Saturday, March 14, 2020

3% Of How Many?

One brisk and foggy April night in the North Atlantic Ocean, people came on deck and threw ice chips at each other, just minutes after R.M.S. Titanic struck an iceberg a blow just glancing enough to be mortal. They weren't absolute morons, they simply didn't understand the magnanimity magnitude (G-d---n spellcheck!) of the event, or that an annoying (particularly to themselves) number of them would be as dead as canned tuna in a few hours.

Keep your finger in that spot; we will circle around back to it presently.

It takes two years, minimum, to train a respiratory therapist. I asked them at work to insure I gave you the right information. They can only run and oversee about 4 ventilators at a time. (By law, hereabouts.)
A decent RN takes 3 years, minimum, to just license, and another year or so to know WTF they're doing. 
I mention this because some soopergenius with FedGov was yakking about buying and paying for 100,000 ventilators.
Okay, fine, Sparky. You do that.
So say they whistle up $200M, because for Uncle, that's chump change.
But it takes a year or two to make them.
And 10-20 years to try to pull 25,000 RTs, 100,000 doctors, and another million nurses out of somebody's ass, from a system that couldn't ramp up to make a tenth that many extra, in two decades, even if you shoveled money at the problem 24/7/365 from now until then.
Nineteen years after this is history.

It took 2 1/2 years with total mobilization, just to put 100,000 guys on the beaches of Normandy one June morning.
With this outbreak, the war is over before they get out of basic training.

"But South Korea is doing fine, with no massive lockdown!"
Yeah. And they also have 22 hospital beds for every 1000 citizens there.
Italy has 3.2.
The U.S. has 2.8.
Let me know when the penny drops.
You've got what you've got now for this thing, and from here on out, it gets worse, not better, for at least the next year.
Whether that's only a few thousand dead, or a few million, it's still too late, "you go to war with the army you have, not with the army you wish you had."

Currently, ER visits are drastically reduced, because nobody's bringing their usual 30% b.s. complaints in, because nobody wants Kung Flu.

Last night, no cops, no criminals, no crazies.
Literally zero. On a Friday night. Unheard of.
Everyone's hunkered down, watching reruns, eating their toilet paper, and drinking their bottled water.

But we had several potential cases of Kung Flu, and we're testing them now. NOW.
In March, two months after the horse got out of the barn. That will end well.

I will be shocked (and properly ecstatic to be wrong) if this doesn't explode presently, owing to the likelihood of tens to hundreds of thousands of unsuspected cases wandering about the country, probably going back to January.
As it is, testing is going to reveal it's two to three orders of magnitude worse than suspected.
And for 80+%, it's probably "just the flu".

Just like for the people in the lifeboats, the Titanic had "just a wee mishap, and a small inconvenience to their travel plans".

The problem, as always, is those people in the water.
And there's liable to be an awful lot of them this time, too.


chewbacca said...

To be a devil's advocate, we just need people to monitor the respirator, strictly speaking. They dont need to know anatomy, drugs etc etc. Just run the respirator. They are supervised by a qualified RT, who responds in crises. Could that scale up the personnel? Ya, it's far less than ideal, even less than adequate. But is it POSSIBLE?

Hawkin'Gal said...

22 beds per 1000 people? Wow. Do you have any idea why? Was it preparing for SARS redo?

I ask because I have a couple of sources talking about Embrel and Zinc being what "saved" SK.

Hawkin'Gal said...

BTW, I'm glad to hear some people are actually showing enough wisdom to stay away from the ER. Hopefully, you had an easier shift.

Unfortunately, my parents are regressing in their wisdom. After going to a funeral visitation last night, we were supposed to begin self-isolating today. They said they weren't going to the funeral today. They did. But they weren't going to go to the wake. They did.

I may kill them myself.

Or just give them ammo for the 12 ga., go home to my Tiny House, and leave them to their fate. Dammit!

Reltney McFee said...

"To be a devil's advocate, we just need people to monitor the respirator, strictly speaking. They dont need to know anatomy, drugs etc etc. Just run the respirator. They are supervised by a qualified RT, who responds in crises. Could that scale up the personnel? Ya, it's far less than ideal, even less than adequate. But is it POSSIBLE?"

Chewbacca: "Possible"? Certainly. "less than ideal"? you betcha, along the lines of "let's send Mayberry PD onto Gold Beach, because we'll have the Rangers take Pont Du Hoc, and they'll be able to be along shortly, in case Mayberry runs into any difficulties".

I was a ICU RN for a coupla years. I have been an RN for nigh onto 40 years, and a Physician Assistant for a dozen. If you take half/un trained personnel to oversee ventilators, YOU. WILL. Kill. PEOPLE. And, may I watch you whistle up two ICU trained/experienced/qualified/current RNs per ventilator, in, say, 28 days? Not gonna happen. And, you require FOUR PER VENT, because your peeps WILL take days off, and will ONLY work 12 hours a day, so your two vents require FOUR RNs to oversee them, if and only if your patients are not so ill as to require 1:1 staffing.

