Question about Viruses

[tb-av]

So can some of you doctors, scientist, researchers, etc. help me out here.

I have been doing a lot of reading lately as I suppose many people have but it ends up being either the same basic stuff or too science heavy.

I have always thought that a virus would morph, mutate, whatever layman's term might apply.

I've read articles where Iceland has found versions of the current virus... I don't even want to use the name because one name is a virus and one is disease. I'm sure you know what I mean.

I have always thought that a virus by nature was pretty much morphing or mutating for reasons unknown. That we adapt to some, some mutate and get worse or mutate and get less harmful. Various versions of a head cold so to speak.

When I look at this https://nextstrain.org/ncov I can't honestly say I understand it, but it looks like the far right dots are showing the various mutations of a single entity ( virus or disease )

Now I am being told that a virus never weakens. It is a static entity. It's not even alive. ???

Can someone explain to me in laymans terms what I am missing here?

As a secondary question. I have been told that hand sanitizer is not a good defense against a virus but is against a bacteria. So I feel like my confusion is related to that comment as well.

If a virus is not alive, exists in a static state, what does the hand sanitizer do?

I guess the short story is, what is a virus and what is it's typical existence? The analogy I was given was polio will always be polio, smallpox always smallpox and they will not weaken. Which makes sense too.

Is there any way to explain this in layman's terms? I have come to realize I have no idea what a virus is.

[FromMyColdDeadHand]

I think the biggest thing to realize is that mutations are random in nature and the effect that they have on how the DNA is expressed isn't in response to some 'pressure'. Sure, load up on UV and some chemicals and you'll get more mutations. Natural selection determines if the mutation is beneficial or not. Simply.

A virus isn't 'alive' in that is so stripped down, biologically, that it can't reproduce with out a host cell to replicate.

[Ready.Fire.Aim]

A virus is RNA or DNA with an outer shell made of protein called a capsid.
Some have an outer membrane around the capsid.

The capsid protects the DNA & RNA. It also allows it to interact with ( infect) other cells such as plants, animals or bacteria.

Hand sanitizers, UV rays in sunshine, etc will break down the outer membrane and capsid and thus damaging the RNA.

[Averageman]

Can this live in air filters, remain dormant and reactivate when it becomes moist?

[Cold/Bore]

Can this live in air filters, remain dormant and reactivate when it becomes moist?

It depends on the virus type and strain. An airborne virus, such as influenza or covid19 can remain viable outside of the body for a couple of hours or days or perhaps more. Contrast that with the HIV virus that causes AIDS, and it is not viable outside the body for any significant amount of time. This is why it is primarily a sexually transmitted disease.

[Cold/Bore]

I found this interview with Michael Osterholm, an American infectious disease epidemiologist, regents professor, and director of the Center for Infectious Disease Research and Policy at the University of Minnesota, quite informative and useful with regards to understanding our current predicament with Covid19. https://youtu.be/E3URhJx0NSw

[SomeOtherGuy]

I guess the short story is, what is a virus and what is it's typical existence? The analogy I was given was polio will always be polio, smallpox always smallpox and they will not weaken. Which makes sense too.

Is there any way to explain this in layman's terms? I have come to realize I have no idea what a virus is.

This should answer all your basic questions:

https://infogalactic.com/info/Virus

I use this or its predecessor Wikipedia whenever I encounter something I just don't know much about. (Wikipedia is bigger but has been taken over by leftist-statist slanted views in the last few years; Infogalactic is a right-wing alternative but can also be biased.)

[MegademiC]

1: are viruses living vs non-living? Depends on who you ask. I fall on the non-living side like “colddeadhands” because they cannot reproduce. They enslave other cells to make more of them. Some scientists to consider them to be alive, and we categorize them like living things (phylum, order, genus, species, etc).
2: most solvents destroy/de-activate most viruses by breaking down the shell and protein receptors that interact with cells
3: this current virus is SARS-CoV-2, which causes the disease COVID-19. (Think HIV=virus, which causes the disease AIDS)
I cant speak to evolution of them, out of my lane.

[FromMyColdDeadHand]

I cant speak to evolution of them, out of my lane.

I hope not, you talking monkey!

[tb-av]

Thanks everyone.... @SomeOtherGuy still digesting your link. Need to finish reading and probably a re-read or two.


I've still got a mental block going on with mutations. Is a mutation a disease mutation? Or a virus mutation? I still can't get past a virus is set thing, then it attaches to a cell, that new life can then mutate? If that's the case then I suppose the host has to shed that new mutant. If that is the case then would the original and new mutant be the same level of dangerous? If things are random it seems like a mutant could be anything from no problem at all to way worse than original and anything in between.

[WillBrink]

So can some of you doctors, scientist, researchers, etc. help me out here.

I have been doing a lot of reading lately as I suppose many people have but it ends up being either the same basic stuff or too science heavy.

I have always thought that a virus would morph, mutate, whatever layman's term might apply.

I've read articles where Iceland has found versions of the current virus... I don't even want to use the name because one name is a virus and one is disease. I'm sure you know what I mean.

I have always thought that a virus by nature was pretty much morphing or mutating for reasons unknown. That we adapt to some, some mutate and get worse or mutate and get less harmful. Various versions of a head cold so to speak.

When I look at this https://nextstrain.org/ncov I can't honestly say I understand it, but it looks like the far right dots are showing the various mutations of a single entity ( virus or disease )

Now I am being told that a virus never weakens. It is a static entity. It's not even alive. ???

Can someone explain to me in laymans terms what I am missing here?

As a secondary question. I have been told that hand sanitizer is not a good defense against a virus but is against a bacteria. So I feel like my confusion is related to that comment as well.

If a virus is not alive, exists in a static state, what does the hand sanitizer do?

I guess the short story is, what is a virus and what is it's typical existence? The analogy I was given was polio will always be polio, smallpox always smallpox and they will not weaken. Which makes sense too.

Is there any way to explain this in layman's terms? I have come to realize I have no idea what a virus is.

Actually, you can't imagine the can of worms that Q asks. Some believe the virus is the bridge entity between what's alive and what's not. They're not alive in the classic sense, yet their behavior is that of a living entity. Take a trip down the rabbit hole:

https://www.scientificamerican.com/article/are-viruses-alive-2004/

[tb-av]

Actually, you can't imagine the can of worms that Q asks.

I kinda figured it might. Story of my life. I can go to the store looking for a hardware part that I think should be a normal everyday item..... 'oh we don't have that, I've never seen one'

Thanks for link. I'll check it out tomorrow.

[1168]

Thanks everyone.... @SomeOtherGuy still digesting your link. Need to finish reading and probably a re-read or two.


I've still got a mental block going on with mutations. Is a mutation a disease mutation? Or a virus mutation? I still can't get past a virus is set thing, then it attaches to a cell, that new life can then mutate? If that's the case then I suppose the host has to shed that new mutant. If that is the case then would the original and new mutant be the same level of dangerous? If things are random it seems like a mutant could be anything from no problem at all to way worse than original and anything in between.

Mutations occur in offspring. So, two brown bears in Canuckistan have some cubs. One of the cubs is white. Thats from a genetic mutation. Nature later determines if this new mutation gives the white cub an advantage over its peers, allowing it to replicate, or even replicate more than its peers. Many years later, perhaps there are many white bears, living further north than their ancestors did, with some dietary changes that match the shift in habitat. Turns out, the brown bears have continued to replicate parallel to the white ones. Because they are better adapted to THEIR habitat.

Brown Bear, Polar Bear, they are both still bears, and they will both eat you.

Viruses replicate much more rapidly than bears and in greater numbers. So there is more opportunity for nature to experiment with mutations.

There is more to this than that, but this is the gist of it.

[sundance435]

Mutations occur in offspring. So, two brown bears in Canuckistan have some cubs. One of the cubs is white. Thats from a genetic mutation. Nature later determines if this new mutation gives the white cub an advantage over its peers, allowing it to replicate, or even replicate more than its peers. Many years later, perhaps there are many white bears, living further north than their ancestors did, with some dietary changes that match the shift in habitat. Turns out, the brown bears have continued to replicate parallel to the white ones. Because they are better adapted to THEIR habitat.

There is more to this than that, but this is the gist of it.

I don't think natural selection is a good point of reference for genetic mutations, at least as applied to viruses - also where the living or not debate comes into play. Viral mutations occur at random - whether they are beneficial or not is also random, but a non-beneficial mutation does not get weeded out. There is no "natural selection" for virus mutations through breeding and propagation. Most viruses eventually become less potent because the mutations occur rapidly and at random. Given enough mutations, it will naturally be less deadly to the host 80% of the time.

[WillBrink]

I don't think natural selection is a good point of reference for genetic mutations, at least as applied to viruses - also where the living or not debate comes into play. Viral mutations occur at random - whether they are beneficial or not is also random, but a non-beneficial mutation does not get weeded out. There is no "natural selection" for virus mutations through breeding and propagation. Most viruses eventually become less potent because the mutations occur rapidly and at random. Given enough mutations, it will naturally be less deadly to the host 80% of the time.

