March 14, 2020

"The United States has roughly 2.8 hospital beds per 1,000 people. South Korea, which has seen success mitigating its large outbreak..."

"...has more than 12 hospital beds per 1,000 people. China, where hospitals in Hubei were quickly overrun, has 4.3 beds per 1,000 people. Italy, a developed country with a reasonably decent health system, has seen its hospitals overwhelmed and has 3.2 beds per 1,000 people."

From "This is the coronavirus math that has experts so worried: Running out of ventilators, hospital beds" (WaPo).

As for the ventilators:
In a report last month, the Center for Health Security at Johns Hopkins estimated the United States has a total of 160,000 ventilators available for patient care (with at least an additional 8,900 in the national stockpile). A planning study run by the federal government in 2005 estimated that if the United States were struck with a moderate pandemic like the 1957 influenza, the country would need more than 64,000 ventilators. If we were struck with a severe pandemic like the 1918 Spanish flu, we would need more than 740,000 ventilators — many times more than are available.
That's some background on "Healthcare system capacity" means in this now-familiar graph:

194 comments:

wendybar said...

What can we scare the masses with today???

wendybar said...

Good read from another perspective...https://newcriterion.com/blogs/dispatch/compared-to-what

tim in vermont said...

I don’t think that it is “panic” to want to put off getting it until we get our shit together. It would be great if it died out, like SARS, but it’s kind of hard to see the path to that.

This bit about how China is handling it is interesting

https://twitter.com/MikeIsaac/status/1238604080571772928

Although I wonder about some of it being actually true on the ground rather than aspirational.

Curious George said...

"If we were struck with a severe pandemic like the 1918 Spanish flu..."

So these Wapo "journalists" are no smarter then our resident dullard.

Spiros said...

I think the Chinese were quarantining all people with respiratory illness. There is no way the Chinese had enough tests, especially early on, and, according to South Korean medical authorities, in a Covid 19 cluster, only 4% of people with respiratory illness have Covid 19. So, I think, in Wuhan, people with influenza were locked up with Covid 19 patients (a double whammy). Something awful happened in China and we're paying the price...

Darrell said...

If only we could make more ventilators. Or beds.

Levi Starks said...

This is simply a cost/benefit calculation.
What level of resources are we willing to divert from an alternate use in an effort to extend the lives of citizens who are already near their theoretical age limit.

tim maguire said...

How many beds per 1,000 people is the wrong question. Hospitalizations are not spread evenly among infected people. The real question is how many hospital beds per 1,000 elderly, cancer patients, etc.

Masscon said...

I pay little attention to this article as there is little distinction between critical care beds where any hospitalized Covid-19 patients would be cared for and regular hospital beds.

The US leads the world in ICU beds.

https://www.forbes.com/sites/niallmccarthy/2020/03/12/the-countries-with-the-most-critical-care-beds-per-capita-infographic/#71e729f17f86

Darrell said...

If we all treated the WaPo like COVID-19,we'd all be better off.

Annie C. said...

Friends, I finally had my aha moment regarding COVID 19 yesterday. I read and heard the right information for the precautions to make perfect sense.

Yes, most will have mild symptoms, but the problem lies with the approximately 5% of patients who get super sick (i.e. require ICU care and mechanical ventilation). The problem is that there aren’t enough ventilators.

If this infection sweeps across the country like a bolt of lightening and everyone is sick at the same time, it will overwhelm our ability to care for the critically ill patients. Decisions will have to be made about who to intubate and who to let die.

If, however, the “curve is flattened” and it spreads more slowly, then we will be more likely to have the necessary resources to care for and save the lives of many people.

So, the bottom line is that these unprecedented cancellations are for good reason. Take care of yourself. Drink plenty of water, get your sleep, eat healthfully, wash your hands, and stay away from anyone who has symptoms of a respiratory type infection.

But stop panic-buying toilet paper!

Leland said...

They keep showing the graph, but it is stupid. The US healthcare system isn't beyond capacity. There are 1629 cases total in the US, of which 1362 are still under investigation. We have far more hospital beds than that, and for most people around the world, the preferred treatment is over the counter medication and home rest.

Wince said...

Exiled from Main Street?

Everybody walking 'round
Everybody trying to step on their Creator
Don't matter where you are, everybody, everybody gonna
Need some kind of ventilator, some kind of ventilator
Come down and get it


Ventilator Blues

When your spine is cracking and your hands, they shake
Heart is bursting and your butt's gonna break
Woman's cussing, you can hear her scream
Feel like murder in the first degree

Ain't nobody slowing down no way
Everybody's stepping on their accelerator
Don't matter where you are
Everybody's gonna need a ventilator

When you're trapped and circled with no second chances
Code of living is your gun in hand
Can't be browed by beating, can't be cowed by words
Messed by cheating, ain't gonna ever learn

Everybody walking 'round
Everybody trying to step on their Creator
Don't matter where you are, everybody, everybody gonna
Need some kind of ventilator, some kind of ventilator
Come down and get it

What you gonna do about it, what you gonna do?
What you gonna do about it, what you gonna do?
Gonna fight it, gonna fight it
Gonna fight it, gonna fight it
Gonna fight it, gonna fight it
Gonna fight it, gonna fight it
Gonna fight it, gonna fight it
Gonna fight it, gonna fight it
Gonna fight it, gonna fight it

J. Farmer said...

Honest question for those who keep saying this is all panic, hysteria, overreaction. What do you think is an appropriate course of action to contain the spread of infections?

tim in vermont said...

"The US leads the world in ICU beds.”

How many times have we been hectored about how much money the US spends on health care and we need to reduce that number?

stlcdr said...

IF X were to happen then we need Y. We currently don’t have enough Y.

That’s a very big IF. But people mitigate for the eventuality of X so that Y is not needed. Also, people are unpredictable. Also the US is not like other countries (if it was, why would people want to come here? Why would they not want to go to Italy? Or Taiwan?)

Americans have the ability to be self sufficient to a greater extent (although some believe and want the government, and only the gov!, to do something - these people are idiots, don’t listen to them).

Inga said...

“If we were struck with a severe pandemic like the 1918 Spanish flu..."

“So these Wapo "journalists" are no smarter then our resident dullard.”

Apparently they are smarter than our resident dumb monkey, but then again most people are. If you cannot see any purpose in looking at the last pandemic to mitigate the current one you should just shut your ignorant mouth.

GatorNavy said...

*Sighs in healthcare*

1. ICU beds do not equal all hospital beds available. You can be vented anywhere, including at home.
2. There are multiple modes, partial to complete, of ventilation for patients, the overwhelming percentage of victims of the Wuhan flu will never need ventilation.
3. The overwhelming percentage of victims of the Wuhan flu will never go to the hospital.
4. Visiting RN’s will suddenly be very busy
5. Wash your hands
6. Use hand sanitizer
7. Disinfect as you go
8. Shut off the news and turn your dial to Cartoon Network, you’ll feel better instantly

tim in vermont said...

"What level of resources are we willing to divert from an alternate use in an effort to extend the lives of citizens who are already near their theoretical age limit.”

Zeke Emanual? Is that you?

Bill, Republic of Texas said...

What's wrong with hospital tents? That's a rational use of resources.

One problem I have is with these new resort quality hospitals going up. Single patient rooms that at 10x8 with 10' ceilings and hardwood floors. Motorized hospital beds.

There's a lot of waste in our medical system.

stlcdr said...

Currently, my biggest problem is trying to buy toilet paper, though. I don’t understand why people are buying all the toilet paper - now that’s something you can’t predict!

Mrs. X said...

Have the demand and supply of panic achieved equilibrium?

Howard said...

I am sure glad that my dad saved all those Montgomery Ward catalogs. I'm guessing about 10% of you will get that

tim in vermont said...

"o, I think, in Wuhan, people with influenza were locked up with Covid 19 patients (a double whammy). “

You know what? If you go to the link I gave and watch it, the guy never mentions that, but it seems like it would inevitably be true if they followed the procedures he outlined. If you get on a bus, they take your temperature, fever? off you go to a “fever clinic” to mix with all of the other sick people.

Throw in the pollution damage to lungs...

Shouting Thomas said...

Whole family in quarantine for 2 weeks. School shut down. No church services.

Grandkids are running around screaming and going crazy. Mommy home full time for 2 weeks! Carnival!