And, if they are (a) ill enough to require ICU, and (b) ill enough to require a vent, what are the odds that none of them are ill enough to require 1:1 nursing care?

As Aesop has, painstakingly, detailed multiple times in this very blog, the number do NOT add up, except (a) if The Creator is exceedingly kind to our woefully underprepared asses, or (b) the numbers add up to a long term, high mortality, mass casualty incident, the veritable MOTHER OF MASS CASUALTY INCIDENTS.

Hey! Let's offfshore MORE of our workforce and manufacturing! How could that end other than well for us?

Anonymous said...

Yep. Small percentages are never any big deal. Unless you are part of that small percentage.

Small question (that I probably know the answer to): where have said ventilators been manufactured these last 20-30 years?

Cougfan said...

Paying all those millions for fancy wealth-extraction admin suites and dozens or hundreds of administrivia staff instead of actual facilities is now coming back for us.

Anonymous said...

Must read

Anonymous said...

Good post, again. One nit: "magnanimity" seems unlikely to be the word you were looking for.

Robin Datta said...

The money for the 100,000 ventilators might be better spent buying front-loader backhoes: lot less training needed to dig mass graves à la Iran.

Robin Datta said...

Magnanimity: magna (great) + anima (mind)

Aaron said...

Chewbacca, I want you to know this isn't a snide comment, just an honest one from a 10 year ED RN. You'd be better off just digging holes.

Unknown said...

I been with you the whole time on this. I knew it was bad before it left China.

On top of that, we are at war. Been a secret war going on since last year rooting Chinese out of certain industries after they caught the ones stealing corona out of a lab in Canada.

If Trump and Putin had not shut their airports, Moscow and every major American city would be Europe right now. China tried and tried to get them to open them like they did Europe.

This is as act of war.

I feel sorry for California. It's gonna take a big hit. I was actually very relieved by how well Kemp-and Mayor Bottoms have worked hard from day one to keep Atlanta on point. It's better than I thought it would be by now. This whole state has been down. to the county level.

When Italy exploded, I was like oh shit, Atlanta is gonna be the same next week.

I believe Russia is gonna help us out with some medical personnel. Brazil too.

I hope warm weather coming will slow this down. It does not like warm and sun kills it.

Oh, and if were Xi, I'd kinda be worried right now. I get the feeling he is about to learn a hard lesson. God never lets evil triumph. Trump owns the Tesla papers. Team US and Mossad are by far the premier network hacking team in the world.

Rods from God.

Anonymous said...

Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy
Early Experience and Forecast During an Emergency Response

Anonymous said...

On 10-MAR I started a spread sheet recording data from the John's Hopkins Kung Flu tracking site. I open the JH site and record the World Wide (WW) cases, deaths, and recovered, and the same data for the USA at 8:00AM.

During the five days that I've recorded data, the death rate WW has increased by .25% from 3.51% to 3.77%. The death rate for the USA has dropped almost one percentage point (.99%), but the number of US cases has jumped by ~ 3.5X.

Can't reliably determine a trend with such a small sample, but in another week a trend for WW and USA should be identifiable.

I know that there is a at least one site out there that's tracking and charting the trends from much further back with nicely done graphs for #sick and #deaths for each data group that I'm looking at. I developed my own because it's been more than ten years since I messed with even a simple spread sheet and I wanted to see if I remembered how (I didn't, but the Internet is a great storehouse on how to do most anything.).


Anonymous said...

Here's the site I referred to above.


MuscDys Guy said...

"If you take half/un trained personnel to oversee ventilators, YOU. WILL. Kill. PEOPLE."

No kidding. As it is, even with full RTs on a normal day you've got only a 50-50 chance of having a competent one.

ThatWouldBeTelling said...

[ South Korea has ] 22 beds per 1000 people? Wow. Do you have any idea why?

At any moment, perhaps with little or no warning, their crazy neighbor to the north might create a mass casualty event, up to a full scale war. Trump's actually managed to get them to stop killing South Koreans for quite a long time.

Anonymous said...

4 new positives in Montana. News is saying all had travel history, 2 Washington state and 2 out of country. I guess they did not get the memo to stay put, quarantine for 14-28 days. unreal. just like everywhere, gonna be in my rural area soon enough.

Anonymous said...

I agree with unknown at 1416. It was clear by mid/late Jan that this was very bad in China. However, listening to the radio today the host was of the mind that all this has happened in the last 3-4 days, week at most. Talk about being clueless. Seems maybe a rather large part of the populace is represented by this guy. Even with the interwebs people somehow remain ignorant.. and call those who pay attention 'conspiracy theorists' etc. Amazing. Also explains why the stores weren't hit hard until Thursday around here.

Anonymous said...

Appears the good Dr has gotten into the medicinal MJ:

DrJanesDC™️ 4️⃣5️⃣ @DrJaneRuby

Seriously people, slow down and think.

This is not like a hurricane in a 3rd world country where delivery routes are cut off for months.

The longest you’d be quarantined would be 2 weeks — you don’t need to buy out Walmart & Costco to survive in your home for two weeks

Twitter post included in:

Unknownsailor said...

