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Eerie emptiness of ERs worries doctors: where are the heart attacks and strokes?

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Re: Eerie emptiness of ERs worries doctors: where are the heart attacks and strokes?

#101

Post by ajmurmann »

sacks2k wrote: post #45
newacct583 wrote: post #37

Earlier quoted context omitted.

How is that related to the lockdown? Hospitals are open. People are staying home because they're scared of getting sick, that's not something that can be fixed by public policy.

"fixed by public policy" Public policy right now is to stay home or die of Covid 19. Many people are scared to even go outside or go to a hospital if they don't have the virus. Starting to open businesses again and requiring social distancing would definitely help with the fear and more people would actually go to the hospital for non-covid health issues.

I for one will be feeling less safe love we start opening things again. Nothing has changed in the US except that people are getting tired of the situation. We have enough idiots walking around without masks or who aren't distancing as it is. Once we start opening up there is only now risk in going to places where there are other people.

Re: Eerie emptiness of ERs worries doctors: where are the heart attacks and strokes?

#102

Post by wahern »

maxerickson wrote: post #48
SkyPuncher wrote: post #23

Earlier quoted context omitted.

My wife is a doctor. Not an ER doc, but had to do rotations through the ER and frequently interacts with the ER in other rotations. The amount of non-emergencies the ER department sees is astounding.

Not really. It's often "convenient" relative to all the places that aren't open, and they won't turn you away until they've assessed your situation. What's wild is that we structure payment and regulatory models where a walk in at the ER costs more than a walk in at the urgent care located literally next door. Gotta self assess how serious the situation is if you don't wanna contribute to the high risk revenue pool.

The urgent care clinic can assess you. In fact, they could probably assess you over the phone before you even arrive.

Kaiser heavily pushes their nurse hotline to help minimize costs. I can hardly fathom going to either the Kaiser emergency or injury departments[1] without calling the nurse hotline. The nurse, in consultation with a staff physician in the call center, does an assessment, tells you what to do next, if anything, and schedules any appointments--phone physician, in-person primary physician, or calls ahead to the emergency or injury clinic to minimize wait times.

Our current healthcare system is so fractured that most people have no idea how to go about seeking healthcare in the most convenient and smoothest way possible. Smaller regional hospitals and even some regional systems don't have the scale to do what Kaiser does, at least not nearly as efficiently as Kaiser. High costs are baked into the system.

[1] Injury department is for broken bones, cuts, etc that happen during the day. At the SF Geary medical center they're conveniently located across the hall from the imaging department.

Re: Eerie emptiness of ERs worries doctors: where are the heart attacks and strokes?

#103

Post by subsubzero »

This is really frustrating, as we were told over and over again from the media of this huge surge of cases that would overload hospitals. Stay away from the hospital we were told over and over, the "worried well" are overloading our medical system and its professionals. Well guess what, people did just that, they avoided the hospitals to allow for a surge. That's why these hospitals are ghost towns now. I had a tele-visit with my physician and he said both covid cases and visits themselves in his location have dropped off a cliff in recent weeks(sfbay area location). The tents they erected in the hospital parking lot to treat the legions of sick are being taken down at another hospital in San Jose. A friend who worked in radiology is now on partial furlough due to such low patient counts(Stanford, Palo Alto) so I guess this avalanche of cases never materialized at least not in the bay area(NY is a different story).

Re: Eerie emptiness of ERs worries doctors: where are the heart attacks and strokes?

#104

Post by macintux »

umvi wrote: post #84
fzeroracer wrote: post #76

Earlier quoted context omitted.

I'm going to keep repeating this until people understand the risks: Opening up too early without adequate testing in place means we go through the same problem that Hokkaido did. Which is that you get a second wave of infections and are forced to back into lockdown. As for the article itself: Reopening the country wouldn't fix that either because it's a catch-22 situation. The people most at risk of dying from COVID-…

So... you propose just staying on lockdown indefinitely until "adequate testing is in place?" And when will that be? It could be 6 months from now or more so long as the Trump administration is running things. Lockdown isn't "free" like you seem to think. It has a very heavy cost. And some day (if not already), that cost will outweigh the lives saved from doing it in the first place. Because the combined suicides/men…

I have yet to hear anyone explain how we’re going to lose millions of lives due to the lockdown, whereas the risks of opening up without sufficient testing include that as a very real possibility.

Yes, it stinks that people are suffering due to the lockdown, but the government could (if it were so inclined) pay people to stay home indefinitely. It clearly can’t manage the virus, however.

Re: Eerie emptiness of ERs worries doctors: where are the heart attacks and strokes?

#105

Post by 34679 »

_bxg1 wrote: post #28
drtillberg wrote: post #22

Don't discount the impact of reduction of air pollution on all causes of mortality. It's not often discussed, but every so often someone makes the connection between small particulates and heart attacks, etc.

