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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

#111

Post by vvanders »

LorenPechtel wrote: post #110

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…

You had the option of heading back down the mountain at any time. Respiratory infection do not behave the same way.

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

#113

Post by mgsouth »

bequanna wrote: post #101
mgsouth wrote: post #64

Earlier quoted context omitted.

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%…

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 that curve, WA currently has 79/million and is growing by 3%/day.

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

#114

Post by misja111 »

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.…

There are ways to limit the number of deaths and still reach herd immunity. For instance by keeping elderly and sick people isolated but the healthier part not, until herd immunity is reached.

This disease has to be handled with intelligence and common sense, not with rethorics and dogma's.

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

#115

Post by andrewtbham »

carbocation wrote: post #76

This is a perplexing article. Prone ventilation has been known to reduce mortality in severe ARDS from randomized, controlled trials for almost a decade[1]. Proning is great! It keeps people alive. We are doing a lot of it. It's not new. 1 = https://www.nejm.org/doi/full/10.1056/NEJMoa1214103

The proning is not the point. The point is to delay using a ventilator.

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

#116

Post by stainforth »

oldgradstudent wrote: post #92
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…

> 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?

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

#118

Post by njharman »

maxerickson wrote: post #90
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…

We have to smash the curve so that we don't need the hospital capacity. It turns out that getting the number of infected down close to zero would also be good for the economy. I don't understand why so many people think that the best possible plan is for everyone to get infected. The best possibilities involve a few percentage points of the global population getting infected, no where near everyone.

> 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 can try to alter the parameters (rate, timing, etc.) of that. But, that is the limit of our control.

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

#119

Post by maxerickson »

njharman wrote: post #118
maxerickson wrote: post #90

Earlier quoted context omitted.

We have to smash the curve so that we don't need the hospital capacity. It turns out that getting the number of infected down close to zero would also be good for the economy. I don't understand why so many people think that the best possible plan is for everyone to get infected. The best possibilities involve a few percentage points of the global population getting infected, no where near everyone.

> 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 vaccines is no reason to not try doing it without one. It's very hard to understand why people aren't screaming to spend a few hundred billion dollars to start doing this right now, as the payoff is essentially incalculable.

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

#120

Post by irq11 »

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, you’re still shifting the goalposts.

The point of “flattening the curve” is not — and was never — to reduce the area under the curve. This is a contagious respiratory virus, and it’s going to spread until there is herd immunity. Maybe there will be a vaccine in 12-18 months. Maybe not. But regardless, we can’t go on for that long with over 30% of society out of work.

Most people are going to get this virus. If you don’t understand that, you are scientifically illiterate. You are pushing on the ocean to prevent the tide.

Trying to forestall the inevitable by keeping us all locked in our homes will inflict such massive economic and social collateral damage that it’s simply unthinkable. We won’t stop the virus, and we’ll burn down our society trying.

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