Most people do not get exponents, much less their inverse, logs.

On a whim I looked at some WA.DOT cameras today, and in places where on a normal Saturday in Seattle there would be traffic jams, traffic is sparse. Sunday morning at 7 AM sparse.

Charles in VA said...

Here's a cheerful thought...

If this thing trends like the Spanish Flu pandemic of 1918 it will come in mutating waves for two or three years with each mutation being deadlier than the last.

We've already gotten word of survivors of Kung Flu being re-infected and dying of sudden heart attacks, and speculation that it has already mutated in the wild once.

I can hardly wait to see what tomorrow brings.

I'd love to see this thing burn out fast, but as Han solo says,"Chewie, I got a Baad feeling about this!"

John Wilder said...

My in-laws are in assisted living. It's locked down - no visitors. That's good. They can't even leave their room, which is probably okay.

We live in a rural area, so when I went to the store yesterday it was busier than usual, but not panicked, and everything was in stock, including, I might add, freeze dried food. We've been hunkered down, only sending the kids out. College is closed, and I expect the rest of the schools will follow.

Next up? Betting we see only "necessary" people on roads. As I drove, I counted up the businesses that could close with no immediate impact, and it was most of them. Scented candles and second hand goods and such can wait.

Anonymous said...

I'm starting to learn just how well our regional hospital/clinic is doing at this point. We're in rural Oregon, with the nearest backups over the Cascades in Medford or up in Bend. TL;DR: Not bad, so far.

The cold I thought I had got more intense, so I called my clinic. Nobody with flu gets into the clinics, but they have a dedicated flu test facility in a now-unused section of an older facility. One patient at a time, two workers. Mask up and wash before anybody gets in range. Both workers were gowned, and were using positive pressure masks. A bit of exposed skin; the back of the head wasn't covered.

Swabbed and sent home. The message was waiting on the machine. (We're almost a hour at legal speeds from the hospital. BFE for the win, sort of.)

Test came out negative for Flu A and Flu B. The doctor on flu duty (same guy who did my colonoscopy two months ago) said a) the Kung Flu symptoms are as follows:

103-104F fever [I'm running a max of 102 so far]
Severe shortness of breath: take 3 steps and sit or fall. [Not that bad for me, but getting close.]
Severe weakness: hard to get out of a chair. [Nope, not unless the fever is spiking--take a nap in the afternoon and it would be nice to feel better when I wake up, not worse.]

b) No coronavirus test kits on hand. I gather the Oregon Health Authority makes the CDC look like a model of efficiency, competency, and transparency in comparison. Kate F'n Brown is a piece of work as governor. Any bad ideas from California seem to get taken by her.

I'm more or less isolated in the house. If it's Corona-chan, it's too late to keep it from my wife. I'm hoping is one of those lesser coronavirus(?) diseases that seemed to hit some people over the winter.

If it gets bad, he says they have an infectious disease setup in their ER. There is one confirmed case in the county, but OHA doesn't break out presumptive/under test. The doctor implied there have been some, generally for people admitted.

We prepped over the years. Touched up our supplies in the past few weeks, but we're good. OTOH, if there is a V2.0 of the Modoc Indian Wars, we're toast. If it's a chimpout in the big cities, probably no problem. Klamath Falls tends to discourage most acts of uncivil behavior. We'll see what happens with the end-of-winter homeless campers.

Life in the country can be intersting.

LSP said...

Well said.

My separated colleague tells me the Calgary health system, emerg, is overwhelmed. And this thing hasn't even really started. She says 811 simply isn't working anymore and the clinics are full to capacity, to say nothing of supermarkets.

I told her, "Prep up, kid," to no avail. In the meanwhile, they've taken to scrapping over food at the local Walmart. Kyrie.

The Gray Man said...

Not really. Those patients still have to get intubated, the doc still has to order the settings and then the adjustments have to made, then the readjustments. And monitoring the patient takes assessment skills. Remember that part above where Aesop mentioned nurses and RTs learning wtf they’re doing? The bulk of that is assessment skills.

As a new RN, I didn’t feel like I was a professional until somewhere around the 2-3 year mark.

Unknown said...


I heard it was an anti-malaria drug (cloroquinine phosphate) mixed with Zinc.
The drug gets the zinc INTO the cell.

Hawkin'Gal said...

I looked up hydroxychloroquinine and an Enbrel ad displayed so I mistakenly thought that it was the same thing.

If it's at all useful for Covid-19, I hope they ramp up production soon.

Anonymous said...

My niece goes to the univ of British Columbia Kelona, the campus that is in the midst of the okanagam, not the one in Vancouver, so any way today three folks in hazmat suits went into a dorm next to hers and four came out.

Robin Datta said...

Embrel is a biologic, with parts of two protein chains joined together, one from an antibody and another from a inflammation-related receptor: It is made from a DNA which was put together in a lab, an so is quite expensive. When the body is fighting off infections, it sometimes follows a "scorched earth" policy, destroying the infected areas: such areas (in this case in the lungs) become scarred and non-functional. Embrel and a couple of other biologics which quell the destructive inflammation elsewhere in the body are being tried for this. They don't do jack squat against the virus.

chewbacca said...