Pretty sure any impact from that would be a very long-term thing. A lifetime without particulates might have an effect; a month seems pretty far-fetched.

"In 2004, the American Heart Association issued a scientific statement concluding that exposure to air pollution contributes to cardiovascular illness and mortality. A 2010 update elaborated on those risks.

Short-term exposure can increase the risk of heart attack, stroke, arrhythmias and heart failure in susceptible people, such as the elderly or those with pre-existing medical conditions, according to the statement."

https://www.heart.org/en/health-topics/consumer-healthcare/w...

Re: Eerie emptiness of ERs worries doctors: where are the heart attacks and strokes?

#106

Post by umvi »

pmiller2 wrote: post #34
umvi wrote: post #24

Are just the ERs empty? Or the whole hospital as well? If hospitals are empty, it's time to stop sheltering in place, because it means it's working too well . What's the endgame? We can't just keep the country shut down indefinitely. Life must move on. Even though there's still a lot of fear, I think reopening the country is the best option (while still maintaining social distancing, etc).

No, it doesn't mean "stop sheltering in place," unless cases of COVID-19 have peaked. In order to tell whether they've peaked, you need testing in place, as well. Even if they have peaked, it could mean "relax some of the restrictions, but not fully end SIP, while monitoring cases." Opening things back up prematurely, without sufficient testing, is just going to get people killed.

> Opening things back up prematurely, without sufficient testing, is just going to get people killed.

Yep, some people will die. That's unavoidable. Tens of millions die every year. Hundreds of millions will die per year in a few decades. That's life.

If you are at-risk, you should continue to avoid contact with others. But there's currently no cure for covid-19 other than your own immune system. The sooner the disease runs its course, the sooner we can return to normal. Sheltering in place forever means you prolong the propagation of the disease to excruciatingly long timescales.

Re: Eerie emptiness of ERs worries doctors: where are the heart attacks and strokes?

#107

Post by [deleted] »

guscost wrote: post #5

Dying at home, many of them. Excess mortality is way up, and it’s not all COVID-19: https://www.washingtonpost.com/health/patients-with-heart-at... > The possibility that patients may be suffering — and even dying — at home rather than going to a hospital led the American College of Cardiology to launch a “Cardiosmart” campaign last week, attempting to reassure a wary population and encourage those with symptoms to c…

[deleted]

Re: Eerie emptiness of ERs worries doctors: where are the heart attacks and strokes?

#108

Post by mrfusion »

guscost wrote: post #5

Dying at home, many of them. Excess mortality is way up, and it’s not all COVID-19: https://www.washingtonpost.com/health/patients-with-heart-at... > The possibility that patients may be suffering — and even dying — at home rather than going to a hospital led the American College of Cardiology to launch a “Cardiosmart” campaign last week, attempting to reassure a wary population and encourage those with symptoms to c…

Should the media have some of the blame for these deaths by scaring people? Cherry picking young corona deaths, up playing tenuous studies saying corona causes diabetes and strokes, replaying stock footage of overloaded hospitals.

If they gave people accurate statistics they could make an informed decision whether they want to go to a hospital.

Re: Eerie emptiness of ERs worries doctors: where are the heart attacks and strokes?

#109

Post by mirimir »

guscost wrote: post #5

Dying at home, many of them. Excess mortality is way up, and it’s not all COVID-19: https://www.washingtonpost.com/health/patients-with-heart-at... > The possibility that patients may be suffering — and even dying — at home rather than going to a hospital led the American College of Cardiology to launch a “Cardiosmart” campaign last week, attempting to reassure a wary population and encourage those with symptoms to c…

Right, they're likely dying at home, and being counted as COVID-19 deaths. That's the safest guess, in the absence of epidemiologic data.

Even so, medical systems and coroners ought to be archiving samples for testing. Eventually there'll be adequate RNA and antibody testing capabilities. Without that data, we won't know what happened.

Re: Eerie emptiness of ERs worries doctors: where are the heart attacks and strokes?

#110

Post by umvi »

rconti wrote: post #91
umvi wrote: post #24

Are just the ERs empty? Or the whole hospital as well? If hospitals are empty, it's time to stop sheltering in place, because it means it's working too well . What's the endgame? We can't just keep the country shut down indefinitely. Life must move on. Even though there's still a lot of fear, I think reopening the country is the best option (while still maintaining social distancing, etc).

The hospitals largely shut down elective surgeries, tried to get rehab patients to other facilities to free up surge capacity, etc. So, generally, they're less busy than normal. The problem with opening back up is, we've already seen the growth curve, and that was 2 months ago. What happens when you multiple that same growth rate against a much higher baseline number of infected people?

Two months ago people weren't wearing masks or practicing social distancing.
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