As I recall, the general tendency of viruses is to become less virulent over time as those viruses that don't make people as sick/kill people, will tend to propagate themselves through a population best. Viruses that kill their host are less likely to be able to spread vs one that makes people mildly sick and so, one stops propagating while the less virulent version continues on. That was the basic theory I had learned, but that was a while ago. It's always a battle between host defenses and viral propagation. This is a good read I thought:

"Natural selection thus favored reductions in virulence. But it did not favor substantial reductions. Benign strains, it turned out, were also less infectious, this time because host immunity was able to control and clear them more rapidly. This work—the time series of isolates tested in a common garden and the experimental dissection of the relationship between virulence and transmission—made MYXV the poster child of virulence evolution: a highly lethal pathogen became less lethal over time. But it was still pretty nasty. It had not become benign"

https://www.the-scientist.com/features/do-pathogens-gain-virulence-as-hosts-become-more-resistant-30219

[sundance435]

As I recall, the general tendency of viruses is to become less virulent over time as those viruses that don't make people as sick/kill people, will tend to propagate themselves through a population best. Viruses that kill their host are less likely to be able to spread vs one that makes people mildly sick and so, one stops propagating while the less virulent version continues on. That was the basic theory I had learned, but that was a while ago. It's always a battle between host defenses and viral propagation. This is a good read I thought:

"Natural selection thus favored reductions in virulence. But it did not favor substantial reductions. Benign strains, it turned out, were also less infectious, this time because host immunity was able to control and clear them more rapidly. This work—the time series of isolates tested in a common garden and the experimental dissection of the relationship between virulence and transmission—made MYXV the poster child of virulence evolution: a highly lethal pathogen became less lethal over time. But it was still pretty nasty. It had not become benign"

https://www.the-scientist.com/features/do-pathogens-gain-virulence-as-hosts-become-more-resistant-30219

I think I agree with what you're saying. A mutation that results in a more or less deadly virus is not evolutionary (in the animal sense, which is generally, though not always, beneficial). If hosts are better able to tolerate it, that particular strain may propagate more, but it didn't "evolve" as living things do. Viruses just keep replicating RNA with minor variances each time that continue to pile onto each other, never being weeded out. I guess what I'm saying is that unlike complex living organisms where more desirable mutations propagate through the effects of higher likelihood to survive and breed, it's totally random with a virus and good and bad mutations carry on on top of one another because there's no real selection. Eventually, all of the mutations counteract each other to some extent.

I'm probably butchering several biological processes and theories here, but my understanding is that there is a key difference primarily because a virus is technically non-living.

[Dirk Williams]

Was in Reno earlier this week, had an Chinese guy standing right behind me hacking and cuffing all over me. Asked him nicely twice to move back, " we were checking out" this idiot steps even closer, I snapped I reached out and popped him on the ear, hard enough that he took off, howling in some lingo I didn't recognize, leaving his cart. The folks behind us, told us he was initially at the back of the long line, did this hacking and sneezing on everybody who allowed him to,crowd in front of them. After he ran off, everybody laughed, the checkout folks were smiling, and his full cart got pushed off to some obscure corner of the store.

Long story, I got sick as a dog, was beginning to think I had the bug, awoke this morning feeling fine. I know I shouldn't of hit him, just tired of those pushy folks. He knew exactly what he was doing, I'm guessing nobody's ever popped his ear drum inside a store, before.

As I walked by the food court, pushing our cart, three guys with heavy tats, stood up and clapped.

DW

[J8127]

Was in Reno earlier this week, had an Chinese guy standing right behind me hacking and cuffing all over me. Asked him nicely twice to move back, " we were checking out" this idiot steps even closer, I snapped I reached out and popped him on the ear, hard enough that he took off, howling in some lingo I didn't recognize, leaving his cart. The folks behind us, told us he was initially at the back of the long line, did this hacking and sneezing on everybody who allowed him to,crowd in front of them. After he ran off, everybody laughed, the checkout folks were smiling, and his full cart got pushed off to some obscure corner of the store.

Long story, I got sick as a dog, was beginning to think I had the bug, awoke this morning feeling fine. I know I shouldn't of hit him, just tired of those pushy folks. He knew exactly what he was doing, I'm guessing nobody's ever popped his ear drum inside a store, before.

As I walked by the food court, pushing our cart, three guys with heavy tats, stood up and clapped.

DW

I don't know whether to call you a liar or applaud your trolling- but nothing you just said happened.

[kwelz]

I don't know whether to call you a liar or applaud your trolling- but nothing you just said happened.

You beat me too it... This should be on r/thathappened

[Dirk Williams]

I don't know whether to call you a liar or applaud your trolling- but nothing you just said happened.


Well I'd have to say you did just call me a liar. No worries mate.

DW

[Averageman]

The reason I asked about Virus's and air filter goes all the way back to Legionnaires Disease.
https://en.wikipedia.org/wiki/Legionnaires%27_disease
It is usually spread by breathing in mist that contains the bacteria.[4] It can also occur when contaminated water is aspirated.[4] It typically does not spread directly between people, and most people who are exposed do not become infected.[4] Risk factors for infection include older age, a history of smoking, chronic lung disease, and poor immune function.[5][10] Those with severe pneumonia and those with pneumonia and a recent travel history should be tested for the disease.[11] Diagnosis is by a urinary antigen test and sputum culture.[6]

[WillBrink]

The reason I asked about Virus's and air filter goes all the way back to Legionnaires Disease.
https://en.wikipedia.org/wiki/Legionnaires%27_disease
It is usually spread by breathing in mist that contains the bacteria.[4] It can also occur when contaminated water is aspirated.[4] It typically does not spread directly between people, and most people who are exposed do not become infected.[4] Risk factors for infection include older age, a history of smoking, chronic lung disease, and poor immune function.[5][10] Those with severe pneumonia and those with pneumonia and a recent travel history should be tested for the disease.[11] Diagnosis is by a urinary antigen test and sputum culture.[6]

Being a bacteria that can grow if given the right conditions and media, air filters are an obvious concern. Virus's don't grow outside their hosts at least.

[Averageman]

Being a bacteria that can grow if given the right conditions and media, air filters are an obvious concern. Virus's don't grow outside their hosts at least.

I remember that stuff killing a lot of folks seemingly immediately or almost.

[Dirk Williams]

Wife dug out our "bug" box, thought I had purchased n100 masks turned out their n95. She issued/gave some to our close neighbors, who had none. We have a hefty reserve of the n95s, tyvex hood/booted suits rubber gloves and saftey glasses.

Also have over cloth disposable booties, escapes me why I purchased these booties. She's wearing masks now, while shopping, today. I'm still home recovering from likely a bad head cold.

DW

[sundance435]

I remember that stuff killing a lot of folks seemingly immediately or almost.

It's less common here than in Europe because most buildings here are newer with better ventilation systems/ducting, at least that's what I was told in France. Still a problem in older retirement and veterans homes, though. It's a big deal when it gets into older ducting, usually through contaminated water that seeps in, kind of like black mold.

[Averageman]

It's less common here than in Europe because most buildings here are newer with better ventilation systems/ducting, at least that's what I was told in France. Still a problem in older retirement and veterans homes, though. It's a big deal when it gets into older ducting, usually through contaminated water that seeps in, kind of like black mold.
Wondering if this Corona Virus could live in there?

[WillBrink]

Wondering if this Corona Virus could live in there?

For as long as the virus can survive on the surfaces of the duct system, yes:

"According to a recent study published in the New England Journal of Medicine, SARS-CoV-2, the virus that causes COVID-19, can live in the air and on surfaces between several hours and several days. The study found that the virus is viable for up to 72 hours on plastics, 48 hours on stainless steel, 24 hours on cardboard, and 4 hours on copper. It is also detectable in the air for three hours."

I'd think the real concern is a duct system blowing covid around a building it pulled in from some location someone had covid, but I don't know how big a concern that is realistically speaking.

[WillBrink]

So, people are going to hospitals in NYC and LA to see the "war zone" and it's crickets. Not totally sure what to make of that but one would expect more activity from a city supposedly overwhelmed by covid. What are those in the med biz seeing in their own AO?


https://www.youtube.com/watch?v=3GnaQoPtDuo&feature=share&fbclid=IwAR3PmR-cl0MWI497hzDEzdeYoIt9_4o2q-FR4ltHUYzhjiNJzqd7Z66rLFU

[kwelz]

So, people are going to hospitals in NYC and LA to see the "war zone" and it's crickets. Not totally sure what to make of that but one would expect more activity from a city supposedly overwhelmed by covid. What are those in the med biz seeing in their own AO?


https://www.youtube.com/watch?v=3GnaQoPtDuo&feature=share&fbclid=IwAR3PmR-cl0MWI497hzDEzdeYoIt9_4o2q-FR4ltHUYzhjiNJzqd7Z66rLFU

What an idiot. Covid19 patients aren't in the ER. They are in isolation and ICU rooms.

[WillBrink]

What an idiot. Covid19 patients aren't in the ER. They are in isolation and ICU rooms.

You wouldn't expect a bit more activity at major facilities claiming long lines, etc? Did you watch the whole thing? It's not one ER, not by a long shot.

If complete fabricated BS, then it's also probably up to every day citizen types to show otherwise as they don't believe the media at this point, and understandably so.

[kwelz]

You wouldn't expect a bit more activity at major facilities claiming long lines, etc? Did you watch the whole thing? It's not one ER, not by a long shot.

If complete fabricated BS, then it's also probably up to every day citizen types to show otherwise as they don't believe the media at this point, and understandably so.

So all the Medical professionals are in on some conspiracy? They are lying about what is happening in the hospitals?

This kind of crap is just beyond stupid. It is on the level of 9/11 truthers and People who claim the Moon landing is a Hoax.

It relies on a lack of understanding on how Hospitals are operating right now.

Elective surgeries and all minor procedures have been halted. Anything not directly related to urgent needs is being put off to free up resources for the people who are in need.

Just because some conspiracy theorist say it is so, doesn't make it reality.

[WillBrink]

So all the Medical professionals are in on some conspiracy? They are lying about what is happening in the hospitals?

This kind of crap is just beyond stupid. It is on the level of 9/11 truthers and People who claim the Moon landing is a Hoax.

It relies on a lack of understanding on how Hospitals are operating right now.

