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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

#101

Post by bequanna »

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…

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% (!) with a flattened curve for some time now. Most of the US is not NYC.

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

#102

Post by shalmanese »

carbocation wrote: post #73
shalmanese wrote: post #60

Earlier quoted context omitted.

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.

Except it's applied to literally every part of the Asian pandemic response from masks to contact tracing. Asian countries have been saying for months that there's not some magical technological solution to contact tracing, the tech helps maybe 10%. The rest of it is just plain on the ground shoe leather pounding, public communication and talking to people.

Watch as Western countries start discovering as they roll out their automated contact tracing apps how little the tech plays a role in an effective contact tracing system.

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

#103

Post by osteele »

misja111 wrote: post #78
killIdeas wrote: post #67

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 becaus…

Hospital capacity is one motivation for flattening the curve. The other is to move infections later in time, when there will be more effective treatments and therefore lower rates of fatality and permanent disability.

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

#104

Post by lobotryas »

maxerickson wrote: post #97
irq11 wrote: post #95

Earlier quoted context omitted.

This simply isn’t possible, and it’s a maddeningly irresponsible shifting of the goalposts. The public was sold these extreme tactics on the basis of preventing excess deaths, not locking down society for years on end until the virus (hopefully) goes away. Respiratory viruses, once endemic, have never been completely suppressed. Even China is seeing a resurgence in cases. What we’re doing now isn’t sustainable or eth…

The lockdowns are a necessary step to smarter tactics working. My point is that if we move forward as if letting lots of people get infected is a 'smarter tactic', it's going to be worse in all ways. More death, more economic damage.

No, not “lots of people”, I don’t see anyone saying that. Given that it’s factually impossible to lock down the economy for a very long time we need conditions where the hospital system retains enough capacity to handle the really sick people.

Since it looks like we’re close to this (even in places like NYC that are sitting on a vent stockpile) we can start loosening the economy back.

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

#106

Post by carbocation »

shalmanese wrote: post #102
carbocation wrote: post #73

Earlier quoted context omitted.

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.

Except it's applied to literally every part of the Asian pandemic response from masks to contact tracing. Asian countries have been saying for months that there's not some magical technological solution to contact tracing, the tech helps maybe 10%. The rest of it is just plain on the ground shoe leather pounding, public communication and talking to people. Watch as Western countries start discovering as they roll out…

Regarding the contact tracing, etc, that you are describing (which is a bit beyond the article's scope, since it is talking about medical therapies): the West's failure is a political one. The experts in the West know and agree with everything you're saying.

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

#107

Post by maxerickson »

tathougies wrote: post #94
misja111 wrote: post #78

Earlier quoted context omitted.

>> 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 becaus…

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…

At any given moment, the appropriate way to look at a fast spreading infectious disease is to consider the more likely range of potential outcomes, work for the best one and plan for the worst one.

When the work pays off with a better outcome, it's foolish to look back and criticize the planning for worse outcomes, especially when the tools to manage the infection are pretty limited (social distance works well, but it's a brutal tool, so you want to use it only as necessary).

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

#108

Post by canada_dry »

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 separate).

Also, the ventilator and assoc. monitors need to be redesigned such that rotating the patient easily/automatically repositions the equipment with the rotation.

[i] https://youtu.be/E_6jT9R7WJs?t=65

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

#109

Post by etimberg »

travisporter wrote: post #59
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…

Honestly, I see the worry that we are overreacting. But you are way more likely to end up in the hospital with covid with rates of around 10-15%. Super broad strokes, if you get the flu every year and are at least 20 years old, what is the probability you would have be hospitalized if covid=flu? I think we are considering things carefully. I can’t remember the last time you saw both dem and rep governors agree on any…

Until there are large scale accurate antibody tests, it will be hard to say if the hospitalization rate for covid is that high or not.

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

#110

Post by LorenPechtel »

If patients are in shape to be on the phone why do they feel the need to put in a breathing tube?? I have measured my O2 saturation being in the 80s and my reaction was "so that's the effect of being this high up"--and I continued to head up the mountain. I had been there before, I knew I wasn't getting into too much. (I forgot to check on the summit itself. I don't expect to be there this year but I'm going to check again next year.)
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