2019-2020 coronavirus pandemic (Vaccination 2021 Edition)

[Agema]

No, it's people jumping to conclusions because they're only thinking in terms of mortality rates and critical care, as opposed to the approximately 14-15% of COVID-19 cases that require medical intervention but not necessarily hospitalization or critical care, because those cases impart a logistic burden on the health care system and supply lines as well.

Yes, everything the health service does imposes a logistic burden on the health service, that's a truism. The important question to ask is how big a burden. Stockpiling PPE, for instance, is really just a question of preparation. The countries that had severe problems mostly just failed to prepare: and even then, the UK for instance avoided critical exhaustion of PPE, albeit uncomfortably narrowly.

Food for thought: do you think the only benefit of telehealth services and drive-through testing is to limit contact between patients and care providers, and thereby minimize potential spread? Or is it also to minimize the amount of labor-hours needed per patient, in terms of administrative and clerical staff, and care providers?

It's all about efficiency and minimising manpower - the UK installed telehealth years ago. But they are also (relatively) easy services to expand.

The issue is about acquiring things that can't be stockpiled or have production ramped up in a short period, and the non plus ultra is healthcare staff. They're around a minimum of 2-3 years to produce, and well over 5 years for more specialised ones. There is only so much work they can do, which cannot be expanded much (never mind doing so increases risk of errors in healthcare, and depletion of staff through illness and burnout). To a lesser extent, some forms of medical equipment and facilities may also be relatively hard to procure (say, months).

So what really put a drain on healthcare staff resources? Answer, hospitalisations. Staff per patient requirements for hospital treatment, particularly severe and critical care, is much higher than primary health. In terms of covid-19, if a patient isn't hospitalised, they're at home looking after themselves and virtually no burden at all.

 

[deleted20220709]

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[deleted20220709]

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[stroopwafel]

This already happens. Before any patient is admitted to the ICU the anesthesiologists make a judgement about how likely the patient is to be able to endure the stress of ICU care (being sedated and but into a ventilator takes a toll on any body) and the prognosis after the patient leaves the ICU. For patients with a low life expectancy or high risk of dying during ICU care, it is quite common to go palliative instead, especially these days when ICU beds are hard to come by.

In fact, Swedish doctors caught quite some criticism for being too stingy with who they admitted into ICUs. Still the ICU staffs in Sweden have struggled to met the care demand. All my colleagues who work in ICUs or IMUs (Intensive Medical Unit, the 'after care' wards for those healthy enough to leave the ICU but still in need of assisted breathing or oxygen) have told me that the majority of patients that has come through have not been elderly-elderly, but people in their 40s-60's. The elderly-elderly have largely been put on palliative care because their prognosis is bad, but the influx of obese men in their 50s and 60s has been where the real workload is.



I can tell you don't work in healthcare. Most of us who've worked healthcare for a few years develop a rather cynical attitude to this idea. There is a definite point after which it is hard to defend further medical procedures to save someone's life, simply because the life the person will have afterwards will be so miserable that there's little benefit for the patient. Very few experienced nurses or doctors will operate on the assumption that everyone must be saved, but rather work with the guiding principle that good care sometimes means doing less and letting life and death run their natural courses.

No, I don't work in healthcare and fully admit I'm just theorizing here. I'm not going to pretend I know more than you do. But why then are there so many people in ICU beds with such grim prospects? Sometimes for weeks? I understand circumstances can deteriorate quickly but usually there are already severe risk factors. People for who they already know will have severe complications and poor quality of life even if they 'recover'? Or maybe live a few months longer and then die anyway? I'd rather be dead than vegetate in a hospital bed. Some doctors will resuscitate someone of 90 with severe dementia if need be. Hell, it's even difficult for doctors to euthanize someone who's life is already over and wants to die. I won't argue what the value of life is and if even a 10% chance of 'recovery' is worth it but a doctor will always proritize their patient and not necessarily consider it a waste of resources if the attempt failed. And even if they do consider this, you can't deny there is atleast great difference of opinion among doctors. Quality of life should be the priority here not necessarily survival at all costs. And I do have the impression not all doctors think the same about this or have vastly different interpretations about what can be considered a reasonable quality of life or are afraid of legal consequences. But again, ofcourse I could be completely wrong about this. That's why I argued an objective(if that's possible) selection at the gate might not be such a bad idea if there are only so much resources that can be distributed.