With all due respect, we're going to kill people anyway. I'm not talking about people off the street. What about experienced PSWs? There are more of them than nurses. I think you call them HCPs in the USA.

nick flandrey said...

" Anonymous MuscDys Guy said...

"If you take half/un trained personnel to oversee ventilators, YOU. WILL. Kill. PEOPLE."

No kidding. As it is, even with full RTs on a normal day you've got only a 50-50 chance of having a competent one. "

--still better odds than not having any vent at all. Just saying, if you're in the zombie apocalypse, the rules are changed.

--if China got thru this we can too.

I did things around the house today. I've got to sort and put away a ton of crap that I basically have just been buying and stacking for months. Neighbor went to the grocery store so I asked him to grab me a gallon of milk at about 5pm today. He came right back with it. It was however the last one in the case, and he got the last jar of spaghetti sauce (what he was sent for). He did say they were restocking.

wrt a comment upthread, it won't just be two weeks. Two weeks (better three) to get clear of your immediate concern about being infected. There will be LOTS of community infections at that point, and you won't want to be going out then either. Who knows how long THAT period will last.

And if you get sick during that 3 weeks, it's two more before you either turn the corner toward recovery or death. At the end of the SIX weeks, anyone in your household that didn't yet get sick will need an additional 2-3 weeks.

Right there, you are past 8 weeks, at the peak of the madness, and will want to stay under cover for a while yet.

3 months, or more, is a reasonable, defensible, timeline.


Wendy (KekistanTrans) said...

@ Hawkin'Gal

"Unfortunately, my parents are regressing in their wisdom. After going to a funeral visitation last night, we were supposed to begin self-isolating today. They said they weren't going to the funeral today. They did. But they weren't going to go to the wake. They did.
I may kill them myself.
Or just give them ammo for the 12 ga., go home to my Tiny House, and leave them to their fate. Dammit!"

My Father passed away in 2004 at the age of 83. Cancer he refused to get treated for. My 90 year old mother lives 10 miles from me in her Senior Citizen's apt. and I call her every day to check and remind her to take her meds and visit her about every other day for clean-up, laundry, food, trash, etc. So I think I know a little bit about old(er) people as I tell you this (and if my Mom is 90 be assured that I am not so young anymore either)...

I think your parents have probably decided among themselves - as husband and wife - that they are going to continue to live their lives and if their time comes, then their time comes. Hopefully together. And also hopefully save you the trouble of dealing with them when they are too old or senile to take care of themselves. Know that they love you and that they know that you love them, and that they love each other and have chosen to live the rest of their lives and eventually die together if it comes down to that.

Anonymous said...

FWIW this doesn't happen in Australia until today

nick flandrey said...

link didn't work

nick flandrey said...


? that didn't make sense.

BTW, many of the people here ARE experts. Up to you whether to listen to them or not.

The economy is already toast. Has been for a while. Stock market is not the economy, and is finally reflecting reality. Things are not fine, haven't been for some time, and while Trump is better than the alternatives, he's not Jesus anymore than the last one was.


Anonymous said...

Here is some real foil hat stuff. A disturbing video,

and from a link in comments, there is this, which is even worse. Some of the scenes in the video lend credence to what is in this narrative. The truth out of China? Given their secretive nature, we'll probably never know. Read it anyway and take into consideration that 'super flu' COVID 19 may not be the whole story. Also, keep in mind the nature of the 'research facility' in Wuhan.


robins111 said...

I saw the same thing when SARS hit southern Ontario Canada. The ER typically had about 35% hypochondriacs sitting around demanding attention to their imaginary illnesses.

When it was possible that they could actually get sick and die, they apparently stayed at home and read medical books to develop their next imaginary nonsense.

From Norway said...


That last link of yours is utter crap

Anonymous said...

I work for a company that makes ventilators, I service them. And little ECMO devices. No rest for me, unless I die.

Anonymous said...

Shootings in Chicago seem to be way down according to HeyJackAss! too.

I am praying all these shutdowns interrupt the infection chains.
Not much else I can do at this point.

Swrichmond said...

Paper Funny Money papered over all the inefficiency that we have built into the system to create make work jobs, administrative, government and otherwise such as compliance, over the past four decades or so. Very few American workers actually produce anything anymore,

Middle and upper management and the executive suites are all totally populated by sociopaths who care about literally nothing other than themselves.

In this environment doing an increasing amount of work has fallen onto a rapidly diminishing number of people who still do actual work. I seen estimates that something like 10% of the people in this country support through their efforts the other 90%. Everyone else is either a leech, a skimmer or a corporate robber.

Yes I'm a boomer and yes I have seen this developing over the past decades and yes I have tried to warn people and tried to fix it and yes I've been powerless to do so. Go ahead and blame me I don't give a f***. But you should also know yes I am still working and producing, because work ethic.

Swrichmond said...

A work ethic which is wavering, by the way, thanks to s*** heads like z-man.

Mark Matis said...

How many of those RTs and nurses are Affirmative Action???

