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

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

#71

Post by rsanek » Thu, Jun 11, 2020, 5:31 AM UTC

40four wrote: post #63

m4rtink wrote: post #32

Earlier quoted context omitted.

This is what I thin many forget when they speak against lockdown and for "heard immunity" - that this would not only result in a huge ammount of unnecessary deaths, but also pretty much wear out if not outright kill a signifficant part of medical personel. It's basically condemning them to working nonstop for months if not years, watching people die all day long & being in infection danger at all times while at work.…

I think it is more complicated than that. Almost all states very early on had some level of 'lock-down', stay at home order, or what have you. This has limited movement of people, and as a side effect, or maybe even direct order from governors, closed down/ limited many business. Including hospitals. Hospitals in America, believe it nor not, are for profit businesses. It is un-intuitive, but many of them are in serio…

Actually, over half of US hospitals are not-for-profit and another quarter are public. Only a small minority are for-profit. See https://en.m.wikipedia.org/wiki/Non-profit_hospital

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

#72

Post by akiselev » Thu, Jun 11, 2020, 5:36 AM UTC

40four wrote: post #63

m4rtink wrote: post #32

Earlier quoted context omitted.

This is what I thin many forget when they speak against lockdown and for "heard immunity" - that this would not only result in a huge ammount of unnecessary deaths, but also pretty much wear out if not outright kill a signifficant part of medical personel. It's basically condemning them to working nonstop for months if not years, watching people die all day long & being in infection danger at all times while at work.…

I think it is more complicated than that. Almost all states very early on had some level of 'lock-down', stay at home order, or what have you. This has limited movement of people, and as a side effect, or maybe even direct order from governors, closed down/ limited many business. Including hospitals. Hospitals in America, believe it nor not, are for profit businesses. It is un-intuitive, but many of them are in serio…

> At this point, nobody wants to go in for routine examinations or non-emergency procedures. For-profit hospitals (almost all of them are) as a business, depend on providing these non-emergency services/ surgeries/ procedures. Hospitals across the country are laying off health-care workers en-masse.

Nitpick: Over half of US hospitals are nonprofits or government owned [1] though I believe hospitals are vastly outnumbered by private clinics and independent practices. Doesn't change your overall point - even the hospitals run by governments, the Catholic church, and other institutions have budgets and are watching their main incomes disappear without much hope for the near future.

[1] https://www.aha.org/statistics/fast-facts-us-hospitals

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

#73

Post by WalterBright » Thu, Jun 11, 2020, 5:40 AM UTC

el_nahual wrote: post #30

wahern wrote: post #23

Earlier quoted context omitted.

The fact they're worn around so freely should be a hint that they merely look like surgical scrubs, not intended to be used like surgical scrubs. Realistically, I would think scrubs are common because 1) they've become emblematic of healthcare occupations[1] and 2) they're easier to clean and relatively cheap--they protect the wearer from spills and contamination, not the other way around, and in contrast to traditio…

Yes, I know surgeons actually change into sterile scrubs before going into surgery, but even "normal" parts of hospitals are biologically filthy. Even the possibility of bringing MRSA into the outside world should merit a change of clothes.

For comparison, the number of MRSA deaths in 2017 was 19,832 in the US.

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

#74

Post by Gibbon1 » Thu, Jun 11, 2020, 5:40 AM UTC

majormajor wrote: post #62

redis_mlc wrote: post #56

Earlier quoted context omitted.

> "Cannot"? Why wouldn't it just require a much bigger effort? Corona is basically endemic in the US. You can test nursing homes and airport arrivals, and do followup testing on a small population. You cannot test 320 million people, and do followup weekly testing on them. Perhaps you're inspired by the success in NZ or Taiwan. The US has a totally different situation. You seem to think that "doing something" is bett…

This isn't "hope" that I'm expressing. This is me saying that *if we never try, we'll never succeed, at ANYTHING, not just at this. You're convinced hard equals impossible. Which is definitely part of why the US is so incompetent when it comes to this (or healthcare in general). People don't care that we suck. I just find that sad and horrifying. Let's say you take NYC, where the cases have been tailing off, and you…

Walk back.

Look at the hapless response to Hurricane Maria. You see any difference between that and the hapless response to Covid19? I don't. Hurricane Katrina? Ditto.

Consider the need to replace the year old train tunnels that service New York. Nope can't do it.

California needs to build a high speed rail system to deal with increased commuter and air traffic? Watch people get into a rage at the idea.

The US healthcare system is completely out of control. Costs twice what other countries systems cost, with worse outcomes and large numbers of unserved people. Lots of countries have systems that work. But reform is impossible.

The underlying cause here isn't technical. It's nihilist ideology.

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

#75

Post by stickfigure » Thu, Jun 11, 2020, 5:47 AM UTC

rsanek wrote: post #71

40four wrote: post #63

Earlier quoted context omitted.

I think it is more complicated than that. Almost all states very early on had some level of 'lock-down', stay at home order, or what have you. This has limited movement of people, and as a side effect, or maybe even direct order from governors, closed down/ limited many business. Including hospitals. Hospitals in America, believe it nor not, are for profit businesses. It is un-intuitive, but many of them are in serio…

Actually, over half of US hospitals are not-for-profit and another quarter are public. Only a small minority are for-profit. See https://en.m.wikipedia.org/wiki/Non-profit_hospital

This fact is missing something essential; Kaiser Permanente is a nonprofit but it sure isn't what you think of when you use that term. Also, it's something of a minor nit - nonprofit corporations need revenue too.