I'm going to play a lot of music and produce some video. Staying away from the gyms for a couple of weeks. Even my men's choir group is shutting down for the duration.

Maybe we all just need a good rest.

BleachBit-and-Hammers said...

We don't need to infect our hospitals with nasty viruses.
We should have a separate system and separate buildings. Emergency infectious disease centers.


the answer for the hack press is to inflate the panic and offer NO useful solutions other than - 'vote for Biden, he'll solve it.' Right after he enriches his family and the deep state actors who will have their hands up his butt.

tim in vermont said...

"There's a lot of waste in our medical system.”

“We don’t need 17 kinds of deodorant.” - Bernie Sanders

Howard said...

Math is hard for the Republican Barbies

Fernandistein said...

Everybody was kung flu fighting
Infections were fast as lightning
In fact it was a little bit frightening
Too bad they didn't fight with expert timing.

BleachBit-and-Hammers said...

I recommend watching "Marvelous" on BBC TV or Acorn TV.
An adorable and sweet little story starring Toby Jones.

Enjoy yourself... it's later than you think.

chuck said...

There's a lot of waste in our medical system.

Sort of like higher education in that regard.

Lurker21 said...

According to a survey a few years back, the states with the fewest hospital beds per capita were the three West Coast states (plus Colorado and Vermont), states where people may usually be thought to be healthier than elsewhere, and states that have been hard hit by Covid-19. The states with the most hospital beds per capita were Iowa, the Dakotas, DC and Florida.

Globally, the developing countries with the most hospital beds per capita were Japan and South Korea, both hard hit by the virus, followed by Russia, Germany, Austria, Hungary, the Czech Republic and Poland. The UK, Sweden, Canada and Mexico are further down the list than the US.

The Hospital beds per capita statistics seem to be correlated with an aging population, and countries with aging populations have been hard hit by the virus. Places with many hospital beds may be places where those hospital beds are usually occupied, so they may not have excess capacity waiting to be filled.

Of course the Post is scoring partisan points here, but the virus crisis does suggest that some of the anti-government, limited government, budget cutting rhetoric of recent decades may have gone too far. Services that appear to have no real value in good times may turn out to be essential if disaster strikes. I'm not saying it's a right versus left, Republican versus Democrat thing, but that politically active people ought to restrain the excesses of their own side and not get carried away by heated rhetoric.

Megthered said...

Honest question for those who keep saying this is all panic, hysteria, overreaction. What do you think is an appropriate course of action to contain the spread of infections?


I know far less than many on this board about the spread of disease, but my take on this is if it were going to spread like wildfire thru the US it would have been doing it right now. It seems like the flu, regular old flu unless you have other underlying conditions. Then it can be a superbug. But it doesn't seem to be mutating to attack healthy humans with any lethality. The best way to curb the panic is to turn off the news. Wash your hands and use basic hygiene. That to me is the most awful thing. That people have to be told to wash their hands and keep clean.

David Begley said...

Stampede.

BleachBit-and-Hammers said...

"we don't need 17 kinds of deodorant." Bernie said that?

What a dumb-shit. Yeah - so lets remove deodorant choices, close up the businesses who make deodorant and force them out of business. but first lets tax rape them before they go under so we can have One Universal choice is deodorant.

Good idea.

tim in vermont said...

I got a call from my PCP office that said “If you are sick, CALL US FIRST, don’t come in sick.” That seems reasonable to me.

Masscon said...

"Apparently they are smarter than our resident dumb monkey, but then again most people are. If you cannot see any purpose in looking at the last pandemic to mitigate the current one you should just shut your ignorant mouth."

Inga rant = Igna rant. She should trademark this. The 1918 Spanish flu is hardly the last pandemic and considering the progress made in medical care over the last century hardly one useful for comparisons

Fernandistein said...

What do you think is an appropriate course of action to contain the spread of infections?

Old and unhealthy people covers their asses and wait for vaccines/etc; everyone else goes about their business.

Temujin said...

Aunty Trump- the link to the MSNBC clip with the Health & Science expert from the Times talking about 'how they did it' in China did sound aspirational. This is the country that allowed this to escape from the BLS-4 lab (their only one) in which they were studying/developing(?) this virus. They are the country of origin for the SARS outbreak as well. They should be better at this. They've had more practice at it. That said, this has shown how woefully not ready we are as a country and as a people. The panic I've seen in stores and in people's faces is pretty astonishing and does not bode well for a complete, instant, and massive calamity.

There are things about the Chinese culture (total authoritarian rule) that can help them get control of their population. That will be much harder here. But I have to say, I am still waiting to see the spikes, aside from the Northwest (mainly Seattle and mainly in a senior home) and the Northeast. It is true that we do not have any testing at all, relatively speaking, so we can be sure there are thousands more who have this. I might have it. But even without testing, if people around you and I suddenly start to get very sick with fever and lung complications, we don't need a test to know what's going on.

I'm still waiting to hear about this sort of observable cluster spiking somewhere in the US. Or for that matter, around the world. Aside from China, Italy, and Iran- all countries that have economic ties together, this remains less deadly than the current flu. Worldwide. I'm all in on separating the population to slow down the spread. I'm wondering aloud- when does this expected spread happen? The next 2 weeks? The next 4 weeks. Are we on hold until June? At what point does someone poke their head up and say...'well, I think the worst has passed. Please return to the life you had before.'?

tcrosse said...

I am sure glad that my dad saved all those Montgomery Ward catalogs.

Finally a use for phone books. White pages only, please.

Stephen said...

Thanks for this post Professor Althouse.

I am interested in what folks here are actually doing, and what is happening in your communities.

Here in Alameda County, we have two confirmed community spread cases as of yesterday. There are about 400 cases confirmed statewide. The major employers, including UC and the big tech companies, are doing as much as possible remotely. Both colleges and schools have canceled all classes, though school age students can still get breakfast and lunch at school if they need it. My wife and I are 68. As of two days ago, we've gone to strict social distancing. Both of us are working remotely. We go out for walks, but we are not having people to our home or going to other people's homes. One of our children has offered to shop for us, and we have taken him up on it. I have a major medical appointment this coming week--we will do it by Zoom.

Our thinking is that this is in many ways the period of maximum risk and maximum opportunity. Maximum risk because the lack of testing means that the degree of spread both more pervasive than we know and impossible to track accurately. Maximum opportunity because if we jump on it now we can prevent or mitigate hospital overload and a lot of extra deaths, particularly among older populations and among health care workers. We see these risks very concretely, as both our mothers are in their mid 90's, and our son in law is an emergency room doctor in a working class community where many workers will not be able to afford social distancing.

We are hopeful that as testing improves over the next few weeks, we will feel comfortable easing away from these restrictions. But we are also aware that it could go differently, in which case everyone in our community will be ordered to do what we are doing now.

What is your experience?

Inga said...

I really have to wonder how so many here seem to be upset by any Covid 19 news or analysis. Do you think it would serve the populace better to not discuss it, to not report it, to downplay it so as not to scare the more sensitive among us? Do you not see any purpose in letting people know that there is something we can actually do to slow it down, to buy precious time to for our healthcare system to prepare for a possible influx of critical patients all in clusters?

Annie C above @8:25AM speaks about flattening the curve on the graph, she’s got it right. I have to wonder what is driving people who become angry at what is happening, or those who want to discuss it, as if it’s someone’s fault. It’s not the media’s fault, it’s not Trump’s fault, it’s an act of nature and nature can be a bitch. So how about the more sensitive here try to face reality, no one is trying to make this thing be worse than it is. Be grateful we have scientists who are working with this administration to mitigate the damage this virus can do to our society.

pacwest said...

This is simply a cost/benefit calculation.
What level of resources are we willing to divert from an alternate use in an effort to extend the lives of citizens who are already near their theoretical age limit.


Same thing can be said without the current pandemic. Old people use most of the medical resources. Why should that be a cost shared across generations?

BleachBit-and-Hammers said...

I watched a PBS documentary on the 1918 Spanish Flu (that they think started in Kansas) and wow was it frightening.
After all this time we still haven't conquered the common cold virus.

At some point mother nature wins.
all we can do is hoard TP.

If this virus is as deadly at the 1918 flu - we are screwed. I doubt it. But keep hope alive!

Milo Minderbinder said...

Perhaps it's time to discard the certificate-of-need process applicable in many states that requires a regulator's approval before a hospital may add beds and permits another hospital competitor to object to, delay and perhaps deny such applications.