Elective surgeries and all minor procedures have been halted. Anything not directly related to urgent needs is being put off to free up resources for the people who are in need.

Just because some conspiracy theorist say it is so, doesn't make it reality.

I posted this in the wrong thread. Supposed to be here:

https://www.m4carbine.net/showthread.php?220394-(COVID-ETC-CONTENT-HERE)-China-Locks-Down-11-Million-in-Wuhan&p=2829444#post2829444

Mods, remove as needed.

[tb-av]

You wouldn't expect a bit more activity at major facilities claiming long lines, etc?

Around here the instructions are that calls are made so hospitals can prep for your arrival. I don't think they go in the ER entrances. Plus it's been my understanding that the hospitals themselves are not overwhelmed, just the ICU and any warding off of COVID19 people.

Then again I'm not in NY or LA.

[tb-av]

Being a bacteria that can grow if given the right conditions and media, air filters are an obvious concern. Virus's don't grow outside their hosts at least.

So if we go with bacteria is a alive and a virus exist on a surface. What exactly are we doing to it as we try to remove it from a surface? Could we liken it to say an ink dot on our hand. Wash with alcohol or soap and we no longer have a dot or a stain. We are basically just ripping it up or dissolving it into something non-virus? Like maybe a dried leaf from a tree. We still call it a leaf until it's ground to dust and not likely you could reassemble a spoon of dust into a leaf.

What about putting food in your freezer? Can the cold preserve the virus regardless of the surface it's on?

[WillBrink]

So if we go with bacteria is a alive and a virus exist on a surface. What exactly are we doing to it as we try to remove it from a surface? Could we liken it to say an ink dot on our hand. Wash with alcohol or soap and we no longer have a dot or a stain. We are basically just ripping it up or dissolving it into something non-virus? Like maybe a dried leaf from a tree. We still call it a leaf until it's ground to dust and not likely you could reassemble a spoon of dust into a leaf.

Soap and water, diluted bleach, alcohol at high enough %, etc kills the virus. The virus has an envelope, the viral envelope disrupted, kills virus, and no longer an active virus.



What about putting food in your freezer? Can the cold preserve the virus regardless of the surface it's on?

I recall the virus is very cold tolerant and will shrug off being frozen for lengthy periods of time (Google that one to confirm), but is not heat tolerant and or killed by above listed. Anything you purchase now and put in fridge or freezer should be wiped down first if in a package. Food itself will get cooked, so that's not an issue.

[mrbieler]

For as long as the virus can survive on the surfaces of the duct system, yes:

"According to a recent study published in the New England Journal of Medicine, SARS-CoV-2, the virus that causes COVID-19, can live in the air and on surfaces between several hours and several days. The study found that the virus is viable for up to 72 hours on plastics, 48 hours on stainless steel, 24 hours on cardboard, and 4 hours on copper. It is also detectable in the air for three hours."

I'd think the real concern is a duct system blowing covid around a building it pulled in from some location someone had covid, but I don't know how big a concern that is realistically speaking.

Contaminated duct work (especially return air ducting) is the highest risk area as it's pulling air from occupied spaces.

HVAC filter can't stop the virus. It's too small. A MERV 16 HVAC filter (the highest before HEPA) only captures 95% of particulate 0.3 micron and above. The virus itself is down in the 0.1~0.2 micron size. HVAC filters CAN capture the particulate the virus is riding and we suggest MERV 13 and MERV 14 in more critical areas. MERV 13 is the lowest rated filter that will capture particles down to 0.3 micron.

Unfortunately, most homes use 1", 2" and 4" pleats and despite what the filter says, none are actually above MERV 9 in real efficiency (which capture 50% of particles 1.0 micro and above .

Even HEPA filters are not 100% vs small virus particles, but they capture much more particulate.

In theory, the virus captured on the filter will be dead in a few days. We're recommending that buildings go to 100% outside air where ever possible to avoid recirculating air from inside the building. By and large, people are the biggest contributor to inside air quality problems. We're also recommending that buildings change filters much more frequently to keep static pressure inside the system as low as possible to maximize the amount of air we can circulate through a room.

Hospitals and health care centers are scrambling to upgrade their systems now.

[MegademiC]

Contaminated duct work (especially return air ducting) is the highest risk area as it's pulling air from occupied spaces.

HVAC filter can't stop the virus. It's too small. A MERV 16 HVAC filter (the highest before HEPA) only captures 95% of particulate 0.3 micron and above. The virus itself is down in the 0.1~0.2 micron size. HVAC filters CAN capture the particulate the virus is riding and we suggest MERV 13 and MERV 14 in more critical areas. MERV 13 is the lowest rated filter that will capture particles down to 0.3 micron.

Unfortunately, most homes use 1", 2" and 4" pleats and despite what the filter says, none are actually above MERV 9 in real efficiency (which capture 50% of particles 1.0 micro and above .

Even HEPA filters are not 100% vs small virus particles, but they capture much more particulate.

In theory, the virus captured on the filter will be dead in a few days. We're recommending that buildings go to 100% outside air where ever possible to avoid recirculating air from inside the building. By and large, people are the biggest contributor to inside air quality problems. We're also recommending that buildings change filters much more frequently to keep static pressure inside the system as low as possible to maximize the amount of air we can circulate through a room.

Hospitals and health care centers are scrambling to upgrade their systems now.

Inline UV systems destroy viruses. Do hospital hvac systems not have them?

[mrbieler]

Inline UV systems destroy viruses. Do hospital hvac systems not have them?

Some do. Many don't. UV is nice, but the bulbs have to be replaced annually and they shorten the life of the plastic frames on the MERV 14 final filters. They have a lot of benefits, but until now many hospitals didn't see the cost benefit of the retrofits. Many hospitals also neglect to keep up on bulb replacement. Too many other service issues for the crews to manage. Most of hospital facility management is damage control. Many of those same hospitals are calling for it now. There are also upper air UV units that sweep the upper air in a room. We're seeing a lot of demand for that as well.

As with many things, things tend to change when the shit hits the fan.

We ASSUME UV will kill this virus, but as of now I'm not aware of a completed study. Most likely it does.

[sundance435]

What an idiot. Covid19 patients aren't in the ER. They are in isolation and ICU rooms.

Not to mention the numerous remote hospitals that have been set up. Most hospitals have triage areas set up so that patients avoid the ER altogether. And many hospitals around here will turn you away if you don't call in advance so that they can pre-screen you over the phone and direct you where to go.

[ABNAK]

What happened to the big COVID thread?

[TehLlama]

So if we go with bacteria is a alive and a virus exist on a surface. What exactly are we doing to it as we try to remove it from a surface? Could we liken it to say an ink dot on our hand. Wash with alcohol or soap and we no longer have a dot or a stain. We are basically just ripping it up or dissolving it into something non-virus? Like maybe a dried leaf from a tree. We still call it a leaf until it's ground to dust and not likely you could reassemble a spoon of dust into a leaf.

What about putting food in your freezer? Can the cold preserve the virus regardless of the surface it's on?

Basic answer is that you're doing what you can to denature the proteins the virus needs to actually bind to a cell and infect it, or otherwise cause key elements of the capsid to break up or become useless for the infection phase, and you have prevented that instantiation of the virus from reproducing (it's basically just dead protein and genetic material at that point).

Physical capture is hard, and you need airflow in HVAC systems to the point where filters arbitrarily large aren't that workable. UV will denature things, but again power to throughput ratio makes that pretty hard to fully disinfect things... but decent filtration will capture a lot of the aersol-borne virus particles that are hitching a ride in water droplets and airborne sputum.

[ramairthree]

That’s a way more complicated question than it seems and no black and white direct answer. Sort of like trying to come up with a single definition for a species, why some bacteria act like a fungus, where to draw the line at a lichen, etc.

Presumably you’re asking because of the current virus furor.

Overall odds are good.

f you go into this with, it’s nothing but the flu, you won’t objectively evaluate it.
If you go into this with, it’s the big one, you won’t objectively evaluate it.

It’s not a discrete Newtonian equation.
It’s an overlapping circles of conditional probability quantum estimate that is half gestalt/pattern recognition and half math.
That’s something that drives people mad about medicine. And people trying to plan for responses and resources even madder. It is what it is. When you find out grandma has cancer you want to know how long she has. You only know statistically and a range and an average. And that’s if she doesn’t have a heart attack and die next week instead of her average 8 months to live. Or if she will be miserable and suffering still 18 months from now.

Yet everyone without math beyond what even used to be freshman high school algebra, let alone the basic first year of calc or grad/doctoral level biostatistics thinks they know what they are looking at when the news shows the start of exponential growth on a linear scale graph. In real life that would be like graphing your fat loss, muscle gain, and Personal bests when you first start a killer diet and workout regimen and thinking it would keep doing that.

60k to 600k is a nice tight estimate for a population of 330 million people plus running around America.
With an impact zone right in the middle of old, frail, multiple pre-existing, and poorly controlled conditions population.
With some minimal collateral damage outside of the impact zone. That was the hand dealt.

An impossible compression of spread time and resource limitations would drive it towards the high end. Mainly because without the insight to rationally assign and limit resources away from futile care a lot of the capacity would have been wasted. With the greatest impact on resources being that people that were going to die in the next few months would be shifted into dying sooner. Sort of like everyone wanting a new boat or convertible in the summer. Only not as fun.

The steep grade of diminishing returns means relatively low impact to control spread measures are about 90% + as effective as very drastic measures to control spread. Why did we go so drastic? By all indications the Oval Office and team were going let it ride and to do some basic border control, etc. while everyone else was calling them racists and telling people to go kiss gay Chinese people and other people of color and immigrants and refugees at parades and stuff. Then the media starting fanning the flames. Whether unintentional in search of ratings or calculated to political goals, it spun the public into a panic demanding something, anything, everything, be done.

