Saturday, April 4, 2020

Math Update And Ventilator Numbers


S3: Shit Mardi Gras.
Worse than a Shit Show (S1).
Worse than a Shit Circus (S2).
Better than a Shit Riot (S4).


















1)  On March 17th, we had 4000 confirmed cases. Today, April 4th, it's at over 300,000 confirmed cases.

We have more than that; you know it, I know it, Yellow Dog knows it. But that means, minimum, this is doubling every three days, and has done so six times in the last nineteen days.

That's eight million cases by the 19th of April, give or take.
And spotting this the low end of only a 1% CFR, that's 80,000 dead in two more weeks, which surpasses any flu season, and is 4 times worse than the average one.

In perspective, it's nearly a year's worth of U.S. combat deaths from WWII, in just 2 more weeks, if it rolls out that way. It may be better or worse, but it's sure as hell not anywhere close to good yet.

So, can we please finally STFU about how this is "just the flu", and how "the cure is worse than the disease", when opening the floodgates takes the spread of this to Mars, on a rocket ship?

It's doubling every three days now, not just because of testing, but because it can, and this is with most of the country on at least voluntary stay-at-home, to restrain the spread (which is working, when dumbasses actually do it).

You can think happy thoughts when cases and deaths (over 1100 since yesterday) peak, and come down the other side of the roller coaster. Not before.




2) We've covered this material, multiple times, but probably in a response in comments, or on another forum, so once and for all here, a reminder about ventilators and such.

Nurses don't run ventilators.
Respiratory therapists do that.
It takes 2 years to train one, and another year of OJT to get them good at it.
Each RT can manage 4 vents, if you want it done right.
If you don't care about killing people, maybe you can surge that, short-term, to 6 or 8@.
And that's it.

A vent can deliver 100% fiO2, at pressures you need to understand to do properly.
It's known as PEEP. A good setting for a vented ICU patient with Kung Flu is as high as 25.
Average for normal times and cases is much lower, but that's what happens with Kung Flu pneumonia: it requires more force to pop the alveoli open when they're filling with fluid and mucus. Think lungs full of goop, like blowing up a balloon partly full of Elmer's Glue, and you're on the right track.

You can't get to this level of O2 concentration with an oxygen concentrator, and you can't get that level of forced pressure from a C-Pap machine.
Period.
Can. Not. Be. Done.

You're trying to fly to Mars in a hot air balloon.

So just no, for all related questions of "Can I do_______?"

And if somebody, anybody, thinks we're good if we just crank out 100,000 or 1,000,000 ventilators, because "'Murica!", then please, tell me how you plan to squat, grunt, and shit out the 25,000 to 250,000 trained respiratory therapists you'll need to run that many vents, which you don't have now just sitting around playing cards and waiting to come to your Pandemic Party in ICU or the ER.

And BTW, the Nawlins ER Doc who wrote this clinical missive (which is probably dead-on balls accurate - it's an industry term) notes that Kung Flu patients on ventilators die at rates between 70% (Seattle) and 86% (worldwide average), to date.
So anyone bad enough off to need to go on a ventilator with this (which means they're also sedated, and in ICU, as either a 1:1 - one nurse:one patient - or 1:2 patient), has between 1 chance in 3, and 1 chance in 7, of surviving to recover and go home. The other 2 out of 3 or 6 out of 7 will simply die, between Day 11 and Day 21 of intubation. Sometimes, even quicker. (Our patient last week lasted 48 whole hours, and coded multiple times before the MDs called it off for good.)

So I repeat, for emphasis:

Stay your happy ass at home, and DON'T catch this.
 
Somewhere between 97 and 99% of you will probably recover just fine. But 1-3% of you, and not all of them "old" by any standard, are going to die in a coma, isolated, with a plastic tube down your throat, and breathing mucus while you drown in your own body fluids.
 
If you don't have it now, and don't catch it, you don't have to see about finding that out firsthand, even at 1 chance in 33 or so.
 
Go back and read this morning's post, and see what you need to be working on. Worrying about this won't fix it. Just know it's still craptastic. Now go get on with your life, such as it may be, and do constructive things with your time.
 

37 comments:

ASM826 said...

And pretty clearly,if you get to the point where you need a vent, your odds are shitty no matter what the level of care.

Grandpa said...

