What doctors on the front lines wish they’d known a month ago • Hacker News Board

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

#171

Post by irq11 » Sat, Apr 18, 2020, 8:22 PM UTC

yongjik wrote: post #135

irq11 wrote: post #126

Earlier quoted context omitted.

I am well aware of the numbers in South Korea. The virus is still spreading. There are still new cases, every day. We have managed to eliminate one human virus in history: smallpox. And we only did that through mass vaccination. We have never eliminated a respiratory virus, nor have we ever developed a successful vaccine against a coronavirus, despite huge financial incentives to do it. The inevitable outcome here is…

South Korea has 51M people. If we have 1,000 patients every day, it will take 141 years to infect everyone. We had 18 new patients yesterday. (I'd normally write a snarky comment here, but the numbers speak for themselves.)

I don’t know why you’d write a snarky comment. You’re confirming what I said: the virus is still spreading in Korea.

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

#172

Post by maxerickson » Sat, Apr 18, 2020, 8:24 PM UTC

downerending wrote: post #162

maxerickson wrote: post #77

Earlier quoted context omitted.

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.

It's because it is a much bigger immediate problem. Look at the Mortality Surveillance section on https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidvi...

That's with lock downs.

It's also hard to say what individual behavior would look like absent government orders to close businesses. Retail business could well be way down without any orders.

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

#173

Post by oldgradstudent » Sat, Apr 18, 2020, 8:55 PM UTC

stainforth wrote: post #116

oldgradstudent wrote: post #92

Earlier quoted context omitted.

> There's simply a shocking degree of arrogance from the West Not sure it is Western arrogance rather than standard medical arrogance. The video accompanying the NYT piece (5m:37sec) one doctor says: > We have large randomized controlled trials. The patients in those trials had met the same diagnostic criteria that are current patients meet. We should apply the results of the trials. This is insane for a new disease.

I don't understand the takeaway from the doctor's quote? Is the doctor saying they're not doing something special?

I should have quoted the previous sentence:

> I'm arguing for evidence-based medicine, which is something we all purported to agree with before the outbreak hit.

> We have large randomized controlled trials. The patients in those trials had met the same diagnostic criteria that are current patients meet. We should apply the results of the trials.

The problem is that Covid-19 is caused by a NOVEL virus which has no evidence base. There should be at least some skepticism regarding the applicability of previous studies.

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

#174

Post by tathougies » Sat, Apr 18, 2020, 8:57 PM UTC

acqq wrote: post #133

tathougies wrote: post #94

Earlier quoted context omitted.

But our hospitals do have enough capacity. So far we have not seen widespread hospital overruns as predicted. Army field hospitals were set up and then taken down with no one treated. New York wanted 40000 ventilators but only needed 5000. Surely we should increase availability, but the original predictions that inspired this level of lockdown have not come to pass and with the information we have now, we know they a…

> the original predictions that inspired this level of lockdown have not come to pass The predictions of what would have happened had no lockdown been introduced then haven't materialized precisely because the lockdown have been executed. That is no argument that the lockdown haven't been needed.

No, my claim is that the models that were used with the lockdown were wrong. Cuomo claimed to need 40k ventilators after the lockdown was put in place. He ended up needing only a fraction of that. Obviously, without the lockdown, there would likely be more needed. Of course, modeling has errors, but this is an extremely large error, and one that has direct policy implications.

Had the model's predictions been more accurate we could have found a better middle ground when it comes to lockdown. Every job saved and individual financially secure is one more person who can contribute to the community's well-being. I think it's pretty safe to say in retrospect that the lockdowns need not have been as draconian as they were. We had the hospital capacity to have less severe lockdowns and we should have done that. While we can't change the past, we can certainly look at how our models failed and rework our approach in the future. Anything else is irresponsible.

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

#175

Post by pbhjpbhj » Sat, Apr 18, 2020, 9:36 PM UTC

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's after flu shots, in the year where flu shots were a misfire (they guessed the wrong strains) there were 2000 additional deaths (according to another source I'm not confident in that claims to have ONS figures but which I've not been able to confirm); for comparison the reported deaths (ie hospital only) for UK [which includes Scotland] has passed 15000 for Covid19 according to https://www.worldometers.info/coronavirus/#countries [fwiw I wrote 10,000 as that was the figure last time I looked ... but then checked the current number ...].