We got the response. People wanted to know worst case scenario, beyond reason, and everything possible done. They got it.

This should have been a pretty standard threat eval and response.
With some pretty basic recommendations, and plans for amelioration.
That’s not what happened. The media fueled a public demand for more. With zero perspective.

Now the public and the media want to blame leaders and experts for giving them a worst case scenario and doing everything possible.

As for the virus itself and the infected.
Not every infection is the same. Not every patient is the same.

Some people get a massive viral load and their body is overwhelmed even if they are young and healthy.
Some people get a minimal or average load but their luck and their body turn on them and also end up bad off.
Some people have a course different than others.
Some people are already in such rough, frail shape it does not matter if they had the infection or not, their time was upon them. Others get a little speed boost and a slightly quicker arrival to their time.

As for vents. There are only so many people that can manage a patient on a vent. Making a bunch of vents does not increase that. People end up on a vent for different reasons. They get too tired to breath on their own. Their mental status is too poor to maintain their airway. Their lungs are full of fluid, or pneumonia, or they have bad reactive airways symptoms and are getting hypoxia. They are getting enough oxygen but are not ventilating and getting too hypercaepnic. These are issues people show up to the hospital with all the time, sometimes several times a year. The complications from being on a ventilator are not unique to this virus. Reports are mixed, but overall, the age, medical conditions, and severity of those conditions seem to have the same outcome in negative and positive patients.


As for meds, Some meds may be of benefit. Right now you can find evidence some make things worse, some do nothing, or it helps. This kind of process takes months if not years to sort out.

Some people have a myocarditis and heart failure component. This is not unique to this virus.

Some people may have competitive O2 binding. This is not a new medical concept.

Some people may develop a hypercoagulable state. Neither hyper nor hypo coagulable states are new medical concepts.

Now, I was firmly in the classic jumped a host to people virus naturally occurring virus. It is, after all, 85 to 90% identical code to a related naturally occurring virus.

I’m not going to go full tinfoil and say this virus had some help, but’s it’s propensity to do and combination of the above is a little atypical. It’s sort of like a 5’11” white guy dunking a basketball or a 175 lb. guy benching 400 pounds. Some do. But not what your first thought would be. It still could be entirely natural.

And the elephant in the room. There is no guarantee having it means you are immune, let alone long term. This is likely going to be endemic and seasonal. You can be an asymptomatic carrier. Likely 85% of people with it have either no or such mild symptoms they don’t seek care. This means the 400k plus positive tested population is not the normal. Many were admitted and treated presumptively. Many were sent home presumptively without tests. Many never sought care. There are very likely millions of People in America with this virus.

“Flattening the curve” means a smaller peak in resources and less outpacing of resources. (Totally forgetting the concept a bunch of those resources would be tied up in futile care and should not be tied up). Everyone has quoted that concept. Less well discussed is what that means in terms of prolonging the outbreak and decreasing herd immunity. There is no guarantee their will be a vaccine or highly effective specific medical therapy. This may rear it’s head seasonally every year.

But, instead of ending on a bad note,
If this truly had a high death rate like everyone was running around crazy about,
There are vulnerable parts of the population this would have already burned through like kindling,
That are not really amenable ro self quarantine and social distancing. This has not happened.

Ok, went way longer than planned, but the gist was supposed to be,
No matter what steps you take today to not get infected with this virus, it will likely be there next week, next month, and next year.

[jsbhike]

Also have over cloth disposable booties, escapes me why I purchased these booties.


Read that and started laughing since I make a similar statement at least once or twice a year.

Any chance of insect transmission? Ticks or mosquitos?

[Life's a Hillary]

ramairthree, apologies for not knowing this before but what is your profession? You seem to be really knowledgeable on this so I’m just curious as to your background to give it a little more context.

[ramairthree]

ramairthree, apologies for not knowing this before but what is your profession? You seem to be really knowledgeable on this so I’m just curious as to your background to give it a little more context.

I'm not going to AROCK myself totally.

Yes I started out as an E1 11B in Ranger Bn.

I do have an undergrad brick and mortar degree from a school that was around over a couple of hundred years old before I graduated from it in applicable sciences.
I do have a doctorate from a real you go there brick and mortar school with applicable background.

I do have over a decade in time in other SOF units. With several years related to applicable stuff plus time on target in direct support during TICs. The last several years I was in before retiring involved direct one on one interaction GO/FOs, in both command and staff roles. With some of my recommendations and programs being theater / nation wide.

From the late 1990s until about 2010 when I was otherwise engaged I had about a dozen and a half publications in peer reviewed real paper journals about half of which involve viruses and febrile disease. And some of which involve information from massive disease/medical databases.

Plus another half dozen published abstracts. And about another half dozen presentations at national conferences.

My role since retiring from the military gives me insight into about 6000 trauma, critical care, and emergency data points per year. With additional information on more. Not near as much as when I was doing research.

I'm not the guy who is going to come up with a vaccine, research novel applications of medications, develop new medications, or manage people in the ICU.
No more than I'm the guy that was going to extract DNA and hatch dinosaurs in Jurassic Park or fly the ship that defeats the aliens in Independence Day.
I'm more like the Jeff Goldblum dude in both movies people don't like hearing what they need to hear, not what they want to hear from.

[WillBrink]

“Flattening the curve” means a smaller peak in resources and less outpacing of resources. (Totally forgetting the concept a bunch of those resources would be tied up in futile care and should not be tied up). Everyone has quoted that concept. Less well discussed is what that means in terms of prolonging the outbreak and decreasing herd immunity. There is no guarantee their will be a vaccine or highly effective specific medical therapy. This may rear it’s head seasonally every year.
.

That's the position here, and as expected, he's taking a lot of heat for it. I posted article and vid on Dr. Knut Wittkowski - who was head of the Department of Biostatistics, Epidemiology, and Research Design at the Rockefeller University - RE, his position our approach to Covid was counter productive. For those who have the epi/bio stats background to wade through it, here's his full paper:

The first three months of the COVID-19 epidemic: Epidemiological evidence for two separate strains of SARS-CoV-2 viruses spreading and implications for prevention strategies

Two epidemics of COVID-19

KNUT M.WITTKOWSKI1

Abstract

About one month after the COVID-19 epidemic peaked in Mainland China and SARS-CoV-2 migrated to Europe and then the U.S., the epidemiological data begin to provide important insights into the risks associated with the disease and the effectiveness of intervention strategies such as travel restrictions and social distancing. Respiratory diseases, including the 2003 SARS epidemic, remain only about two months in any given population, although peak incidence and lethality can vary. The epidemiological data suggest that at least two strains of the 2020 SARS-CoV-2 virus have evolved during its migration from Mainland China to Europe. South Korea, Iran, Italy, and Italy’s neighbors were hit by the more dangerous “SKII” variant. While the epidemic in continental Asia is about to end, and in Europe about to level off, the more recent epidemic in the younger US population is still increasing, albeit not exponentially anymore. The peak level will likely depend on which of the strains has entered the U.S. first. The same models that help us to understand the epidemic also help us to choose prevention strategies. Containment of high-risk people, like the elderly, and reducing disease severity, either by vaccination or by early treatment of complications, is the best strategy against a respiratory virus disease. Social distancing or “lockdowns” can be effective during the month following the peak incidence in infections, when the exponential increase of cases ends. Earlier containment of low-risk people merely prolongs the time the virus needs to circulate until the incidence is high enough to initiate “herd immunity”. Later containment is not helpful, unless to prevent a rebound if containment started too early.

Cont:

https://www.medrxiv.org/content/10.1101/2020.03.28.20036715v2.full.pdf

[ramairthree]

It would be sweet if it dropped down and away. Even something like MERS lingers around with a couple hundred cases a year. I am very suspicious of what lingering amount of SARS and related my have been lingering about China the past 17 years.

[tb-av]

Thank you for the thorough insight. Would you object to my posting your reply #42 above in another small semi-private forum? I know a few people that are looking for some qualified insight. Some are worried about a Typhoid Mary type situation which I think your post basically covers as well.

Completely understand if you rather it not be placed elsewhere.

thanks,

TB

[ramairthree]

Thank you for the thorough insight. Would you object to my posting your reply #42 above in another small semi-private forum? I know a few people that are looking for some qualified insight. Some are worried about a Typhoid Mary type situation which I think your post basically covers as well.

Completely understand if you rather it not be placed elsewhere.

thanks,

TB


Sure. No prob.

Thirty days ago I did a model using an impossible 100% infection rate over an impossible four month period. This was about 60k to 600k with the high end because of not enough critical care resources. Divide by five over eight months, divide by ten over 12 months. But.... the vast majority of the resources would be tied up in futile, end of life care among patients most likely to be among the 250k average deaths per month without COVID we would have expected this year. Virtually all among those likely to die this year. And that reasonably appropriate levels of resources would be available if we focused on outliers and took a different approach to resource use in futile, end of life care. This was posted a few days after I calculated it in the COVID thread and seems to have been extremely unpopular. I predicted millions of lost jobs, hundreds of thousands of ruined retirement accounts, and thousands of lost businesses. And that the long term impacts of the panic were more harmful than less drastic measures saving those that would not be expected to soon die if they were not infected, but providing easement and comfort to those who would be expected to die soon even without infection. As I said, very unpopular. But the virus is not going to magically disappear in two weeks, three weeks, etc. and taking the hit with trying to glance it off was a good option vs. jumping off a cliff to avoid taking the hit was not a good option. The true impact of COVID had to be taken in perspective with our baseline death rate, who was in line to die this year without it, and who would likely only die this year if they were an outlier. I seem to have failed at conveying any perspective to most.