I believe I've mentioned it before; won't be the virus or the economy that kills us, it will be "the stupid". At this juncture, those who simply can't/won't understand;should be considered to have passed the first step in disqualification from the gene pool.And,to ensure the safety of the rest of the planet;should be moved quickly to step two; which is retroactive birth control. Step three, napalm the remains.
Desperate times... severe penalties. I figure a few examples on the evening news as a visual aid, and folks may begin to learn...
All I needed to read was "ventilator/intubation = probably die anyway" -
and my decision was made. Easy peasy.

Sentenza said...

...and now, the mayor of NYC wants to steal doctors and nurses because NYC needs them...

https://www.theguardian.com/us-news/2020/apr/03/de-blasio-new-york-coronavirus

Aesop said...

Pretty sure the Thirteenth Amendment and the federal kidnapping statutes rule that out.

Bee Ess said...

If you have ANY space, grow where you can. Go long on beans, potatoes, peas NOW. Go long on squash for the fall. If you can pressure can, do your spinach, kale, radish. GROW IN ANYTHING YOU CAN. If you have dried beans from the store, you can germinate them. Whether they produce more, i've never seen, but i know they grow.

GROW SHIT, you're gonna need it sooner OR later OR both.

Doug Cranmer said...

I work at Costco as a stocker. They are limiting the number of people in the store, so we have lineups that snake through the parking lot and round the back of the building.

People walking around with signs and to remind people to stay 6 feet apart. But the store has a constant stream of people with 150 or so in there at any one time. All doing the usual shopping things. Touching merchandise, picking it up and putting it back. Chatting in small groups when the carts bunch up around the toilet paper and other special items. All in an enclosed building where the air is recirculated as someone pointed out here.

It's all theater. My area has some cases and deaths, nothing like New York, yet, but it seems it would take nothing to touch it off here if this is the way "self isolation" is being handled by the local authorities. Multiply this by the Walmarts, the large grocery stores, the hardware stores.

It's all theater. People are just counting on luck.

Paul W said...

@ Aesop:

“We have more than that; you know it, I know it, Yellow Dog knows it. But that means, minimum, this is doubling every three days, and has done so six times in the last nineteen days.”

While I generally agree with your analysis (especially that there are MANY more infected than the published stats say, by at least a factor of 3), some of that increase is due to recognizing what is already a fact (testing), rather than new infections. I would peg our doubling at every 4 days, rather than 3 - but that only changes the slope of the curve (and, of course, depends a lot on how the great unwashed behave. I saw a picture of a crowded #2 train in NYFC on Thursday, so even in the worst hit schitty where you would assume that awareness is as high as anywhere, they are still not being near as careful as they should be).

What are your thoughts about how much more massive AND EARLY treatment with hydroxychloroquine,z-packs and zinc would change things?

John said...

"Yellow Dog doesn't even know what town he's in.” - Funny Farm

(and this John is Wilder)

Nick Flandrey said...

Just the flu. Totally normal to have unattended bodies in bags on the sidewalk. Totally normal to build carnie bunks in reefer trailers for the overflowing dead. Our hospitals are always full of bodies in hallways. Yep.

https://www.dailymail.co.uk/news/article-8188533/US-sets-grim-global-record-1-497-virus-dead-one-day-half-NYC.html

n

BTW headline writer, with exponential increase, or even linear increases, EVERY DAY WILL HAVE RECORD HIGH DEATHS until the day this starts to be over. yeah, I know, tabloid paper, but the others aren't any better.

Robin Datta said...

If they can't get enough ventilators, and the staff. to operate those ventilators, their efforts may be better invested in getting/setting up makeshift crematoria and securing a large supply of urns, à la ChiCom. Last I knew few hospitals had spare staff stashed away long-term in storage rooms. However I am retired for more than ten years now, while robotics has made has made exponential progress, and so my information may well be outdated.

ThatWouldBeTelling said...

If everyone self quarantines to the level needed, the economic dislocation will lead to huge numbers of deaths from suicide, etc.

Maybe there will be a difference between the normal getting fired or laid off, and it happening because of an act of God, with a bigger safety net, government, civil society, and private? Maybe someone somewhere will get a clue about esprit de corps?