Just why would YOU trust them to treat YOUR loved ones for this???

Reltney McFee said...

"Robins111 said...
I saw the same thing when SARS hit southern Ontario Canada. The ER typically had about 35% hypochondriacs sitting around demanding attention to their imaginary illnesses.

When it was possible that they could actually get sick and die, they apparently stayed at home and read medical books to develop their next imaginary nonsense.

March 15, 2020 at 2:21 AM"

Heh. I KNOW that The Almighty is punishing me, when my next patient's opening conversational gambit is , "I Googled my symptoms, and..."

Generally followed by insisting on azithromycin ("Da Zeeee-Pak!") for their (likely viral, if extant in any way) symptoms. Had similar conversations, every night, when I was an ED nurse.

Reltney McFee said...

Since I work a second job (because I am NOT going to finance a jillion dollars for a new truck!), here's a snapshot from Michigan's Upper Peninsula: after work yesterday, went shopping for a few items. TDW-Mark II wanted some ramen (grandkids out of school, gramma watch 'em so parents can go to work). No shopping frenzy, stocked shelves, and Ramen! Galore! (along with abundant TP). This is in small town Northern Michigan, so considerably less off the Blue Hive mindset.

Tucanae Services said...

"Oh, and if were Xi, I'd kinda be worried right now. I get the feeling he is about to learn a hard lesson. God never lets evil triumph. Trump owns the Tesla papers. Team US and Mossad are by far the premier network hacking team in the world."
-- Unknown


In rank order the hack teams I fear the most --

1) China
2) France
3) Russia
4) USA

China is number one on the list, not so much as to their prowess, as it is to the massive amount of resources they are willing to throw at an objective. Couple that with the fact that much of the net gear these days is made in china and you find from time to time firmware additions not part of the original design.

France? Yes indeed. France has always been willing to cut corners to swing a deal. Their favorite targets are industry not military for that reason. That is not to say they don't have the skills they do. Couple that with they have free reign in the West and their stealthy positioning and they are a nation to watch.

Russia is indeed the Avis of the dark web. They know more than anyone that their actions are under scrutiny so they have to work harder. That and US paranoia about them puts them under the spotlight. As a consequence on balance their skills are far better than the Chinese. Resource limitations and scrutiny hamper them.

USA? What was that Churchill used to say about us? We reach the right conclusion after we have exhausted all others? Fits us to a tee. We have excellent tools and techs. All that has an IP address has a 60% chance of hitting a net node in the US that our friends at the NSA suck up like a whore at Spring Break. But that is the problem, to find what you are looking for you need to know what to look for. Our culture tends to blind us to alternative motives.

The Israelis. Good but limited resources. They would be number 5 or 6 on the list after the UK and Germany. Their advantage is in humint. Stuxnet as good as it was required a mole to plant it.

Xi is going to learn a lesson alright but it won't be about Kung Flu. It will be economics. Politics and economics are like estranged brothers. They can share a dinner but they hate each others guts otherwise. Anything a Pol does distorts the pricing signals that a capitalist economy depends on. Such distortions ultimately ends up in collapse and China has $40Tn of it in outstanding debt payments and misallocation of resources.

robins111 said...

One annoying scam that kinda stopped during the SARS thing, was the 'Unknown 911 scam. In the Niagara area, with enhanced 911, when you called in, you could get Police, Fire and Ambulance (I was fire). It wasn't unusual for a vague information emergency would result in a person standing on their front step, with their bags packed, looking for a free ride to the base hospital. Naturally, because of our socialist health care, it was free, except to the taxpayer who was funding this fraud.

I took great delight in telling the fake casualty that they were being delivered to a SARS hotspot in the Emerg, but they were likely going to be OK.

The expression on their faces was priceless.

Tucanae Services said...

The fundamental problem....

Aesop points out the primary issue -- insufficient humans to man the machines. But it goes deeper than that.

Ask any business operator, construction or health care. They are going to go for the averages based on known knowns; bed demand, staffing, supplies, etc. The entire system is based on some form of EOQ model. In business jargon lean and mean. When the system gets anything over a 10% spike it will be viewed as a 'shortage' or 'anomaly'.

The hard reality is that it was a planned outage. But saying it that way is not acceptable practice.

Ropro said...

I’m a very busy Hospitalist in FL. I round at three different hospitals accounting for about 900 beds. So far, I’ve not seen or heard of ANY confirmed or suspected ‘AIPAC Flu’ cases. Not one. Nor have I had (I see 35 + pts/day) or heard of any strange, unaccountable respiratory illnesses. So WTF is going on here? I’m not an epidemiologist but this pattern of spread ( and lack of spread) is very concerning. There are at 4 international airports within 3 1/2 hour drive of me, so where are the AIPAC Flu victims? It is suspicious for a strategic, and thus intentional spread of something. A poison? with a more benign virus as cover? I don’t know but even my wife “you know I hate your conspiracy theories” is starting to suspect something more to this story

Matt Bracken said...

