dotted lines are their model, not data. Note the big *. When they have real data they put in solid lines (like the deaths).

IHME's model has been reasonably good for deaths; and way, way off for resource use.

[N02L84ER]

But also note they say they use shaded areas for projections starting on April 22nd and very small shaded areas prior to that date. I think the dotted lines are because the could be off by +/- some small percentage. It also says the peak was April 8 but below that they show April 7 thru April 10 because the numbers are not 100% known.

[Dtail]

Quote:

Originally Posted by USGrant1962 It does not say what you think it says - the dotted lines are their model, not data. Note the big *. When they have real data they put in solid lines (like the deaths). IHME's model has been reasonably good for deaths; and way, way off for resource use.

Predicts a total of 72k deaths by Aug 1st with only ~300 most likely total deaths between June 1 and Aug 1. Yes, there is a range to 114k deaths.
Hope it is right, but appears to me to be very optimistic.

[becca]

My daughter is a RN in the pediatric unit of a large hospital. Over 600+ beds and the largest number of covid patients they have had is 30 (currently less than 20). The covid patients are isolated in a separate section of the hospital. The Hospital revenues are down 90% because the hospital has been empty since March. All but one of my daughter's scheduled shifts have been cancelled since March, the same with her coworkers. When cancelled they must take vacation time or not be paid. These nurses can't apply for unemployment because technically they are still employed. Nursing was once thought of as a bulletproof profession in an economic downturn. Wonder what this will do to the future outlook of the nursing profession?

[Aerides]

My definition of overwhelmed is "Would I feel like a normal priority if I were a patient there for a more routine hospitalization?"

So, some of those NY hospitals, the answer would have been nope. While things didn't get overflowing-terribad as some projections may have estimated, we had plenty of arguments here about the distress of moving patients around in the hospital system - patients being shuttled out of the city to other parts of the state. That's probably not normal.

It was bad, it wasn't as bad as the worst bad, but it was bad enough. OK?

[donheff]

I think we are rewriting history if we view the situation in NYC and many other systems as simply overworking hospitals. N95 masks were, by FDA decree, single use prior to this epidemic. Doctors and nurses were writing their names on them and taking them home for weeks. They are still reusing PPE. Swabs and reagents are not available for tests. Call it stressed or call it overwhelmed. It was a mess and it could be a bigger mess come round 2. I'm still for reopening the economy but I don't think we can afford to under estimate the danger. We need to be ready to accept and respond to a new wave or we could see states or cities opening up and then slamming back down. That could be more devastating for the economy that a slow reopening.

[gwraigty]

Quote:

Originally Posted by donheff I'm still for reopening the economy but I don't think we can afford to under estimate the danger. We need to be ready to accept and respond to a new wave or we could see states or cities opening up and then slamming back down. That could be more devastating for the economy that a slow reopening.

I've read a couple of articles that say we might have to face a new reality of repeated lockdowns. I don't see how that would be sustainable, either short-term or long-term. The consequences would be widespread and dire.

[Midpack]

Quote:

Originally Posted by gwraigty I've read a couple of articles that say we might have to face a new reality of repeated lockdowns. I don't see how that would be sustainable, either short-term or long-term. The consequences would be widespread and dire.

+1. I’m probably wrong and I’ll get flamed by some but... It may be the right thing to do, but I think it will be much harder to lockdown a second or third time. Governments, businesses and individuals are now really feeling the economic damage and realize 80-90% of us are at low risk. Health care resources could more easily keep up if the vulnerable were semi locked down or otherwise protected. [I’d be happy to make accommodations for the vulnerable in exchange for reopening the economy]. The vulnerable are going to have to take much greater precautions voluntarily or otherwise, or face a triage situation. More and more people now realize the economic damage could cost lives too, it’s not one or the other - health v economy.

[devans0]

I do not trust published stats to be accurate. The surge in total deaths and barriers in testing suggests that the stats are under counted and this would be primarily in younger victims.

The places that are at greatest risk are places with close contacts between people. Prisons, detention centers, care facilities, cruise ships, and factories are being hit hard.

We have a several family members with high risk of complications. We are fortunate that we can isolate, so we are isolating.

[sengsational]

Quote:

Originally Posted by Midpack CDC stats seem to clearly show those with underlying health issues (heart disease, cancer, respiratory issues, diabetes, compromised immune systems, etc.) are the ones most at risk. The same people who are usually less able to fight off many serious illnesses. The elderly are at risk only because they typically have a higher incidence of underlying health issues and weaker immune systems. Not to be cavalier about it, but those of our generation in good health are much lower risk as well, not every 65+ yo is at high risk. And there’s a small group of healthy people with a genetic predisposition to suffer or die from Covid-19.

Age often correlates to endothelial related diseases, which is why earlier the news was that it's harder on the oldest people. But more specifically, it's harder on those that are subject to runaway inflammation. NYC reported (saw on MedCram) that the hospital admissions had a much higher rate of hypertension and obesity than the general population. And COPD turned out NOT to be a risk factor!

[donheff]

Quote:

Originally Posted by Midpack +1. I’m probably wrong and I’ll get flamed but... It may be the right thing to do, but I think it will be much harder to lockdown a second or third time. Governments, businesses and individuals are now really feeling the economic damage and realize 80-90% of us are at low risk. Health care resources could more easily keep up if the vulnerable were semi locked down. The vulnerable are going to have to take much greater precautions voluntarily or otherwise, or face a triage situation. Most people realize the economic damage could cost lives too, it’s not one or the other - health v economy.

+1 I hope schools don't shut down every time a kid gets infected or we will have backdoor shutdowns screwing up millions of lives. We initiated this shutdown to ease the transition for the medical community. Now we need to prepare to deal with the long term more along the lines of a bad flu season (albeit with far more deaths in nursing homes and among challenged populations). At 71, I'm in a challenged population.