[In the Costco Doug Cranmer works at, social distancing is not strict.] Chatting in small groups when the carts bunch up around the toilet paper and other special items. All in an enclosed building where the air is recirculated as someone pointed out here.... Multiply this by the Walmarts....

This week Walmart will be starting to make their isles one way, so that should help, and maybe others will follow their lead. The recirculated air, though, could be a tremendous problem, as we more and more suspect direct infection by airborne droplets is a major, or maybe the major mode of transmission. Universal masking would help there, if only to decrease carriers spewing out virus laden droplets.

Charlie said...

https://www.globalresearch.ca/manufactured-pandemic-testing-people-any-strain-coronavirus-not-specifically-covid-19/5707781

https://www.youtube.com/watch?v=KUw1Rzbde5U

Unknownsailor said...

Heard reports yesterday that the CDC is finally getting off the X and starting to codify how widespread asymptomatic spread is via anti-body testing.

This is a critical thing to know, so that we can tell where we are in the doubling phase. If there is widespread immunity, then the case doubling should start to level off soon. Up until now we haven't the foggiest clue who has had it outside of those who have been officially tested due to symptoms.

I hope Trump starts to loosen the stay at home orders for people who have had it, beaten it, and are no longer contagious. These people can get back to work.

Avalanche said...

Bee Ess: "GROW SHIT, you're gonna need it sooner OR later OR both"

Here's a fantastic book, with a funny tale of its birth. Paraphrased, of course, cause I wasn't there: "David the Good" -- whose several gardening books are superb -- went to the Senior Editor at Castalia House, a great Finland-based publisher that has published several of his book (really good one is Compost Everything!). He suggested he 'had an idea of a book that might be good?'

"Tell me."

"Well, all these preppers, you know? They're laying in supplies and lots of guns and ammo and stuff? But few of them are laying OUT gardens and planting food. I've been thinking I could write a book on how to do that; would Castalia be interested?"

"Absolutely!"

When he returned with the book; David the Good said to the Editor: "Um, I've thought of a title that I think is good, but I'm not sure you'll like it."

"Tell me."

"Grow or Die."

"Perfect."


Grow or Die: The Good Guide to Survival Gardening is a solid, very funny, book on how to begin and keep up your survival garden. I'm NOT a gardener -- and won't be one -- and I'm enjoying reading it!

Hope it's okay to post the URLs, Aesop? eBook: http://www.castaliahouse.com/downloads/grow-or-die-the-good-guide-to-survival-gardening/ Paperbound: https://aerbook.com/maker/productcard-3039486-1875.html (Also Amazon and B&N. Aerbooks is Castalia's physical-copy seller.)

ThatWouldBeTelling said...

https://www.globalresearch.ca/manufactured-pandemic-testing-people-any-strain-coronavirus-not-specifically-covid-19/5707781

It's garbage:

Here’s the problem, we are testing people for any strain of a Coronavirus. Not specifically for COVID-19.

RT-PCR tests look for specific genetic sequences, different tests for different ones in the conserved parts of the SARS-CoV-2 genome. It would be rather strange if every test so far looks for sequences that are also found in sequenced normal "common cold" coronaviruses, and no one has noticed this yet.

That’s because most Coronavirus strains are nothing more than cold/flu like symptoms. The few actual novel Coronavirus cases do have some worse respiratory responses, but still have a very promising recovery rate, especially for those without prior issues.

The novel coronavirus will still be spreading at a tremendous rate, because, you know, it's novel, no population had immunity to it when it arrived on the scene. So the "few actual novel Coronavirus cases" totally fails, eventually we expect 80% or more of the population to gain immunity to it, from getting it or a vaccine.

PCR basically takes a sample of your cells and amplifies any DNA to look for ‘viral sequences’, i.e. bits of non-human DNA that seem to match parts of a known viral genome.

The problem is the test is known not to work.

It uses ‘amplification’ which means taking a very very tiny amount of DNA and growing it exponentially until it can be analyzed. Obviously any minute contaminations in the sample will also be amplified leading to potentially gross errors of discovery.


Well, yes. That's why the tests have controls, the null control is pure water without nucleic acids. If it gives a result, you know your lab. machine. or reagents aren't clean enough, there's cross contamination. Which is believed to be a major problem with the tests the CDC sent to the states, and why their Atlanta manufacturing faculty was shut down, after an FDA troubleshooter saw what a s***show it was.

