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| Sorry, kids. No choice. Had to do it. Bummer for you. |
In case you missed this post Saturday, go RTWT at Borepatch's blog.
Re: Ms. Specht.
Some of her assumptions are okay, but many, many of them aren't just wrong, they're ridiculous.
In a nominal 300-bed hospital, fewer than 10-20 beds (on average) are suitable for Kung Flu isolation in a negative airflow room.
So:
1) Kung Flu will never flood all hospital beds. TPTB cannot let it.
2) Kung Flu will soak up all available isolation rooms, and all possible ICU beds, body-slamming an always scarce resource.
3) For 80% of Kung Flu victims, they will be told to go home and self-quarantine, and treat the symptoms, and they'll be fine.
4) In fact, some 20% of the total number of victims may not have any notable symptoms.
5) The problem then, is the 20% at the other end of the bell curve.
15% will need hospitalization, and it won't be available. But not by the date specified; she's probably a month or more early.
6) The 5% of the little end will be the ones who die, soaking all ICU beds up, and all available ventilators, and then swamping mortuary services, crematoriums, and graveyards, and leading to a pretty good shot at mass burials and/or corpse bonfires.
7) Overall, we'll be turning Kung Fu patients away, in droves (because if we didn't, health care would totally collapse for everything, which would be asinine), and sending them to whatever slapdash FEMA-camp hellholes FedGov comes up with. Because we're not going to infect the staff, and all public spaces in the hospital, to waste resources on 1-3% of the population that's going to die anyways, and simultaneously dropping the ball on heart attacks, strokes, trauma, and other easily-treatable medical conditions for which we can save lives.
8) Masks are similarly important overall, but pointless in the short term, as are all other supplies, because eventually, TPTB will have a come-to-Jesus epiphany, and realize than anyone that gets Kung Flu needs to go - in all cases - to a Kung Flu treatment Center, not to the Friendly Local Big Medical Center, because if we see them there, they'll die anyways, and kill all healthcare for everyone else, which keeps most hospitals running around 90+% of capacity 24/7/365/forever even without Kung Flu.
That's why I've been telling people not to get the virus: because if you're in the sick-or-dying 20%, you're going to get shunted into FEMA-ghetto care, far below typical first-world standards of care, because it's all there can be, and all there will be.
Health care in this country is not going to stand on the railroad tracks and dare the onrushing express train to squash it. American health care is not going to fling itself on the pandemic live grenade in a futile bid to try and save everyone.
It's going to necessarily throw Kung Flu victims, en masse, under the bus. It's Lifeboat Ethics 101: when you can't save everyone, you save the mostest with what you can, and let the sea of disease take the rest.
When faced with losing everyone, or letting the sickest victims of Kung Flu die, the adage will be the old Russian saying:"toughski shitskiy, Comrade."
Something Ms. Specht never even considered, but which makes exquisitely logical sense, with virtually irrefutable logic.
Trying it the other way is why Italy's medical system is in freefall meltdown nationwide, as detailed in the last couple of posts here.
We won't do that, because we dare not.
Bigger problem: what happens to our system in the in-between times from when Chinese-supplied Rx meds and antibiotics stop arriving here, and before alternative and new lines of supply pick up the slack? That could be a far bigger problem, and crush regular healthcare anyways, let alone the Kung Flu victims needing antibiotics we won't have any more of, because they're all made either in China, or with Chinese chemical precursors. So American healthcare may not die in May, but in August, from lack of basic treatment supplies and drugs. And then, it's a bad day for Grandma and Gramps either way.
Think about this long and hard. Then try to tell me why I've got it wrong, and we'll kill everyone and destroy all healthcare for everything to try and save some few people with Kung Flu, because that approach makes more sense, in Comments.
33 comments:
Aesop your logic is excellent BUT your talking about an emotional response issue.
Or maybe the answer why we would destroy the US Medical System via that "Live Grenade" scenario? Two Words Political Incompetence.
As a fellow health care worker I fully expect to die in place up and until the system has no good use for my employment. It's what you and I DO.
A few quotes from Winston Churchill a Leader that stood in the breech of disaster.
"There is no such thing as public opinion. There is only published opinion"
Thus what is posted as "Everybody's doing..." is mere propaganda.
"I'm just preparing my impromptu remarks."
