Covid, the "lockdowns" etc.

[Mistwell]

Here we have a lot more people wanting to point out the economic risks while brushing off the strain to the healthcare system than we do the reverse.

And in the real world, from the people in actual power with decision making capabilities (as opposed to whiny bitches in an RPG forum), we have the complete polar opposite. Along with many places were hospitals are NOT overflowing and overcapacity, and no concrete evidence that the lockdowns do in fact work. It's all a faith-based initiative.

In the real world Los Angeles is out of ICU beds. So, what do you recommend we do, and how does "no lockdowns" result in less usage of ICU beds?

[HappyDaze]

This takes us back to the early pages of this thread (or maybe the thread that was the precursor to this one). Those insisting that this is just "the sniffles" don't want to look at the ripple effects on the capabilities of the healthcare system even though they want everyone to look at the ripple effects of the lockdowns on the economy. Both are important, and while any sane person should be looking at both, every person's situation (location, demographics, occupation, etc.) are going to make value calls. That's not entirely bad. What is bad is the assholes trying to ignore the other side and dismiss their concerns. Here we have a lot more people wanting to point out the economic risks while brushing off the strain to the healthcare system than we do the reverse.

BTW, it can't help that California is having some strikes among their nurses. I've seen offers for 2-week stints paying $1500/day for scabs.

I would believe the "strain on the healthcare" line 9 months ago.

If you have strain on your healthcare now then what the fuck was your state doing for the last 9 months while there was a pandemic raging through the world?

It was reasonably assumed the lockdowns would in fact keep the levels well below the ICU bed numbers we have. And it did. For 9 months. And then massive spike on top of massive spike. Which was not predicted. By anyone.

Did you imagine we would what, import more ICU-level emergency doctors just in case? Where would we get them? It's not a matter of physical beds, it's a matter of the people able to deal with an ICU-level situation.

And remember this is WITH LOCKDOWNS. SHARK is advocating no lock-downs So the number of needed ICU beds would be even more than the number needed now.

In some cases, it is a matter of physical beds. In one hospital I've been working with, private (single) rooms are being turned into semi-private (double) rooms and rooms usually holding two beds are being arranged to hold a third. However, even as this is going on, you are right that it's becoming very hard to get the staffing to cover all of the added bed space. Additionally, some supporting elements--like kitchens, laundry, housekeeping/environmental, and others--can't necessarily expand facilities to accommodate the surge as easily even if they can find new minimally skilled staff.

[Shasarak]

This takes us back to the early pages of this thread (or maybe the thread that was the precursor to this one). Those insisting that this is just "the sniffles" don't want to look at the ripple effects on the capabilities of the healthcare system even though they want everyone to look at the ripple effects of the lockdowns on the economy. Both are important, and while any sane person should be looking at both, every person's situation (location, demographics, occupation, etc.) are going to make value calls. That's not entirely bad. What is bad is the assholes trying to ignore the other side and dismiss their concerns. Here we have a lot more people wanting to point out the economic risks while brushing off the strain to the healthcare system than we do the reverse.

BTW, it can't help that California is having some strikes among their nurses. I've seen offers for 2-week stints paying $1500/day for scabs.

I would believe the "strain on the healthcare" line 9 months ago.

If you have strain on your healthcare now then what the fuck was your state doing for the last 9 months while there was a pandemic raging through the world?

Like you said, raging through the world. There are only so many resources--including healthcare workers--to go around. Supply chains have been stepped up, and while that's good news for keeping current operations running, it doesn't directly increase the number of beds available and staffed. The last nine months have not really been focused on erecting new hospitals and training a new crop of workers. While it might be possible to set up field hospitals and staff them with un(der)trained personnel, that's not a solution that's generally acceptable in first world nations until everyone agrees the situation is dire...and there are still a lot of people that don't accept that for various--usually political--reasons.

Out of curiosity, what did you expect the CA healthcare system to have done over the last 9 months to be able to take care of the COVID-19 admission rate it currently faces?

Does not directly increase the number of beds available?  Then what the fuck has your local government been doing?  Everyone knew that there would be a second wave coming.

As for CA, I would suggest considering moving to Texas.

[VisionStorm]

Here we have a lot more people wanting to point out the economic risks while brushing off the strain to the healthcare system than we do the reverse.

And in the real world, from the people in actual power with decision making capabilities (as opposed to whiny bitches in an RPG forum), we have the complete polar opposite. Along with many places were hospitals are NOT overflowing and overcapacity, and no concrete evidence that the lockdowns do in fact work. It's all a faith-based initiative.

In the real world Los Angeles is out of ICU beds. So, what do you recommend we do, and how does "no lockdowns" result in less usage of ICU beds?

The real question is, how have the lockdowns resulted in less usage of ICU beds? Cuz it's been 9 fucking months already, and the only result I've seen is the destruction of the middle class and the economy, while massive corporations like Walmart, Costco and Amazon make record profits.

[Shasarak]

It was reasonably assumed the lockdowns would in fact keep the levels well below the ICU bed numbers we have. And it did. For 9 months. And then massive spike on top of massive spike. Which was not predicted. By anyone.