The Mickey Mouse test kits being sent out to hospitals, at best, tell analysts you have some viral DNA in your cells. Which most of us do, most of the time. It may tell you the viral sequence is related to a specific type of virus – say the huge family of coronavirus. But that’s all.

Oh really? Didn't know our immune systems were so inefficient, I guess I'll discover if that's true in the coming months as I learn about it. But there's a slight problem here. Coronaviruses are RNA viruses, and aren't complex enough hide out in cells.

The idea these kits can isolate a specific virus like COVID-19 is nonsense.

Here he posits a vast, industry and world wide conspiracy, that also includes research labs who use PCR and RT-PCR (RT is use for RNA), are cargo cultists. With no one blowing the whistle until he does. Possible, but unlikely.

And that’s not even getting into the other issue – viral load.

If you remember the PCR works by amplifying minute amounts of DNA. It therefore is useless at telling you how much virus you may have. And that’s the only question that really matters when it comes to diagnosing illness.


Oh, yeah, it doesn't matter if you've got a bacterial infection, for which antibiotics are prescribed, or a viral one. Everyone approving, making, selling, and prescribing antivirals is a fraud. In fact, the whole worldwide healthcare industry is composed of witch doctors.

And coronavirus are incredibly common. A large percentage of the world human population will have covi DNA in them....

And here I can stop the Fisksing, no one ever has coronavirus DNA in them unless they have an HIV coinfection or the like, to convert that RNA into DNA.

Note also the powers that be would have to be executing huge numbers of people to generate the COVID-19 death statistics. I suspect our host can tell us if that's the practice in his hospital.

FredLewers said...

Somewhere there's an executive order that can be twisted to allow it. TPTB just aren't desperate enough yet to invoke it.

FredLewers said...

I think yellow dog is working as Joe Bribem's therapy dog.

Nick Flandrey said...

Maybe some of the issues in NYFC come from stuff like this?

https://i.dailymail.co.uk/1s/2020/04/05/06/26822918-8188533-A_trash_can_is_full_of_used_masks_and_gloves_outside_Wyckoff_Hos-a-70_1586064947562.jpg

There is tubing in there too, and who knows what else.

No way is it approved practice to dump masks, gloves, and used medical equipment in an outdoor trash can. What does inside look like?

n

ThatWouldBeTelling said...

Nick Flandrey, "Third World Immigrant Medical Workers Exploited by NYC Democrats" Key graphs:

Less than a month ago, at the now infamous Elmhurst Hospital in Queens where patients with the Chinese virus are reportedly dropping like flies, the same recruiters were only willing to pay nursing assistants and patient care techs the federally mandated minimum wage with zero medical benefits, zero paid time off, and zero opportunities for a pay raise or professional advancement.

[...]

Most of these workers are Third World transplants that form an endless pool of disposable low-wage labor for New York City’s nursing homes and hospitals. Many of them, yes even the RNs, have very low literacy skills; and having barely passed their licensure exams, they will put up with anything to keep their jobs. No amount of abuse is too much. And in fact, most of them are locked into their pre-Chinese virus wages, which means they are risking their lives and those of their loved ones for $15.00 an hour in one of the most expensive cities in the world.

[...]

When I first started receiving calls about a week ago to work permanently at Elmhurst Hospital, even though the money was very tempting, two things made me decide against it: my health and the prospect of working with these low culture immigrants, mostly women from the Caribbean (Jamaica and Haiti), Africa, and the Philippines. My apprehension was two-fold. These women tend to be unhelpful, verbally combative and sometimes even outright refusing to speak English on the floor, making their medical units a multicultural nightmare. Their indifference to professional protocol also means that they can put your own license at risk. I have personally witnessed medical directors coming close to being suspended and investigated for careless mistakes made by medical subordinates who lied and covered up to save their own hides.

Careless mistakes happen because these workers tend to be very easily distracted, with very short attention spans. The chief contributor to all of this is that most of them are unnaturally addicted to their cellphones, using every free moment to check social media accounts, make calls, and to watch insipid videos. In most unionized facilities in New York City (1199 SEIU), walk onto any medical unit, especially in the nursing homes, and you will see bells ringing non-stop and patients in distress. But somewhere on the floor you will also find a cluster of nursing aides and nurses laughing loudly while watching videos until a supervisor is forced to come to the floor to crack the whip....

old but still rolling said...

for those wanting some insight in how a virus functions and immunology, this is fairly basic and quite interesting.

https://www.youtube.com/watch?v=EhCCiIaGae8&list=PL55B28888146FAD78&index=3&t=0s

explanation from a virologist/immunologist

. said...

