COVID-19 Shutdown Exit Strategy?

[Fermion]

And so it continues. If you think we have food shortages now, and businesses are on the edge of bankruptcy, watch what happens if the following becomes more commonplace going forward:

Grocery store loses over $35K after woman intentionally coughs on food in Pennsylvania

https://wset.com/news/coronavirus/g...-intentionally-coughs-on-food-in-pennsylvania

If we get to food shortages and someone does that, I predict bad things will happen to that person right in the store or outside.

 

[PatrickA5]

Actually it is the ventilators that save your life (if you get so bad you need one). Someone who declined to go to a hospital if that hospital has an available ventilator and they need mechanical assistance to breath.... well hospitalization would have saved their life.

My question is how many of the people that go on ventilators actually get off of them and recover?

I read somewhere that a small hospital in Italy hasn't had anybody other than dead people come off the ventilators (around 30 deaths at that point). Maybe it's too early to tell? I wonder what the survival rate stats are normally (non-covid19) for someone on a ventilator for a couple of weeks?

 

[Fermion]

I read about a person who had recovered after being on a ventilator for a week or two.

 

[Aerides]

My question is how many of the people that go on ventilators actually get off of them and recover?

I read somewhere that a small hospital in Italy hasn't had anybody other than dead people come off the ventilators (around 30 deaths at that point). Maybe it's too early to tell? I wonder what the survival rate stats are normally (non-covid19) for someone on a ventilator for a couple of weeks?

I think it's too early to tell, but I agree it's not looking great. Of course, many patients are hospitalized for care that precedes the need for a vent, oxygen and fever management, etc.

 

[gerntz]

So for example, if NY stays closed and PA opens up totally, can the folks from PA travel to NY?

Seems NY would be saying no.

 

[gerntz]

And so it continues. If you think we have food shortages now,

Why would anyone think that?

 

[NameRedacted]

Why would anyone think that?

The stores in my area are routinely out of most meat, lots of canned goods, frozen foods and pasta.


It's not that we are short of food there is still plenty to eat - it's that there are sporadic shortages of certain foods.



On my last shopping trip I visited 5 stores to get everything that we needed/wanted.

 

[doneat54]

They should let small businesses open first. Small businesses are suffering the most and the workers are usually minimum wage employees with no sick leave and they are very disparate people.



The higher paying jobs with sick leave benefits, work at home options, high salaries, etc can afford to wait.

That's a very good point. And to add, small businesses in general have smaller populations of people, so less person to person contact/proximity. And if they open first, they will get a preferential boost when they are not competing with the larger businesses.

 

[kyzymurgist]

WSJ this morning has a couple opinion pieces that try to use others where there are numbers where an entire population has been tested and suggests that infection rates are a factor of 10 higher and mortality is likewise much lower. Just something to think about. There are other places that have tested populations and not just those with symptoms. Hrmm

The Diamond Princess was an epidemiologists dream. Nearly all passengers and crew tested and 712 positives.

So far 1.4% dead with another 2% still in critical condition. Very likely CFR will be well above 2% and the other critical survivors will have lasting debilitating lung damage.

Yes, the average age was higher than general population of most countries but the crew age offset some of the age effect.

And keep in mind that Diamond Princess CFR was not influenced by a saturated healthcare system.

I think when this is over and all the data is in, the untreated CFR will be close to the 1% estimated by Dr. Fauci.

However, the actual fatality rate could be shifted higher if we fail to lower R0 by social distancing orders and saturate hospitals. Or much lower if we quickly approve effective treatments or manage to keep R0 near 1 for long enough to develop a vaccine.

 

[Gearhead Jim]

Actually it is the ventilators that save your life (if you get so bad you need one). Someone who declined to go to a hospital if that hospital has an available ventilator and they need mechanical assistance to breath.... well hospitalization would have saved their life.

My question is how many of the people that go on ventilators actually get off of them and recover?

I read somewhere that a small hospital in Italy hasn't had anybody other than dead people come off the ventilators (around 30 deaths at that point). Maybe it's too early to tell? I wonder what the survival rate stats are normally (non-covid19) for someone on a ventilator for a couple of weeks?