I will add that post below. A month after my initial hobby, napkin math assessment, - the official evaluations are starting to look a lot like my numbers vs. the initial super scary numbers they were giving.

I am only one guy with no say in national policy and no role in anything significant these days.
With an educated opinion but still just one man’s opinion.

From one month ago-

For starters,
Exponential growth, doubling time, etc. does not work out in real life like it does with pure math, out side of a lab, etc.
Some basic, less economically devastating, educationally interrupting, societal interrupting, business destroying measures could have spread the curve.

You see a lot of sensationalist news about ICUs being full.


Ummm....
At most hospitals on any given day the ICU is at or near 100% capacity.

This is like saying,
Oh my God! With COVID I can’t find a single bottle of Pappy or Blantons near me! Well good luck with finding one pre COVID.


My point is that “The ICUs are 100% full!!!!” Is business as usual.
It is not because of C19.

Everyday, there are people that die of their heart attack because the cath lab was occupied and in use before they could make it there, the CT team was tied up with another case, waiting hours for transfer to a place with neurosurgery, both the trauma OR and backup OR are running and someone is dying of internal bleeding with no OR or surgeon available.

Most people don’t feel or know about it. That concept is hitting home to a lot of people right now.

You see a lot of graphs and curves about exceeding capacity because of C19.


Again, the point was that is a problem in medicine without C19 issues.
It is not caused by C19.

A bunch of people are running around acting like full ICUs, full ER beds, long ER wait times, etc, are because of COVID.

That is business as usual.

If C19 doubles the number of people needing to be in the ER, hospital, or ICU on a vent-
There is no magical Elysium supply of medical care, equipment, and people.

The majority of those beds are already filled with a 94 year old non verbal, bed ridden, patient that had a head bleed and aspiration pneumonia and the family wants everything done. Or a septic IV heroin user with sepsis, endocarditis, epidural abscess, etc. Or a 400 pound 35 year old HIV positive patient with a huge saddle embolus that has spent the last three weeks in rehab from a stroke. Or a 50 year old heart failure, dialysis patient that does not take his meds and skips dialysis because they would rather keep doing cocaine. Or a 66 year old that rolled over his truck with an alcohol level of 300, COPD, cardiac stents, and has already had his license taken away years ago. Or the illegal alien that just had a massive anterior MI. Or the terminal, metastatic cancer patient that was supposed to be on hospice and comfort care. Or the 300 pound septic shock, chain smoking diabetic with peripheral vascular disease and limb infections. Or the psyc patient on their 87th visit to the hospital but this time they did their research and overdosed on Tylenol and lithium. None of them are long for this world. They are going to die in the next few days, or in the next few months, or this year with a ton of time spent in and out of the hospital.


The point is critical and emergency medical services, in the complete absence of COVID, are typically at or near full capacity.

About three million people die in America every year. About a quarter from heart disease, a fifth from cancer, about 5% each from lung disease, strokes, dementia/old age, and trauma. Throw in diabetes, kidney disease, and suicide for another 5%. Note how interrelated and coexistent many of these are.
Then throw in recreational overdoses, autoimmune disorders, and everything else into the other 25 percent.

Could masks, no shaking or hugging, gloves handling money and items between people, and copious hand sanitizer had the same impact as a hard stop destroying the economy, businesses, retirement, jobs, of a massive portion of the population?

Could reasonable, sane news broadcasts accomplished similar instead of fan flaming led to a less panicked, more in depth planned response?

Could a plan to increase capacity by avoiding futile care been more reasonable?
This is a harsh question.
How many vents would be free if-
No inoperable head bleeds get vents.
No metastatic/palliative chemo/xrt cancer patients on vents.
No LVAD, EF below 20%, or septic endocarditis patients on vents.
No self ingested overdoses on vents.
No intentional self inflicted gunshot wounds on vents.
No BMI >50 on vents.

I won’t even get into the severely senile and demented who don’t know who they are, are non verbal, have PEG tubes because they won’t eat or drink, etc.


Should people that were going to die anyway in a few days or this year be allowed on a vent when someone that would have a long, normal life after recovery ?

Ok, now let’s add in some C19.


Say all 330 million people in America magically catch the virus in March, April, May, and June. There would normally be about 12 million hospital admissions during a four month period in America.) 100% exposure and infection is not possible. But we are going to paint the worst case scenario. On a graph with a 4 day doubling time, you could go from a few hundred cases to the entire population in about three weeks. Humans are not bacteria on a medium in a culture. There are shut ins, closed social circles, geographic barriers, closed loop repeat interaction circles, etc. even the four months I am using is crazy compressed but go with it.

Over 283.5 million people are not going to have any significant symptoms, go to a doctor, or have any issues.

About 49.5 million people will feel sick.

Let’s say About 7.5 million will be severe and need to be in the hospital.

And 750,000 of those are going to buy ten days on a vent.

I am being very, very generous with the doom percentages.

(There are over 36 million hospital admissions in over 6000 hospitals in America each year. With about 2% of patients accounting for 10% of costs, and about 1/3 of patients accounting for multiple admissions.)

This is not 7.5 million people admitted to the hospital on top of 12 million people normally admitted to the hospital during that four months.


It’s probably about 8 million people being admitted once or more than once, for a total of 12 million admissions.
And the vast majority of the 7.5 million people that will need to be admitted for COVID are the same old, sickly, poor health, multiple medical problem, way above average disease for their age, etc. patients that were already among those getting admitted.


Anyways, let’s say we range from 75,000 to 600,000 of those admitted patients die.


And most are from the categories of the 3 million people that were going to die this year anyway.

Yes, it’s worse than the flu.
Yes, it will strain the system.
Yes, some alleviating, flattening, procedures needed to occur.
But it is not a death sentence. We are talking 8% death rate with average age of 80 in a second world health care system with way less ICU and vent capacity.

We have destroyed a nation’s economy and way of life, ruined tons of businesses, put millions out of jobs, etc. in order to save elderly, sick, and unhealthy people from dying from COVID that were already going to die from other medical conditions at the same time or later this year.

Now let’s look at little kids under the age of 5.
Let’s pick one single other virus.
RSV. Each year,
About half a million will show up in the ER. About 50,000 will be admitted to the hospital.
About 500 will die. Add in flu. Add in other organisms for pneumonia.
That’s thousands of little kids dying every year from pneumonia with zero media attention.
The kids susceptible to the above are the same that would be susceptible to C19.
Little kids dying is sad. The only good news is they can’t die twice from two different things.


And this goes for older kids and young adults.

I have painted the worse case scenario I can.

You will need to form your own opinion regarding the media, politicians, the public, the response, the current impacts, the long term impacts.

Was your 88 year old grandmother with dementia, heart disease, AFIB, falls, head bleeds, and bleeding ulcers that was going to die this year worth keeping alive a few more months not getting corona virus a fair trade for hundreds of men that worked for decades but have had their retired accounts shattered and will have to keep working? Was your beloved child with severe CF not being exposed to corona virus and making it another year before succumbing to another infection worth a dozen local businesses folding and hundreds of people losing jobs? Did saving the chain smoking alcoholic repeat accident drunk driver from getting C19 and dying next week so he can die from his variceal bleeding next month warrant thousands of kids having their education, lives, and futures interrupted and delayed? Was watching your everything to you wife spend another month or two miserable on palliative chemo therapy worth also losing your home, job, and the same for dozens of other people? We have bought a non compliant, crack fiend self inflicted heart failure, LVAD, dialysis, 40 year old that has never had a job and never supported his bastard children and been in and out of jail another month or two of life at significant expense and sacrifice to dozens of other people, was it worth it?


The questions are meant to be very harsh and soul searching.

[TexasGunNut]

The questions are meant to be very harsh and soul searching.

Regardless of how you feel, this post and the vast majority of what this man says on this subject is gospel.

Triage occurs daily in all therapeutic settings; always has and always will. Thank God most people aren’t privy to the hallway decisions health care people HAVE to make. That is a cold hard fact. I’ve seen it destroy and consume men and women who can’t see past their intrinsic nature to save everyone.
Excess capacity is a myth; good people bleed out because there was only one MD on shift when five ambulances and two packed cars pulled in. Then add in the knowledge that a bureaucrat cut two MD’s weeks before that school bus crash.
The majority of health care resources are wasted on people that do not need or deserve to live, and in my 60 years I still haven't figured out any better way. It’s easy to play god and awfully hard to be proficient at it. The slippery slope part sneaks up on you.
I would much rather live with pulling the plug on my own father than have a government agency telling me he did not check the right boxes to justify care.

As the man says...these are the harsh and soul searing questions that may have no good solutions.

[AKDoug]

Sure. No prob.

Thirty days ago I did a model using an impossible 100% infection rate over an impossible four month period. This was about 60k to 600k with the high end because of not enough critical care resources. Divide by five over eight months, divide by ten over 12 months. But.... the vast majority of the resources would be tied up in futile, end of life care among patients most likely to be among the 250k average deaths per month without COVID we would have expected this year. Virtually all among those likely to die this year. And that reasonably appropriate levels of resources would be available if we focused on outliers and took a different approach to resource use in futile, end of life care. This was posted a few days after I calculated it in the COVID thread and seems to have been extremely unpopular. I predicted millions of lost jobs, hundreds of thousands of ruined retirement accounts, and thousands of lost businesses. And that the long term impacts of the panic were more harmful than less drastic measures saving those that would not be expected to soon die if they were not infected, but providing easement and comfort to those who would be expected to die soon even without infection. As I said, very unpopular. But the virus is not going to magically disappear in two weeks, three weeks, etc. and taking the hit with trying to glance it off was a good option vs. jumping off a cliff to avoid taking the hit was not a good option. The true impact of COVID had to be taken in perspective with our baseline death rate, who was in line to die this year without it, and who would likely only die this year if they were an outlier. I seem to have failed at conveying any perspective to most.

