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

nytimes.com

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

#161

Post by dang »

andrewtbham wrote: post #158
dang wrote: post #153

Earlier quoted context omitted.

Downvotes don't have to be because of guideline violations.

Well... that is my complaint about hacker news is that people frequently downvoted stories and comments that "gratifies one's intellectual curiosity" and don't violate any other guidelines. And they are never held accountable. I am not referring to my own history. I often read downvoted comments and sometimes upvote them. If people could indicate a reason for the downvote, it would probably help the whole situation.…

You might have a mistaken idea of how HN works, which is maybe why you've been finding it frustrating. On HN, it has always been ok to downvote a comment because one disagrees with it: https://news.ycombinator.com/item?id=16131314

Sure that's controversial, but the controversy is perennial. People have been making exactly the same arguments about it for a dozen years now, and that's just on HN—the debate goes back well before that. Different takes are possible. HN has its take. It's stable, we're not going to change it, and in my opinion it works relatively well. Moreover, the problems with it are not the problems that the users who post complaints about it are complaining about.

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

#162

Post by downerending »

maxerickson wrote: post #77
downerending wrote: post #22

Earlier quoted context omitted.

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.

Arguably we should. For that matter, we should really do more about traffic fatalities. Bringing that down would be far easier per person than fixing flu or coronavirus.

We're not going to, though, and it's becoming less clear why COVID-19 is an exception. It reminds me some of 9/11--it's flashy and freaking everyone out, which leads to irrationally conservative behavior.

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

#163

Post by downerending »

pbhjpbhj wrote: post #85
DanBC wrote: post #53

Earlier quoted context omitted.

> 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. At the moment we count flu deaths differently to covid-19 deaths. Counting deaths due to flu is hard. We've only just started this work for Covid-19 by putting in standards for death certification. These stats lag the real time cou…

Well in England&Wales the National Statistics Office figures show Now there's some controversy that UK government have been reporting other deaths as flu, basically hiding Winter deaths due, eg to poor elderly care, in flu figures. So other sources suggest far far higher flu rates; but this is going off death registrations. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsde... Covid19 death rates for under…

That doesn't sound right. If fewer than 500 per year were dying of flu, we probably wouldn't even bother with flu shots.

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

#164

Post by andrewtbham »

carbocation wrote: post #156
andrewtbham wrote: post #152

Earlier quoted context omitted.

Ask him why he downvoted me. I'm really curious what guideline he thinks I violated.

Hi, I downvoted your post. I think `dang hit the nail on the head in re: why I didn't reply (don't really want to argue since arguing on this topic has occupied more of my recent HN activity than I really like; and I'm busy doing other things). I certainly don't think your original post violated HN policy by any means, but that isn't the threshold for downvoting on HN as far as I understand. I downvoted because the m…

> the material in question isn't inline with how the majority of us are thinking about this disease.

That may be true. But that is what makes this important. The current protocols aren't working. This guy is a doctor on the front lines. Gattinoni, whom he references, is an expert in ventilation. This is not a crackpot conspiracy like 5G towers and I'm sick of seeing it dismissed like it is.

I have watched all his videos and I have never seem him say it is HAPE. My recollection is he said it was similar to HAPE.

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

#165

Post by canada_dry »

inamberclad wrote: post #157
canada_dry wrote: post #108

After watching this video [i] it seems like there's an opportunity here to completely rethink/redesign of the related equipment. I.e. instead of a normal bed, one that allows for a device to temporarily enclose the patient (like a tanning bed) inflate like a blood pressure cuff, rotate/turn the patient, then deflate and be removed for use on the next bed (i.e. the bed and rotating machines are co-operative, but separ…

Rotating beds are already used with intubated patients quite frequently.

Example [i]. The issue is that the cost to equip care facilities with these beds. My suggestion is to separate the rotating function such that a much less expensive general purpose bed can be used.

[i] www.arjo.com/en-us/products/medical-beds/critical-care/rotoprone/

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

#166

Post by downerending »

mgsouth wrote: post #64
downerending wrote: post #45

Earlier quoted context omitted.

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 dea…

FWIW, I don't know 1,000 people. Of the people I know about, one person has (probably) had COVID-19 (mild), and it's possible that I had it early (also mild).