Almost nothing said my "Government Officials" isn't a well prepared propaganda to support.....
"There is in the act of preparing, the moment you start caring."
Don't wait for some else to "Save and your family" if you care about something PROTECT it with Effective Actions. Hat Tip to Aesop's Gun Woodstock effective actions or No actions comments.
"I no longer listen to what people say, I just watch what they do. Behavior never lies."
Self explanatory. Would any country shut down over a mere "Flu".....
"Socialism is a philosophy of failure, the creed of ignorance, and the gospel of envy, its inherent virtue is the equal sharing of misery."
AND some folks in America want to VOTE it in..... The Wu Flu, the Economic crash or Socialism pick one, pick all.....
"When you're 20 you care what everyone thinks, when you're 40 you stop caring what everyone thinks, when you're 60 you realize no one was ever thinking about you in the first place. You have enemies? Good. That means you've stood up for something, sometime in your life."
Wow so many quotes but this post is getting long, sorry.
And finally the quote I was looking for, spoken to the full assembly of both houses of Congress by Winston Churchill:
"You can always count on This August Body to do the right thing - after you've tried everything else.
AND that Aesop is why I feel Governmental Blundering will place both you and I as well as the whole US Medical System on that live grenade.
And I Pray I am wrong....
self-quarantine will not work, Americans are too self centered, like the guy who went to the father/daughter dance.
Nope.
TPTB have no say.
The medical establishment and administration does, and ultimately, the staff will refuse to die in place.
They will simply decamp homeward until sanity breaks out.
Handing health care to government would be like giving books to monkeys.
That's why you don't expend all assets on 30M people, by forfeiting all care for the other 300M. That's pointless.
The problem for health care is going to be muddling along until patients and governments reach that obvious conclusion.
@Anonymous,
Yes it will.
Because you won't be getting into a hospital, and your neighbors will shoot you on sight.
Watch and see.
As to incoming supplies. I can only speak to what is handled by DHL. CVG (Cincinnati) is DHLs largest hub here in the states. Usual cargo influx of flights from China is 5+ 747s a day. Every day. Chinese new year has in the past made for a 2 week break in that pattern, usually in early February. CVG has not seen a single direct Chinese DHL cargo flight since late January. Make of that what you will.
Echoing the first "Anonymous" comment, you're assuming facts not in evidence, that our authorities will act as rationally as you expect them to do (for example, what will it take for Trump to focus more on the virus than the economy? When will move to mitigation?). We also have, this time the analogy is really apt, 50 state Petri dishes in which various policies will be tried. Then again, as you implicitly note, American are an ornery bunch, lowest level policy will perforce happen at the point of care level like hospitals.
One thing you didn't think of: in a place with enough hospital infrastructure, one or more hospitals might be solely dedicated to COVID-19. If every bed can provide oxygen, that might not even be a totally insane thing to do, but obviously it won't help with ICU overload. Doesn't solve the PPE problem, though, but presumably in due course a population of healthcare workers who've recovered from it will be available.
Meanwhile, this German study of mild cases, see this CIDRAP news piece for an overview, suggests "wash you hands" / avoid touching your face is not going to help hardly as much as we hoped.
Aesop, you are talking about the brutal reality, triage on a massive scale. Likely the next 60 days will be one for the history books.
One of my closest friends is a primary care doctor. He is the most beloved doctor in the community. We went to the same college. He is a hard core freedom loving conservative, prepper, and gun guy. He has a BOL. We were were together on Saturday. He told me that he has decided not to bug in or bug out. He said he will work at the hospital every day until he catches the virus and hopes that he will recover from it. That's how he rolls. We are both in our 60's.
My wife is due to retire in June after over 40 years as an RN. I told her that when the first Kung Flu case comes in, she submits her resignation and walks out the door. I have no problem enforcing that with her if I have to. I believe that we have worked to help our society in our professions most of our adult lives and deserve to live out the rest of our lives together. (30 years in Law Enforcement and 14 years in the Fire Service for me)
Some people are now are only waking up. Most of the others I talk with are stuck in the "It's just the Flu". Reality will hit them like a sledge hammer.
You have to assume that once this is loose in a community, the doctors, nurses, and staff from receptionists to janitors are all going to get this. Whatever impact that has hospital operations can be left to the imagination.