Policy-makers need to be directly accountable to voters. But, policy-makers also need to accept that there's a big difference between good ideas and efficient implementation of those ideas. The private sector often can implement good policy far more rapidly and efficiently than the public sector given a reasonable incentive to do so. We have the government today we deserve after three decades of increasing, Chevron-doctrine-inspired bureaucracy.

Michael said...

Maybe fewer beds is because our hospital stays are shorter. When I was born, it was standard for a healthy mom/baby to spend 3-4 days in the hospital. Now it's 24 hours if that. Even with super-hygiene protocol, hospitals are still germ bazaars.

Question for Ann, when you have birth to John how long was your hospital stay?

tim in vermont said...

"he 1918 Spanish flu is hardly the last pandemic and considering the progress made in medical care over the last century hardly one useful for comparisons”

That’s ridiculous. Certainly there are differences, but the similarities are there, and we have case studies from the time where different cities tried different strategies. There is also the suggestion that many of the deaths may have been caused by giving so much aspirin to fight the fever that the patients developed bleeds.

I have a healthy respect for the limits of human reasoning powers, even the smartest among us can’t think of everything, and for that reason, we need to look at the past. If humans were that smart, we wouldn’t need to do experiments to prove theories, for example. It would be a waste of time because we would just know. Well, nature did an experiment on us in 1918, and it would be extremely foolish of us not to study that pandemic for clues.

Wince said...

But stop panic-buying toilet paper!

Where's Mr. Whipple when you need him?

Fernandistein said...

Colorado hospitals are making billions in profits while consumers pick up the tab, a new report from the state says.
...
"Despite money from the state to make up for funding shortfalls and increases in Medicaid payment rates, hospitals — not the providers — are making billions in profits while forcing patients to pay more, according to a report released Thursday by the Colorado Department of Health Care Policy and Financing."

My goofy doctor works out of a hospital and they're always trying to get me to come in for bogus te$t$.

Inga said...

“She should trademark this. The 1918 Spanish flu is hardly the last pandemic and considering the progress made in medical care over the last century hardly one useful for comparisons.”

It’s the last pandemic that affected the US in a big way. Do you think that scientists haven’t been looking at the Spanish flu to learn how deadly viruses spread in the population? Of course our medical technology has improved since then, that warrants a big fat DUH.

Howard said...

There's only one deodorant a man ever needs. Old spice. If your grandfather didn't use old spice you wouldn't even be here.

tds said...

"Currently, my biggest problem is trying to buy toilet paper, though. I don’t understand why people are buying all the toilet paper - now that’s something you can’t predict!"

Probably immigrants from the soviet block. Toilet paper experienced regular shortages there. Photo from Warsaw 1983.

tim in vermont said...

CONCLUSIONS: In the close contacts of COVID-19 patients, nearly half or even more of the 'asymptomatic infected individuals' reported in the active nucleic acid test screening might be false positives.

https://www.ncbi.nlm.nih.gov/m/pubmed/32133832/

Testing is not a silver bullet. If you mass test everybody, you get a massive number of false positives.

Bill, Republic of Texas said...

I'm actually ok with the quasi-quarantine. 2-4 weeks of limited contact shouldn't be a big problem. Many European countries basically shutdown in August for vacations.

So if all this slows the spread then the economical hit should be worth it.

But if 2-4 turns into 2-4 months, then we'll be very hard hit economically.

Beloved Commenter AReasonableMan said...

Temujin said...
The panic I've seen in stores and in people's faces is pretty astonishing


I haven't seen anything of this where I am. In fact people seem nicer than usual, making jokes, sharing information, or, where they can, offering help.

Ann Althouse said...

"They keep showing the graph, but it is stupid. The US healthcare system isn't beyond capacity. There are 1629 cases total in the US, of which 1362 are still under investigation. We have far more hospital beds than that, and for most people around the world, the preferred treatment is over the counter medication and home rest."

You should be more careful about what you call stupid!

Did you see the numbers I quoted? We have a lot fewer beds in proportion to the population than Italy has, and in Italy they are deciding who gets treatment and who is left to die. Outright triage.

Do you not understand what exponential growth is? "There are 1629 cases total in the US"... and then that doubles within X days. How long before there are a million cases if X is 4 days? If 2% of those infected need hospitalization, on what day do the need exceed the supply? (For the purposes of doing this math problem, you may assume that hospital beds are not needed for anything other than taking care of people with coronavirus.)

Ann Althouse said...

If you want the ICU number, this is in the linked article:

"And the United States has 46,800 to 64,000 medical intensive-care unit (ICU) beds, according to the AHA. (There are an additional 51,000 ICU beds specialized for cardiology, pediatrics, neonatal, burn patients and others.)"

tim in vermont said...

I think Trump should create a cabinet level position of “The Department of Stupid Shit” and we should move all of the people like those at the CDC trying to redefine sexual coercion as “telling promises that aren’t true” or other things having nothing to do with the original departments core mission to that department. The walls could be padded, and the grounds could be really nice and calming and suitable for peaceful strolls, and it should be surrounded by a high fence.

Shouting Thomas said...

To show you how our attitudes have changed toward age and death:

Do you remember when pneumonia was called "the old man's friend"?

I watched a TV documentary about the building of emergency medical helicopters. The dramatic rescue footage was of a +80 year old woman with heart failure being transported to a hospital to be kept alive on ventilators and heart assist machines.

I think at some point, we have to do triage.

tim in vermont said...

"If your grandfather didn't use old spice you wouldn't even be here.”

My grandfather was born in 1880 something and farmed behind a mule, so I think he used a more manly scent to turn on grandma.

Bill, Republic of Texas said...

Inga there were two other pandemics in the 20th century. Both came out of China. The 1957 and 1968 outbreaks. Those were less sever because modern medicine? Or luck?

Howard said...

I think in this case I would rather have the test be biased for false positive rather than false negative. It is what it is we have to use the tools that we have not wish for the tools we would want to have

Ann Althouse said...

"Question for Ann, when you have birth to John how long was your hospital stay?"

I had a C-section, so the question is inapplicable, but I remember that time (1981) as being when they were keen on turning new mothers out within 24 hours. I think some activism after that time led to somewhat longer stays.

tim in vermont said...

"They keep showing the graph, but it is stupid.”

It’s kind of funny to see people say “it’s stupid” when they really mean “I don’t understand it.” We see a lot of that here, but it’s a commentariat of the common man, so I guess that’s to be expected.

Howard said...

Everything will be fine until the water sewage and electricity quit flowing

Phil 314 said...

As someone who manages the process of care in hospitals its not about the number of beds but how you use them efficiently and only have people who need hospital level services in those beds. At this point we are far below the point of saturation of ICU beds and vents. We did approach that point briefly in AZ with the peak of the 2017 flu season.

The initial capacity concern would be ED’s flooded with worried well. The COVID testing facilities will mitigate that concern. I’m curious if the testing stations have a good call in/follow up system to direct those who are positive but not too sick to stay home.

Personally I’m struck by the distinct regionality of it all. By all rights AZ should have a lot more cases than it does. March is peak tourist season and typically lots of tourists from cold climates (i.e. state of Washington) come here. We have had many big events in the past two months that would bring in individuals with the virus (theoretically) but we haven’t seen a huge COVID case load. In fact after our very first case, someone at ASU who had just returned from Wuhan in late January, Maricopa County, a county of 4 million, has had only two cases. And as far as I know there have been no cases in AZ in individuals over 65.

tim in vermont said...

"I think at some point, we have to do triage.”

Obviously, but some are more eager to start the process than others, even gleeful, if you take Obama’s health care ethicist. I think he made an exception for people of “high utility” to society, which was a carve out for politicians and their wealthy donors. I was thinking of linking his paper from The Lancet, but honestly, it was so stupid it was embarrassing. We did a better job playing that game in high school social studies.

Michael K said...

Read most of the comments. Remdesivir is being tested for efficacy now. If it is as effective as in the first case, ICU beds are not going to be as impacted.

A lot of smaller hospitals have closed since Obama care devastated health care.

Testing is not going to solve this but is a good index to see how effective government medicine is.

A genetic engineered vaccine is a possibility.

Wilson, lour first Fascist president , contributed a lot to the Spanish flu epidemic by shipping US soldiers to Europe in the middle of it.

