I'm Married to an ER Doc in NYC • Hacker News Board

Re: I'm Married to an ER Doc in NYC

#201

Post by pas » Thu, Jun 11, 2020, 7:44 PM UTC

gizmo wrote: post #159

pas wrote: post #151

Earlier quoted context omitted.

Has this been demonstrated? Is this true? Is this really how the immune system works?

Yes, for instance in this 2015 study on influenza: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342672/ Higher initial dose results in worse outcomes. Low dose still helps build immunity. Covid19 should be assumed to work like other RTIs. (This is also why obsessively washing your hands and cleaning your house with bleach isn't a good idea, because being in too sterile an environment harms your immune system.)

Wow, conducting this study (and the IRB review) must have been great.

Hm, okay, at first I just saw the very linear response and wasn't sure how that translates low dose still helps build immunity, but then went back and read your comment up thread, which captures it better: the partial sickness gives partial immunity, thus "priming" the body for the full-blown thing.

Though getting the active transmission rate down could be more important in some places.

Re: I'm Married to an ER Doc in NYC

#202

Post by ryandrake » Thu, Jun 11, 2020, 8:51 PM UTC

aerostable_slug wrote: post #196

pphysch wrote: post #191

Earlier quoted context omitted.

You're omitting that it's only a single digit % of the population that gets access to these expensive, specialized treatments. The US has the best healthcare system in the world--if you're a millionaire.

Anecdotes and all that, but a friend of mine had Deep Brain Stimulation surgery for his essential tremor. The surgery was performed at Stanford and the total bill was in the hundreds of thousands of dollars. His out of pocket charge? ~$1200. I have a hard time rationalizing his recent experience with the assertion that you have to be a millionaire to receive top-flight care.

Your friend must have outstanding insurance. Our out-of-pocket for a standard run-of-the-mill baby delivery with no complications was several thousand dollars--after what I thought was pretty good tech-company provided health insurance. I'll never forget my wife's reaction (who is not from the USA) at how absurd it is that someone would have to pay any money, let alone thousands of dollars, to have a baby.

Re: I'm Married to an ER Doc in NYC

#203

Post by klmadfejno » Fri, Jun 12, 2020, 2:01 AM UTC

davycro wrote: post #185

klmadfejno wrote: post #164

Earlier quoted context omitted.

I'm hoping this doesn't come off as snarky but, why can't / don't we tell people to prone at home? As I understand, it's literally just lying down on your stomach. I first encountered the concept in a new york times article where the interviewed nurse was saying the problem was people got bored and stopped doing it. That sounded... dumb. And as though being prone should be plastered all over the public health recomme…

Good question. Proned patients are too sick to survive at home. As soon as the roll onto their back or sit upright they start suffocating and must work for their breath. Because of this they need help caring for themselves. They also are at risk of becoming much worse and needing more oxygen.

> Proned patients are too sick to survive at home.

Proned patients are just people lying on their stomachs, are they not? I get that its something you would recommend to someone who is really low on oxygen, but why aren't people who aren't too sick to survive at home being told to do this also? Is there a downside?

Like if your pulse oximeter starts readying 88 and slowly dropping, its probably a good idea to start proning, in the very least at night while sleeping?

Re: I'm Married to an ER Doc in NYC

#204

Post by sanchostache » Fri, Jun 12, 2020, 4:52 AM UTC

dr_ wrote: post #3

Not an ER doc, but a doc in long term care facilities which have been hit particularly hard. Fortunately things have slowed down considerably now, but at its peak it was absolutely nerve racking. There’s an element to this pandemic which many people working in healthcare have felt. We see patients fall sick often, and we see them die often, although this was at an near overwhelming scale. But what we don’t see often…

How do you feel about doctors out cheering on massive crowds of protesters?

Re: I'm Married to an ER Doc in NYC

#205

Post by mixmastamyk » Fri, Jun 12, 2020, 4:09 PM UTC

Intermernet wrote: post #117

kmonsen wrote: post #101

Earlier quoted context omitted.

A substantial part of the US population will not cooperate.

Yes, but why? It may be a valid reason, but I don't know what it is.

Basically, the government takes way more information than it is entitled to already. And then doesn't secure it. Look up snowden leaks, opm breach, etc etc. Rereading the 4th Amendment might be helpful as background as well.

Re: I'm Married to an ER Doc in NYC

#206

Post by gvjddbnvdrbv » Sat, Jun 13, 2020, 10:16 AM UTC

ryandrake wrote: post #202

aerostable_slug wrote: post #196

Earlier quoted context omitted.

Anecdotes and all that, but a friend of mine had Deep Brain Stimulation surgery for his essential tremor. The surgery was performed at Stanford and the total bill was in the hundreds of thousands of dollars. His out of pocket charge? ~$1200. I have a hard time rationalizing his recent experience with the assertion that you have to be a millionaire to receive top-flight care.

