Saturday, March 28, 2020

Today's Reality Check

This is cases. It's also a launch profile for a moonshot.
And deaths to date tracks this apace.

On January 21,2020, the US had 1 case of Kung Flu.
On February 1, we had 8 cases.
On March 1, we had 98.
Today, March 28, at 1:26AM EDT, we have 104,837.
Blame all of that on finally doing testing that you like, I don't care.

On about March 21st, we had 400 deaths from 1/21-3/21, total.
Today, we've had 410 deaths in the US in the last 17 hours.
I'm waiting to see how many more by 8AM today, but it's somewhere around 700 deaths/day now.
That's not because we just started testing. Deaths are deaths. Period.

Flat-lined at that rate, that's a 9/11 by the end of the month, at midnight Monday, in four more days.
That's the entire Iraq OIF War by Friday.
By the end of April, that's 21,000 additional deaths, which is more flu deaths than we get in an entire average year of influenza. So clearly, this isn't "just the flu, bro." And that's extrapolating them out on a flat line.

But the death rate doesn't flat-line. It grows, exponentially, just like the infection rate.
And the death rate, and tally, aren't even the problem with this bug (for the fiftieth time).
Because odds on, 97% or more of everyone lives through this just fine.
That's 320M out of 330M Americans who'll get through it with minimal muss and fuss.
And probably more than that.

But we still only have hospital beds for 0.28% of America.
2.8 per thousand of you.
And we still only have ICU beds for about 0.018% of you.
1.8 per 10,000 of you.
(Which last, BTW, isn't even enough for everyday problems, 6 days out of 10.)

But if either 1M of you need to be hospitalized, or 100,000 of you get really sick, because of Kung Flu, and need the ICU and a ventilator, health care goes bye-bye, until a month after this is all gone.

And people on vents with this are in ICU for 11-21 days.
We don't even have numbers yet on how many, even with that level of intervention, survive.
But it looks like "not many".

And if we get the numbers, and that comes back as less than 1%, we're probably going to tell you that "there will be no more ICU admits for Kung Flu pneumonia. If you get Kung Flu, and you have pneumonia, we'll be sending you back home to die. It's that, or cancel health care for everyone else. Sorry, but that's how it is."

The latest straw-clutching happy gas is to claim this will peak completely in 2 weeks, because of the assumption that "everybody's got it, so people will stop getting it."

Mathemagic FTW.

And if we just erase five or six zeroes from the Holocaust, it never happened either. That's the level of bullshit you're being spoonfed by the idiots and soothsayers.

So let's see how that fairytale works out, day by day.

You can claim anything you want with infection rate, because of the testing problems and shortcomings. Fair enough. I get that. It also bones us for ever getting accurate handles on the breadth and width of this pandemic.

But you can't gainsay the body count. We aren't suddenly counting car accidents and gang shootings as Kung Flu deaths, anywhere, AFAIK.

For the perennial shit-for-brains club, that's not panic.
It's just the actual ground reality.

Nota bene: No one told anyone to do the Headless Chicken Fandango.
Never. Not once, at any point this year.

But use the actual reality to counter the happygas b.s the idiots are pimping, harder and harder, the worse this gets.