I will add that post below. A month after my initial hobby, napkin math assessment, - the official evaluations are starting to look a lot like my numbers vs. the initial super scary numbers they were giving.

I am only one guy with no say in national policy and no role in anything significant these days.
With an educated opinion but still just one man’s opinion.

From one month ago-

For starters,
Exponential growth, doubling time, etc. does not work out in real life like it does with pure math, out side of a lab, etc.
Some basic, less economically devastating, educationally interrupting, societal interrupting, business destroying measures could have spread the curve.

You see a lot of sensationalist news about ICUs being full.


Ummm....
At most hospitals on any given day the ICU is at or near 100% capacity.

This is like saying,
Oh my God! With COVID I can’t find a single bottle of Pappy or Blantons near me! Well good luck with finding one pre COVID.


My point is that “The ICUs are 100% full!!!!” Is business as usual.
It is not because of C19.

Everyday, there are people that die of their heart attack because the cath lab was occupied and in use before they could make it there, the CT team was tied up with another case, waiting hours for transfer to a place with neurosurgery, both the trauma OR and backup OR are running and someone is dying of internal bleeding with no OR or surgeon available.

Most people don’t feel or know about it. That concept is hitting home to a lot of people right now.

You see a lot of graphs and curves about exceeding capacity because of C19.


Again, the point was that is a problem in medicine without C19 issues.
It is not caused by C19.

A bunch of people are running around acting like full ICUs, full ER beds, long ER wait times, etc, are because of COVID.

That is business as usual.

If C19 doubles the number of people needing to be in the ER, hospital, or ICU on a vent-
There is no magical Elysium supply of medical care, equipment, and people.

The majority of those beds are already filled with a 94 year old non verbal, bed ridden, patient that had a head bleed and aspiration pneumonia and the family wants everything done. Or a septic IV heroin user with sepsis, endocarditis, epidural abscess, etc. Or a 400 pound 35 year old HIV positive patient with a huge saddle embolus that has spent the last three weeks in rehab from a stroke. Or a 50 year old heart failure, dialysis patient that does not take his meds and skips dialysis because they would rather keep doing cocaine. Or a 66 year old that rolled over his truck with an alcohol level of 300, COPD, cardiac stents, and has already had his license taken away years ago. Or the illegal alien that just had a massive anterior MI. Or the terminal, metastatic cancer patient that was supposed to be on hospice and comfort care. Or the 300 pound septic shock, chain smoking diabetic with peripheral vascular disease and limb infections. Or the psyc patient on their 87th visit to the hospital but this time they did their research and overdosed on Tylenol and lithium. None of them are long for this world. They are going to die in the next few days, or in the next few months, or this year with a ton of time spent in and out of the hospital.


The point is critical and emergency medical services, in the complete absence of COVID, are typically at or near full capacity.

About three million people die in America every year. About a quarter from heart disease, a fifth from cancer, about 5% each from lung disease, strokes, dementia/old age, and trauma. Throw in diabetes, kidney disease, and suicide for another 5%. Note how interrelated and coexistent many of these are.
Then throw in recreational overdoses, autoimmune disorders, and everything else into the other 25 percent.

Could masks, no shaking or hugging, gloves handling money and items between people, and copious hand sanitizer had the same impact as a hard stop destroying the economy, businesses, retirement, jobs, of a massive portion of the population?

Could reasonable, sane news broadcasts accomplished similar instead of fan flaming led to a less panicked, more in depth planned response?

Could a plan to increase capacity by avoiding futile care been more reasonable?
This is a harsh question.
How many vents would be free if-
No inoperable head bleeds get vents.
No metastatic/palliative chemo/xrt cancer patients on vents.
No LVAD, EF below 20%, or septic endocarditis patients on vents.
No self ingested overdoses on vents.
No intentional self inflicted gunshot wounds on vents.
No BMI >50 on vents.

I won’t even get into the severely senile and demented who don’t know who they are, are non verbal, have PEG tubes because they won’t eat or drink, etc.


Should people that were going to die anyway in a few days or this year be allowed on a vent when someone that would have a long, normal life after recovery ?

Ok, now let’s add in some C19.


Say all 330 million people in America magically catch the virus in March, April, May, and June. There would normally be about 12 million hospital admissions during a four month period in America.) 100% exposure and infection is not possible. But we are going to paint the worst case scenario. On a graph with a 4 day doubling time, you could go from a few hundred cases to the entire population in about three weeks. Humans are not bacteria on a medium in a culture. There are shut ins, closed social circles, geographic barriers, closed loop repeat interaction circles, etc. even the four months I am using is crazy compressed but go with it.

Over 283.5 million people are not going to have any significant symptoms, go to a doctor, or have any issues.

About 49.5 million people will feel sick.

Let’s say About 7.5 million will be severe and need to be in the hospital.

And 750,000 of those are going to buy ten days on a vent.

I am being very, very generous with the doom percentages.

(There are over 36 million hospital admissions in over 6000 hospitals in America each year. With about 2% of patients accounting for 10% of costs, and about 1/3 of patients accounting for multiple admissions.)

This is not 7.5 million people admitted to the hospital on top of 12 million people normally admitted to the hospital during that four months.


It’s probably about 8 million people being admitted once or more than once, for a total of 12 million admissions.
And the vast majority of the 7.5 million people that will need to be admitted for COVID are the same old, sickly, poor health, multiple medical problem, way above average disease for their age, etc. patients that were already among those getting admitted.


Anyways, let’s say we range from 75,000 to 600,000 of those admitted patients die.


And most are from the categories of the 3 million people that were going to die this year anyway.

Yes, it’s worse than the flu.
Yes, it will strain the system.
Yes, some alleviating, flattening, procedures needed to occur.
But it is not a death sentence. We are talking 8% death rate with average age of 80 in a second world health care system with way less ICU and vent capacity.

We have destroyed a nation’s economy and way of life, ruined tons of businesses, put millions out of jobs, etc. in order to save elderly, sick, and unhealthy people from dying from COVID that were already going to die from other medical conditions at the same time or later this year.

Now let’s look at little kids under the age of 5.
Let’s pick one single other virus.
RSV. Each year,
About half a million will show up in the ER. About 50,000 will be admitted to the hospital.
About 500 will die. Add in flu. Add in other organisms for pneumonia.
That’s thousands of little kids dying every year from pneumonia with zero media attention.
The kids susceptible to the above are the same that would be susceptible to C19.
Little kids dying is sad. The only good news is they can’t die twice from two different things.


And this goes for older kids and young adults.

I have painted the worse case scenario I can.

You will need to form your own opinion regarding the media, politicians, the public, the response, the current impacts, the long term impacts.

Was your 88 year old grandmother with dementia, heart disease, AFIB, falls, head bleeds, and bleeding ulcers that was going to die this year worth keeping alive a few more months not getting corona virus a fair trade for hundreds of men that worked for decades but have had their retired accounts shattered and will have to keep working? Was your beloved child with severe CF not being exposed to corona virus and making it another year before succumbing to another infection worth a dozen local businesses folding and hundreds of people losing jobs? Did saving the chain smoking alcoholic repeat accident drunk driver from getting C19 and dying next week so he can die from his variceal bleeding next month warrant thousands of kids having their education, lives, and futures interrupted and delayed? Was watching your everything to you wife spend another month or two miserable on palliative chemo therapy worth also losing your home, job, and the same for dozens of other people? We have bought a non compliant, crack fiend self inflicted heart failure, LVAD, dialysis, 40 year old that has never had a job and never supported his bastard children and been in and out of jail another month or two of life at significant expense and sacrifice to dozens of other people, was it worth it?


The questions are meant to be very harsh and soul searching.

Thank you. My own 72 yr old mother sat in my office the other day and said she'd be glad to take one for the team to keep our business alive. That's a powerful statement. People who have never built anything substantial in their lives have no idea what some business owners are going through.

[ABNAK]

Regardless of how you feel, this post and the vast majority of what this man says on this subject is gospel.

Triage occurs daily in all therapeutic settings; always has and always will. Thank God most people aren’t privy to the hallway decisions health care people HAVE to make. That is a cold hard fact. I’ve seen it destroy and consume men and women who can’t see past their intrinsic nature to save everyone.
Excess capacity is a myth; good people bleed out because there was only one MD on shift when five ambulances and two packed cars pulled in. Then add in the knowledge that a bureaucrat cut two MD’s weeks before that school bus crash.
The majority of health care resources are wasted on people that do not need or deserve to live, and in my 60 years I still haven't figured out any better way. It’s easy to play god and awfully hard to be proficient at it. The slippery slope part sneaks up on you.
I would much rather live with pulling the plug on my own father than have a government agency telling me he did not check the right boxes to justify care.

As the man says...these are the harsh and soul searing questions that may have no good solutions.

I think he's saying that should be a policy in some way shape or form. As a policy, it wouldn't be up to you to make the decision to pull the plug; it would be made for you. Agree or not, I do believe that is what he's suggesting.

To play Devil's Advocate, too many times I've seen the family wants everything done. Even when it's a losing battle, pull out all the stops. For ramairthree's theory to be implemented, it would require there be some overriding "law" or "statute" (read: policy) that could nix the wishes of the family. If that's what enough folks want, they'll get it. I just like to be humble enough to realize that it could be ME in that bed clinging to life. What is that saying? "There but for the grace of God go I"?

Hey, if I was toast, do it. But some dude in his 50's who gets the ChiCom Flu and carries a few extra pounds, maybe diabetic. With a little medical prudence on he and his doc's behalf, he could live for another 20+ years. I'd say he deserves a damn good shot at doing so. Just because he "checks a few boxes" doesn't mean he should be denied intensive, expensive care.