The best thing everyone personally and societally can do is to delay getting the Wuhan Flu as long as possible.
Social Distance
Good hygiene
Stay out of crowds,
Don't go into public places unless absolutely necessary.
We have to survive and be around to rebuild.
Question for the assembled medical types. Me 60, wife 61. My co-morbidities ae not the sort that will cause problems with the Wuflu. Wife has asthma. Normally well controlled, but when it gets going it often winds up at the doc-in-a-box or the ER. She has a nebulizer and a good supply of albuterol.
I figure if this gets as bad as we all think, she will be triaged. Aesop is right; the mathematics will demand it. So I'm planning to provide as effective care at home as I can figure out how to provide. I've researched older and "alternative" methods to deal with pneumonia, and I'm trying to get her to get her pneumonia shot. Would an oxygen concentrator be a worthwhile device to have handy? Not a vent, but could it make a difference?
Or would I be better off buying more food so we can avoid people?
The COVID-19 treatment centers will hopefully be warm and welcoming places with soothing music and pleasant scenes projected upon the walls.
https://m.youtube.com/watch?v=bshz1reMTVY
@ASM826,
That really depends on whether there's a quarantine or not, and how far-reaching it is.
@Freeholder,
Avoidance always trumps treatment.
"Be somewhere else." - Commander Zero
@ThatWouldBeTelling,
Oh no, I've thought about that.
It's a total non-starter.
TPTB could try that, for about ten seconds.
Not having been hired on for that, and having no buy-in to the plan, 95% of the staff would walk out the door in a New York Minute. (I would, without a second's hesitation.)
And never return.
It's a seller's market in healthcare, for every skill and specialty, from now until long after I'm dead. You can't automate our jobs, you can't ship them overseas, and you can't hand them to lesser-trained people without killing more people than the diseases you're fighting. Lose-lose for management.
Which turns a multi-million dollar 21st century medical marvel into a trailer park FEMA Kung Flu Treatment Center in as long as it took to read this.
Plan over.
There's a reason there are only four (working on five) BL-IV bio-hazard ICU units in the country. Virtually no one wants to work in one. They can't even afford to staff the beds they have in them now. And they can only handle 11 patients, nationwide, where they do isolation correctly and scrupulously.
Well Aesop, I hope you are right but after 30 years in the infantry I think poster number 1 has the unfortunate answer. Think TF Smith, US Grant throwing bodies at a tactics problem, Sherman tanks against Nazi armor, USMC in Lebanon, or for the political laugh-ins like the Clinton solution to the Liberia blood diamonds (UK had the right solution, US military liked it, but Rice shoved a political Clinton move on us anyway), the multiple Israel-Palestine boondoggles, the multiple Iran boondoggles, etc. My faith in logic when applied to politics is zero - it is all about the feels don't ya know. I hear you on docs and nurses voting with their feet, but I fear the govt. might have a solution for that as well. Only time will tell and watch your six!
GruntPa
responding to The Freeholder comment at 10:58: research serotonin causes asthma. Start here: https://raypeat.com/articles/articles/serotonin-depression-aggression.shtml and here: http://raypeat.com/articles/articles/co2.shtml and here: http://raypeat.com/articles/aging/tryptophan-serotonin-aging.shtml. Lowering serotonin improves lung function and reduces asthma. Increasing carbon dioxide in body tissues is very helpful. These do not require a medical doctor. Get off of meds that increase serotonin because one of the side effects is asthma.
"but presumably in due course a population of healthcare workers who've recovered from it will be available."
---there is evidence that having wuflu does not provide immunity, and in fact if you get it the second time, you can just drop dead of heart failure. Something is at work in all those videos from China, people walking along and just drop. Beyond the videos, there was an article about a patient that recovered and then tested positive when she got sick again.
Unlike staffing ebola centers with recovered patients, that doesn't look like it will work this time.
nick
wrt any "plan" they might have for medical pros, almost exactly 2 years ago I went thru the CDC pandemic guidance to providers and pulled out some interesting things.
https://asprtracie.s3.amazonaws.com/documents/aspr-tracie-hcc-pandemic-checklist-508.pdf
I’m looking thru the CDC’s Flu Pandemic readiness checklist for health care providers and I see a whole bunch of stuff that’s worth thinking about. So I’m highlighting some here:
3.11 Pre-identify strategies and resources to ensure behavioral health support for staff to mitigate adverse stress and grief and loss reactions.