Recommended reading for medical personnel, and others interested in what's coming next:

Coronavirus in Italy—Report From the Front Lines
[embedded video interview]

Physicians in Lombardy, Italy, have been overwhelmed by COVID-19 patients requiring critical care. Based on an existing ECMO center network they developed an ICU network to rapidly identify, triage, and manage patients infected with SARS-2-CoV. Maurizio Cecconi, MD, of Humanitas University in Milan discusses the region’s approach to the surge, including clinical and supply management, health care worker training and protection, and ventilation strategies, with JAMA Editor Howard Bauchner.

chewbacca said...

I have a sister who is an RN, another sister who is a NP, a brother who was an RT. Basically, they said "possible " to train in a month. If hospital personnel are overwhelmed, patients are 10x more than you can handle, you have to throw staffing at the problem. Or they start dying on the streets gasping for air. We are not there yet. Maybe psychologically mindsets will change when we become Italy 2.0

Again, if we dont start setting up for this eventuality, it wont matter. We wont have the staff to even do the training.

Aesop said...

Doc, here's a hint why you're not seeing cases:

We just started testing in SoCal. On Friday. For a pandemic that's been rampant since January, in a region with a yuuuuuuge Asian sub-population. See if you can think why we didn't have many cases before now.

Thanks for noticing my typo. This is why I rarely use the damned Chiclet keys and "smart" phone b.s. But I had a few minutes before clocking in for work last night, but not enough time to goof-read a reply for WRSA, which morphed into a cross-posted blog entry.
Deal with it, FFS. I have bigger fish to fry.

And maybe, by Monday or Tuesday, I'll find out if any of the three suspect cases so far this weekend (so far) were positive for Kung Flu, and whether I'm getting 14 days off without pay soon. Or something worse.
This is a f**k-story now, and people are still figuring it out, so we're going to hit the wall facefirst for quite awhile until everyone gets their groove.
Which is probably how you'll lose the first 10% of health care workers right off the bat.

nick flandrey said...

Asked of my group elsewhere, and very sceptically...

“Anybody have family or friends infected? ”

–Yes. We just learned that several families in our neighborhood/school circle have kids with symptoms and negative flu tests. Some of them even have a recent travel history but all were told by their pediatrician that tests were unavailable.

Since Houston is supposed to have approved labs, I’m not sure why testing would be limited.

The family with both symptoms and travel has self quarantined since they started coughing, and this is the first time they’ve mentioned anything about it, and that was only in response to and after another family’s admission.


Avalanche said...

Wendy: "I think your parents have probably decided among themselves - as husband and wife - that they are going to continue to live their lives and if their time comes, then their time comes. Hopefully together."

Aaaaand if they pass this virus on to 30-50 OTHER folks at a funeral and a wake ... 'eh, bound to happen anyway; tough for the folks they gave it to'? IF they had decided between them that they wanted to wait this out and see if they get it and die.... HOW is it they never considered -- at the VERY least, their OWN daughter?! To whom they could very easily have brought this thing -- and thence to her friends and families and so on and so on?

NO. No "mercy passes" for bad selfish choices that could KILL other people! They were either too close to senile to make a decent choice -- or just plain didn't give a damn!

Time to stiffen spines!!

bearcub7250 said...

it's not the virus, it's the f-tardary. fear that, and plan accordingly.

nick flandrey said...

IF this goes the way the numbers and math indicate, every one of you who downplayed the danger and the urgency after the examples of Italy and Spain, should be dragged into a public square and drawn and quartered. Those who survive it, anyway.

DO THE MATH. Anyone who can read should be able to double from 2 to 10,000. EVERY THREE DAYS the reported infections double, as do the deaths (once they take off at least). Those are reported and tested cases. They are a small fraction of the population overall, but if that other 80% doesn't get immunity, they'll get it the second or third or fourth time.

For everyone who says "well, it's not here so I don't believe it." Cases are not uniformly distributed, nor should they be, until it has well and truly spread everywhere. Is there anywhere you can say "it's impossible to get the flu here"? That's a virus that had time to get uniformly distributed.

Look at the maps of cases. Only a couple of weeks ago, there were only a few states with cases. Now, the whole map is red. It's spreading, it will kill a bunch of people, and if it can't be slowed down it will reach a point locally where it will kill people who otherwise would have survived because we're out of acute care capability.

Predictions I made for growth just 5 days ago have already been exceeded. There is no such thing as over-reaction at this point.


nick flandrey said...

"Stop your fear mongering and listen to the CDC."

--please quote some specific guidance that would reduce my concern. Better yet, go back and listen to their weekly calls and tell me at what point they were both correct in their assessment and also not prepping us for increasingly worse news.

Was it when Dr Messonnier recounted that she talked to her kids at breakfast and told them to get ready for significant disruptions in their lives? Or maybe when she admitted they weren't getting any good data our of China?

maybe it was when she said all this?