 

[Agema]

No, I don't work in healthcare and fully admit I'm just theorizing here. I'm not going to pretend I know more than you do. But why then are there so many people in ICU beds with such grim prospects? Sometimes for weeks? I understand circumstances can deteriorate quickly but usually there are already severe risk factors. People for who they already know will have severe complications and poor quality of life even if they 'recover'? Or maybe live a few months longer and then die anyway? I'd rather be dead than vegetate in a hospital bed. Some doctors will resuscitate someone of 90 with severe dementia if need be. Hell, it's even difficult for doctors to euthanize someone who's life is already over and wants to die. I won't argue what the value of life is and if even a 10% chance of 'recovery' is worth it but a doctor will always proritize their patient and not necessarily consider it a waste of resources if the attempt failed. And even if they do consider this, you can't deny there is atleast great difference of opinion among doctors. Quality of life should be the priority here not necessarily survival at all costs. And I do have the impression not all doctors think the same about this or have vastly different interpretations about what can be considered a reasonable quality of life or are afraid of legal consequences. But again, ofcourse I could be completely wrong about this. That's why I argued an objective(if that's possible) selection at the gate might not be such a bad idea if there are only so much resources that can be distributed.

Patient autonomy is a pretty big deal these days in many countries, including a right to refuse treatment. Thus in many countries, patients are allowed to effectively choose death, and the health service will move to palliative care. If the patient is deemed saveable and unable to give consent, however, the obligation is to treat.

In the case of rationing, medical staff would have to decide best use of available supplies. There are as you say no fixed answers to this, although plenty of ethical principles. Some health systems will have "scoring systems" to ensure consistency in the process of most effective use of resources, which will effectively decide people's life and death. However, simply deciding one form of condition is not to be treated will not pass an ethical sniff test.

 

[Eacaraxe]

Yes, everything the health service does imposes a logistic burden on the health service, that's a truism...In terms of covid-19, if a patient isn't hospitalised, they're at home looking after themselves and virtually no burden at all.

Exactly, and my point to stroopwafel is that if you're looking at numbers of patients in critical care, or mortality rate, as opposed to morbidity rate or total number of patients receiving care, you're not looking at the whole picture to make an informed judgment. Patients in need of medical care still impose a logistic burden, however light that burden may be, especially when you're talking about public policy decisions that could result in stabilizing the number of active cases versus exponential growth of them.

The proverbial mountain made of pebbles, if you will.

The examples stroopwafel made are of care rationing already in place, even once lockdowns and quarantine measures had been implemented. Perhaps a bit late, but still implemented. It's exemplary of policy-makers having to triage the whole damn health care system to prevent wholesale collapse, which doesn't just put COVID-19 patients at risk but all of them. Heart attacks, embolisms, edemas, thromboses, and strokes can't exactly be rescheduled.

 

[lil devils x]

DFW is going back up at an alarming rate already, and are starting with over 60% of ICU beds already occupied.

Tableau Public

public.tableau.com

I am still really sick right now, on my 2nd antibiotic from a severe ear and sinus infection, though luckily not related to COVID-19. I am really worried that if I can't get rid of this, I will likely wind up in the hospital for IV antibiotics, which is the most dangerous place I could be right now so I am trying to do everything I can to stay away in the meantime. I have struggled my entire life with ear infections, had tubes put in my ears twice and STILL have this persistent issue. I have hardly been able to get out of bed, when you have a severe inner ear infection like this though the vertigo is unbearable. The medication just makes me sleepy rather than actually stop the spinning so I am just super sleepy while I still fall down. LOL

 

[stroopwafel]

DFW is going back up at an alarming rate already, and are starting with over 60% of ICU beds already occupied.

Tableau Public

public.tableau.com

I am still really sick right now, on my 2nd antibiotic from a severe ear and sinus infection, though luckily not related to COVID-19. I am really worried that if I can't get rid of this, I will likely wind up in the hospital for IV antibiotics, which is the most dangerous place I could be right now so I am trying to do everything I can to stay away in the meantime. I have struggled my entire life with ear infections, had tubes put in my ears twice and STILL have this persistent issue. I have hardly been able to get out of bed, when you have a severe inner ear infection like this though the vertigo is unbearable. The medication just makes me sleepy rather than actually stop the spinning so I am just super sleepy while I still fall down. LOL

That's rough. Wish you a speedy recovery!