Sooner or later, Trump & his advisers are going to have to make a decision on whether to continue to support a wide-spread stay-at-home recommendation as per Doc Fauci, and totally tank the US(and eventually the world) economy; or decide what is an acceptable number of casualties for people to return to work.

It's a tough decision, and there is no right answer; just a "least damaging" answer.

Dumping it in the various state governors' laps would be the politically expedient thing to do.

Perhaps leaving the "hot spots" in "lock-down" except for essential services workers(I fall into that category, because oil & gas production).
Let the less infected areas slowly return to some semblance of normalcy.


As I said, no completely correct answer. Just one that is the least damaging to both the public health, and the economy.

Nick Flandrey said...

The pols and media seem to have latched onto the idea that the peak is forecastable and is in 2 weeks/1 week/10 days.... No way do they have that good a handle on what's going on. No way are the models that good.

So what happens then?

n

Charlie said...

Perhaps you can answer a couple of odd questions I have.

1. How are deaths being determined to be kung flu so quickly? I ask because every death I have dealt with it took weeks to get a cause of death.

2. Both friends and family members working in hospitals, one in New Orleans and one in New York, are telling me that they are being told to take time off. Not ease their schedule, but take time due to lack of patients.

Thanks

Zero the EBTs said...

Covid-19's 64,753 current world death toll represents 2.7% of average annual pneumonia deaths worldwide. With 1,202,236 cases currently, it would have to infect 44,559,578 people while maintaining identical case fatality rate (CFR) even as the winter flu season is rapidly running out of winter to work with. Quite the stretch, even with the CDC inflating "no tests requires!" bogus death numbers in the US as fast as it can, and policy many places is to bottle everyone up indoors fooling their grubby little bodies into thinking it's still winter because they're not making natural vitamin-D in the sunshine. --And this is all just to REACH average from the bottom side.

Nick Flandrey said...

Why the sudden concern about (theoretical) suicides? I've seen more articles about (potential) suicides in the last three days than three years.

Seems odd, and manipulative to me. Just think of the children. Poor hit hardest by CV.

Why should we be worried more about hostage takers than involuntary victims?

n

ThatWouldBeTelling said...

Mars Ultor: Not Aesop, but it's pretty obviously either malignant lying or fatal sloppiness. See here for the clanger that prompted me to stop reading, I've emphasized the critical passages:

China did not release the RNA sequence required to create a COVID test until 12 Jan. The virus had already spread so far by that time that the first confirmed case outside China was discovered in Thailand the very next day.

Two months elapsed between the date China claims COVID originated and when the test sequence was made available in January. That means there were at least 60 days of undocumented spread of a highly transmissible, often asymptomatic virus. COVID could’ve seeded itself all over the world and spread undetected for several months and no one in the US could’ve even tested because there was no available test until the very end of February....

So on the one hand, the author admits there's a test done in Thailand just as soon as was possible (this is well established technology), they're on the ball no doubt because Her Royal Highness Princess Chulabhorn is a biochemist, they had a brush with SARS, and especially after MERS everyone knew another was coming sooner or later. And yet somehow there's no testing in the US for another month and a half??

And on January 31st, the director of the CDC was the first to alert the world to how flaky these tests are, later echoed by many other countries, presumed to be in part from sampling issues. [From the transcript of the press conference](https://otter.ai/s/V4P5IYwFTaOjefIQdbc1JQ):

[...] I want to be clear the current tests that we developed at CDC, is not, we're not sure of the natural history of how the virus is isolated. Can you isolate it one day, then, three days later, you can and we are seeing in the cases that are in the hospital. We've seen people had detectable virus, then they didn't have detectable virus. Then three days later, they had detectable virus. We're using the virus cultures right now and these individuals more to help us learn about this virus. How much asymptomatic carriage in fact is there? So I want people to understand that distinction. We're not using it as a release criteria, because we don't know the natural history of how this virus is secreted. And this is what we're continuing to learn.