Your friend must have outstanding insurance. Our out-of-pocket for a standard run-of-the-mill baby delivery with no complications was several thousand dollars--after what I thought was pretty good tech-company provided health insurance. I'll never forget my wife's reaction (who is not from the USA) at how absurd it is that someone would have to pay any money, let alone thousands of dollars, to have a baby.

I'm against the concept of privatised healthcare completely but within the privatised paradigm insurance only works properly to share risk across a population. A normal birth is not really an insurable event. Normal births are not a risk (in the sense of risk being a semi random events) since on average each women an America has about 2 in their life. In a privatised system insurance make sense as something to cover the risk of complications during a birth. So in a functioning privatised system with insurance working as it theoretically should any birth whether simple or with huge complications should cost the same amount of money. This is similar to dental most people spend X±Y amount of money over their life on dental work where X is high and Y is low. Insurance only works properly where X is lower and Y is higher (for example getting a rare cancer that costs $1million to treat is a very insurable event). Where dental is covered by 'insurance' the person paying for the insurance policy would be better just paying the dentist directly.

Meanwhile I am glad I live in a society with a nationalized health system where births cost nothing.

Re: I'm Married to an ER Doc in NYC

#207

Post by kmonsen » Sat, Jun 13, 2020, 5:48 PM UTC

pedrocr wrote: post #146

kmonsen wrote: post #103

Earlier quoted context omitted.

Of course testing scales with the size of the country.

So do available resources. This go to argument that things that work in smaller countries don't work in the US is bizarre. It's used in all these discussions of how things that work in the EU couldn't possibly work in the US, even though the EU has a larger population.

Mostly agree 100% with you, there is one caveat: you can’t restrict travel inside the USA, so it’s harder to keep things local.

For scale it clearly should scale, and there should be efficiencies you can find in bigger countries.

Re: I'm Married to an ER Doc in NYC

#208

Post by hcknwscommenter » Tue, Jun 16, 2020, 5:18 PM UTC

kmonsen wrote: post #97

hcknwscommenter wrote: post #90

Earlier quoted context omitted.

There is totally an endgame. Lockdown worked in NYC. That is huge. NYC is crushing the curve. 1 in 600 people in NYC have died of COVID (NOT GOOD). However, it is estimated that 1 in 5 is already immune. That's great news! A huge step towards herd immunity.

It means NYC must do this three times more to get to herd immunity, and strike the right balance each time. Still it is far from safe since people can come from the rest of the country so it’s not a real herd immunity.

Your comment implies that "do[ing] this three times more" would be very difficult. That's totally incorrect. As the level of immunity rises, R0 goes down naturally. The effect is huge at even 20%. Giant at 50%, etc., especially with moderate social distancing. Moreover, there is every reason to believe that some people are just naturally resistant/immune to the virus. I believe Bergamo never got above 57% sero-positivity and even the USS Rosevelt was around 60% sero-positivity. It seems impossible to believe the other 40% weren't exposed. If (okay a big BIG if) 40% just don't ever get COVID, and 50% get it but have mild moderate symptoms (the data strongly supports this), NYC is basically done with this emergency.

Re: I'm Married to an ER Doc in NYC

#209

Post by hcknwscommenter » Tue, Jun 16, 2020, 5:20 PM UTC

amiga_500 wrote: post #172

hcknwscommenter wrote: post #90

Earlier quoted context omitted.

There is totally an endgame. Lockdown worked in NYC. That is huge. NYC is crushing the curve. 1 in 600 people in NYC have died of COVID (NOT GOOD). However, it is estimated that 1 in 5 is already immune. That's great news! A huge step towards herd immunity.

Will they be immune in one year? Two?

The data on long-term immunity for COVID is non-existent, that is why the experts are being cautious. However, the data on animal coronavirus vaccines (not COVID) is very suggestive that yes they will be immune in a year and two. Coronaviruses do mutate but do not mutate like the flu virus does.

Re: I'm Married to an ER Doc in NYC

#210

Post by aerostable_slug » Tue, Jun 16, 2020, 10:31 PM UTC

ryandrake wrote: post #202

aerostable_slug wrote: post #196

Earlier quoted context omitted.

Anecdotes and all that, but a friend of mine had Deep Brain Stimulation surgery for his essential tremor. The surgery was performed at Stanford and the total bill was in the hundreds of thousands of dollars. His out of pocket charge? ~$1200. I have a hard time rationalizing his recent experience with the assertion that you have to be a millionaire to receive top-flight care.

Your friend must have outstanding insurance. Our out-of-pocket for a standard run-of-the-mill baby delivery with no complications was several thousand dollars--after what I thought was pretty good tech-company provided health insurance. I'll never forget my wife's reaction (who is not from the USA) at how absurd it is that someone would have to pay any money, let alone thousands of dollars, to have a baby.

I have never figured out what "outstanding" insurance is, and my late father was a physician.

I just go with a PPO because that seems less crappy than the alternative. If anyone knows what metric leads to outcomes like my friend's (I'm not being facetious here), I would like to know.