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What doctors on the front lines wish they’d known a month ago
31–40 of 192 posts
Re: What doctors on the front lines wish they’d known a month ago
#32Re: What doctors on the front lines wish they’d known a month ago
#33Anecdata: I distinctly remember spending a lot of time lying on my stomach in hospital beds during several stints of double pneumonia I experienced as a child, some 30 years ago. It's hard to imagine that front line doctors didn't know about proning a month ago. Is this a technique that went out of vogue since my childhood, only to be replaced with a reliance on sedation and ventilators, and is it making a comeback d…
> Is this a technique that went out of vogue since my childhood
I think it's just as likely that maybe the knowledge is unevenly distributed, and if a doctor at the hospital is aware of it then it may spread, but may not spread beyond that hospital easily. It also may not spread until there are cases that benefit from it so other doctors can observe or hear about it.
Just like in software engineering, there are things that are taught, and then there are things that are learned over time, imparted by a mentor, or spread through a group. Doctors seem to have a better handle on this, as they do residencies to learn a lot of the practical skills that are hard to teach in a classroom, but that does probably lead to those skills learned in residency being fairly variable.
Re: What doctors on the front lines wish they’d known a month ago
#34> “You put a tube into somebody,” Dr. Levitan said, “and the amount of work required not to kill that person goes up by a factor of 100,” creating a cascade that slows down laboratory results, X-rays and other care. I'd hope this could be a generally applicable lesson after the pandemic. In less overwhelming times, the medical best practice is once someone is in hospital, prescribe the statistically best treatment ev…
Using extreme scenarios to plan for normal life has long been the recipe for bad policy.
This may make sense where hospital beds/ICU/medical professionals to capita ratio is low such as in low income neighbourhoods and countries but otherwise it’s mostly just useful for emergency planning.
The proper solution tends to be higher amounts of hospitals, mental health centers, supplies, preparation for outbreaks, etc. The actual hard stuff.
Otherwise this mostly amounts to doctors trained to use a generalized but dangerous hammer in worst case scenarios, in the face of what looks like a terribly difficult situation with no other solutions, and finding out more refined soft procedures like proning and flipping people on their sides works better for certain types of epidemic viruses.
I’d be wary to practically apply this beyond the next viral epidemic.
Re: What doctors on the front lines wish they’d known a month ago
#35Earlier quoted context omitted.
Unfortunately, the answer seems "no" so far. Based on for example [1], the infection fatality ratio appears to be 10 times worse than the seasonal flu for people aged 30-39. Also, hospitalisation rate is higher (e.g. in age group 30-39, the study estimates that 3.4% of the infected people were hospitalised), which is higher (even for younger people) than the hospitalisation rate of the flu. [1] https://www.thelancet.…
Without disputing that (and thx for link), it's worth noting that the "flu" has been killing a large number of people year in and year out for as long as we can remember. The long-term death rate of COVID-19 remains to be seen. The final verdict on how bad it was will depend on whether or not lengthy immunity is attained (including to mutations).
Yeah, but I don't understand what is significance of that claim. We have flu vaccine and general push to make people vaccinate every year. Up to mandating it for hospital workers at some places. Some employers are organizing them for free for employees.
We do close schools here and there for a week or so when flu is getting large to get it under control. We do close hospitals for visits at this times.
Re: What doctors on the front lines wish they’d known a month ago
#36Here in suffering Sweden 80% of covid patients in intensive care survive. I read that 80% of NY ICU patients on ventilation dies. Are we perhaps using less mechanical breathing devices here i Sweden? Edit: this didn’t come out right... couldn’t find total icu death rate but have read stories about high mortality in NY.
In ICU and on ventilation are not the same thing.
No true that.
Couldn’t find this data for us/ny.
It seems like there’s been a high focus on ventilator supply so I was just guessing a lot of severe icu cases would be put on one.
I have no idea, but would like to know.
Re: What doctors on the front lines wish they’d known a month ago
#37Here in suffering Sweden 80% of covid patients in intensive care survive. I read that 80% of NY ICU patients on ventilation dies. Are we perhaps using less mechanical breathing devices here i Sweden? Edit: this didn’t come out right... couldn’t find total icu death rate but have read stories about high mortality in NY.
Obviously, not everyone in ICU is on ventilator. This is true in both countries. If there was dishonest statistical comparison, this is the one.
It is a question though.
I have no idea.
Re: What doctors on the front lines wish they’d known a month ago
#38That if you're under 54 corona virus isn't any more deadly than the flu?
Besides what others have pointed out, there is no benefit of having the flu and we do not really know about long term damage just yet. There has been a report (I have only found it in German so far) of 6 divers in Hamburg with irreparable lung damage post corona. While under normal conditions these patients are just fine now, doing any type of sports may become a problem for them and that's only now, they may develop scar tissue in their lungs and what not. Only anecdotal for now but again, there is no benefit from having corona or the flu, so try not to get sick.
Re: What doctors on the front lines wish they’d known a month ago
#39Re: What doctors on the front lines wish they’d known a month ago
#40> “You put a tube into somebody,” Dr. Levitan said, “and the amount of work required not to kill that person goes up by a factor of 100,” creating a cascade that slows down laboratory results, X-rays and other care. I'd hope this could be a generally applicable lesson after the pandemic. In less overwhelming times, the medical best practice is once someone is in hospital, prescribe the statistically best treatment ev…
Instead of ventilation, wouldn't a heart-lung machine (or other types of external oxygenators) be the preferred method if cost was not an issue?
https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygen...