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

nytimes.com

71–80 of 192 posts

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

#71

Earlier quoted context omitted.

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?

ICU death rate percentage still would be relevant in terms of ICU effectiveness?

Likely an ICU patient in Sweden is in really bad condition seeing we have something like 90 ICU spots on 2,4 million people in Stockholm.

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

#72

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)

You are proposing slowly letting it run until there is herd immunity, which would likely kill tens of millions of people worldwide.

We should aim to do better than that.

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

#73
post #55

Since January leaks from Chinese health care warned about all of this. Was there internet ban in US I was unaware of? Or a widespread belief in exceptionalism?

It's not even leaks, it's included in the Official Coronavirus Treatment Plan: "(4) Salvage therapy: for patients with severe ARDS, a recruitment maneuver is recommended. When human resources allow, prone ventilation should be carried out for 12 hours or more every day. " https://www.chinalawtranslate.com/coronavirus-treatment-plan... There's simply a shocking degree of arrogance from the West to refuse to learn even…

MGH is proning a bunch of awake patients (who have the physical strength to do so) and about ~30% of our ventilated patients.

There is no "shocking degree of arrogance from the West" but there may be a failure of adequate reporting, in this article and others, of what we are doing in hospitals.

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

#74

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)

Coworker of mine who happens to be Chinese bought portable oxygen for use in this situation. She bought it in February, after looking at videos about what was going on in Wuhan. We all thought she was kind of crazy. Doesn’t look so crazy now.

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

#75
post #55

Since January leaks from Chinese health care warned about all of this. Was there internet ban in US I was unaware of? Or a widespread belief in exceptionalism?

The footage from inside Italien hospitals a month ago shows most patients lying on their stomach.

Starting at 1min https://youtu.be/rfkbv_WQtn0

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

#76
This is a perplexing article. Prone ventilation has been known to reduce mortality in severe ARDS from randomized, controlled trials for almost a decade[1].

Proning is great! It keeps people alive. We are doing a lot of it. It's not new.

1 = https://www.nejm.org/doi/full/10.1056/NEJMoa1214103

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

#77

Earlier 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).

Yes, we should do more about the flu.

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

#78

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)

>> get rid of the need to flatten the curve.

This. A policy of flattening the curve will probably have to last for one or two years until either a vaccine is found or there is enough herd immunity. This will not only destroy our economy but the isolation will be a psychological challenge for many as well.

We have to take one step back and think why we wanted to flatten the curve in the first place. And that is because our hospitals don't have enough capacity. So why don't we do something about that? IMO that, in combination with some moderate curve flattening, is the only acceptable solution in the long term.

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

#79
post #56

Earlier quoted context omitted.

That is not question. That is easy to figure out public information.

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 UK data can be found at ICNARC.

https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports

This link opens a PDF download: https://www.icnarc.org/DataServices/Attachments/Download/c9b...

(17th April 2020)

> To date, ICNARC have been notified of 6664 admissions with confirmed COVID-19, either at or after admission to critical care, by critical care units in England, Wales and Northern Ireland. Of these, early data covering the first 24 hours in the critical care unit have been submitted to ICNARC for 6313 admissions of 5578 patients (Figure 1 and Figure 2). Of the 5578 patients, 2936 have outcomes reported and 2642 patients were last reported as still receiving critical care (Figure 3). The largest number of patients (1924) are being managed by the three London Operational Delivery Networks (Figure 4). Please note that Figure 2 and Figure 3 are affected by a variable lag time for submission of data of about 1-3 days (shaded grey)

[...big snip...]

> Critical care unit outcomes have been received for only 2936 (of 5578) patients, of whom 1499 patients have died and 1437 have been discharged alive from critical care (Figure 8 and Figure 9).

There's probably some more stats about critical care capacity here: https://www.england.nhs.uk/statistics/statistical-work-areas...

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

#80
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…

My company has been working with a hospital in the Bronx for several years. We’ve been working on a system that is designed to tell when intubation is actually needed and when it is not. They already knew, a long time ago, that intubation increased mortality, but no one expected the mortality rate they are seeing with COVID-19.
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