Dire situation in New York State

[braumeister]

FWIW, I had a long phone conversation today with a friend who lives in Brooklyn. He said that apart from mostly staying at home and the extreme social distancing that everyone is practicing, they're not all that far from normal life. So it's not the complete horror movie that some are thinking.

 

[NW-Bound]

I read somewhere that about 10% of hospitalized cases ended up with a ventilator.

However, it is not said if these are all of the intubated type that is inserted down the trachea (windpipe), and the patient is given an induced comatose.

See video below for an example at 1:00. For adults only.

I hope this post and its video link will not be deleted. People need to know what treatments are required.

 

[Midpack]

Hope this is true...

New York sees early signs that social distancing could be slowing the virus’s spread. On Sunday, for example, the state’s projections showed hospitalizations doubling every two days. By Tuesday, the estimates showed hospitalizations doubling every 4.7 days, he said — adding the caveat that such a projection was “almost too good to be true.”

https://www.nytimes.com/2020/03/25/world/coronavirus-updates-maps-usa-world.html#link-192788bd

 

[Aerides]

I read somewhere that about 10% of hospitalized cases ended up with a ventilator.

However, it is not said if these are all of the intubated type that is inserted down the trachea (windpipe), and the patient is given an induced comatose.

Many patients do not stay in comas while ventilated. Now, the procedure to implant it intubation does almost require general anesthesia, and another drug to paralyze the patient, but following that, in many cases the patient can be awake for the duration (unless other medical needs require them to remain unconscious.)

ETA: referring here generically to vented patients, no idea if this applies to COVID patients.

 

[Freedom56]

Just to be clear, a BIPAP is a way to pump oxygen into lungs, but a Ventilator is far more invasive and complex.

So they are "similar" only in that they are ways to help get oxygen in, but a ventilator requires intubation and directly places a device into the patient's windpipe, to basically directly assist with actual breathing.

Here is an example of an all in one solution:

https://www.resmed.com/us/en/healthcare-professional/products/devices/lumis-tx.html

By replacing the hose, you can reconfigure between a BIPAP and a ventilator. My brother works at a hospital (he is a busy doctor these days) and referred me to a system they use in the above link.

 

[gerntz]

Actually I think that's quite worrying. What it means is that there are a lot more people with the disease than we thought and those people didn't know they have it.



Surely, the ideal situation would be if we did a lot more tests and found little increase in the number of cases.

I see it the opposite. We already knew we weren't testing near all cases. Finding these doesn't translate to even one more person hospitalized. Same number would be hospitalized, tested or not.

My interpretation is she's saying the number of new cases found, while a lot, is less in proportion to the percents already found because the new testing numbers are "massive". New cases, not so much.

 

[USGrant1962]

FWIW, I had a long phone conversation today with a friend who lives in Brooklyn. He said that apart from mostly staying at home and the extreme social distancing that everyone is practicing, they're not all that far from normal life. So it's not the complete horror movie that some are thinking.

NYC is our national hot spot. The "dire situation" is forecasted to be coming, not here yet. For example, Cuomo said today that the state is stockpiling all the ventilators coming in because no hospital has asked for any yet.

 

[USGrant1962]

I see it the opposite. We already knew we weren't testing near all cases. Finding these doesn't translate to even one more person hospitalized. Same number would be hospitalized, tested or not.

My interpretation is she's saying the number of new cases found, while a lot, is less in proportion to the percents already found because the new testing numbers are "massive". New cases, not so much.

And keep in mind that in most places only 5-10% of those tested under the current rules about showing symptoms are positive. I understand NYC is running over 20% positives, so it is certainly hitting hard there. OTOH, that means over 70% of NYC tests are negative too.

 

[Toocold]

The latest stats is of those who are tested positive, 13% require hospitalization and 3% will need ICUs (which require ventilators) but most people are modelling out 15%/5%. You can look at Cuomo's briefing for these figures.

Outside of lack of PPE/mask supplies, there is no emergency or dire situation. This is all in prep for the spike that they modeled will come in 2 weeks. Whether or not it becomes truly "dire" will be based on the accuracy of the models and the preparation that is done beforehand.

I suspect that once NY has its wave, many models will change and it'll be interesting to see the difference.

 

[Amethyst]

I agree, but I saw it as a Governor whose job is looking out for his own state. He knows he will get whatever the Feds decide to parcel out amongst the states, based on where they perceive greatest need. In times like these, being quiet and classy gets you nada. Scream loud, and you may get more.

The situation is dire in many places. Mr. Musk acquired over 1200 ventilators for LA and 50,000 masks for Seattle. We need people who can get us more pies to divide up. We don't need people who are demanding all the slices for their own folks.

If the Feds are sitting on ventilators... What are they waiting for?

 

[Teacher Terry]

An Italian doctor said that if you are older and need a ventilator that all it dies is prolong your dying. It is mostly saving younger people.

 

[aiken]

The problem isn't simply ventilators. This is an advanced medical procedure that requires Pulmonary physicians to administer. Those folks aren't stockpiled somewhere.

 

[brewer12345]

I grew up in Queens, which is becoming the epicenter of the crisis now. Sad to watch it get bad there.

