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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?

#121

Post by jaggederest »

guscost wrote: post #97
calibas wrote: post #92

Earlier quoted context omitted.

Where's the source of "excess mortality is way up"? I didn't see it in the article, though it does suggest there may be fewer heart attacks and strokes because of "a decrease in air pollution and fewer high-fat restaurant meals".

https://www.nytimes.com/interactive/2020/04/21/world/coronav... http://euromomo.eu There's nothing for the USA as a whole, it will be compiled from states' records and estimates eventually. But it already seems obvious to me that the excess deaths in the next few years from secondary effects (avoiding hospitals, drug overdoses, suicides, stress/panic attacks, less traffic/police on roads, etc) will far outnumber the…

I don't envy those who have to make these decisions. I think the public health impact from prolonged isolation could actually outweigh the direct effects of the virus. Just mental health alone is going to be rocked to the foundations.

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

#122

Post by furyofantares »

jungletime wrote: post #13

Doctors in California went on strike and mortality dropped. One reason for the drop may be due to elective surgeries not being performed. And since more people at staying at home in a safe environment, due to COVID there will be fewer accidents. And far fewer medical mistakes too, not COVID related. "The third-leading cause of death in US most doctors don’t want you to know about" https://www.cnbc.com/2018/02/22/medi…

Most interventions are for something that's not going to kill you right away, so I would guess that seeking intervention for a medical problem I'm having would increase my odds of dying right now (due to a mistake, or exposure to other wick people) while increasing my long term odds. I would not expect an increase in mortality when non-emergency doctors go on strike.

And I hope to someday live in a world where medical error is the #1 cause of death. I hope we also focus on quality of life and not just quantity -- but if medicine seeks to continue extending life then the success case is that error is essentially the only cause of death. Those articles, and especially their headlines, are sensational and misleading.

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

#123

Post by sushid »

downerending wrote: post #80
treeman79 wrote: post #72

Earlier quoted context omitted.

Had a dozen visits to the ER. I was Constantly sent away because nothing serious. Tests generally clean. Told it was mental. Problems persisted. Kept avoiding ER, I felt bad wasting time. Plus money. Finally went in and they ran an extra test and found the issue. Probably had seen 30 doctors during all of this. Some of the doctors were amazed I hadn’t dropped dead yet.

The realization that the median doctor is probably about as good at their job as the median techie makes me shudder at the thought of going to the ER. Yeah, I'll do it if I have to.

I unfortunately came to this realization as I was graduating college. A decent number of my less-than-stellar high school acquaintances were going to be attending medical school.

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

#124

Post by recursive »

wahern wrote: post #102
maxerickson wrote: post #48

Earlier quoted context omitted.

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…

I am a current Kaiser subscriber. (member?/customer?) Even despite the simplicity for which Kaiser is clearly striving, I had a tough time figuring out how it was supposed to work at first.

I was accustomed to urgent care without a phone call. I tried to apply that experience to Kaiser. I found a Kaiser facility, via their web site, that claimed to offer urgent care during certain hours. I even double checked the definition of "urgent care" on wikipedia. I arrived at listed opening hour. The security guard I found there didn't know anything about it, except that no one else would show up for another hour. Then I wandered around trying to figure out where "urgent care" was, but there was some confusion about it. Eventually, I got to a desk somewhere. I was told to call for an appointment, which I did from there. All in all I spent three or four hours waiting and shuffling around between different desks. It was a very frustrating experience.

Eventually, I found out that everything in Kaiser starts with a phone call. But I don't think I was ever told that. What you're supposed to do, as far as I can tell now, is just call the number on your card any time you want to do anything.

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

#125

Post by yongjik »

mrfusion wrote: post #108
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.

Wow, you just jumped from an unexplained drop of ER vists straight to blaming the media for scaring people.

More than 70k have died in the US so far - are we also going to blame the media for not scaring people early enough, or is that too inconvenient?

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

#126

Post by maxerickson »

remote_phone wrote: post #120
maxerickson wrote: post #116

Earlier quoted context omitted.