[translation- EMS is gonna have family and friends that die from the pandemic- try to keep them working]
3.12 Determine virtual coordination mechanisms that will enable remote engagement of senior staff to prevent exposures and maximize ability to engage in both daily and incident operations”
[translation- senior staff need to be kept out of the treatment areas to keep them alive while everyone else risks dying.]
“3.21 Develop criteria for on-scene denial of transport by EMS personnel for influenza-like illness and other patients – with or without on-line medical control – ideally regional rather than agency-based criteria and process.
[trans- figure out at what point do you stop bringing flu cases into the hospital and effectively quarantine them at home, and when you let EMS make that decision on their own.]
3.22 Develop/provide patient information sheets on homecare for influenza-like illness
including usual clinical symptoms and course, infection prevention, treatment, and when to seek additional medical care.
[trans- people are on their own at some point, figure out what point, and give them some info about what to do]
3.23 Develop/provide patient information sheets for other conditions that may be left without transport if the service volume suggests a relevant need (e.g., minor injuries).
[trans- again, you’re gonna be on your own, with minimal guidance]
3.24 Determine alternate transport resources and triggers to utilize them, e.g., private
ambulance, wheelchair, contract/courier, for hire vehicles, military assets, buses
[trans- martial law at some point, and how many NG or regular Army units will want to deploy into a Flu zone? How many will be ABLE?]
Here’s a nice one:
4.5 Determine actions that the state emergency management or public health agency is likely to take that affect health care including:
• Suspension or modification of requirements for hospitals or clinics
[when will you be able to use tents, parking lots, warehouses]
• Specific emergency orders or actions that may limit liability or expand scope of
operations (for facilities and providers, including volunteers)
• Requests for 1135 waivers from the Centers for Medicare & Medicaid Services (CMS)
• Crisis standards of care activation
[when will you drop normal operations and just do whatever you can without liability- ie at what point does S really HTF?]
• Issuance of clinical guidelines for care and resource allocation
[when do you start rationing and triage?]
• ‘Taking powers’ of the state relative to medical materials and staff (i.e., does the state have ability to commandeer resources under their emergency powers and does this include medical materials?)
[trans- when will they come for YOUR stuff, and do you need to give it to them. side question- where would ‘the state’ be TAKING the siezed materials????]
• Promulgation or enforcement of legal obligations of medical staff to provide care
[trans- when will they come for YOU, and what if anything can you do about it?? this is where preppers worry about ‘being on a list’ of EMS or First Aid trained, or CERT, etc, can they force you to provide medical aid? what if you are licensed?]
And these are grim:
4.38 Develop a plan for implementing a supplemental facility security/controlled access plan (which may be phased) particularly during the peak pandemic weeks to assure controlled campus ingress and egress and monitoring.
4.39 Provide patients and staff with information about stress responses, resilience, and available professional mental health resources. Develop staff monitoring for those exposed to high levels of cumulative stress or specific severe stressors (death of coworker, etc.).
4.40 Consider ways to maintain staff resilience and morale when congregate gatherings and close physical contact are discouraged. This may need to include memorial services for staff members.
4.41 Determine if the fatality management plan is sufficient for an increased volume of decedents at the facility
There’s lots more and it’s worth looking at. After all, this is what CDC thinks your local health care providers need to consider and plan for WRT flu pandemic.
-EMS not transporting sick people
-facilities and services shut down or reaching capacity and rationing of other treatment
-local authorities SEIZING medical supplies
-local authorities FORCING med staff to work
-deaths among EMS, facility staff, and care providers
-physically securing the treatment areas
-giving priority to staff family and pets
-using the military to provide transportation, reserve medical services, and security
-too many dead people to deal with normally
nick
(the link came to me in the weekly newsletter I get for EM and first responders)
@The Freeholder at 10:58:
Oxygen concentrators are nice but frighteningly expensive. At least, they were when I last looked at them about 10 years ago.
They are also nowhere near as effective as the ventilator if someone is really in respiratory distress.
Unless money is no object, I'd go with canned goods, batteries, etc.
