ICU beds – The Laughing Wolf

COVID-19 18Mar20

Okay, now I’m pissed. We need to finish this, and COVID-19 needs to go be dealt with permanently. Not quite the movie quote, but close enough. Honduras has shut down all cigar factories. If you thought that the U.S. was the only country shutting things down, well, you must be watching the major networks or reading the paper with a record. Stop it. The best thing you can do for yourself, outside of washing your hands, is to cut off or cut out the mainstream media.

Yes, the number of cases and number of deaths have gone up. Woo. You’ve been told this would happen no matter what, at least by responsible outlets. What matters now is the rate of increase and if we can flatten it out. We will not know that for several weeks, as Dr. Fauci has repeatedly said.

Meantime, an incident here prompts me to remind you that if you think you have COVID-19 or have been exposed to it, please don’t go to the ER or anywhere else unannounced, and if you have to call first responders — TELL THEM YOU MAY HAVE IT/HAVE BEEN EXPOSED TO IT! Call your state COVID-19 line, call your provider, but for the love of Pete don’t be stupid and just go without calling to warn them you are coming. We don’t need any more first responders having to be quarantined because they didn’t know they needed full protocols.

Also, don’t give a false name, address, and phone number to the ER if you get tested. If you do that, and go back out in public, you are not just a jackass, but should face charges for willful spread and manslaughter charges if someone you cause to be infected dies. Also, if there is violence inflicted on you by those around you, you deserve it.

Facebook did some good shutting down factual articles on COVID-19 as spam (what do you expect from FB?), as the article I read on it led me to this interesting site courtesy of this article. Plan to add that link to the resources section below.

For all the brainless twits out there, while the worst hit are 60+, you are not immune and it can be bad for you too. For example, in France there are some 300 people in ICU, and more than half of them are under 60. Another doctor is reporting patients in ICU as young as 40, and that none of them had underlying health conditions. There are reports of others in the U.S. and elsewhere that are showing up in ICU without underlying health conditions. In Texas, new patients are showing a spread from 20s to 70s, with around half being 40 or below. In short, you too can be hit and hit hard, so if you are not willing to consider others, here’s a selfish reason to follow the precautions.

As for precautions, washing your hands frequently seems an even better idea based on the data in this paper in the New England Journal of Medicine (NEJM) on how long COVID-19 lasts in the air and on surfaces. Short take: on surfaces it can last more than 72 hours, and remains viable as an aerosol for more than 3 hours. Remember what I said about hitting most used surfaces in bathrooms every hour or two? There was and is a reason… Another resource for those collecting them is this NEJM section on COVID-19

Another reason to take part in quarantine/social distancing/whateveryoucallit is that according to this paper, up to 80 percent of the spread is from people who are either asymptomatic or otherwise not aware they have COVID-19. This article puts it closer to American. Hat tip to Instapundit for this one. Also, got these two links on quarantine and the law from Insty, so go read this and then go read this to learn more about the legality and precedents for what is going on. Would that more of the chest thumpers would read it, as a good solid debate on the Constitutionality and legality is needed and timely. That would take a degree of rationality that is all too rare in this pandemic.

There is more, much more, but I’m out of time this morning.

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As always:

If you suspect you have COVID-19 or have been exposed: call your state health department and work with them so that you can be dealt with in a way that minimizes the chance of spreading the virus to those helping you and to the general public. Can’t get them? Call your local department or see if your health service has online/telemedicine screening set up; or see if one who has will let you use it even if you are not in their network. Do not go out in public, and don’t go to an ER or other facility without calling ahead. Be smart.

Use the interactive graphic to keep track of things. Is COVID19 an epidemic? Yes. Is it a Pandemic? Yes. Is there need for panic? NO. HELL NO. Should you be paying attention? Yes. Hell yes. Should you be preparing? Yes, better late than never. And good luck finding/getting stuff.

Want to avoid catching COVID19 here in the U.S.? Wash your flippin hands frequently, wash them thoroughly every time you use the bathroom, then follow with hand sanitizer after every washing, use hand sanitizer liberally when you can’t wash on a regular basis. Cover your mouth and nose when you sneeze, and stay away from those who don’t. Also, keep your bugger hooks out of/away from your eyes, nose, and mouth. Do NOT shake hands with anyone, and avoid touching or being touched by strangers. Or your strange friends.

Avoid travel if at all possible. Right now, there is no way I’m going to a trade show, major convention, etc. If you can telecommute, get that set up now. If you have to travel, use lots of hand sanitizer and go to full flu protocols. If you have to use a public restroom, take full precautions including using paper towels and such to handle faucets, doors,etc. Believe it or not, this was highly recommended before now, and major grocery chains have long told employees to use those practices to avoid getting or spreading colds, flu, etc. Not many actually do it, but…

If you own a business, make sure your employees know the above protocols. Have someone who refuses to wash their hands or otherwise follow the protocols? Talk to them, write them up, and if necessary fire them as they now pose a risk of infection to you and your customers. Extreme? Yes, but while the CDC and others are working to slow it down, odds are it is already here and could hit hard and fast. Prepare for the worst and hope for the best.

I want to reiterate that there is no need for panic, but there is a strong need to be alert, be informed, and be prepared.