A lot of the 1918 flu deaths were from empyema, which was not understood until Evarts Graham's "Empyema Commission" figured out how to treat it.

The influenza pandemics of 1917 and 1918 caused 21 million deaths worldwide; in the United States alone, there were more than half a million deaths. The United States had just entered World War I, and in the crowded barracks of US military camps, influenza took a heavy toll. Soldiers with influenza frequently developed bacterial pneumonia caused by what was then termed “hemolytic streptococci”—what we now know as group A streptococci. One striking feature of hemolytic streptococcal pneumonia was the rapid, almost concurrent development of a hemorrhagic pleural effusion progressing to empyema; when this complication occurred, the mortality rate was very high [1–8]. According to Edward Churchill [9], “The streptococcal pneumonia and empyema which accompanied the influenza epidemic was a new disease....Early evacuation was a dogma of surgery of the period....The operation was rib resection with open tube drainage. Death occurred quite frequently about half an hour after the operation”

Phil 314 said...

My wife just reminded me of the initial concern around Legionnaire’s disease when it first appeared. I recall the deep fear medical personnel had about contact with HIV positive patients in the ‘80’s and early ‘90’s.

Bill, Republic of Texas said...

Italy always limits medical treatment based on age and health (but not wealth). We have a friend who lives in Milan. He's 68 and had a couple heart attacks in the past 15 years.

Last year he was diagnosed with throat cancer. His doctor told him he was not eligible for treatment because of his age and past medical issues. Of course he was devastated.

But in true Italian and socialized medicine tradition, he just paid a government official 10,000 euros and he got started on his treatments right away.

tim in vermont said...

"By all rights AZ should have a lot more cases than it does. March is peak tourist season and typically lots of tourists from cold climates”

Boston and New York, where there are a lot of cases, practically have shuttle flights to Europe, not to mention thousands of Chinese students who went home for Chinese New Year. The Pacific Coast is similarly coupled with China.

CStanley said...

Do you not understand what exponential growth is? "There are 1629 cases total in the US"...

Of course this comment or also understated, the current number is over 2400, up by around 500 new cases yesterday.
https://www.worldometers.info/coronavirus/country/us/

Josephbleau said...

“Same thing can be said without the current pandemic. Old people use most of the medical resources. Why should that be a cost shared across generations?“

Making young people pay a lot to cover the old folks was the basis of Obamacare, thus the penalty for not buying it. Obama was a saint and genius so you can’t question the morality of generational cost transfers, specifically in health care. Old people pay for schools for kids though.

Josephbleau said...

“Same thing can be said without the current pandemic. Old people use most of the medical resources. Why should that be a cost shared across generations?“

Making young people pay a lot to cover the old folks was the basis of Obamacare, thus the penalty for not buying it. Obama was a saint and genius so you can’t question the morality of generational cost transfers, specifically in health care. Old people pay for schools for kids though.

tim in vermont said...

"he just paid a government official 10,000 euros and he got started on his treatments right away.”

I heard a similar story from a Canadian I met, not as bad as not treating cancer, but a problem of getting her “free” health care in a timely manner by offering a “donation.”


"Old people use most of the medical resources.”

Should have aborted you while we had the chance.

Ken B said...

Annie C
Good for you.exactly what some of us have been saying here. However the some includes Inga and Farmer so a few of the Trumpkins dug in their heels. Notably one of the most vocal Trumpkins, Michael K, did not. Read his comments, they are sober and informative.
It is certainly true the the media is indulging in orange man bad exultations over covid, but that is no excuse for reciprocating stupidity.

CStanley said...

Personally I’m struck by the distinct regionality of it all. By all rights AZ should have a lot more cases than it does.

People talk about seasonality based on temperature but I wonder about humidity. Covid-19 seems to be spreading pretty rapidly in GA where we’ve had a record wet winter.

tim in vermont said...

Denial is psychologically comforting. Kind of like the rabbits and the snares in Watership Downs.

CStanley said...

Ken B +1

It’s like politics have rotted people’s brains out.

Ken B said...

“But it is stupid”

No, actually it presents the key issue very well. You would know this if you were a data person.

Fernandistein said...

Now with working link...

"Colorado hospital profits are skyrocketing, new state report says"

CStanley said...

Of course I also think some cities are ahead of others because of busy international airports, which brought in the first cases.

Beloved Commenter AReasonableMan said...

Howard said...
Everything will be fine until the water sewage and electricity quit flowing


Now that I have my plague breadmaker my only concern is water. I have a generator and nearly 100 gallons of fuel in the fuel tank of our boat that I can siphon but I need water to make bread. I can live on bread and water indefinitely. We have plenty of flour. We have a septic system and I can always take a dump on the neighbors lawn if that fails.

gilbar said...

J. Farmer asked...
Honest question for those who keep saying this is all panic, hysteria, overreaction. What do you think is an appropriate course of action to contain the spread of infections?


we need to find a way, to inoculate the entire country with the virus
the people that are dying, are not just old; they are old and weak
Those people are just a drag on our society; it's NOT like they are still paying into social security. Already, MOST of our healthcare costs are going to the old and weak

EVERYONE SAYS that
a) the world is over populated
b) health care costs are too high
c) old people are BORING

This covfefe-19 virus isn't a pandemic; it's a panacea

The Minnow Wrangler said...

We have more ICU beds per capita in the US than any other country.

We also have home health and hospice services that can provide oxygen machines and hospital beds, along with lots of other medical supplies. I don't know how that supply compares with other countries. But if patients only require supportive oxygen therapy, as opposed to ventilators, it's probably best to care for patients at home, assuming they don't live alone.

Italy has the oldest on average population in Europe which is certainly contributing to their rates of critical illness and death.

tim in vermont said...

"It’s like politics have rotted people’s brains out.”

That’s why my respect for Inga has gone up.

Inga said...

“People talk about seasonality based on temperature but I wonder about humidity. Covid-19 seems to be spreading pretty rapidly in GA where we’ve had a record wet winter.”

I was wondering about UV rays and heat slowing the spread, but in Qatar they are having a surge of cases. Hot and dry. Someone mentioned air conditioning in these hot climates, so the weather may not do much or slow the spread.

CStanley said...

It’s hard to know how to interpret the data with regard to beds, ventilators, and ICU beds. Are the non ICU beds really useful? I would think not, but maybe there is a group of patients who need lower levels of care and can get it in a non ICU setting. I do think GatorNavy is incorrect about “multiple modes” of ventilation because I’ve read that other assisted ventilation methods can’t be used with communicable diseases because there’s too much spread of the virus. I think the ventilator number really is the limiting factor.

And as much as I like stlcdr’s patriotic spirit, I don’t really get it. Are we supposed to start building ventilators in our garages?

Inga said...

“Now that I have my plague breadmaker my only concern is water. I have a generator and nearly 100 gallons of fuel in the fuel tank of our boat that I can siphon but I need water to make bread. I can live on bread and water indefinitely. We have plenty of flour. We have a septic system and I can always take a dump on the neighbors lawn if that fails.”

Stock up on beer. It makes the best bread.

tim in vermont said...

You can spot the preppers, because they are walking around either with erections, or wet spots on their pants.

Inga said...

“Are the non ICU beds really useful? I would think not, but maybe there is a group of patients who need lower levels of care and can get it in a non ICU setting. I do think GatorNavy is incorrect about “multiple modes” of ventilation because I’ve read that other assisted ventilation methods can’t be used with communicable diseases because there’s too much spread of the virus. I think the ventilator number really is the limiting factor.”

I read somewhere, can’t recall where, I’ve been reading so much about it, anyway I read they were using Cpap machines in airway management. Maybe those patients could be put in non ICU beds as they would be less critical?

Ambrose said...

We had plenty of beds under Obama and then Trump sold them off to finance tax cuts for the rich, or something...

Beloved Commenter AReasonableMan said...

Inga said...
Stock up on beer. It makes the best bread.


Corona beer has been on sale for a while now, but so far no one's buying.

gilbar said...

according to the WHO situation report from 3/13 (the most current one)

Qatar has 262 TOTAL cases, of which 000 are NEW cases all of which are Imported cases only

Igna, are you Truly Ignorant, or are you a liar?


Inga said...

