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I'm Married to an ER Doc in NYC

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

#81

Post by davycro »

klmadfejno wrote: post #2

The way things are described make the doctors sound powerless. I've been frustrated by the lack the information on the usefulness of hospitals. The impression I've gotten is that they cannot do much, and if they would go as far as intubation, you're highly likely to die even with intubation.

We can put a patient on oxygen without intubating them. High flow oxygen can provide up to 60 liters per minute. We can prone patients, and provide them with nutrition to help support their immune system. We save many patients with supportive care.

We can’t however cure the virus. And if it progresses far enough then no amount of oxygen will save a patient. These cases are hard because we have to watch someone die without any means to save them. Doing cpr on a patient with covid can feel pointless. If the lungs do work then no amount of chest compressions, oxygen, and cardiac drugs will save that person.

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

#82

Post by SamReidHughes »

trhway wrote: post #43
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.…

>It's basically condemning them to working nonstop for months if not years how come? wouldn't without lockdown the herd immunity with that R0 would come in like 2-3 months (and during that period the vulnerable people would have to be locked down), while with lockdown we're already 3 months into it without reasonable lockdown based endgame in sight?

On the other hand, with social distancing and masks, herd immunity comes at a lower level, even if mask-wearers still suffer >1 R0. So vastly fewer people die.

Simplistically, we don't want to lockdown or distance until we get to whatever that herd immunity level is. And then, a bit past that level, we might want to lockdown hard and then ease up to a steady-state lockdown, and then hold it there until the disease has passed.

The reason we'd lockdown hard and ease up is because, well, a continuity argument -- more lives are saved if you do a week of hard lockdown when 1000000 people are infected than if you wait until 10 cases remain.

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

#83

Post by m0zg »

akiselev wrote: post #72
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…

> 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 outnumb…

While factually true, this does not defeat the point: those non-profit and public hospitals rely on paid procedures to pay their employees. And yes, those employees are furloughed and laid off en masse.

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

#84

Post by unishark »

stickfigure wrote: post #75
rsanek wrote: post #71

Earlier quoted context omitted.

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 nu…

> 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.

Why is that? You don't think they lay people off in Canada or Japan when there's no patients? Even single-payer systems can have private hospitals. They are simply paid by the govt instead of (or really in addition to) by patients. They still need business and to balance the books.

Canada has a similar mix of all kinds of hospitals like the US, though it may be more slanted in some way.

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

#85

Post by throwaway1777 »

wahern wrote: post #33
el_nahual wrote: post #30

Earlier quoted context omitted.

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.

Clothing is probably the least problematic thing. Every time some nurse or doctor uses a keyboard I want to scream. I regularly see doctors use the keyboard, wash their hands, and then use the keyboard again before beginning an examine. Recently I've started to see plastic covers on the keyboards, as if that mattered relative to the order of touching things. Realistically, cross-contamination in the hospital is almos…

The plastic cover can be taken off and washed (in theory) so it should be much less dirty.

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

#86

Post by Intermernet »

mixmastamyk wrote: post #79
majormajor wrote: post #62

Earlier quoted context omitted.

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.

Sorry if this seems rude, it's not meant to be, I'm genuinely curious.

I understand (and support) opposition to contact tracing by badly designed technological solutions, but what is your argument against manual contact tracing? (actually asking people one-on-one who they've been in contact with if they test positive to Covid-19)

I'm just after your reasoning. I promise I won't deride your decision in any way (and I hope others refrain from doing so as well). People react differently in extreme situations, and I try to be aware of as many different reactions as possible, and possibly try to understand the reasons for those reactions.

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

#87

Post by unishark »

HarryHirsch wrote: post #38
newacct583 wrote: post #20

Earlier quoted context omitted.

It's not as bad as it's been. The US new case rate is down to about 65% of peak now. It's not dropping fast, but it's dropping. But a medical professional's subjective experience is local, and the US is a big place. Some regions are still (sigh) growing, and are indeed "as bad as it's been". But New York is now recording new cases at less than 10% of its peak from April. Broadly: much of the country, and all of the w…

It's bad. Try this graph to see how bad it really is: https://ourworldindata.org/grapher/new-covid-cases-per-milli... New infections per capita in the US are not falling and are an order of magnitude higher than in Western Europe. Israel brought new infections down to a few cases/million until they opened schools back up, now they are in line with Western Europe. The trouble is that there are superspreading events, s…

Models such as this one are estimating the number of actual infections is many times higher than the confirmed tests... and falling. Though this is projected to turn around again as social distancing ends.

https://covid19.healthdata.org/united-states-of-america

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

#88

Post by hcknwscommenter »

stickfigure wrote: post #75
rsanek wrote: post #71

Earlier quoted context omitted.

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 nu…

>Kaiser Permanente is a nonprofit but it sure isn't what you think of when you use that term.

Huh? It is exactly what I think of when I use the term non-profit in the context of a healthcare maintenance organization. I truly have no idea what you mean by your quoted statement.

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

#89

Post by hcknwscommenter »

thdrdt wrote: post #77
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.…

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…

I think you are missing the point. We are long past the point of containment. We will get to herd immunity no matter what. The question becomes, how to do it safely. The answer is to have in place sufficient capacity. One can have sufficient capacity easily if R is kept low. There are other ways of getting there (i.e., actually increasing capacity), or a combination thereof.

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

#90

Post by hcknwscommenter »

tomrod wrote: post #49
trhway wrote: post #43

Earlier quoted context omitted.

>It's basically condemning them to working nonstop for months if not years how come? wouldn't without lockdown the herd immunity with that R0 would come in like 2-3 months (and during that period the vulnerable people would have to be locked down), while with lockdown we're already 3 months into it without reasonable lockdown based endgame in sight?

The US did not lock down. A portion opted to stay at home if they could afford it, several industries were deemed essential (often with ridiculous inclusions), and the brunt is being borne by folks in poverty. We had between 40% and 60% reduction in urban mobility, much less in rural areas, and an increase in stay at home rates on par with a census block groups median household income. Then we re-opened too early. Th…

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.
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