"Our goal is to protect you. This will require you and your family to take action. I’d like to go through our recommendations for people at highest risk. Make sure you have supplies on hand like routine medications for blood pressure and diabetes. And over-the-counter medicines and medical supplies to treat fever and other symptoms. Have enough household items and groceries so that you will be prepared to stay home for a period of time. Take everyday precautions like avoiding close contact with people who are sick, cleaning your hands often, and to the extent possible, avoid touching high touch surfaces in public places. Avoid crowds especially in poorly ventilated spaces. This weekend the federal government made a very specific recommendation in this context that travelers particularly those with underlying health issues defer all cruise ship travel worldwide. We also recommend that people at higher risk avoid nonessential travel such as long plane trips. Lastly, and most importantly, know what’s going on in your community. If you could end up in the role of helping to care for a family member or friend who is at greater risk, we recommend you familiarize yourself with your loved ones’ medication and help them get extra to have on hand. Help them also get food, medical supplies and other necessities so they can minimize trips to the store. Create a plan for if they get sick and if you get sick.
You have to identify backups to take care of them. Everyone has a role to play to protect our family members, friends, colleagues, and neighbors who are at most risk. I understand these recommendations may not be popular and that maybe — and that they may be difficult for some people. At CDC, our number one priority is the health and safety of the American people. These are the kind of recommendations that I have made to my parents and I’m taking the appropriate steps recommended for family members of vulnerable people. Other staff at CDC are doing the same."

That all seems pretty plain to me.


From Norway said...

You can say what you want o mlf the CDC lady and her brother and the rest, but is the ONLY one I hear from the US that speaks clearly.

Anonymous said...

@various anon: Math is not fear mongering. As stated above look at the math in Italy and SK. Even in China the math is hideous and it is very likely their overall numbers are purposefully low.

Don't be lulled into complacency by the apparently linear portion of the exponential curve.

Go a-googling and see if you can get a primer or two on exponential math for dummies.

nick flandrey said...

@from norway,

go directly to the source if you can. The press will pick and choose, distort, and lie by fact or omission. The CDC, although they are managed by a bunch of opportunists and career politicians and insiders, at least publish a ton of information, much of it very useful. The press calls are online in audio and transcription.

From watching closely many disasters, both man made and natural, there are always people saying what needs to be said. It is always reported somewhere so that later, the press can point to the reporting and say "See we told you..."

For US news, journalists are taught to write in "inverted pyramid" form. That puts increasingly specific info at the end of an article. I often just skip to the end and read that, and I am surprised how often the facts listed in the very end of the article flatly contradict the headline or modify it in some important way.


nick flandrey said...

This article, which has some real numbers, is why people are dying in Italy. And why they'll die in France, Spain, the UK, and Germany.

If you have trouble with the paywall, google this phrase, and click on the result. If that doesn't work to get past the paywall, turn off javascript for the site and try from google again.

"Italy, the country at the epicentre of the European outbreak, told the country’s only ventilator manufacturer to quadruple monthly production, even deploying members of the armed forces to help meet the new quota. "

--even seeing the numbers with my own eyes, I can't believe them. All of France has only 5k beds with vents? The UK has only 4100. Jeez.


From Norway said...

People normally do not need respirators, and we are in max efficiency times. That is why the west does not produce anything, all is done in China with slave labor. Italy is lucky that they have one vent producer, other countries are not so lucky.

Sam Spade said...

This is so bad that the CDC only publishes updated numbers once a day, at noon, Monday through Friday. Leaving 23 hours 59 minutes for the media to fear monger more economic destroying decisions by government and companies.

The world population is approximately 7.7 billion people. The WHO is currently estimating 166,000 cases with 6,500 deaths worldwide. I'm not a math expert but my calculator says that's about .002% of the world's population that's infected.

Just how far would China, other countries that despise the new US policies, the media and the DC establishment go to destroy the economy in an effort to rid themselves of Trump?

Would members of the Democratic Party reference nuclear weapons over the 2nd Amendment? Would Democratic presidential campaign workers reference re-education camps for people who disagree with their policies?

Would a Republican president and Congress use 9/11 to further non-Constitutional surveillance of its citizens in the name of "national security"?

I'm not suspending my normal skepticism of the goal of worldwide governments' good intentions toward the freedom and liberty of their citizens.

nick flandrey said...

It's not the current level of death or infection that is the problem. It's the fact it doubles every 3-4 days and that likely NO ONE in the whole world is immune. So it has the potential to kill essentially everyone who gets it bad enough to need breathing support, because after all the ventilators are in use, everyone after that is on their own.

The number of available ventilators vs the world population is a tiny percentage.

Exponential growth is very non-intuitive. The last few doublings are what gets you, when you go from half the world to all of it in 4 days.


I understand your point, and I look at some of the measures required in horror, but I believe the math. If you believe the math you understand that only extreme measures applied early will change the outcome in any significant way. Look at China for an example of extreme measures applied early. And it seems to have worked, for some values of worked. The next wave thru China will be telling. Look at Italy for what happens if you wait too long.


BTW, we should never stop our vigilance but ... there are legit reasons for tyrannical acts in the face of extraordinary threats.

June J said...

I hope your justification for tyrannical acts in face of extraordinary threats don't come back to haunt us all.

The gun grabbers would love to use your justification for advancing their agenda.