Right, my point is, why isn't the nurse line also standing at the door to the single walk in access point for the hospital? Because we are wild fools, that's why. The hospital is liable for the costs in the ER, so fuck no are they going to tell you go home and get some rest if they can charge you $2000 to do that after taking your insurance.

Except with something like Kaiser, they are the insurance provider and the hospital system. You only pay a copay for the ER, and that’s it. There’s no incentive to push unnecessary medical services.

I expect they are subject to EMTALA and won't triage down in the event an outside customers strolls in.

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

#127

Post by henrikschroder »

guscost wrote: post #97
calibas wrote: post #92

Earlier quoted context omitted.

Where's the source of "excess mortality is way up"? I didn't see it in the article, though it does suggest there may be fewer heart attacks and strokes because of "a decrease in air pollution and fewer high-fat restaurant meals".

https://www.nytimes.com/interactive/2020/04/21/world/coronav... http://euromomo.eu There's nothing for the USA as a whole, it will be compiled from states' records and estimates eventually. But it already seems obvious to me that the excess deaths in the next few years from secondary effects (avoiding hospitals, drug overdoses, suicides, stress/panic attacks, less traffic/police on roads, etc) will far outnumber the…

The CDC has all-cause excess mortality tracking and graphs here: https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm

As far as I can tell the numbers are statistically computed estimates, based on real reported deaths, so it's not actual counted deaths, and there's still reporting lag skewing the last couple of weeks.

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

#128

Post by recursive »

newacct583 wrote: post #88
JackFr wrote: post #73

Earlier quoted context omitted.

A solid month of messaging “stay at home” and “hospitals are overwhelmed” and ratings driven fear-mongering been far more effective than policy makers ever intended.

Hospitals were overwhelmed in many places in the world. People absolutely should have stayed home. Or are you trying to claim that the virus is a hoax or something? This is a real risk. We've seen what happens in Madrid and Milan if you lock down just ~10 days too late.

And the messaging to that effect was effective. People have taken it to heart.

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

#129

Post by umvi »

fzeroracer wrote: post #117
umvi wrote: post #106

Earlier quoted context omitted.

> 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 disea…

Bold of you to assume that a disease can just run its course and then end. Would you say the same thing about the Chickenpox or some of the earlier flu pandemics we've seen? Are you willing to bet on a far deadlier second wave not occurring?

> Bold of you to assume that a disease can just run its course and then end.

Not that bold, since it is how most diseases/viruses work (with a few exceptions like HIV, and there's no reason to assume covid-19 is an exception)

> Would you say the same thing about the Chickenpox

Yes, chickenpox is one-and-done. Once you've had it, you (basically) can't get it again.

> Are you willing to bet on a far deadlier second wave not occurring?

Yes - "Survival of the fittest"

If there is a second wave, it will only affect survivors of the first wave, and as far as I can tell, the vast majority of first-wave survivors had mild-to-no symptoms. Kids are barely affected at all, it seems.

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

#130

Post by umvi »

pmiller2 wrote: post #90
sfj wrote: post #79

Earlier quoted context omitted.

> Opening things back up prematurely, without sufficient testing, is just going to get people killed. But how many will get killed? Allowing people to drive down the street also kills people. What's the limit?

Well, do you have research on how many excess deaths there would be if states started opening up now? California is taking a cautious approach by only opening in stages after cases have stabilized, and only after testing is present. Do you have a better plan than what a group of public health experts have come up with?

> Do you have a better plan than what a group of public health experts have come up with?

As far as I can tell, public health experts (and basically all medical experts) are in over their heads on this one. It's like 1970s computer scientists issuing guidance on a stuxnet-esque infection. Sure, they are the experts in that they know more about computer science than other people, but they also have no experience with something like stuxnet-esque worms and so... how valuable is their expertise? "We recommend turning off all computers until further notice to stop the spread of stuxnet. Meanwhile, we will take 6-12 months or more to try and reverse engineer it and then we will issue further guidance." Except... "turn off your computer for a year" isn't going to fly with the general population. After so many months there will be riots and people will start disobeying.

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