“Staffing
Staff shortages may be the primary challenge to implementing surge capacity plans during an epidemic. Staff may be furloughed due to unprotected exposures or illness. COVID-19 has sickened many health care workers, although it is unclear how many of these were personal protective equipment (PPE) device failures versus failure to use PPE for patients with mild or atypical symptoms [20].
Key issues to address are:

Child care provision – noting that in-home day care or small group care may have to be arranged as congregate child care at the hospital may not be well accepted with a virus that may be transmitted during prodromal/asymptomatic periods. School closures are proposed as a social distancing mechanism but may impact the ability of staff to work. Pet care may also be needed.

Staff safety – comfort with the PPE provided and the care techniques practiced [16].

Housing – providers at risk of nosocomial acquisition of infection may request alternate housing to avoid exposing family members – on and off-campus options may be needed.

Information – staff must be informed about contingency and crisis practices being implemented and the reasons for these decisions.
Shift type/length – shifts should be balanced to avoid fatigue and burnout over the weeks or months of an epidemic yet ensure appropriate staffing.

Support, information, and training – Medical assistants, environmental services, transporters, and others may have equal or greater need compared to physicians, advanced practice providers, and nursing staff.”

I ran across this looking for more info on using cpaps for Covid patients. I’m glad I’m retired, I think this pandemic is going to give healthcare workers PTSD.

AllenS said...

Howard said...
I am sure glad that my dad saved all those Montgomery Ward catalogs. I'm guessing about 10% of you will get that

Me, Howard, I get it, however, I'd also like to say that Sears catalogs, also were available.

One question, Howard, did it have one hole or two?

Curious George said...

"Inga said...
“If we were struck with a severe pandemic like the 1918 Spanish flu..."

“So these Wapo "journalists" are no smarter then our resident dullard.”

Apparently they are smarter than our resident dumb monkey, but then again most people are. If you cannot see any purpose in looking at the last pandemic to mitigate the current one you should just shut your ignorant mouth."

Few things:

1) The Spanish Flu was not the last pandemic. The main reason it was so deadly was because it was in 1918. Lessons have already been learned. COVID-9 won't be like the Spanish Flu because we have gone through the Spanish flue.

2) These idiots, like you, are not scientists (Thank you baby Jesus!) You all are not looking at it to mitigate anything. Bringing it up is just to cause panic. And in some cases to make Trump look bad.

3) It's funny that you actually self identify as our resident dullard.

Phidippus said...

When my wife was in nursing school at the Hospital of the University of Pennsylvania, she had occasion once to visit one of the basement levels. There were stored dozens and dozens of "iron lungs", early negative pressure ventilators that were developed during the polio epidemics of the 40' and 50's. They were keeping them "just in case".

That was in the late '70s. If they still have them now, they're probably glad that they do.

Fernandistein said...

I'm getting the impression that susceptibility has a genetic component, e.g.

""Up until recently, no probable SARS patients were reported among Taiwan indigenous peoples who are genetically distinct from the Taiwanese general population, have no HLA-B* 4601 and have high frequency of HLA-B* 1301."

...because there have been so few cases in the poor and crowded areas of India and Africa, and the few cases in Africa have been Europeans or Asians when they're ID'd (most are not, though). Of course, that could be due to 3rd-world standards of recording and reporting.

tim in vermont said...

"however, I'd also like to say that Sears catalogs, also were available.”

Certain pages of my Sears catalog are stuck together, for some reason.

tim in vermont said...

"Corona beer has been on sale for a while now, but so far no one's buying.”

Now that tick season is here in the northeast, you can enjoy your Corona with Lyme free of charge. Ba dump bump.

tim in vermont said...

It seems like once we get a bunch of people who have survived it, they could be put to work caring for the people who have it, if the situation truly gets desperate.

Inga said...

“according to the WHO situation report from 3/13 (the most current one)

Qatar has 262 TOTAL cases, of which 000 are NEW cases all of which are Imported cases only

Igna, are you Truly Ignorant, or are you a liar“

Timeline
Total Cases Active Cases Deaths Total Recovered Total Discharged from Quarantine
337 337 0 0 121
On 11 March 2020, Ministry of Public Health (MOPH) of Qatar, announced that there were 238 new cases of confirmed coronavirus in a single day, bringing the country's total to 262.[1]

On 13 March 2020, Ministry of Public Health (MOPH) of Qatar, announced that there were 58 new confirmed cases of coronavirus 2019 (COVID-19), bringing total to 320.

On 14 March 2020, Ministry of Public Health (MOPH) of Qatar, announced that there were 17 new confirmed cases of coronavirus 2019 (COVID-19), total now 337.

As of 13th March 2020 Qatar has the world's 9th highest per capita rate of positive Coronavirus cases in the world at 111.1 cases per million people (1.6x times the rate of China)[2]

rcocean said...

Who produces the ventilators? It doesn't seem like a high tech industry.

Fernandistein said...

I'm guessing about 10% of you will get that

I don't "get it" because it's not funny, but I am glad that my grandparents saved all those old corn cobs. The touristas think Indians made those funky pipes.

toilet paper - now that’s something you can’t predict!

Maybe not: look at what the hoarders and wreckers hoarded in Venezuela:

"Over 3800 rolls of toilet paper, 440 litres of powdered milk and 1560 litres of long-life liquid milk were taken by order of the Public Prosecutor for being allegedly hidden in a warehouse of the Don Biagio Mini Market and Super Express, located in Maracaibo, Zulia state."

exhelodrvr1 said...

Smoking and air pollution - South Korea, Italy, China, Iran all have high rates of both of those

tim in vermont said...

This issue is a real IQ sorter. Like most other life and death issues, BTW.

exhelodrvr1 said...

Smoking and air pollution. Countries hardest hit have high rates of both

Francisco D said...

Farmer wrote: Honest question for those who keep saying this is all panic, hysteria, overreaction. What do you think is an appropriate course of action to contain the spread of infections?

After this is all over, people will be blamed for overreacting and under reacting. If it is as severe as feared, the under reactors will get most of the heat. If not, the overreactors will be ridiculed.

We have limited understanding of the appropriate course of action. I cannot blame people for trying different actions and risking ridicule.

People want to do something, so they buy up all the toilet paper and disinfectant. The latter makes sense, but the former is a way of taking easy action in order to do something .

Mark said...

Here in the D.C. area, we have had two or three hospitals close in recent years for lack of business.

One of them is less than two miles from where I live. Another is about a mile from where I work (or, at least, where I used to work, given that we are now working from home for the next week or two).

We have some urgent care facilities, but most of them cannot handle anything beyond something you could probably DIY.

Bruce Hayden said...

Blogger stlcdr said...
“Currently, my biggest problem is trying to buy toilet paper, though. I don’t understand why people are buying all the toilet paper - now that’s something you can’t predict!”

Was at Sam’s Club yesterday, and they had a whole row out on the floor for TP, and it was mostly sold out. Dozens of shopping carts piled high with TP. We are talking the mega packages, so the average TP load in a cart was maybe 3x1 50 rolls (equivalent to 150 normal rolls) I’d they had any. Or they had the boxes of generic house brand. It was quite the sight. And then every cashier line station at the store had a long line, including the six self scan lines, and it looked like half the people had their carts full of TP. Little bulk food though, and they still seemed well stocked with gloves. Probably over half Hispanic, esp with the TP. It was weird. Luckily for me, I have a Business membership, and can go back next week some day early and pick up what we need - which isn’t TP.

Lucien said...

Michael K: I had understood that one reason the Great Influenza killed so many younger people was that a virulent immune response produced too much fluid for the lungs to handle. Is that different from, or connected with empteyema?

narciso said...

we know the one steven scalise was in, was so bad it nearly killed him, in the way the bullet did not,

Mark said...

Re: using hand sanitizer

Then there is this --

Federal health officials are calling on GoJo, the maker of Purell products, to stop making claims that its hand sanitizer is effective at eliminating diseases.

In a letter, the Food and Drug Administration called out the company for posting several claims across Purell website pages and its social media platforms that the over-the-counter hand sanitizers could reduce the risk of illnesses including Ebola, norovirus, influenza and Methicillin-resistant Staphylococcus aureus (MRSA), which is an infection is caused by a type of staph bacteria.

"We are not aware of evidence demonstrating that the Purell Healthcare Advanced Hand Sanitizer products as formulated and labeled are generally recognized by qualified experts as safe and effective for use under the conditions suggested, recommended, or prescribed in their labeling," the letter stated.

Enlighten-NewJersey said...