 

[Sunset]

One other issue with hospitalization, especially ventilators is that once a person is sick enough to require either one, the stay in the hospital must be long.
Out of our over 68,000 confirmed cases, only about 400 have recovered.
It seems it takes weeks to recover.

I think once the hospitals are full, there will be a need to get beds free and move "getting better folks not on ventilator" to a recovery location (not hospital) where they can get less intensive care for a couple of weeks until discharge.

 

[Bamaman]

So many of us are hunkered down at home, and not really able to do anything but protect ourselves and those in our immediate family. At this point, I honestly don't remember when we went into this mode.

But nothing's been said about the one thing we all can do--PRAYER. Pray for the patients' healing, and pray for their caregivers to not catch the virus and to have strength in all ways. Also pray for those in power to make proper decisions, and that the supplies and beds to get to the right place when it needs to be there.

 

[NW-Bound]

Here's a brief interview with 2 doctors in NYC. They pleaded with us to stay home.

I hope this post will not get deleted.

 

[NameRedacted]

Looking at the latest numbers - within 2-3 days the US will have the most confirmed cases of any country in the world.

 

[Another Reader]

A video piece from the NY Times, following an ER doctor in Queens.

https://www.nytimes.com/video/nyreg...s8x1Q73-X8cDacNd-s_YypmGQmraaXYEyYz8mANgslfXA

 

[ERD50]

Looking at the latest numbers - within 2-3 days the US will have the most confirmed cases of any country in the world.

We also have a higher population than almost any other country in the world (China, India are higher)!

Current cases, per 1M population, puts us at about 33 on the list. About 1/5th the case rate of Spain or Italy.

Yes, we are probably in a faster doubling rate at this stage, but still.

https://www.worldometers.info/coronavirus/#countries

You can sort most rows. And this web site does it right, the heading does not scroll off the top of the screen like so many lists!

-ERD50

 

[atmsmshr]

So many of us are hunkered down at home, and not really able to do anything but protect ourselves and those in our immediate family. At this point, I honestly don't remember when we went into this mode.

But nothing's been said about the one thing we all can do--PRAYER. Pray for the patients' healing, and pray for their caregivers to not catch the virus and to have strength in all ways. Also pray for those in power to make proper decisions, and that the supplies and beds to get to the right place when it needs to be there.

Thank you

 

[Aerides]

I think once the hospitals are full, there will be a need to get beds free and move "getting better folks not on ventilator" to a recovery location (not hospital) where they can get less intensive care for a couple of weeks until discharge.

Problem is, some covid patients can go from bad to terrible in a matter of a few hours. Rushing from a ward over to the ICU is difficult enough - moving from another non-ICU location means you might not make it to the ICU when you need it.

 

[P.S.]

Some quick thoughts:

At this point, “stats” are possibly more anecdotal than anything as the numbers reported in various case series are very varying and likely to change as a better understanding of COVID disease progression and management evolves.

As of writing right now, non-invasive positive pressure ventilation (i.e. CPAP and BiPAP) is NOT preferred b/c of the risk of aerosolization. It may have utility in the setting of an OSA pt, at his home, with COVID19. In the hospital setting, even in a private negative pressure room, the recommendation would be not to.

Don’t think we’re quite at the point where jimmy-ing devices designed for one function, into another... is acceptable. Liability issues not withstanding...

Case series are clearly showing earlier intubation is associated with better outcomes than waiting ‘til acute respiratory distress or acute failure (respiratory or cardiac). Check NEJM, JAMA, BMJ et. for case series (free during outbreak).

My hospital system (since Jan) and I assume plenty, if not most, have been working on ventilator triage protocols. This best involves lots of different parties and time to get all views: hospital admin, physicians, nursing, ethics committees, legal, etc. This is best coordinated at the state or regional level, as one can imagine differing protocols can be disastrous at a societal level.

 

[Boho]

The odds of an elderly person surviving for more than a couple of weeks after intubation are low in general. Extremely low at certain ages. I wonder if the statistics are different for coronavirus cases.

 

[pacergal]

So many of us are hunkered down at home, and not really able to do anything but protect ourselves and those in our immediate family. At this point, I honestly don't remember when we went into this mode.

But nothing's been said about the one thing we all can do--PRAYER. Pray for the patients' healing, and pray for their caregivers to not catch the virus and to have strength in all ways. Also pray for those in power to make proper decisions, and that the supplies and beds to get to the right place when it needs to be there.

++1

 

[MRG]

We also have a higher population than almost any other country in the world (China, India are higher)!

Current cases, per 1M population, puts us at about 33 on the list. About 1/5th the case rate of Spain or Italy.

Yes, we are probably in a faster doubling rate at this stage, but still.

https://www.worldometers.info/coronavirus/#countries

You can sort most rows. And this web site does it right, the heading does not scroll off the top of the screen like so many lists!

-ERD50

I've been looking at that site. Interesting to me is to sort on daily new cases at night. Appears the state's dump their stats at different times and likely reset at midnight EDST. It appears to me you can see the other major urban areas growing by the day. A scary trend.