[TehLlama]

To play Devil's Advocate, too many times I've seen the family wants everything done. Even when it's a losing battle, pull out all the stops. For ramairthree's theory to be implemented, it would require there be some overriding "law" or "statute" (read: policy) that could nix the wishes of the family. If that's what enough folks want, they'll get it. I just like to be humble enough to realize that it could be ME in that bed clinging to life. What is that saying? "There but for the grace of God go I"?


It's one of those things where marrying into a family of medical professionals, the policy exists for a reason, people can make decisions on what exceptions make sense, but I know full well that barring unrelated catastrophic events happening, I'm going to kick it a bit prematurely because my upper respiratory system already sucks managing its primary job when there's any form of tree orgy going on, and decades of asthma symptoms driven by that turning into secondary infections are a pretty obvious path toward recurring pneumonia as I age into biological obsolescence... your last sentence pretty much sums of where I'll be at with that, if by grace of the mighty one I know I'm not coming out the other end, the most I'd want to hold on for is saying goodbye to anybody who wants to visit from out of town.

I do think if there's anything beyond a one decade positive prognosis on the table, first world western medicine is basically never going to turn that down. There are plenty of cases where that doesn't apply, and people inherently want to jump to the fallacious conclusion that 'it's not that different from the other case you did spend huge resources on', because medically there's a huge gulf in what is likely to result, even though external factors to somebody with no medical background don't seem that different.

[TexasGunNut]

I think he's saying that should be a policy in some way shape or form. As a policy, it wouldn't be up to you to make the decision to pull the plug; it would be made for you. Agree or not, I do believe that is what he's suggesting.

To play Devil's Advocate, too many times I've seen the family wants everything done. Even when it's a losing battle, pull out all the stops. For ramairthree's theory to be implemented, it would require there be some overriding "law" or "statute" (read: policy) that could nix the wishes of the family. If that's what enough folks want, they'll get it. I just like to be humble enough to realize that it could be ME in that bed clinging to life. What is that saying? "There but for the grace of God go I"?

Hey, if I was toast, do it. But some dude in his 50's who gets the ChiCom Flu and carries a few extra pounds, maybe diabetic. With a little medical prudence on he and his doc's behalf, he could live for another 20+ years. I'd say he deserves a damn good shot at doing so. Just because he "checks a few boxes" doesn't mean he should be denied intensive, expensive care.

You make very good and valid points.

I agree, ergo I have no sensible solutions. I advocate individual choice and that commonly leads to nonsensical save at all cost decisions. That’s not good for anyone but I could never support an outsider deciding who lives or dies. Yet the reality is that outsiders make these decisions every day in real life. I’ve got a solid DNR and have had honest hard discussions with all that may face this decision for me. That’s my “policy” but not all individuals or families operate at that level.

Catch 22 but these “feel strongly both ways” thoughts are basic, intractable truths of life and may have no answers or even good solutions.

More than a few of us on this forum have and will continue to make these types of decisions. I wish I had a better answer that didn’t involve so many sleepless nights, anger and alcohol. My prayers go out to all that are on any side of this issue.

[ABNAK]

You make very good and valid points.

I agree, ergo I have no sensible solutions. I advocate individual choice and that commonly leads to nonsensical save at all cost decisions. That’s not good for anyone but I could never support an outsider deciding who lives or dies. Yet the reality is that outsiders make these decisions every day in real life. I’ve got a solid DNR and have had honest hard discussions with all that may face this decision for me. That’s my “policy” but not all individuals or families operate at that level.

Catch 22 but these “feel strongly both ways” thoughts are basic, intractable truths of life and may have no answers or even good solutions.

More than a few of us on this forum have and will continue to make these types of decisions. I wish I had a better answer that didn’t involve so many sleepless nights, anger and alcohol. My prayers go out to all that are on any side of this issue.

Good post. Can't say I disagree.

[ramairthree]

I think he's saying that should be a policy in some way shape or form. As a policy, it wouldn't be up to you to make the decision to pull the plug; it would be made for you. Agree or not, I do believe that is what he's suggesting.

To play Devil's Advocate, too many times I've seen the family wants everything done. Even when it's a losing battle, pull out all the stops. For ramairthree's theory to be implemented, it would require there be some overriding "law" or "statute" (read: policy) that could nix the wishes of the family. If that's what enough folks want, they'll get it. I just like to be humble enough to realize that it could be ME in that bed clinging to life. What is that saying? "There but for the grace of God go I"?

Hey, if I was toast, do it. But some dude in his 50's who gets the ChiCom Flu and carries a few extra pounds, maybe diabetic. With a little medical prudence on he and his doc's behalf, he could live for another 20+ years. I'd say he deserves a damn good shot at doing so. Just because he "checks a few boxes" doesn't mean he should be denied intensive, expensive care.

Things have definitely ran away from us in America.
In many other countries if you go to the hospital without being able to pay and with no entity to pay for you, you don’t get care. This is why we get a flood here from those countires.
In most first and first-ish world countries with modern medical systems, You get care without an ability to pay in a socialized medical program.
But patients get told/offered what they are going to get and if they are or are not a candidate. If they want more than the acceptable level of care, or don’t like how long it is going to take to get it, they go pay out of pocket at a private facility in their country or here in Amercia.

Americans SAY they want socialized medicine. They don’t. They want what we have here. Only more of it and faster. And to not pay for it.

Medicine has significant point of diminishing returns in terms of results and costs. In a humane, modern westernized first world nation with socialized medicine they are not going to intubate an 87 year old with pneumonia and sepsis, put him on a vent in the ICU with a central line, arterial line, and pressure supports and code him three times before he dies. Or survives and goes to rehab or the nursing home for a week or two before he is back again and dies. They will put him on mask oxygen, give fluids and antibiotics through a peripheral IV, and comfort medicines. A reasonable, humane, comfortable course of care. He may pull through. If not he will be care free and comfortable. What we typically do is America is not.


We do some horrible things to our significantly old and / or significantly sick people. You may say, well there can’t be anything worse than dying. There are several things.

So yes, I am a proponent of a base of medical options that are provided for everyone. But beyond that someone has to own the expense and responsibility for more instead of other citizens being forced to pay for it.

This does not mean the 50 year old with 29 extra pounds over the past ten years on the last hole on his belt that used to smoke in his twenties and has good blood pressure from the pill he takes every day doesn’t go to the cath lab and get his stent when his widow maker gets stopped up.

It means the 87 year old guy demented in a nursing home with blockages that can’t be reached to stent and too many other medical problems to survive bypass surgery does not get intubated and fo to the ICU and rack up a couple of million in care before he dies in a few weeks. He gets pain medicine and sleep medicine and oxygen and some sympathy, comfort, and dignity and nature takes its course.

For the 50 year old cocaine abuser, non compliant, does not take his meds, left AMA to get high soon after his last stent, never follows up after, and has spent his life shacked up with baby mommas on welfare, EBT, and section 8 and never held a job and medicaid cares for his offspring, and shows up in heart failure needing to be intubated- current law dictates he gets everything if he wants it. But it is neither practical nor sustainable during the best of times and only works because we deficit spend decades into the future. Putting him or the 87 year old above on a vent or keeping him on one during a worst case scenario when you are running short of medical personnel, out of vents, and could save a young, healthy RT, critical care RN, emergency physician, or intensivist you could save and have back in the fight in a few weeks would be insane.

Now, again, in a worst case scenario even harder would be some choices -
You have one vent-
27 year old morbidly obese mechanical engineer with uncontrolled hypertension and pre-diabetes,
27 year old fit no medical problem lineman,
27 year old slightly overweight smoker works the counter at autozone,
27 year old healthy, fit, unemployed semi-literate video game player lives with parents,
27 year old otherwise healthy, medically compliant HIV positive woman,
27 year old stay at home mom with mild asthma

Who gets it?

[ABNAK]

Things have definitely ran away from us in America.
In many other countries if you go to the hospital without being able to pay and with no entity to pay for you, you don’t get care. This is why we get a flood here from those countires.
In most first and first-ish world countries with modern medical systems, You get care without an ability to pay in a socialized medical program.
But patients get told/offered what they are going to get and if they are or are not a candidate. If they want more than the acceptable level of care, or don’t like how long it is going to take to get it, they go pay out of pocket at a private facility in their country or here in Amercia.

Americans SAY they want socialized medicine. They don’t. They want what we have here. Only more of it and faster. And to not pay for it.

Medicine has significant point of diminishing returns in terms of results and costs. In a humane, modern westernized first world nation with socialized medicine they are not going to intubate an 87 year old with pneumonia and sepsis, put him on a vent in the ICU with a central line, arterial line, and pressure supports and code him three times before he dies. Or survives and goes to rehab or the nursing home for a week or two before he is back again and dies. They will put him on mask oxygen, give fluids and antibiotics through a peripheral IV, and comfort medicines. A reasonable, humane, comfortable course of care. He may pull through. If not he will be care free and comfortable. What we typically do is America is not.


We do some horrible things to our significantly old and / or significantly sick people. You may say, well there can’t be anything worse than dying. There are several things.

So yes, I am a proponent of a base of medical options that are provided for everyone. But beyond that someone has to own the expense and responsibility for more instead of other citizens being forced to pay for it.

This does not mean the 50 year old with 29 extra pounds over the past ten years on the last hole on his belt that used to smoke in his twenties and has good blood pressure from the pill he takes every day doesn’t go to the cath lab and get his stent when his widow maker gets stopped up.