I read about a person who had recovered after being on a ventilator for a week or two.

My point was that the percentage of covid-19 people who get ventilated and go on to survive is unknown to us common folk.
I'm surprised that we're not hearing more from doctors on this subject.
I think that having lots of test kits early in the spread would have been better than having lots of ventilators now. Having both would be better, but that ship has sailed.

 

[USGrant1962]

WSJ this morning has a couple opinion pieces that try to use others where there are numbers where an entire population has been tested and suggests that infection rates are a factor of 10 higher and mortality is likewise much lower. Just something to think about. There are other places that have tested populations and not just those with symptoms. Hrmm

Related, Neil Ferguson of the Imperial College of London COVID-19 response team (and source of 2.2 million Americans are going to die if we do nothing with 1.1 if we shut everything down), just testified in Parliament that their model of 250,000 dead in UK with shutdown has been revised and is now less than 20,000. That's a big revision.

https://www.newscientist.com/articl...e-care-units-for-coronavirus-expert-predicts/

He said that expected increases in National Health Service capacity and ongoing restrictions to people’s movements make him “reasonably confident” the health service can cope when the predicted peak of the epidemic arrives in two or three weeks. UK deaths from the disease are now unlikely to exceed 20,000, he said, and could be much lower.

See my sig.

 

[NameRedacted]

My point was that the percentage of people who get ventilated and go on to survive is unknown to us common folk.
I'm surprised that we're not hearing more from doctors on this subject.
I think that having lots of test kits early in the spread would have been better than having lots of ventilators now. Having both would be better, but that ship has sailed.

I saw a study online earlier today:


https://www.ncbi.nlm.nih.gov/pubmed/8404197


Not sure of course if we'll see the same numbers for Covid-19 but here are the ones from the study - they make grim reading:


"We reviewed a 5-year experience with mechanical ventilation in 383 men with acute respiratory failure and studied the impact of patient age, cause of acute respiratory failure, and duration of mechanical ventilation on survival. Survival rates were 66.6 percent to weaning, 61.1 percent to ICU discharge, 49.6 percent to hospital discharge, and 30.1 percent to 1 year after hospital discharge. When our data were combined with 10 previously reported series, mean survival rates were calculated to be 62 percent to ventilator weaning, 46 percent to ICU discharge, 43 percent to hospital discharge, and 30 percent to 1 year after discharge. Of 255 patients weaned from mechanical ventilation, 44 (17.3 percent) required an additional period of mechanical ventilation during the same hospitalization."

 

[NameRedacted]

Seems NY would be saying no.

Speaking as someone who lives in NY we don't want people visiting from PA even at the best of times

 

[Teacher Terry]

A Italian doctor said if you go on a ventilator at age 60+ you are just prolonging your death.

 

[Fermion]

A Italian doctor said if you go on a ventilator at age 60+ you are just prolonging your death.

That is very arbitrary. So a 58 year old smoker who goes on a ventilator is fine but a 62 year old in great health shouldn't bother?

 

[Nemo2]

..........you are just prolonging your death.

Something I (attempt to) do on a daily basis.

 

[PatrickA5]

In the NY press conference today, the Governor said they had a significant number of people that have been on ventilators for 20-30 days. He went on to state that the prognosis for someone on a ventilator for that time period is poor. I imagine families are having to make tough choices.

 

[Midpack]

Last night on CNN:

You’ve gotta be realistic,” Fauci told CNN’s Chris Cuomo when asked when states, including hard-hit California and New York, could expect to see a reduction of infections. “You’ve got to understand that you don’t make the timeline, the virus makes the timeline.”

States need to respond to what’s happening in real-time, he continued. “If you keep seeing this acceleration, it doesn’t matter what you say. One week, two weeks, three weeks ― you’ve got to go with what the situation on the ground is.”

“You can’t make an arbitrary decision until you see what you’re dealing with. You need the data,” added Fauci, who ― like other medical professionals ― has urged Americans to “hunker down” and practice social distancing to mitigate the spread of the virus.