The first two people in New Jersey with the Coronavirus were in their early 30s and had no underlying medical conditions. Both had to be hospitalized and placed on ventilators. The first death in my state from the virus was 69. Would the first two patients have bird without being placed on the ventilators, I don’t know.

CStanley said...

Blogger Michael K said...
Read most of the comments. Remdesivir is being tested for efficacy now. If it is as effective as in the first case, ICU beds are not going to be as impacted.


Even if it works and can be fast tracked though, if I understand correctly it requires 10- 20 IV doses. I suppose if people aren’t too critically ill (and I think it has to be given before things progress to far anyway) maybe home healthcare nurses can administer the treatments.

Skookum John said...

Levi Starks makes a great point: This is simply a cost/benefit calculation.
What level of resources are we willing to divert from an alternate use in an effort to extend the lives of citizens who are already near their theoretical age limit.


We need to think long and hard about that blue line on the graph. It has a comfortingly low maximum on the Y axis, which is probably wishful thinking anyway, but a mighty long tail on the X axis. Hidden in the length of that tail are months of disruption to the economy, bankruptcies of many small businesses, millions of job losses, lost educational opportunities for our kids, savage cuts to everyone’s retirement savings, and worst of all, no baseball season. Is it worth it to save perhaps 20% of our 80+ population, 10% of whom die every year anyway? My mom is in her mid 80’s and she says no. She has made it clear she will not take a ventilator away from someone in the younger age cohorts who might need it. She is self isolating at home and my daughter is looking after her. If she gets the virus, she will stay at home and take her chances.

tim in vermont said...

I don’t think that I have ever been so disgusted as I was. just now at Schumer’s press conference about the new bill, which began “Despite Donald Trump...” Schumer was misusing impeachment to attempt to remove Trump from office for the “crime” of asking about possible corruption and foreign election interference out of Ukraine when this virus first came to the attention of the CDC, and was demanding that more and more investigations be started to try to find evidence of any conceivable possible “crime” by Trump as the virus progressed in its march, now he is complaining that the administration lost time.

Michael K said...

Lucien said...
Michael K: I had understood that one reason the Great Influenza killed so many younger people was that a virulent immune response produced too much fluid for the lungs to handle. Is that different from, or connected with empteyema?


I think the reason the young were affected more was that a similar flu had come through and immunized older people. I have not had a cold in years,

Empyema is infected fluid between the lung and chest wall. It was recognized by Hippocrates. He also made the crucial observation. Staph empyema causes a thick empyema fluid that causes the lung to adhere to the chest wall. It is safe to drain these by open incision between the ribs. The lung does not collapse.

Strep empyema causes a thin bloody fluid to collect and the lung does NOT adhere to the chest wall. If strep empyema is drained by open incision, the lung collapses. It becomes a "sucking chest wound."

Hippocrates observed that if the empyema fluid was thin and bloody, the patient died.

Most of the flu empyema cases in 1918 were strep. This is what the Empyema Commission figured out. Lung physiology then was understood and thoracic surgery followed. Now, if a tube is inserted into the chest cavity to drain empyema or to release a pneumothorax, it is connected to water seal, which keeps the air from going in. The lung does not collapse.

At the Mass General in 1965, lots of nurses still did not understand this and they would empty water seal bottles. Now plastic drain collectors are mostly used. They can't empty them completely.

Narayanan said...

I vaguely remember HillaryCare wanted to reduce number of doctors and many other assignments

narciso said...

they only count that variable, not others, only certain assumptions are in play,

Bob said...

Enlighten-NewJersey, please explain this sentence:

"Would the first two patients have bird without being placed on the ventilators..."

What does "have bird" mean? Or is it a typo? Thanks.

Michael K said...

if I understand correctly it requires 10- 20 IV doses.

You may be correct but I don't think so. The NEJM report does not mention more than one dose.

Treatment with intravenous remdesivir (a novel nucleotide analogue prodrug in development10,11) was initiated on the evening of day 7, and no adverse events were observed in association with the infusion. Vancomycin was discontinued on the evening of day 7, and cefepime was discontinued on the following day, after serial negative procalcitonin levels and negative nasal PCR testing for methicillin-resistant Staphylococcus aureus.

On hospital day 8 (illness day 12), the patient’s clinical condition improved. Supplemental oxygen was discontinued, and his oxygen saturation values improved to 94 to 96% while he was breathing ambient air. The previous bilateral lower-lobe rales were no longer present.


It says "the infusion." That may be interpreted either way, one dose or more than one but I doubt 20.

tim in vermont said...

We need to be pushing that blue line up at possibly great expense, even if it’s easier and cheaper to just give old people morphine, because those old people have children and grandchildren. It’s not “simply” a cost benefit question. My mother is 92, and on oxygen a couple hours a day. She would take the morphine, but when she was 82? She was a vital part of our family.

Bob said...

Regarding U.S. beds per capita, I think a better metric would be beds per capita in concentrated urban areas (there's a government or sociological term for this I can't recall). Doesn't it make sense we're more likely to see serious cases there than in the less populous areas?

BleachBit-and-Hammers said...

Fern @ 9:31

Read thru you link and it's more promotion for a "public option" - as if a "public option" will solve all of our problems.
I'm convinced it will not.
We already have boat loads of public options. That's what medicare is - a public option.
the dems finally realized they can use words to fish it all in. "transparency" is their buzzword. but that's all it is to them, a buzzword. It actually goes against what they really want - which is less transparency and more government. We never get transparency, after decades of this fight, and we should. Prices for medical procedures should be there for all to see, just like every other area of life. We don't say OK to the auto-repair shop until we know the price.
We need price tags, transparency and a public option for those who need it. Medicare.

Marc said...

Honest question for those who keep saying this is all panic, hysteria, overreaction.

I don't imagine, judging by what I read in the comments here, that anyone is arguing "all" of any of that. But that there is some of it is inarguable, and that some of that is motivated by partisan politicking seems also inarguable. Myself, I appreciate the several different perspectives etc displayed here, particularly since my own social life is fairly circumscribed.

Enlighten-NewJersey said...

Yes, it was a typo. The word is died. Must have been an odd autocorrect.

Yancey Ward said...

Geez- "beds" isn't the right metric in this case. Beds are the easy part- you can put a hundred beds in a large hall and call them hospital beds. How many ventilators does Italy, China, and South Korea have per 1000 people?

Bob said...

Bleach Bit & Hammers,

To call Medicare a "public option" might be a stretch even if technically correct. You get cost-penalized if you don't sign up timely. And the penalty is permanent.

https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-late-enrollment-penalty

I otherwise agree with your comments on transparency.

Michael K said...

concentrated urban areas (there's a government or sociological term for this I can't recall).<

One I know is "MSA" or Metropolitan Statistical Area, used in outcomes research among other things,

West Texas Intermediate Crude said...

One thing I'm convinced of is that nobody knows anything- all we are doing is informed conjecture.
Question for the crowd: why are we not seeing high rates of infection and death among the hundreds (?thousands) of homeless folks in west coast cities? Homeless people as a group have horrible hygiene, lots of smoking and drug use, poor underlying mental and physical health, and exposure to the elements. They live in tents at best, and are exposed to all kinds of people. They are subject to more than typical supervision by SJWs who would be likely to publicize the impact of this emergency on a vulnerable group.
The relative lack of news about this topic, plus the run on TP, make me lean toward this being a function more of the madness of crowds than a real national emergency.

Howard said...

Homeless don't mix much with international travelers, Dipshit. Their filthy animal smell is their quarenteen.

Birkel said...

Panic is a bad look on anybody.

Narayanan said...

Would it be more effective to disinfect with UV?

Are there such special lights for portable daily use?

Is there app for that?

Kevin said...

No one could have seen this coming.

Certainly not the CDC who were focused on the epidemic of gun violence.

Openidname said...

FWIW, I'm hearing that ventilators don't work for this coronavirus:

https://twitter.com/AbraarKaran/status/1238284994117881857

Maybe because ventilators don;t work when there's fluid in your lungs?

Openidname said...

FWIW, I'm hearing that ventilators don't work for this coronavirus:

https://twitter.com/AbraarKaran/status/1238284994117881857

Maybe because ventilators don;t work when there's fluid in your lungs?

Mark said...

My stepmother survived MRSA in the lungs.

But it did significantly damage/ravage them. She recovered, but died a couple years later when she got something and the lungs just couldn't handle it.