My wife is a nurse for Dignity Health (another "nonprofit" hospital here in California) and has been effectively laid off for the last couple months. It's great that the ER is empty, but in the mean time nurses are struggling and people aren't getting their cancer screenings. If this goes on long enough, our healthcare system will fall apart from atrophy, not from overuse.

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

#76

Post by latchkey » Thu, Jun 11, 2020, 5:48 AM UTC

gvjddbnvdrbv wrote: post #68

laichzeit0 wrote: post #64

Earlier quoted context omitted.

Say the US gets to herd immunity and the rest of the world has done a really good job at containing the virus, e.g. New Zealand. What are they realistically going to do long term? Shut up their country until a vaccine arrives? Quarantine everyone coming in or going out for two weeks? Who is realistically going to want to travel into or out of there with those kind of restrictions. I seriously wonder if the short term…

https://en.m.wikipedia.org/wiki/Post-polio_syndrome Covid is a new disease. Will it have long term effects?

Chickenpox -> shingles is another example.

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

#77

Post by thdrdt » Thu, Jun 11, 2020, 5:49 AM UTC

m4rtink wrote: post #32

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…

This is what I thin many forget when they speak against lockdown and for "heard immunity" - that this would not only result in a huge ammount of unnecessary deaths, but also pretty much wear out if not outright kill a signifficant part of medical personel. It's basically condemning them to working nonstop for months if not years, watching people die all day long & being in infection danger at all times while at work.…

More and more researchers start to believe that the virus (also) spreads as aerosols. They also believe the amount of virus that enters your body affects how sick you get. This might also be the reason that healthy health workers can get sick when they are exposed a lot.

So I have no doubt that working as health worker without enough protective gear is scary when you see healthy collegues getting sick.

But that does not mean that going for herd immunity is a bad thing. We know now that most people even don't know they have the virus when they were just exposed a little bit to it.

And if the virus travels like an aerosol it might even be true that the world wide protests that are going on in the open air won't lead to much more sick people.

But this also means that people inside a bad ventilated building are at risk.

Edit: an example of an article that explains this more in depth: https://www.webmd.com/lung/news/20200527/aerosol-scientist-c...

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

#78

Post by nashashmi » Thu, Jun 11, 2020, 5:51 AM UTC

bsder wrote: post #39

nashashmi wrote: post #8

Earlier quoted context omitted.

It actually benefits you to have a doctor in the family who is there navigating and talking to the doctors. The doctors are more receptive to each other and listen carefully. Otherwise you are just a number. And the doctors won't try so hard on patients who really don't have any understanding of medicine in the first place.

> And the doctors won't try so hard on patients who really don't have any understanding of medicine in the first place. I have never found this to be the case. Generally, if I was fighting with a doctor, it was because he was trying to be too aggressive and do too much, not too little.

Clarification : Doctors won't try so hard to do thorough testing of the patient nor would they take a deep look to assess all symptoms.

But if they feel you know medicine or are capable of understanding medicine or have a drive to learn more about your condition, then they will try harder, do more tests, ask more questions, etc.

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

#79

Post by mixmastamyk » Thu, Jun 11, 2020, 5:52 AM UTC

majormajor wrote: post #62

redis_mlc wrote: post #56

Earlier quoted context omitted.

> "Cannot"? Why wouldn't it just require a much bigger effort? Corona is basically endemic in the US. You can test nursing homes and airport arrivals, and do followup testing on a small population. You cannot test 320 million people, and do followup weekly testing on them. Perhaps you're inspired by the success in NZ or Taiwan. The US has a totally different situation. You seem to think that "doing something" is bett…

This isn't "hope" that I'm expressing. This is me saying that *if we never try, we'll never succeed, at ANYTHING, not just at this. You're convinced hard equals impossible. Which is definitely part of why the US is so incompetent when it comes to this (or healthcare in general). People don't care that we suck. I just find that sad and horrifying. Let's say you take NYC, where the cases have been tailing off, and you…

I and a lot of folks won’t submit to contact tracing. So it is infeasible in more ways than one.

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

#80

Post by toyg » Thu, Jun 11, 2020, 5:52 AM UTC

nradov wrote: post #69

laichzeit0 wrote: post #64

Earlier quoted context omitted.

Say the US gets to herd immunity and the rest of the world has done a really good job at containing the virus, e.g. New Zealand. What are they realistically going to do long term? Shut up their country until a vaccine arrives? Quarantine everyone coming in or going out for two weeks? Who is realistically going to want to travel into or out of there with those kind of restrictions. I seriously wonder if the short term…

Yes it seems that New Zealand will attempt to wait for a vaccine and in the mean time impose a quarantine on anyone who arrives from another country. Balaji Srinivasan thinks we will see the world divided into "red" zones where the virus is still widespread and ”green" zones where the virus has been contained. Travelers will be able to move fairly freely between green zones countries. So if you're in Taiwan you might…

Considering for most countries the published numbers are very debatable (even in Europe there are plenty of arguments), imho that’s a foolish strategy. Quarantine should probably be implemented worldwide. I say that against my best interests, I am long overdue a holiday, but I don’t want to feel my lungs full of water.