And I think he acknowledged that when and how the economy restarts may vary considerably from one state, city or region to another - but no one can say when for anywhere in the US yet. Not until new cases per day have clearly slowed or leveled off. It appears NY and NOLA are the hotspots at present.

I’m all for partially and later fully restarting the economy as soon as we can safely do so. And it’s not too soon for some people to be planning for same IMO, like Cuomo has/is while keeping focus on the pandemic first and foremost. But anyone setting a firm date now is kidding themselves or worse (to be kind).

 

[PatrickA5]

I saw a study online earlier today:


https://www.ncbi.nlm.nih.gov/pubmed/8404197


Not sure of course if we'll see the same numbers for Covid-19 but here are the ones from the study - they make grim reading:


"We reviewed a 5-year experience with mechanical ventilation in 383 men with acute respiratory failure and studied the impact of patient age, cause of acute respiratory failure, and duration of mechanical ventilation on survival. Survival rates were 66.6 percent to weaning, 61.1 percent to ICU discharge, 49.6 percent to hospital discharge, and 30.1 percent to 1 year after hospital discharge. When our data were combined with 10 previously reported series, mean survival rates were calculated to be 62 percent to ventilator weaning, 46 percent to ICU discharge, 43 percent to hospital discharge, and 30 percent to 1 year after discharge. Of 255 patients weaned from mechanical ventilation, 44 (17.3 percent) required an additional period of mechanical ventilation during the same hospitalization."

It would be interesting to know of the 61% that got off the ventilator, how many days they were on. My uneducated guess is that most that got off the ventilator weren't on very long - maybe a few days. At any rate, it looks like around 70% don't make it a year (according to the study above).

 

[Gearhead Jim]

Well, a 30% 1-year survival rate isn't great, but certainly worth the effort.
Of course the numbers could be quite different in either direction, for covid-19.

 

[RetiredAt55.5]

Speaking as someone who lives in NY we don't want people visiting from PA even at the best of times

Yea, the feeling's mutual, especially you Mets fans!

Mostly kidding ....

 

[Independent]

I live in Iowa. We are well behind NY or WA. Some factoids

Population ................3,156,000
Hospital beds ................. 6,300
Confirmed Cases ............... 179
Negative Tests ................ 2,975
New cases today ................. 34
Number in hospitals today .... 31
Number discharged ............. 16
Number of deaths ................. 1

Governor recommended that all schools close as of March 16 (many were already on spring break).
Governor ordered no groups of more than 10, also closed restaurants, bars, gyms, theaters, casinos, senior centers as of March 17 (I was at the gym and they kicked us out at noon).

The actions above occurred when we had 27 confirmed cases. We are now 9 and 10 days into the closed period.

I'm interested in how this plays out. New York closed restaurants one day sooner than Iowa. I think it had 700 cases at the time, and now has 37,000.
Iowa's case load is growing much more slowly. I wonder if we actually got out ahead of it, or just had better luck.

The issue is what happens if cases continue to grow very slowly in Iowa?

 

[Toocold]

They are pivoting from a single strategy to one based on a risk segmentation strategy by counties. This may be the first step to a methodical exit.

https://www.npr.org/2020/03/26/8220...er-to-governors-on-new-coronavirus-guidelines

 

[Midpack]

Just a moment in time that'll be completely out of date tomorrow, with countries (and NY state) at different trajectories and very different locations on the curve, and questionable reporting/testing standards between countries.

And don't read any conclusion into this, just for perspective we average 9,000 flu deaths per month in the US on average (36,000 average over the worst 4 months of flu season) - with vaccines and established therapies. But it's not constant from Oct thru Mar, e.g. Feb is the worst month at 14,000 with relatively fewer cases in Oct/Nov on average. https://www.cdc.gov/flu/about/season/flu-season.htm

 

[USGrant1962]

They are pivoting from a single strategy to one based on a risk segmentation strategy by counties. This may be the first step to a methodical exit.

https://www.npr.org/2020/03/26/8220...er-to-governors-on-new-coronavirus-guidelines

There was never a single strategy - it was always "we'll evaluate".