In other words, a full month before she says the US can't do tests, we've done a number on real patients, and have been discovering a lot about the whole process. Based on the first source I found, we had identified 6 by January 31st, and 62 by February 29th.

ThatWouldBeTelling said...

I really don't see how her getting dates wrong on testing is relevant to the idea that this disease could have been spreading earlier.

If you can't look at the text I quoted and realize she's either unable to think straight, or expects us to read that without noting the contradictions....

Her whole thesis depends on early spreading in the US which was not found by testing. Except for, you know, the fact that we were testing, for a month and a half, when she insisted we weren't.

Someone who has a thesis based on dates of events cannot be sloppy with dates if they want people to invest the time necessary to consider their thesis.

Marty said...

Aesop
Is it possible that the more sever cases are so because they have an excess of Iron in their blood.

I ask because the symptoms remind me of HFE hereditary haemochromatosis the shut down of organs,Fatigue malaise joint and bone pain hemochromatosis presents as Porphyria cutanea tarda and "COVID-19: Attacks the 1-Beta Chain of Hemoglobin and Captures the Porphyrin to Inhibit Human Heme Metabolism" see below

Hemochromatosis is treated with hydroxychloroquine which has been seen to improve Covid patients

In addition if it is an issue of too much Iron women generally have lower iron than men and children have lower iron than adults then there is the way people come back later and sicker as if their blood has had an iron build up

then there is this which seems to indicate the the hemoglobin is the issue

'hemoglobin to dissociate the iron to form the porphyrin. The attack will cause less and less hemoglobin that can carry oxygen and carbon dioxide. The lung cells have extremely intense poisoning and inflammatory due to the inability to exchange carbon dioxide and oxygen frequently, which eventually results in ground-glass-like lung images' ,,,the novel coronavirus is dependent on porphyrins https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surface_Glycoprotein_Inhibit_Heme_Metabolism_by_Binding_to_Porphyrin/11938173

I don't know if this has been looked at, I just thought I would throw it out there if it hasn't been looked at a simple blood test for iron would tell us if it is a factor if it is an iron overload then a simple phlebotomy might be undertaken

HA Reynolds, Houston TX said...

From daughter, Attending/Prof in EM at Tier One here:
NYC has discovered ventilators are the wrong therapy. This is a blood disease, not an influenza.
It blows apart the HEME, resulting in hypoxia, and (in end stages) excess free iron causing renal failure.
Patients still HAVE good respiratory action, but their blood has lost oxygen carrying capacity.

More akin to High Altitude syndrome than influenza. In my amateur mind, more like a supercharged MALARIA, which is why I’ve always thought chloroquine sounded good.

Their prescription:
Very High Flow O2 (generally 70-80 l/min !!!)
Remdesivir or hydroxychloroquine + Z-Pak
No ventilator until O2 requirements reach ~90 l/min, and then only w/ patient distress.

Perversely, using ventilators EARLY may have exactly the WRONG approach, but then everyone always fights the last war, until they adjust to the CURRENT one.

HA Reynolds
Houston

Don RN said...

Charley 4/5 916AM
"1. How are deaths being determined to be kung flu so quickly? I ask because every death I have dealt with it took weeks to get a cause of death.

2. Both friends and family members working in hospitals, one in New Orleans and one in New York, are telling me that they are being told to take time off. Not ease their schedule, but take time due to lack of patients."

1 -- you may be referring to the time it takes for the official Medical Examiner's report; &/or to deaths occurring outside of the hospital.
In clinical hospital practice, a death certificate is usually filled out by the attending physician at time of death and includes their professional clinical opinion of the cause(s) of death. Usually pretty accurate IMO. Many patients that die in hospital are not sent to the ME.
Finally, public health reporting I believe is a separate process than routine ME death reporting. As I recall, there are required short time frames for communicable disease reporting forex.

2 -- depends on role, and day to day volumes.
Many hospitals have been cancelling or delaying anything not emergent, so hospitals are seeing significantly lowered volume. That is going to be a major financial stressor once we get on the far side of the COVID surge ...
For employees who are not direct care, I suspect many health care systems are looking at which activities absolutely need to continue in expected emergent conditions, what can be done remotely, what might be delayed, etc. They are looking at preserving the health of staff, and looking at how they can utilize staff in unique ways when the crush does come.
Finally, both across the country and within regional areas, the demand is at different levels. The demand for any individual hospital I suspect is likely to take a major jump in an extremely short period of time -- a couple of days; and the place 'up the street' might be a day or two delayed. Requests to take time off a couple of days ago may well have no relevance on today's hospital staff needs.