Other COVID19/COVID-19/2019-nCoV articles:

COVID-19 13Mar20 The Game Of Loads And Vectors Gets Real For America

COVID-19 12Mar20

COVID-19 11Mar20

COVID-19 10Mar20

COVID-19 9Mar20 The Game Of Loads And Vectors

COVID-19 8Mar20

Heh

COVID-19 7Mar20 How To Do It Right If You Have/Have Been Exposed To COVID-19

COVID-19 What Am I Doing?

COVID-19 2Mar20

COVID-19 1Mar20

COVID-19 29Feb20

Quick Additional Thoughts On The Bureaucracy

Panic Is Off And Running

COVID-19 28Feb20 Reasons To Hope, Reasons To Fear

COVID-19 A Plea To The Politicians (And Media)

COVID-19 27Feb20

COVID-19 Breaking A Chain?

COVID-19 26Feb20

COVID19 The Situation In China Gets Even Weirder

COVID19 25Feb20

COVID19 24Feb20 Raising DEFCON

COVID19 23Feb20

COVID19 22Feb20

COVID19 21Feb20: Just Look At The Blooms Dear

COVID19 Update 20Feb20

COVID19 Update

Update & Quick Thoughts On Preparedness

Expansion On A Theme

Well Maybe I Was Wrong

Some Quick Thoughts On Coronavirus 2019-nCoV

Why Should You Be Prepared?

Keeping Alert

Coronavirus And Practical Preparedness

COVID-19 15Mar20 It’s The Rate Of Spread Stupid

The Game Of Loads And Vectors is a game of numbers. Sadly, far to many in the media and online are playing a very dangerous game with the numbers. One group uses each new case, each famous person (or even people related to or vaguely related to a famous person) to stoke fear and panic and/or for personal gain. The other group of idiots is using numbers to claim this isn’t a real threat.

As I’ve noted before, it is not the total number of cases or the number of deaths that truly matters right now. The outcome for people with COVID-19 is going to be vastly different from the outcomes in China, Iran, or elsewhere. Here, the most at-risk population is going to be 70+ with underlying health conditions, and/or those who smoke cigarettes heavily now or previously. A good bit of that has to do with the ACE2 binding previously discussed. For most in the U.S., it will likely be much like having a regular flu.

The real threat we face is in controlling the rate of spread. Why did China, Iran, and Italy have the outcomes they have/are having? It spread rapidly, and overwhelmed the health systems. They simply did not have the beds, the ICU beds, or the supplies to handle the huge number of cases that hit.

Right now, according to the American Hospital Association, there are 924,107 staffed hospital beds in all types of hospitals including psychiatric and other specialty hospitals. There are 792,417 staffed beds in community hospitals. Where there are 97,776 staffed ICU beds in the U.S., only 46,825 of them are medical/surgical intensive care.

While many will have very mild symptoms, there is a percentage of patients that require time in the ICU. This paper looks at data from China (and acknowledges that the official data is problematic) to try to estimate how many that will be, and comes to a max of 2.6 – 4.9 per 10,000 adults. This report looks at Italy and reports a rate of 11 percent needing ICU. This report lays out why COVID-19 is worse than the flu, and looks at the impact on the healthcare system — and on the rate of spread and how it could spread exponentially as in Italy and elsewhere.

So, using the 11 percent figure, there being curretly 2,952 cases in the U.S., that means approximately 325 patients will need long-term (days to weeks) of ICU care. With 46,825 staffed beds, we’re good, right? Yes, we are — today. Will that hold true tomorrow or even next week? The magic ball says maybe. Let’s look at the following two graphs.

This is from the Johns Hopkins interactive graphic that I’ve linked to in almost every post. Note the significant rise associated with the spread of COVID-19 in almost every location. Where spread has not been controlled, there is effectively exponential growth. Now, let’s look at the U.S.

This comes from the CDC, and while not interactive it does have a lot more data than I can show. I would urge you to scroll through the number of cases and watch how it jumps.

Again (and again), there was never any chance to prevent it from getting here, as the Chinese government has lied from the start and used it’s considerable power to prevent other nations from responding by stopping travel. There is no doubt that if President Trump had not — despite howls of outrage from China and the leaders of the Democratic party — put in place a travel ban things would be much worse.

All we can do now is slow the rate of spread. We have to do this to:

• Prevent the spread from overwhelming ICU beds, ventilators, and other medical treatment. Keep in mind that right now Italy has ordered hospitals to stop treating the elderly.

• To buy time to overcome bureaucratic and other roadblocks to testing. Effective, efficient, and fast testing is essential to being sure those who have COVID-19 get treatment and are prevented from helping spread the disease.

• To push the spread out into warmer weather, a time when colds and the flu normally drop off.

• To buy time to develop effective vaccines and treatments and get them made here since the Chinese are now threatening to cut off drug exports to the U.S. (even as they try to blame COVID-19 on us).

What is going on now is not an overreaction to “the flu” as many idiots are claiming. It is a needed, indeed almost a desperate, attempt to prevent our healthcare system from being overwhelmed like far too many others. The number to watch in the days ahead is NOT the number of cases (or who has gotten it), and it is not the number of deaths. It is the rate of spread. If the rate of spread drops, and the total number of cases stays low, we will be in very good shape from a healthcare perspective — and that will drive financial and other perspectives.

Right now, we are in good shape. Let’s all be smart and work together to help keep it that way.

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