Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

What doctors on the front lines wish they’d known a month ago

nytimes.com

Post reply on HN
Print view View original

61–70 of 192 posts

Re: What doctors on the front lines wish they’d known a month ago

#61

Post by shalmanese »

jordanbeiber wrote: post #24

Here 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.

Sweden has reported 1,511 deaths and 13,822 cases. Does that mean 7,555 of the 13,822 cases have passed through the ICU or a significant number of people have died without entering the ICU?

Re: What doctors on the front lines wish they’d known a month ago

#62

Post by jordanbeiber »

watwut wrote: post #58
jordanbeiber wrote: post #57

Earlier quoted context omitted.

I’ve spent an honest 20 minutes looking for corona ICU survival statistics. It might be public, but not easy to google. In the UK it seems to be 50%.

The easy to find part is that not everyone in ICU is not attached to ventilator. Most people are not attached there.

The data out there indicate a 50% ICU death rate in general.

Ventilators seem to exacerbate the condition for covid patients.

Sweden seem to have better success with intensive care than average.

Are we perhaps intubating less.

Train of thought ^.

Re: What doctors on the front lines wish they’d known a month ago

#63

Post by jordanbeiber »

shalmanese wrote: post #61
jordanbeiber wrote: post #24

Here 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.

Sweden has reported 1,511 deaths and 13,822 cases. Does that mean 7,555 of the 13,822 cases have passed through the ICU or a significant number of people have died without entering the ICU?

My wife runs a home for old people with dementia.

A lot (100s) of deaths where old people have died of flu-like symptoms is counted as covid deaths. Teating has not been possible until just recently.

Re: What doctors on the front lines wish they’d known a month ago

#64

Post by mgsouth »

downerending wrote: post #45
watwut wrote: post #35

Earlier quoted context omitted.

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.

One implication is that COVID-19 might not be "just the flu". It might actually end up being far less damaging than the flu, as viewed over decades. And we don't trash our economy and the lives of the working class that depend on it due to flu deaths, even though they are still quite dramatic. Personally, I'm conservative on this, and have barely left my place in the last eight weeks. I can work from home and will su…

New York state has had 1 person in 1,200 [0] die from COVID-19, and is on track for 1 in 1,000. Do you know 1,000 people? If you lived in NYC, how many of your acquaintances would have died? How many people you know die from the flu every year?

Not even the most extreme estimates I've seen suggest that NY has anything approaching 50% immunity. Reopening NY and letting people catch CV19 would double, triple, ? the death rate.

There is no suggestion that NY is special as regards total numbers. (Velocity, due to population density, assume yes.) This is not the flu.

[0] A of 2020-04-17 880 deaths per 1M population. http://91-divoc.com/pages/covid-visualization/

Re: What doctors on the front lines wish they’d known a month ago

#65

Post by shalmanese »

jordanbeiber wrote: post #63
shalmanese wrote: post #61

Earlier quoted context omitted.

Sweden has reported 1,511 deaths and 13,822 cases. Does that mean 7,555 of the 13,822 cases have passed through the ICU or a significant number of people have died without entering the ICU?

My wife runs a home for old people with dementia. A lot (100s) of deaths where old people have died of flu-like symptoms is counted as covid deaths. Teating has not been possible until just recently.

So couldn't it just be that New York is admitting many more sicker people into their ICUs vs Sweden's ICUs performing better?

Re: What doctors on the front lines wish they’d known a month ago

#66

Post by ethbro »

dmix wrote: post #34
dmurray wrote: post #20

> “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…

If you read through the Red Dawn email chain NYT pieced together through FOIA requests [1], which gives an overview of initial professional thinking (January / February), there's a great insight in the first few emails.

No other emergency grows exponentially.

Nuclear detonation, dirty bomb, power outage, hurricane, tainted food, etc. At worst they grow linearly at a high rate.

Consequently, highly contagious pandemic response must be fundamentally unlike any other response.

There are references to this bearing out in their prior wargaming of scenarios. All players (mistakenly) escalated linearly based on intuition.

When in reality you're talking about needing 10x resources every week, ceteris paribus.

[1] https://int.nyt.com/data/documenthelper/6879-2020-covid-19-r...

Re: What doctors on the front lines wish they’d known a month ago

#67

Post by killIdeas »

Oxygen and laying prone is not exclusive to hospitals. I'm wondering if we can get oxygen tanks ready for home use.

Reduce hospital load, reduce healthcare costs, get rid of the need to flatten the curve.

(Waiting for a my job to begin, waiting for my son to get his surgery)

Re: What doctors on the front lines wish they’d known a month ago

#68

Post by pbhjpbhj »

jordanbeiber wrote: post #62
watwut wrote: post #58

Earlier quoted context omitted.

The easy to find part is that not everyone in ICU is not attached to ventilator. Most people are not attached there.

The data out there indicate a 50% ICU death rate in general. Ventilators seem to exacerbate the condition for covid patients. Sweden seem to have better success with intensive care than average. Are we perhaps intubating less. Train of thought ^.

FWIW not all ventilation is intubation, you can have non-invasive ventilation. Just in case you weren't aware, this makes stats hard to ascertain as some sources seemingly are interpreting orginal sources as if they were synonymous.

Re: What doctors on the front lines wish they’d known a month ago

#69

Post by ethbro »

jordanbeiber wrote: post #62
watwut wrote: post #58

Earlier quoted context omitted.

The easy to find part is that not everyone in ICU is not attached to ventilator. Most people are not attached there.

The data out there indicate a 50% ICU death rate in general. Ventilators seem to exacerbate the condition for covid patients. Sweden seem to have better success with intensive care than average. Are we perhaps intubating less. Train of thought ^.

Confounding factor: obesity rates and comorbidities

From a glance, the US averages 3x the incidence rate of obesity as Sweden. Obese patients with existing health problems will result in substantially worse outcomes from Covid-19.

Post reply on HN