Originally Posted by
ramairthree
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.
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