 

[lil devils x]

No, I don't work in healthcare and fully admit I'm just theorizing here. I'm not going to pretend I know more than you do. But why then are there so many people in ICU beds with such grim prospects? Sometimes for weeks? I understand circumstances can deteriorate quickly but usually there are already severe risk factors. People for who they already know will have severe complications and poor quality of life even if they 'recover'? Or maybe live a few months longer and then die anyway? I'd rather be dead than vegetate in a hospital bed. Some doctors will resuscitate someone of 90 with severe dementia if need be. Hell, it's even difficult for doctors to euthanize someone who's life is already over and wants to die. I won't argue what the value of life is and if even a 10% chance of 'recovery' is worth it but a doctor will always proritize their patient and not necessarily consider it a waste of resources if the attempt failed. And even if they do consider this, you can't deny there is atleast great difference of opinion among doctors. Quality of life should be the priority here not necessarily survival at all costs. And I do have the impression not all doctors think the same about this or have vastly different interpretations about what can be considered a reasonable quality of life or are afraid of legal consequences. But again, ofcourse I could be completely wrong about this. That's why I argued an objective(if that's possible) selection at the gate might not be such a bad idea if there are only so much resources that can be distributed.

Many of the patients in ICU still have the possibility to recover, or are lucky enough as this woman was to receive a lung transplant:

Young woman with coronavirus receives double lung transplant in Chicago

The procedure at Northwestern Memorial Hospital marks the first successful double lung transplant of a COVID-19 patient in the U.S.

www.cbsnews.com

This patient required ECMO for 30 days

Coronavirus patient discharged after 58 days at OHSU

Washington woman survived after 30-day life support treatment.

news.ohsu.edu

I was in ICU for over a month myself when I was battling another respiratory illness, and I am glad that they didn't give up on me either. The issue is that although we have risk assessments, people can and do surprise us and beat the odds. It happens everyday in medicine. Finding possible treatments can happen at any time, today, tomorrow, next week..we just do not yet know, and making the decision too soon to let them go, when they could have been saved is not a decision that can be made in haste. You have to keep in mind each of these lives are someone's Mom, Dad, Sister, Brother, Wife, Husband, who have people who love and depend on them and whose lives will be forever changed without them in it. Before we make this decision, we have to be completely sure that we have done everything we possibly can within our ability to help them so that their family can have their loved one return home to them while also considering their quality of life.

Yes, there is a great deal of differences of opinion among Physicians, as well as what course of treatment should be pursued and what each physician considers "quality of life" even widely varies, however, in the US at least, this decision is rarely made by one physician alone, but instead we have a team of specialists discuss this thoroughly before coming to that conclusion.

Personally, I for one, sort of look at it like Stephen Hawking. If it were up to his physicians, he would have likely died young in his life and missed out on so much and the world would be lesser for it, but instead he did not want to accept that prognosis and instead changed how many viewed his quality of life and was still able to accomplish so much in his lifetime in spite of his paralysis. Of course no one wants to live that way, but when the choice is to live with assistance and technology or to not live at all, I would choose to live and certainly hope someone else would not impose their view of that not being a "quality of life" worth saving on me against my will, as I would rather extend my life as much as possible, even if that means I was paralyzed and had to communicate via chip implanted in my brain. At the same time, when I do eventually die, I would rather do so at home rather than in a hospital.

 

[lil devils x]

That's rough. Wish you a speedy recovery!

Thank you. I hope so too. I am ready for the room to stop spinning.

 

[Agema]

So my wife tested positive for covid-19 antibodies, and it's extremely unlikely she didn't pass it to me, so that's hopefully us done and dusted with covid-19. She had covid-19 type, mild, flu-like symptoms back in early April, and I think I may have had reduced sense of taste (mild, so I can't be sure) about the same time, so that was probably that. It's quite a relief, really.

 

[tstorm823]

So my wife tested positive for covid-19 antibodies, and it's extremely unlikely she didn't pass it to me, so that's hopefully us done and dusted with covid-19. She had covid-19 type, mild, flu-like symptoms back in early April, and I think I may have had reduced sense of taste (mild, so I can't be sure) about the same time, so that was probably that. It's quite a relief, really.

Well I'm jealous.

 

[Agema]

Well I'm jealous.

I'm quite relieved. It's good to know my wife and I are (theoretically) no longer at risk, and less likely to be able to spread it to others.