Personally, I'd rather die free than live under tyranny enacted for any reason.

nick flandrey said...

A certain percentage of us are going to die from this no matter what. All the current restrictions can do is slow the spread and save what lives they can. Most of my friends and acquaintances are in the 'most likely to die' group.

The gun grabbers and their would be ground troops will have their hands full without going door to door getting shot in the face during this pandemic. TPTB will be lucky to maintain any sort of control or order at all with 15% of LEOs and troops down with covid at any one time.

When people feel threatened they arm up, and a large part of the population is currently or will soon feel threatened- especially once this gets into the FSA and they get hungry.

You can always fight the narrative by sharing video of the chinese authorities locking people into their homes to die... if that doesn't convert people to gun owners, nothing will.


nick flandrey said...

Or if anyone wants an alternative to my analysis, you can check out this…

When you see how badly they have to misrepresent things, and how poor their logic skills are, (like comparing current numbers of sick and dead to YEAR LONG numbers of flu, when we know this is exponential and doubling every 3-4 days. hell their numbers are already woefully out of date) I hope it removes any lingering doubt you might have about the seriousness of this outbreak.


They don’t even LOOK at the real death rate for cases bad enough to need treatment. If you get it and didn’t even know you had it, it doesn’t matter since it didn’t affect you. We’ll NEVER know the number of mild cases unless we have true universal antibody testing, so talking about guesses at that number is a waste of time.

BTW, it only takes 20 doubles from last week when we had 600 cases to get to everyone in the USA .

That’s 60 days at current rates.

IF there is immunity, and because some people are already sick, the doubling rate should slow at some point. Or if countermeasures work.

As a reminder, on Mar. 2 we had 100 cases in the US. Today we have over 4000.

Two weeks.

And that isn’t all from increases in testing, the news is full of the whole LACK of testing issue….

We’re also running 50-50 dead to recovered for cases that have run their course with the full might of our medical establishment available.

We certainly don't run 50-50 for common flu, although I can't find a source to back me up on that. If anyone has a link...


nick flandrey said...

They also make the mistake of comparing confirmed cases to deaths, using year long numbers for flu, but only the deaths SO FAR against all of the tests for COVID. Of course that % isn't higher, all the infected haven't had time to complete their course of the disease and live or die.

That's why I look at only completed cases for the rate people die, if they get it bad enough to be tested and hospitalized. Given that people without symptoms are tested and confirmed, the rate of sickenoughtohospitalize vs deadfromwuflu is even higher than using the numbers shown.


Aesop said...

I saw Gateway Pundit's utter horseshit today.

It takes a special kind of stupid to be that retarded with numbers.
Reading it was like going to the Academic the Special Olympics.

nick flandrey said...

Yup. And a scan of the comments revealed the left hand side of the bell curve has access to the internet and isn't afraid to use it.


From Norway said...

I do not understand these people. Don't they see what is happening in Italy? Doctors in Italy are surprised that 30% of those confirmed with coronavirus need hospitalization. When has that happened with the flu?

vigilantcitizen said...

The emails are online.

All of them.

Pizzagate...alll of it.


Nahanni said...

The only ones I've seen who are "speaking clearly" are Aesop, Peter at Bayou Renaissance Man, Dr. John Campbell on YouTube and Zero Hedge.

If you're interested in how this all came about read the following and the original article it links to.

nick flandrey said...

Changes in the UK policy, with revelations that won't astonish anyone here, except for a feeling of "How could they have thought that?"

It's so you probably have to bypass the paywall by googling for this phrase and clicking on the link in the search results - not the first featured link.

"The latest evidence suggests that 30 per cent of patients admitted to hospital with Covid-19 will need critical care in an intensive care unit, he said. Previous estimates, based on experience with viral pneumonia, were too low.

Critical care bed demand would be eight times capacity after mitigation measures were applied, and around 30 times capacity in both the US and UK in an “uncontrolled epidemic”. "


nick flandrey said...

Over in Italy,

It has reported more than 700 deaths in two days, including a record 368 in a single day on Sunday.

Italy has now confirmed 27,980 infections since the outbreak began, compared to 15,113 four days ago.

Of those 2,749 people have recovered, another 414 in the past 24 hours.

That leaves Italy with 23,073 active cases of the new virus.

Italian health experts have predicted that the numbers will continue to rise in the coming days, with nationwide quarantine measures implemented on Wednesday expected to show results in around two weeks.

More than 12,800 people are currently being treated in hospital, including 1,851 in intensive care. Another 10,197 people are in self-isolation at home.

--the curve is slowing slightly, maybe, or it may be reporting artifacts. Note the "more than doubling in two days".

And this from a couple of days ago---

Lombardy's regional governor Attilio Fontana said the situation in areas around Italy's financial capital of Milan was "getting worse".

"We are close to the point where we will no longer be able to resuscitate people because we will be out of intensive care unit beds," Fontana told Italy's Sky TG24 channel.

"We need those machines (doctors) use to ventilate lungs, artificial respirators that unfortunately we cannot find," Fontana said.

"As soon as those respirators arrive from abroad, we will be ready to go on the attack."