Aside from "old age", the leading causes of death (and certainly years lost) among people I knew are AIDS and traffic collisions. This virus is going to have to try a lot harder to get on that scoreboard.

It's also worth noting that "reopening" doesn't mean people will just revert to prior behavior. Most will be very careful, and some will never revert. Wuhan reopened, and their restaurants are not springing back (yet?).

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

#167

Post by downerending »

mgsouth wrote: post #113
bequanna wrote: post #101

Earlier quoted context omitted.

NYC is absolutely not representative of the rest of the country. In fact, they appear to be the hardest hit locale in the world in no small part due to their poor and delayed response. I agree, reopening NYC would be a mistake, but large portions of the US (especially rural areas) remain largely unaffected by this. The average age of death in my state (MN) is 88 with preexisting conditions. Our death rate is 0.0019%…

The point being, an unusually large percentage of the people who contract CV19 die. Lower density == longer time to hit X% infected and Y% dead, but you'll still get there. (With caveats that X is a bit lower with lockdown, and Y gets higher when medical system is overloaded.) Minnesota death rate is, as you say, currently at 19/million, but is growing at about 10%/day. The curve fits WA state's; continuing along tha…

The question is not "How many will die?". Sadly, many will.

The question is "How much net difference will different reopening schedules make?". The answer to that is unclear, but remaining in lockdown for six months could easily kill more people (net).

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

#168

Post by ghaff »

watwut wrote: post #96
jordanbeiber wrote: post #62

Earlier quoted context omitted.

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 ^.

ICU death rate heavily depends on whether the hospitals are overflown or not. The Italia or Spain ICU is not giving the same care now as it used to. The trajectory of cases and deaths in Sweden does not seem special to me, generally they seem to follow similar curve as other countries so far.

>The trajectory of cases and deaths in Sweden does not seem special to me

Certainly doesn't seem to be well outside of the range of outcomes in other countries at any rate. From what I've read--no first hand knowledge--it's also a bit hard to interpret the effect of Sweden not locking down. Apparently, at least around Stockholm, many people were staying home and not traveling. On the other hand, in at least some places, people were still going to bars and the like so it's a bit of a mixed bag. Almost certainly not business as usual but also likely a fair bit looser than a lot of places with more formal lockdowns. (And there's even quite a bit of variance there.)

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

#169

Post by losvedir »

DanBC wrote: post #93
misja111 wrote: post #88

Earlier quoted context omitted.

I was writing that we should both create hospital capacity and have some moderate flattening of the curve. Of course we shouldn't let the virus run free. But unless you are hoping for a vaccine to be invented soon, which would of course be wonderful, you have to face the other scenario and that is that we have to slowly build up herd immunity. Herd immunity means that people have to get infected and a percentage of t…

> Herd immunity What does her immunity actually mean though? What other diseases do we try to tackle using herd immunity? How many deaths would make herd immunity acceptable or not acceptable? There are 350m people in the US. We need to get about 60% of them to have had covid-19. That's 210m people. We don't know how fatal covid-19 is yet, so here are some lower numbers: 0.1% = 210,000 deaths 0.2% = 420,000 deaths 0.…

For context, about 3 million people die each year in the US.

IF (and that's a big if), the infection fatality rate really were just 0.1% (i.e., regular flu), then yeah I think letting this thing run its course is the reasonable thing to do.

In my mind, the reason for the lockdowns is because we don't know the morality rate yet, and so we should be cautious in case it's 1-3% how it was looking at first.

I could turn the question around on you, and ask what fatality rate makes the "run its course" strategy reasonable to you? No deaths?

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

#170

Post by ghaff »

downerending wrote: post #163
pbhjpbhj wrote: post #85

Earlier quoted context omitted.

Well in England&Wales the National Statistics Office figures show Now there's some controversy that UK government have been reporting other deaths as flu, basically hiding Winter deaths due, eg to poor elderly care, in flu figures. So other sources suggest far far higher flu rates; but this is going off death registrations. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsde... Covid19 death rates for under…

That doesn't sound right. If fewer than 500 per year were dying of flu, we probably wouldn't even bother with flu shots.

That seems very low. In the US, about 25,000 to 60,000 die annually of flu with about 5x the population of England and Wales.
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