NB, my comments and asides are in [brackets] bolded emphasis is mine.
And FWIW, like most published guidance, I'd bet 95% of hospital administration didn't even read it and fewer took it to heart.
nick
O2 concentrators are available on ebay, last time I looked and are much more reasonable.
nick
This was in local news report last night.
The real BS starts at 14:00 in.
https://www.kold.com/video/2020/03/09/watch-pima-county-tucson-officials-talk-about-coronavirus-outbreak/
Top.
Men.
DanH
"but presumably in due course a population of healthcare workers who've recovered from it will be available."
---there is evidence that having wuflu does not provide immunity, and in fact if you get it the second time, you can just drop dead of heart failure. Something is at work in all those videos from China, people walking along and just drop. Beyond the videos, there was an article about a patient that recovered and then tested positive when she got sick again.
We can now state for a fact that SARS-CoV-2 does produce antibodies. We should also be extremely suspicious about anecdotal "recovered", released based on flaky tests, but is discovered to still shed viruses reports, for both of these see for example the links I supplied above. Some of those postulated "reinfections" involved people who were on anti-virals which were discontinued. Data from the PRC should be viewed with extreme skepticism; even if the CCP isn't a direct issue, they cargo cult a lot over there, must for example publish a certain number of papers per unit of time, the CCP of course not being much about the Lysenko level.
As far as I can tell, the big and genuine concern is that there might be an antibody dependent enhancement (ADE) effect, a big issue with dengue, follow the links to see the fiasco this has caused in the Philippines. The English nursing professor lots of people like has also commented on this. I don't at this time feel qualified to comment beyond the previous, and that people are investigating it, we should know after a while if it's going to be an issue.
Here in Norway we are going to try. They are considering the medium scenario, 22000 patients in the hospital, 1700 in need of ICU, at the same time. Norway has about 5M inhabitants. Today they are 1200 ICU beds. Today the prime Minister was on TV and said "money is not a problem".
Please don't quote Churchill. He was an absolute monster who ordered the use of chemical weapons against cities. Thankfully the RAF told him that order was not going to be followed and he should be very careful about pursuing that path.
Anonymous 1:39 and I suppose the FIREBOMBING of Dresden was an improvement over chemical weapons? Roasted alive in their bomb shelters maybe with a side order of French Fries? Maybe the use of Nuclear Weapons on the least damaged Japanese Cities to "Better assess effectiveness" is an improvement over chemical weapons?
The I'll quote Patton "War is Hell". Nothing is nice nor pleasant about maiming or killing people. Been there, done that, still trying to even out my Karma helping and helping folks heal in the medical system.
Aesop while I hear your answer to my Churchill posting as you realize the leadership of the hospital has to determine when they will disobey the Federal Government as to protect their people from this FEMA disaster. By that time you and I are likely casualties to COVID19 anyway. Just trying to decon our facilities to INCLUDE the ENTIRE HVAC system will be horrific.
Never saw a High Up Hospital Sort be that smart in emergency decisions, that's why they normally do the "hands off" let the ER Doctor handle it thing.
Your earlier posts about Wal-Mart COVID19 "Treatment Areas" will occur. Crimean war "medicine" with a side order of panic and folks going VERY Tribal "Defending" themselves from anybody they suspect is a threat to them.
Tribal as in Bosnian Ethnic Cleansing Tribal is what I fear. I SAW that up close and personally for over a year. Horrific.
Who knows if our Republic will survive in a form we recognize as our sense of being identified as an "American" is very weak due to divisive Media and Politics.
War is monstrous. That being said, I suspect your panties are waaay too tight. Best try the big boy panty aisle next time.
Anonymous -
She (and I) are both on statins. If I'm reading this correctly, those can fudge up serotonin receptors. Maybe that's a good thing?
Just watched a portion of what was listed above (conference in AZ). At this point I think we have used the movie Idiocricy as a societal blueprint.
Already seeing effects on health care in UK. Southampton hospital closed its (one level down from) intensive care/post op care ward due a staff member with CoVid19. Numerous operations postponed indefinitely, including some potentially lifevsaving cancer ops....
I think it's going to be a lot tougher on you guys with the healthcare system you guys have...
Because elections.
Better aVoid people and gogle your nose and throat with Hperoxide,30 drops at1/4 of a glass.
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