Aesop said...

@HA Reynolds,

Short answer: That's simply horseshit.
FiO2 @15Lpm delivers nearly pure 100% O2.
Anything higher is just pumping O2 into the room, not the lungs.
70-80Lpm? There are no manifolds in common use that can pump that amount into the patient, nor any need. Most regulators max out @15-25Lpm, the latter of which is already overkill.

To get to 80Lpm, you'd have to be sucking liquid O2 straight form the tanks outside.
And with one spark you'd be a Roman candle.

So whether or not the blood vs. whatever pathology has any merit, there's no one who could be utilizing that level of oxygenation, period.

I call bullshit on the entire idea.
It's like telling me your DeLorean could travel back in time, if I could just pump 1.21 Gigawatts of electrical energy into the flux capacitor.

ThatWouldBeTelling said...

Don RN and Charley: one other area we're seeing medical demand collapse is in testing. At the same time they're being asked to do as many tests as possible, but at a financial loss for most labs if billing to Medicare, they're reported to be losing 30% to greater than 40% of their business because everyone is putting off anything non-urgent, Quest felt compelled to make a filing to the SEC. I covered an article on this a couple of days ago on another topic in this blog.

HA Reynolds, Houston TX said...

Hey Aesop, NOT my idea.
See: https://www.youtube.com/watch?time_continue=3649&v=_T_KT4j4oS4&feature=emb_logo
Go to about 1:00:40 and listen to Dr. Cameron Kyle-Sidell.

I certainly agree with your "oxygenating the room" comment and The Gemini Capsule potential. But I'm a mech engr for 40+ years, 38 US patents, just a mechanic, really.

Again, IT'S NOT MY IDEA.

However, I think Kyle-Sidell's results MAY point to hyperbaric therapy.
Think "soft" portable chambers. Actually easier to make than a ventilator...
The "soft" ones seem capable of ~1.5 atmospheres, which MAY be enough.

Re: Flow rates
Appaprently some fraction of O2 regulators ARE capable of 90 lpm, although I understand (from my fireman son-in-law) that MOST are limited (as you say) to 60 lpm.

HA Reynolds, Houston TX said...

Opps, sorry, it was Apollo 1 that had the oxygen accelerated fire, NOT a Gemini.

Aesop said...

1) I know it's not your idea. I merely pointed out that it's unlikely.
2) Hyperbaric chambers may work, but they'd have to be some portable version. Actual concrete-and-steel chambers are as rare as hen's teeth (there are like...ten or so, in SoCal, that I know of, and they're suitable for, at most one or two people at a time, for a time limited period, not as 24/7 patient bed locations.)
3) The LPM flow would require LOX tanks the size of oil tanks. We 'd probably have to be doing electrolysis of Lake Superior or the ocean with nuclear reactors to get that much O2.
4) I don't doubt your credentials, just the viability of the proposed therapy with existing technology.
It may also be that we could cure this with travel faster than light, but until there's a viable warp drive system, it's kind of annoyingly theoretical, is my point.

HA Reynolds, Houston TX said...

If we had KNOWN, we could have built portable (i.e. "soft") hyperbaric chambers at least as fast as ventilators. Laser-cut (relatively) impermeable fabric, seam weld, zippers with internal seal flap, fabric pressure fittings exactly like used on vacuum bagging. Sail makers could do this.

Offshore, we MAKE O2 and N2 nearly on-demand with RO units (YUGE, and not medical grade of course); the only reason hospitals buy cylinders from Air Products or Air Liquide is that their historical demand is (relatively) low. Again, well within existing technology, if not existing infrastructure (which I think is what you really meant.)

My real point in all of this is the strong possibility that MANY folks got it 180 degrees wrong. You can hear the anguish of that realization in Dr. Kyle-Sidell's voice.

In the grand scheme of things, however, it's the speed with which the accepted wisdom was challenged. Since I'm on of a dwindling number of male "DES Babies" you can imagine that I have mixed feelings about epidemiology.

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