Mark said...

My stepmother survived MRSA in the lungs.

But it did significantly damage/ravage them. She recovered, but died a couple years later when she got something and the lungs just couldn't handle it.

Enlighten-NewJersey said...

Sorry Bob, the word was supposed to be died.

Mark said...

My stepmother survived MRSA in the lungs.

But it did significantly damage/ravage them. She recovered, but died a couple years later when she got something and the lungs just couldn't handle it.

Guildofcannonballs said...

This is a link showing what is truly making the panicers panic: Rachel Jeantel was right all along. About everything.

Michael Corleone knew, "it's the way of nature" he said. Wasn't too controversial when a white man said it. But when a black women says the same thing, Whoa Nelly!

elkh1 said...

Should we check the number of beds per thousand in each area?
Seems NYT needs more beds, Alaska not as many. The beds in Alaska can't help New Yorkers.

I suggest remodel unused shipping containers into isolation wards, one bed in each ward.

I believe the problem is we don't have enough medical personnel.

narciso said...

yes, that's what they leave out, because Obamacare was supposed to solve that,

Bob said...

Michael K,

"One I know is "MSA" or Metropolitan Statistical Area, used in outcomes research among other things,"

Thanks, that sounds familiar.


Enlighten-NewJersey,

Thanks. I read both your comments on this and appreciate the clarification.

Rosalyn C. said...

I had been reading about the 1918 flu and noticed an article about the different responses in public policy between Philadelphia and St. Louis. St. Louis shut everything down faster (social distancing) and had less than half per capita flu-related deaths. A chart of the 1918 Spanish flu shows why social distancing works

Odd coincidence, my mother was born about a week before the outbreak in Philadelphia. Close call.

Bruce Hayden said...

Blogger West Texas Intermediate Crude said...
“One thing I'm convinced of is that nobody knows anything- all we are doing is informed conjecture.
Question for the crowd: why are we not seeing high rates of infection and death among the hundreds (?thousands) of homeless folks in west coast cities? Homeless people as a group have horrible hygiene, lots of smoking and drug use, poor underlying mental and physical health, and exposure to the elements. They live in tents at best, and are exposed to all kinds of people. They are subject to more than typical supervision by SJWs who would be likely to publicize the impact of this emergency on a vulnerable group.”

My (lay) theory is that the virus is just now entering the general population. That probably means that when it does, the homeless population will be affected disproportionately. How do you quarantine them? Very hard, unless you do it enforce they start showing symptoms, and by then, it will be too late. I ultimately expect a high infection rate, as they transmit it to each other, and a high fatality rate, due to compromised lungs and immune systems.

CStanley said...

@Michael K
Here’s what the NIH study protocol says:
Experimental: Remdesivir
200 mg of Remdesivir administered intravenously on Day 1, followed by a 100 mg once-daily maintenance dose of Remdesivir for the duration of the hospitalization up to a 10 days total course. n=197.

So I guess it could be less but up to 10 days. I think a previous source I read talked about some of the MERS protocols were going as long as 20 days.

FullMoon said...

Homeless don't mix much with international travelers, Dipshit. Their filthy animal smell is their quarenteen.

That's right, no tourists in San Francisco or Los Angeles.

FullMoon said...

I have seen mention of the 1957 pandemic. First I had heard of it. Suppose many commenters here were children then.

pacwest said...

Not sure if this came up in previous comments, but that graph is pretty useless without numbers. The time length could be years or decades. Sheltering for a few years doesn't sound resonable.

Yancey Ward said...

I wonder how much remdesivir can actually be produced at this point in time? A regimen is about 1.2 grams/patient, or a 1.2 kilos/1000 patients, and 1.2 metric tons/million. I went through the synthesis of the drug as reported in Wikipedia- not an easy or short synthetic method, and requires a large-scale HPLC purification near the end, followed by a chiral resolution at the very end. I doubt there is more than 10 kilos extant at this point in time.

Achilles said...

J. Farmer said...
Honest question for those who keep saying this is all panic, hysteria, overreaction. What do you think is an appropriate course of action to contain the spread of infections?

Assess vulnerable populations and isolate them.

Then do what we do for the flu which is killing orders of magnitude more people.

Rosalyn C. said...

I just checked that link I had posted and it went back to althouse. Don't know why. Here's the URL: https://qz.com/1816060/a-chart-of-the-1918-spanish-flu-shows-why-social-distancing-works/

Yancey Ward said...

Now, it isn't clear whether or not the reported method is the one the medchemists developed to get their hands on the first quantities. The process chemists may have greatly improved it, and this method is protected in Gilead's trade secrets, or can be found in a process patent.

Mike (MJB Wolf) said...

Without reading the first 100 or so comments I’ll start with I LOVE THIS GRAPH!

The area under the curve doesn’t change, meaning the number if people who get the virus remains unchanged, and only the amount of time we extend it flattens the curve.

daskol said...

I don’t think that I have ever been so disgusted as I was. just now at Schumer’s press conference

Wait until his next one. Greasiest, slimiest oiliest pol around.

n.n said...

Beds are not a useful metric for treating a contagion, unless they can be physically, not merely socially, isolated. Immunity will not prevent infection, or spread, but may mitigate symptoms, and preserve viability. Planned Parent is Gaia's Choice, but there are anthropogenic forcings, and steps to mitigate its progress.

Mike (MJB Wolf) said...

Two counter-panic thoughts to help Althouse see this outbreak in perspective:

1. Results in South Korea show that 96% of people who are POSITIVE for virus antibodies are 100% asymptomatic.
2. Actions so far and taken now are SLOWING THE RATE of infection, in effect reducing the slope of the left half of the graph, allowing us to avoid the steep slope that overwhelms the system. We are spreading the effects out over time with social distancing and the more people are tested the lower the panic level will be.

Howard said...

I wasn't even an itch in 1957

FullMoon said...

Well, at least Drudge Report is staying calm and not contributing to panic..

TEMP CHECKS BEGIN AT WHITE HOUSE...
Journalist With Fever Denied Access...
TRAVEL BAN EXPANDS...
CDC NIGHTMARE SCENARIO: 1.7 MILLION DEATHS...
Hospitals brace for 'tremendous strain'...
Six patients for every bed?
'I Could Easily Kill Them': Terrified Doctors Sound Alarm...
Survivors may suffer reduced lung function...
TRUMP: 'I don't take responsibility at all'...
S&P 500 Had Choppiest Week Since Hoover Was President...
Countries Curb Short Selling...
Mnuchin vows to keep markets open...
APPLE closes all stores outside China...
National Guard activated...
Robberies by suspects wearing medical masks in multiple states...
When will there be vaccine -- and who will get it first?
Companies that feed America brace for labor shortages amid worry about restocking stores...

Brawls break out at stores across country as customers dash for supplies...

Lines to get into supermarkets extend for blocks...

NOONAN: 'Don't Panic' Is Rotten Advice...

Virus Can last a few days on surfaces...

Children less sick from COVID-19, but still spread...

Newborn baby becomes world's youngest victim...
Italians singing from windows to boost morale...

Health workers on edge of exhaustion...

Struggling Europeans tighten measures...

The new epicenter...

Spain imposes lockdown of entire country...
The Internet Can't Save Us From Loneliness in Pandemic...

Hackers find new target as Americans work from home... Coronavirus Will Change How We Shop, Travel and Work for Years...

One-Percenters Keep Calm With $4,995 Go-Bag...

Mexico frets about U.S. spread, could restrict border...

Mike (MJB Wolf) said...

And since I thoroughly botched the example I used and derailed the discussion of exponential growth, I’d love to help calm the herd by showing WHY this graph and what we are all doing now is trending us toward the good one and away from the bad one. We will have an outcome ten times better than Italy and the UK because we acted earlier and have a much more robust and adaptable medical system backed by private sector assets that will really help flatten the curve. Even my idiot governor has recognized the availability of travel industry assets (hotels buses etc) that can be called to action, further extending our triage options.

West Texas Intermediate Crude said...

Full Moon- yes, I thought it was common knowledge that there has always been a lot of traffic between China and the major cities on the west coast, but I overestimated Howard. Thanks for clarifying.
Bruce H- that's what I'm referring to when I said that nobody knows anything for sure. Your theory that the virus hasn't entered the general population is as good as any, but without mass screening, we have no data. We'll probably have a high death rate like Italy in our exposed subpopulations that are smokers, older, and live in polluted areas with poor access to health care, but that is a very small segment of the American population. The homeless should be the canary in the mine, but so far they are still singing. It would be great if we could trust the data coming out from China, but they haven't proved themselves trustworthy to this point.

tim in vermont said...