UPDATE: Such happygas and mainlining hopeium includes the magical belief that things are going to be different in your AO, because your area is administered by [R]s instead of [D]s. FFS, this is a pandemic; the virus doesn't give a shit about your politics. And we've never met a politician yet that had our best interests at heart more often than not, from any party. This is not a D vs. R thing; it's an infected vs. not infected thing.
YMMV, but I sincerely doubt it. More enlightened administration may get you some extra time, and a few better interventions, but in the long run, this is already everywhere, and it won't stay out of town because your mayor or governor is less socialist. That's an entire barnyard of horseshit. You have lower population densities some places, which only slows the spread. If you haven't avoided it entirely, or stopped it cold (and so far, no one has), you're already doing it wrong, and that bill is going to come due, no matter where you live.
And say, how many major acute-care hospitals you got out there in Mayberry, Aunt Bea?
And how many pharmaceutical manufacturing lines? So it's already bitten you in the ass, hard, and you didn't even know it. Unless you prefer 1960s- or 1930s- (or 1830s)-era morbidity and mortality numbers for common conditions. Let me know when the penny drops for you. I'm guessing the first time you go to fill a monthly prescription, and the local pharmacist zeroes it out and says, "Sorry, don't have that anymore." Bummer. All my best to your relatives on monthly meds.
And FTR for the general assistance of the reading comprehension impaired, we've
1) never said this is the Zombie Apocalypse, nor even anything remotely close
2) consistently, early, and often told people not to panic
3) never told anyone, anywhere, anytime, to bug out and head for the hills.
This is a pandemic. We have advocated most circumspectly the appropriate response. Period.
You're not seeing it somewhere, yet? So it therefore isn't happening?
Best wishes with that plan.
We still counsel a firm lever, to break suction, and pull your heads out.
The issue for you is when, not whether.
If you cannot grasp those obvious facts, nor quote us or characterize our statements accurately, kindly don't mention us at all on your pages, unless desirous of the same back.
Trying to make points by telling outright lies only makes you look petty and/or stupid, which is seldom a good look for either your credibility, or your character. Let alone your blog.
We understand that Fucktards gonna Fucktard.
Best not to be one.


whynot said...

Discussing with my ED colleagues nation-wide (even more-so now with this problem)

We were seeing this weird pneumonia, most likely viral, back in mid-December, not many but enough that is was noticeable.. Influenza testing negative. WBCs low. No real response to antibiotics (Cefepime and vancomycin). We didn't have SARS-CoV-2 tests available to us.

In retrospect, we are thinking we were probably seeing COVID-19 in mid-December.

ThatWouldBeTelling said...

That's not because we just started testing. Deaths are deaths. Period.

It is for some subset of early deaths, when there weren't enough tests to go around, and postmortem?? See also LA saying they're stopping testing unless it might change the clinical outcome.

So it depends on who and how is tallying up which deaths get assigned to COVID-19, and which to flu (for example, in coinfection cases), etc.

Now, though, the curve is pretty reliable. And very, very bad. A lot of people should have payed more attention to exponential growth in their math and science courses, and still, I bet a lot of people will continue to "gainsay the body count."

One question about the use of vents: I've read the abstract of a paper that said placing the patient prone, that is, head down, has a higher rate of success for ARDS. And every picture I see of a US patient on a vent is on his back.

Of course, those are probably just file photos.

nick flandrey said...

From the comments on FB, linked in another RR comment-- There is no emergency in a pandemic

"Rishabh Kothari-- With the news of 13 Italian doctors dying from COVID-19. If you do not have proper PPE, do not go in. No matter what.

This post is for my healthcare workers, docs, surgeons, Nurses, aids, and ems, and all staff.

There is no emergency in a pandemic

You as a healthcare worker are a force multiplier. Your training and experience is invaluable moving into this crisis. So, you're going to be faced with some very difficult moments. You're going to have to put your needs first.

I'm speaking specifically about PPE and your safety.

If you're an ICU nurse, or an ICU doc, and you become infected, not only are you out of the game for potentially weeks (or killed) But your replacements could be people without your expertise. Your remaining co workers are short staffed now, more likely to make mistakes and become ill themselves. You stop being a force multiplier and start using healthcare resources.

You going in may save the patient, it may not. But you cant save any patients in the weeks your laying in a hospital bed or using a vent yourself.

People are going to die. Do not become one of them.

There is no emergency in a pandemic.

During the Ebola outbreak, people were dying. But at no point did we rush in, we took the 10 minutes to put on our PPE with our spotter. If we didn't have proper PPE we did NOT go in.

There is no emergency in a pandemic.

You may work in long term care, and want to rush in to save a patient you have had for years. Do not go in without your PPE

There is no emergency in a pandemic.

You may have a survivor in the room, screaming at you to come in because their mother is crashing. Do not go in without your PPE.

There is no emergency in a pandemic.

You may have an infected woman in labor. Screaming for help. Do not go in without your PPE.

There is no emergency in a pandemic.

You may have A self qaurentined patient with a gun shot wound and is bleeding out. Do not go in there without your PPE

There is no emergency in a pandemic

Doing nothing may be the hardest thing you've ever had to do in your life.

Many of you say, I could never do that. I wouldn't be able to stop myself from rushing in and saving my patient.