Happy for you to show it if this is wrong.

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

#176

Post by neonate » Sat, Apr 18, 2020, 9:50 PM UTC

https://archive.md/WzwVN

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

#177

Post by Jeema101 » Sat, Apr 18, 2020, 9:55 PM UTC

maxerickson wrote: post #119

njharman wrote: post #118

Earlier quoted context omitted.

> think that the best possible plan is for everyone to get infected That's like asking why does everyone think the best plan is for the sun to rise tomorrow morning. It's not a "plan", it is fact. Everyone (to some level of precision) will be either have anti-bodies from infection or have been vaccinated (or the unrealistic enough to ignore; remain in isolation their entire life). We don't have a choice in that. We c…

No, it's not a fact! We don't run massive test and trace programs against cold viruses because they are relatively less harmful. We easily have the resources to run a massive test, trace, isolate and support program against COVID-19, and we can eradicate it using those methods. And if a vaccine comes out before suppression is complete, so much the better. The fact that we have only ever eradicated a pandemic by using…

The defeatist mindest is really baffling to me as well.

I think some people must consider the economy to exist in a vacuum. But economics is based on confidence in the future.

A robust, unified, can-do response would do wonders to shore up that confidence.

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

#178

Post by acqq » Sat, Apr 18, 2020, 9:59 PM UTC

tathougies wrote: post #174

acqq wrote: post #133

Earlier quoted context omitted.

> the original predictions that inspired this level of lockdown have not come to pass The predictions of what would have happened had no lockdown been introduced then haven't materialized precisely because the lockdown have been executed. That is no argument that the lockdown haven't been needed.

No, my claim is that the models that were used with the lockdown were wrong. Cuomo claimed to need 40k ventilators after the lockdown was put in place. He ended up needing only a fraction of that. Obviously, without the lockdown, there would likely be more needed. Of course, modeling has errors, but this is an extremely large error, and one that has direct policy implications. Had the model's predictions been more ac…

> No, my claim is that the models that were used with the lockdown were wrong. Cuomo claimed to need 40k ventilators after the lockdown was put in place. He ended up needing only a fraction of that.

What you state now reflects exactly how many casual observers have problems to understand the exponential nature of the epidemics: if one observes the doubling time of three days, and that is what has been observed, this means only that the difference between needing 10k ventilators and needing 40k ventilators is only 6 days -- less than a week! Nobody can wait to actually need them to order them and get them delivered in so short time frames!

It was surely not possible to predict reliably how would have people reactd to which kinds of measures requested of the people, and the exact impact to the slowing down the spread (when exactly would doubling time get to be how much longer as a response).

Having an error of just 6 days in the middle of the exponential growth is not so negative if you are attempting to allocate resources to avoid tens of thousands of unnecessary deaths. And that statement of needing 40k ventilators is not what prevented some "better middle ground".

The "better middle ground" was surely possible to achieve by simply treating the epidemics much earlier as a serious issue and not acting as it is "just like flu" or would "disappear" overnight before anything has to be done.

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

#179

Post by andrewtbham » Sat, Apr 18, 2020, 10:03 PM UTC

dang wrote: post #161

andrewtbham wrote: post #158

Earlier quoted context omitted.

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 we…

Are these comments from pg in 2008 the main source that downvoting signals disagreement? If so, I would suggest you document it somewhere more prominent. Perhaps you could add guidelines on downvoting.

When more is known about covid-19 I plan to come back to this thread and see who was right. If Dr Cameron Kyle-Sidell was wrong, totally off-base, on the wrong track... then maybe you're right... maybe this system does work "relatively well"

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

#180

Post by dchichkov » Sat, Apr 18, 2020, 10:05 PM UTC

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…

A patient coming to a doctor, in the similar condition, is 4 times more likely to come out with a prescription in the United States when in Europe. Why? Because it is profitable. What is the result? Well, life expectancy in the United States had been going down. Ref. https://www.nature.com/articles/d41586-019-02686-2

This epidemic might be an opening to shift the current equilibrium of over-medication and over-use of expensive treatments with questionable efficacy.

The proper solution could be changing the incentives structure in the medical system. From profit and executive compensation aligned structures that over-sell services and drugs into something that is connected with long-term public health.