"but without mass screening, we have no data. “

If we mass screen a population that doesn’t have it, with the high rate of false positives the test gives, it’s going to make matters worse. We will create a phantom population of “carriers” where there is no disease.

bagoh20 said...

We currently have 2300 cases in the U.S. up 500 from yesterday. At 1.3 beds/1000, that's 416,000 beds. The number of cases in China is now dropping. I think we are OK. It seems to be reasonably well controlled here, otherwise, by now we would have many thousands more cases increasing by thousands every day. I'm not an expert, but who really is expert enough to tell us the future of this any better than some asshole in Vegas like me, so you can take that to the bank.

Put my prediction on the hard disk, and we'll compare with the "experts" after this is over.

bagoh20 said...

Around Christmas time in 1957, I was an orgasm, and it's been downhill ever since.

tim in vermont said...

"The number of cases in China is now dropping.”

OR.... Or they have the tiger by the tail and the moment they release the kinds of controls that only a police state can maintain, it all goes pear shaped again.

Nobody knows, but the British approach seems more reasonable. Protect the elderly and compromised, and live your life as best you can.

BUMBLE BEE said...

Mexico frets because they get $20 billion in U.S. dollars in wire transfers annually. Second largest source of their national income.

BUMBLE BEE said...

It's life on the Serengetti. Let's see how many of the what, 26 million illegals, in our country show up in emergency rooms nationwide. Good reasons for them to dodge the census. Remember that racist tool, the census??

BUMBLE BEE said...

There's was reason for the .455 Webly in each lifeboat, you know.

CStanley said...

high rate of false positives

Where is the idea of false positives coming from? Generally PcR tests are very specific (low false positives rate) but can have low sensitivity (high number of false negatives.)

Does someone have a source sayang it’s otherwise for the Covid-19 tests being used? When I try googling I’m seeing evidence of the false negatives or at least concern about that. They’ve looked at correlation between CT chest scans and positive PCR tests, for instance, and they think they are seeing positive cases based on the signs on the scans in patients who tested negative.

West Texas Intermediate Crude said...

Aunty T, you're right- one of the things that we don't know is the sensitivity and specificity of the test, and then Bayes' Theorem comes into play. Where we are right now is absurd, though- e.g., that hostile question from that reporter at PDJT's presser yesterday that demanded that he get checked and quarantine himself because he (PJDT) was standing near someone from Brazil who later tested positive. We have no way to determine if that level of response is necessary, but the reporter said that one of the docs had recommended such paranoia; I haven't seen any reports of the virus jumping from one person to another.

Ralph L said...

If there's going to be mass-temperature-taking, learn your normal.
I didn't realize until a few years ago that mine is 97.5 (it was 96.5 on the one I was using at home, 97.5 everywhere else). When I felt hot and ill as a kid, my mother would measure 99 and tell me I was fine. Now I know I wasn't goldbricking.

CStanley said...

I haven't seen any reports of the virus jumping from one person to another.

Huh? So how do you suppose that it spreads?

Jim at said...

More than 60,000 people hospitalized in 2009 due to H1N1.
Anybody got a link to all the panic-stricken stories back then?

Thanks, in advance.

CStanley said...

@Jim....

Why is it hard to understand that 60,000 over a years time is a much different situation than even a fraction of that all in a few weeks time?

This has been explained multiple times and should not be difficult to understand.

Milwaukie guy said...

What I noticed in the Milwaukie Safeway yesterday was big crowds—it took me 50 minutes for beer and grilled cheese sammy supplies—everyone chatty and friendly and patient. The checker told me that there was a line at the door at 6 a.m. Many were more stuff because the kids, from university on down, are going to be home for a few weeks.

The lines were packed, all Safeway hands were on deck and the local homeless were doing small-time looting. Just coming in I saw a guy with two 12-packs, 1 beer, 1 TP, and a handful of jerky. While I was waiting in line there were many other instances. As I was putting my groceries away, a couple of guys were arriving by bicycle.

Hail Portlandia.

Jim at said...

The 1918 Spanish flu is hardly the last pandemic and considering the progress made in medical care over the last century hardly one useful for comparisons.

Told her that last week. But admitting it means she can't run around screaming and hoping for the worst in order to blame Trump.

Milwaukie guy said...

I'd also like to point to this early study of Wuhan's experience:

https://wattsupwiththat.com/2020/03/13/evolving-epidemiology-and-impact-of-non-pharmaceutical-interventions-on-the-outbreak-of-coronavirus-disease-2019-in-wuhan-china/

tim in vermont said...

False positives:

CONCLUSIONS: In the close contacts of COVID-19 patients, nearly half or even more of the 'asymptomatic infected individuals' reported in the active nucleic acid test screening might be false positives.

https://www.ncbi.nlm.nih.gov/m/pubmed/32133832/

tim in vermont said...

I don’t believe anything out of China. They could easily be restarting their factories with slave workers from their concentration camps. They could be living under conditions that Americans would be a long time accepting.

tim in vermont said...

Maybe the dotted line should show a ramp with some growth curve in resources as factory output is redirected to this problem.

tim in vermont said...

China is making vague threats of withholding drugs. If they do that, they may as well launch missiles, it will be the end of that relationship, full stop.

Lawrence Person said...

When it comes to Chinese statistics about anything, the safest course of action is to presume they're lying.

FullMoon said...

Why is it hard to understand that 60,000 over a years time is a much different situation than even a fraction of that all in a few weeks time?

Exactly. That is only average of 16.43 HOSPITALIZED per day. WUHANhould be able to beat that easily.
The flu has already killed 10,000 across US as world frets ...

Angle-Dyne, Servant of Ugliness said...

CStanley: Why is it hard to understand that 60,000 over a years time is a much different situation than even a fraction of that all in a few weeks time?

This has been explained multiple times and should not be difficult to understand.


Even very simple things are difficult to see, let alone understand, when when you've worked yourself into a panic over everybody else's alleged panic.

Fortunately at least some of the over-reactors appear to have calmed down enough to absorb info that non-over-reactors have been calmly discussing for a while now.

rightguy said...

The latest numbers from South Korea have 8086 proven cases of covid19 with 72 deaths for a death rate of .89%. Out of a country of 51,500,000, who knows how many mild/asymptomatic undetected cases there have been ? The actual death rate probably is quite a bit lower than 0.89%.

FullMoon said...

Exactly. That is only average of 16.43 HOSPITALIZED per day. WUHANhould be able to beat that easily.

OOPs, my bad, 164.38 per day for "other flu".

Fernandistein said...

Remember that racist tool, the census??

If you want to skip "Race" and "Are you some sort of Mexican?" in the online process, hit "Next" twice. It's scientific!

Clark said...

@Mike (MJB Wolf):

"Results in South Korea show that 96% of people who are POSITIVE for virus antibodies are 100% asymptomatic."

I agree that we should expect such results to lead eventually to a substantial lowering of the mortality rate. But the ratio of false positives to total positives is likely to be very high if prevalence of the disease in the population is low (even with a good test). You have probably thought about this before; the idea was new to me. This twitter thread presents the issue pretty well (although he gets something backward in tweet 8/10—it's easy enough to see what he meant to say).

Known Unknown said...

"I am sure glad that my dad saved all those Montgomery Ward catalogs. I'm guessing about 10% of you will get that"

We prefer to use Spiegel catalogs.

Unknown said...

Regarding the number of hospital beds, we don’t build parking lots to accommodate Black Friday crowds either.

Recent medicine has emphasized treatment through drugs and out-patient surgery rather than prolonged hospital stays.

Michael K said...

Recent medicine has emphasized treatment through drugs and out-patient surgery rather than prolonged hospital stays.

The old LA County hospital where I trained was 3500 beds. The new one, built with $600 million in federal money, is 600 beds. The organization was so bad I stopped using it for teaching.

The old hospital, which was "condemned" ten years ago and still in use for offices, was organized around diagnoses, which meant nursing. Surgery nursing is different from medical nursing, and from orthopedic surgery nursing. Last I was there all were mixed together. In the old days there was an infectious disease building. None now.