Liberian nurses and doctors said the same thing, and many did run in to help, saying PPE be damned. My patients need me.

Then they became infected, they infected others. And they died. They didn't help anyone after that.

Do not let the deaths of hundreds of healthcare workers be forgotten."

Stay safe!"

Aesop said...


Concur completely. We had flu-negative patients, and were admitting higher-than-average atypical pneumonia patients back in late Dec-early January, and I suspect the same thing as you.

Aesop said...


Shooters already know that prone is not head down, it's face down. ;)

And yes, that would be contrary to every precept of airway management, and contrary to every stock photo extant.
Starting with the fact that the ET tube comes out of your piehole, not out of the back of your head. We don't use snorkels.

Proning intubated patients, by itself, is going to be a fustercluck.
All the stuff you need to get to is then under the patient.
Suction apparatus. ETCO2 indicator. Etc.
It'd also counter-intuitive to put the whole patient's torso weight on top of the lungs.
Short answer/suspicion: It's Not Going To Happen.

With a 14-30% best case of a successful recovery, in a pandemic, the protocol is going to become to discontinue respiratory support, stop intubating at all, and simply let them die.
Mark my words.

Anonymous said...

The good news?

We got "sporky" in as the new condition superlative before things really went to shit.

That's about the only good news.

Shit Pants Or Roof Koren YOLO, indeed.

Hope people get serious.

There are major qualitative outcome differences available in HOW you crash a plane.

So my skyking frens tell me...

Godspeed to all.


Hope@ZeroKelvin -Proud Deplorable said...

The number of positive tests is not a good indicator of how much we should be worried about this illness - that depends on the number of tests run, which is increasing.

What seems to predict a total S**t show is the number of days it takes for deaths to double.

Texas reached 20 deaths on the 26th. If we reach 40 by the 29th, it would mean we are doubling every 3 days. Better than Italy and NY but worse than CA.

In one of the largest hospitals in my area, if that rate holds, and no other intervention (HQ + azithro or immune plasma) changes that, will overwhelm the ICU beds, ventilators and PPE.

Hope@ZeroKelvin -Proud Deplorable said...

Left out - will overwhelm the ICU beds, ventilators and PPE In 15 days.


This bug it already out there, hard to see how any further quarantine is going to help. People are ALREADY infected, those that are already immune are recovered. IMO.

Aesop said...

As noted, ignore the confirmed case rate.
The current quarantine is half-assed, by design.
Just like the testing regimen.
test everybody, quarantine the infected for a month, everyone else for 14 days, and this is gooooone by May 1st.

But we cannot do that, and even if we could, we wouldn't.

Anonymous said...

Impossible to stop. I work for a company that makes Ventilators, i fix/ service them. I’ve been in every major and minor hospital in New England. Hope I don’t get it, cause I’m going to spread it every where. I should be happy I’m working, overtime. For some reason,I don’t feel that lucky

Anonymous said...

Thanks for the continual updates and tough love. Stay safe everyone

Delta Lima said...

Well....Fuck. It's been a good run, boys. Ima head up into the mountains for a bit and find my war face before it really gets shit sideways. Just want to let you all know that you are fine a group as I have ever come across and I hope to see you on the other side. Aesop...I have thoroughly enjoyed your writings even though I'm a new comer. You do a fine job with no bullshit. I like that. I guess all of us jarheads like it that way. I'm out here behind enemy lines in Commiefornia as well. I'm tired of waiting, one of the worst 2 things about combat. The waiting for it to start and the lulls between action. I'll see you when I see you. Godspeed brothers all.

Anonymous said...

My guess is that the only difference that D v R might make is that the people in certain areas may have more common sense than in others. Thin hope as so many people don't really understand 'essential'.

When the closure of salons etc was announced the wife was seriously disturbed that here greys would show. Tried to call and get an appt before closure. Thank God the place had already closed!

Stupid is a large multiplier that is making the R0 on this far higher than it needs to be.

Steady Steve said...

No way out but through on this one. Prayers and gratitude for those on the healthcare frontlines. Hopefully this changes the mindset of people in this country as to being prepared and more mindful of what they may need to do for their fellow man. Not holding my breath though as there will always be selfish idiots that don't get culled.