 

[lil devils x]

Dallas Woman Battling Coronavirus, Again

A Dallas woman tested positive for COVID-19 in February, recovered then tested positive again in June.

www.nbcdfw.com

McKee tested positive for COVID-19 in February. She was diagnosed after feeling "clear and obvious" symptoms.
"I had a dry cough like you would not believe. It would not stop,” McKee said.
She fought the virus from home and beat it. She even donated plasma twice after testing positive for antibodies, thinking she was in the clear.
"I felt great doing finally something good coming out of the hell that I’ve been through because I'm going to help up to eight people with this plasma,” McKee said.
But this past Friday, McKee went to the hospital with high blood pressure and a headache.
She never imagined -- four months later -- she'd test positive for COVID-19 again.
"I was floored when it was positive," McKee said of her diagnosis. An epidemiologist at UT Southwestern -- not connected to McKee's case -- said catching the coronavirus twice is possible, but it appears to be uncommon.

McKee said her doctors believe the virus went dormant after her first round of coronavirus, then reemerged.

Even if you think you have recovered from COVID-19, you should still behave as if you have not as a precaution due to how little we actually know about this as of now. We are still guessing about entirely too much at this point and do not know the long term impact, so while we are hopeful that the worst is over from your first round of COVID-19, we simply do not have enough data to make that determination yet.

 

[Gordon_4]

Fun story: I got the flu and per regulations of Oz, I'm being tested for the 'Rona.

 

[Fieldy409]

So my wife tested positive for covid-19 antibodies, and it's extremely unlikely she didn't pass it to me, so that's hopefully us done and dusted with covid-19. She had covid-19 type, mild, flu-like symptoms back in early April, and I think I may have had reduced sense of taste (mild, so I can't be sure) about the same time, so that was probably that. It's quite a relief, really.

If you've got Covid-19 antibodies then I think your plasma might be very valuable for science? Maybe ring a blood bank.

Also don't antibody tests get false positives triggered by other members of the Corona virus family? Have you guys had swab tests?

Fun story: I got the flu and per regulations of Oz, I'm being tested for the 'Rona.

Dude I got tested and it sucks. Prepare for deep nasal penetration. It won't hurt but it's super uncomfortable.

 

[thebobmaster]

The closest thing I can think of to describe the feeling for the coronavirus test is: if you've ever had allergies and the stuff drains into your sinuses...that's pretty much how it felt.

 

[Gordon_4]

If you've got Covid-19 antibodies then I think your plasma might be very valuable for science? Maybe ring a blood bank.

Also don't antibody tests get false positives triggered by other members of the Corona virus family? Have you guys had swab tests?




Dude I got tested and it sucks. Prepare for deep nasal penetration. It won't hurt but it's super uncomfortable.

Well, it didn’t tickle that’s for damn sure. The throat part was uncomfortable but the nose, that stung.

Came back negative - big shock - but I’m still off work for a week.

 

[Agema]

If you've got Covid-19 antibodies then I think your plasma might be very valuable for science? Maybe ring a blood bank.

I'm sure they've got enough covid-19 antibodies from the millions of others who've been infected.

False positives are a thing, yes - I think the test is about 90%. And there is a miniscule possibility my wife had covid-19 and I didn't, but it's more likely that I was almost asymptomatic.

 

[tstorm823]

So in the media right now, Trump and some Republicans are being mocked for suggesting more testing leads to higher case numbers, as though that's a stupid or controversial thing to say. (Nevermind the same people criticizing this accused Trump of not testing people to make the numbers look better months ago, so they understand it perfectly.) In some cases, that's probably not enough of an explanation for what's happening. But on the other hand, check out this crap right here:

Lebanon County will stay in yellow phase next week; All other Pa. counties will be green

Lebanon County will be only county in Pennsylvania still in yellow

www.wgal.com

Lebanon county PA (not where I'm from, but somewhat close) is the only county in PA not advancing to the "green phase" of reopening. It was one of a few counties that started opening back up early in defiance of the governor's order. As described by the state health secretary, cited in that article:

“Lebanon County’s partisan, politically driven decision to ignore public health experts and reopen prematurely is having severe consequences for the health and safety of county residents,” Levine said in a statement. “Case counts have escalated and the county is not yet ready to be reopened. Lebanon County has hindered its progress by reopening too early. Because of this irresponsible decision, Lebanon County residents are at greater risk of contracting COVID-19.”

Being the fact checking person I am, I took it upon myself to look up the data and see what this spike looked like, since it seemed odd to have one county in the middle trend opposite everyone else, particularly since a lot of Lebanon County are commuters to Lancaster or Harrisburg. Well, there is a spike in confirmed cases:

Spoiler

They started doing roughly 5 times the number of tests and found less than proportionally more infections, declared that a spike in cases, and blamed the county for being irresponsible. Like, you've got to be freaking kidding me.