It means the 87 year old guy demented in a nursing home with blockages that can’t be reached to stent and too many other medical problems to survive bypass surgery does not get intubated and fo to the ICU and rack up a couple of million in care before he dies in a few weeks. He gets pain medicine and sleep medicine and oxygen and some sympathy, comfort, and dignity and nature takes its course.

For the 50 year old cocaine abuser, non compliant, does not take his meds, left AMA to get high soon after his last stent, never follows up after, and has spent his life shacked up with baby mommas on welfare, EBT, and section 8 and never held a job and medicaid cares for his offspring, and shows up in heart failure needing to be intubated- current law dictates he gets everything if he wants it. But it is neither practical nor sustainable during the best of times and only works because we deficit spend decades into the future. Putting him or the 87 year old above on a vent or keeping him on one during a worst case scenario when you are running short of medical personnel, out of vents, and could save a young, healthy RT, critical care RN, emergency physician, or intensivist you could save and have back in the fight in a few weeks would be insane.

Now, again, in a worst case scenario even harder would be some choices -
You have one vent-
27 year old morbidly obese mechanical engineer with uncontrolled hypertension and pre-diabetes,
27 year old fit no medical problem lineman,
27 year old slightly overweight smoker works the counter at autozone,
27 year old healthy, fit, unemployed semi-literate video game player lives with parents,
27 year old otherwise healthy, medically compliant HIV positive woman,
27 year old stay at home mom with mild asthma

Who gets it?

Okay, I gotta ask: does what insurance they have and it's subsequent reimbursement carry weight in the equation?

[rero360]

Things have definitely ran away from us in America.
In many other countries if you go to the hospital without being able to pay and with no entity to pay for you, you don’t get care. This is why we get a flood here from those countires.
In most first and first-ish world countries with modern medical systems, You get care without an ability to pay in a socialized medical program.
But patients get told/offered what they are going to get and if they are or are not a candidate. If they want more than the acceptable level of care, or don’t like how long it is going to take to get it, they go pay out of pocket at a private facility in their country or here in Amercia.

Americans SAY they want socialized medicine. They don’t. They want what we have here. Only more of it and faster. And to not pay for it.

Medicine has significant point of diminishing returns in terms of results and costs. In a humane, modern westernized first world nation with socialized medicine they are not going to intubate an 87 year old with pneumonia and sepsis, put him on a vent in the ICU with a central line, arterial line, and pressure supports and code him three times before he dies. Or survives and goes to rehab or the nursing home for a week or two before he is back again and dies. They will put him on mask oxygen, give fluids and antibiotics through a peripheral IV, and comfort medicines. A reasonable, humane, comfortable course of care. He may pull through. If not he will be care free and comfortable. What we typically do is America is not.


We do some horrible things to our significantly old and / or significantly sick people. You may say, well there can’t be anything worse than dying. There are several things.

So yes, I am a proponent of a base of medical options that are provided for everyone. But beyond that someone has to own the expense and responsibility for more instead of other citizens being forced to pay for it.

This does not mean the 50 year old with 29 extra pounds over the past ten years on the last hole on his belt that used to smoke in his twenties and has good blood pressure from the pill he takes every day doesn’t go to the cath lab and get his stent when his widow maker gets stopped up.

It means the 87 year old guy demented in a nursing home with blockages that can’t be reached to stent and too many other medical problems to survive bypass surgery does not get intubated and fo to the ICU and rack up a couple of million in care before he dies in a few weeks. He gets pain medicine and sleep medicine and oxygen and some sympathy, comfort, and dignity and nature takes its course.

For the 50 year old cocaine abuser, non compliant, does not take his meds, left AMA to get high soon after his last stent, never follows up after, and has spent his life shacked up with baby mommas on welfare, EBT, and section 8 and never held a job and medicaid cares for his offspring, and shows up in heart failure needing to be intubated- current law dictates he gets everything if he wants it. But it is neither practical nor sustainable during the best of times and only works because we deficit spend decades into the future. Putting him or the 87 year old above on a vent or keeping him on one during a worst case scenario when you are running short of medical personnel, out of vents, and could save a young, healthy RT, critical care RN, emergency physician, or intensivist you could save and have back in the fight in a few weeks would be insane.

Now, again, in a worst case scenario even harder would be some choices -
You have one vent-
27 year old morbidly obese mechanical engineer with uncontrolled hypertension and pre-diabetes,
27 year old fit no medical problem lineman,
27 year old slightly overweight smoker works the counter at autozone,
27 year old healthy, fit, unemployed semi-literate video game player lives with parents,
27 year old otherwise healthy, medically compliant HIV positive woman,
27 year old stay at home mom with mild asthma

Who gets it?

My gut tells me to save the lineman, otherwise healthy individual doing an in demand job that is needed and is vital.

Although the stay at home mom gives me pause

[vicious_cb]

You think viruses are ****ed up? Go do some reading on prions.

[Arik]

You think viruses are ****ed up? Go do some reading on prions.Aren't those the things that can't be killed?

[rero360]

Aren't those the things that can't be killed?

Yeah, I remember from the outbreak of mad cow disease in England, they would kill the cattle and burn the piles of corpses and like years later they would go back and find the prions still just chilling there in the ground.

[Arik]

Yeah, I remember from the outbreak of mad cow disease in England, they would kill the cattle and burn the piles of corpses and like years later they would go back and find the prions still just chilling there in the ground.I remember hearing about this recently just can't remember where. They tried everything and those things were just like...eh whatever!

[ABNAK]

I remember hearing about this recently just can't remember where. They tried everything and those things were just like...eh whatever!

Forget where I read it but those damn things can live on surfaces for decades.

[thopkins22]

Forget where I read it but those damn things can live on surfaces for decades.

Yes. And they don't actually do anything but make other proteins fold differently. TCE started here in America, likely in a research facility in Colorado, is now in deer species worldwide, and will in all likelihood jump to humans at some point. It is fatal in 100% of cases, we don't know how to even treat it. And the damn things live exposed to sunlight, freezing temperatures, hot temperatures, and pretty much everything else for decades.

Iceland found it in a herd, and killed everything for like ten square miles and fenced it off hoping to stop the spread. It will be interesting to see how long it's present in the soil there.

[ABNAK]

Since the big thread is closed for now, I'd like to know EXACTLY what treatment Boris Johnson received. Drugs and other interventions would be nice to know. He circled the drain enough to be sent to the ICU but was kept off a vent. I wanna know the what and how of it.

[thopkins22]

Since the big thread is closed for now, I'd like to know EXACTLY what treatment Boris Johnson received. Drugs and other interventions would be nice to know. He circled the drain enough to be sent to the ICU but was kept off a vent. I wanna know the what and how of it.

It's not helpful at all...but I think we are safe in assuming that the conditions required for normal folks to be sent to the ICU and the conditions required for the prime minister are two different things. Could very well be that they were simply keeping him hydrated and giving him Tylenol or some NSAID for fever.

So...I guess I'm interested as well. I don't think there is anyone offering that information at the moment though.

[ramairthree]

Okay, I gotta ask: does what insurance they have and it's subsequent reimbursement carry weight in the equation?

Not as a primary consideration and as often as not in a trauma or medical code arriving via EMS the initial ER physician does not know who they are.

In my opinion it should be a secondary consideration.

Do you let a fit, healthy, 30 year old mother of two with no medical problems emergency medicine physician who got a massive viral load at work die and not get a vent because there are none available but:
A) A non citizen, non English speaking, here illegally, illiterate in their own language, unskilled manual laborer is on a vent?
B) An 88 year old with pneumonia, septic 85 year old with COPD, CHF, CAD, hypertension, and prostate cancer is on a vent?
C) A 48 year old morbidly obese diabetic bed ridden hemiplegic from a stroke, end stage renal disease dialysis patient is on a vent?
D) A 26 year old homeless schizophrenic, non compliant alcoholic is on a vent?
E) A 46 year old LEO that’s a little overweight with high cholesterol and hypertension is on a vent?
F) A 52 year old retired Force Recon Marine that owns a gun store and a gym that had really bad family history and despite excellent diet and exercise had a massive heart attack and heart failure is on a vent?
G) A 40 year old felon in prison for life with high blood pressure, heart disease, and sickle cell is on a vent?
H) A 27 year old with an autoimmune disorder that needs a lung transplant is on a vent?

How much are productive citizens supposed to give up to support non contributing citizens or non citizens?
What right does one individual have to demand to be supported by others?

Medical care is not a basic right, philosophical concept that costs nothing.
You have freedom of religion, I don’t have to build you a church.
You have freedom of speech, I don’t have to buy you a printing press, book run, fund your website, etc.
You have the right to keep and bear arms. I don’t have to buy you a gun or pay for you to go to a trigger time or VTAC class.

Medical care has serious costs in equipment, man hours, medications, maintenance, etc.

Let’s say someone is a good man and always worked, etc.
His kid is wired wrong and becomes some stripper head skanky junkie.
They have four different looking kids. Multiple ambulance rides, ER overdose visits, abscess surgeries, an ICU admission for bacterial endocarditis. An ICU admission and surgery for epidural abscess. Multiple leaves against medical advice. A couple of sepsis admissions. They need a heart valve replaced. They have failed rehab stints.

I feel bad for that guy. I think it sucks he raised four kids that turned out great but got stuck with how this one turned out. But I don’t feel obligated to pay for raising his grandkids he and his wife now have custody off. I don’t feel obligated nor think he should demand other citizens pay for his adult child’s medical care. A functioning society has absolutely zero use for that individual from a practical perspective. Nor several variants or situations that basically involve someone with self inflicted severe medical problems and non compliance issues. What right do they have to demand that society pay for their stuff? What right does someone that weighs 500 pounds have to injure ambulance personnel or nurses get insured having to move them around, or needle sticks from the millions of tries to get an IV in them, or people to pay for their medical problems?