It was predicted by everyone because that is what happens with infectious disease.

See for example the Spanish Flu and or any season of the normal Flu virus.

[HappyDaze]

This takes us back to the early pages of this thread (or maybe the thread that was the precursor to this one). Those insisting that this is just "the sniffles" don't want to look at the ripple effects on the capabilities of the healthcare system even though they want everyone to look at the ripple effects of the lockdowns on the economy. Both are important, and while any sane person should be looking at both, every person's situation (location, demographics, occupation, etc.) are going to make value calls. That's not entirely bad. What is bad is the assholes trying to ignore the other side and dismiss their concerns. Here we have a lot more people wanting to point out the economic risks while brushing off the strain to the healthcare system than we do the reverse.

BTW, it can't help that California is having some strikes among their nurses. I've seen offers for 2-week stints paying $1500/day for scabs.

I would believe the "strain on the healthcare" line 9 months ago.

If you have strain on your healthcare now then what the fuck was your state doing for the last 9 months while there was a pandemic raging through the world?

Like you said, raging through the world. There are only so many resources--including healthcare workers--to go around. Supply chains have been stepped up, and while that's good news for keeping current operations running, it doesn't directly increase the number of beds available and staffed. The last nine months have not really been focused on erecting new hospitals and training a new crop of workers. While it might be possible to set up field hospitals and staff them with un(der)trained personnel, that's not a solution that's generally acceptable in first world nations until everyone agrees the situation is dire...and there are still a lot of people that don't accept that for various--usually political--reasons.

Out of curiosity, what did you expect the CA healthcare system to have done over the last 9 months to be able to take care of the COVID-19 admission rate it currently faces?

Does not directly increase the number of beds available?  Then what the fuck has your local government been doing?  Everyone knew that there would be a second wave coming.

As for CA, I would suggest considering moving to Texas.

So your answer is a non-answer. Moving to Texas would probably not be all that helpful in any event:
https://www.statesman.com/story/news/coronavirus/2020/12/13/hospital-icus-across-texas-capacity/3813649001/

[Shasarak]

So your answer is a non-answer. Moving to Texas would probably not be all that helpful in any event:

From your link:

At least 50 Texas hospitals are at more than 98% capacity, including 27 hospitals with completely full ICUs, according to new data from the U.S. Department of Health and Human Services.

The way that I read that is that everyone who needs to be in ICU in Texas is in ICU with an additional 2% capacity for any lucky Californian who can make it across the border to safety.

https://www.statesman.com/story/news/coronavirus/2020/12/13/hospital-icus-across-texas-capacity/3813649001/

[HappyDaze]

So your answer is a non-answer. Moving to Texas would probably not be all that helpful in any event:

From your link:

At least 50 Texas hospitals are at more than 98% capacity, including 27 hospitals with completely full ICUs, according to new data from the U.S. Department of Health and Human Services.

The way that I read that is that everyone who needs to be in ICU in Texas is in ICU with an additional 2% capacity for any lucky Californian who can make it across the border to safety.

https://www.statesman.com/story/news/coronavirus/2020/12/13/hospital-icus-across-texas-capacity/3813649001/

You're showing yourself to be a fool. ICUs are not intended to be run at a sustained 100% capacity. But you think it's OK to just move to where the beds are, and that (if possible) creates all sorts of additional stresses to the system. Besides, it's a pandemic...that means that all of those capacities are going to be strained (not that 98% capacity is a normal load--it may not even leave a dedicated code bed in some cases). But, by all means, keep going on about shit you don't understand.

[Shasarak]

You're showing yourself to be a fool. ICUs are not intended to be run at a sustained 100% capacity. But you think it's OK to just move to where the beds are, and that (if possible) creates all sorts of additional stresses to the system. Besides, it's a pandemic...that means that all of those capacities are going to be strained (not that 98% capacity is a normal load--it may not even leave a dedicated code bed in some cases). But, by all means, keep going on about shit you don't understand.

ICUs are not designed to run at 100% of capacity?

[jhkim]

The way that I read that is that everyone who needs to be in ICU in Texas is in ICU with an additional 2% capacity for any lucky Californian who can make it across the border to safety.

I think trying to read safety based on news headlines is not very accurate. Overall, Texas has been doing about average as far as covid deaths among U.S. states: 25,300 deaths out of a population of 29 million - or a death rate of 92 out of 100K. California has had fewer covid deaths: 22,400 -- and it has a much higher population of 39 million. So that's a much lower death rate of 59 out of 100K, one of the better states to be in.

That said, California is experiencing a higher rate right over the last week. So the overall comparison could change with time, but long-term track record is where the rubber meets the road.

[consolcwby]

If I may ask:
What is the number of homeless people, you know - people who live out on the street - who have died of COVID? Because, wouldn't they be the most susceptible to it's effects? Why aren't we seeing them pulling the dead out from the shanties?

It's a fair question at this point.

[jhkim]

If I may ask:
What is the number of homeless people, you know - people who live out on the street - who have died of COVID? Because, wouldn't they be the most susceptible to it's effects? Why aren't we seeing them pulling the dead out from the shanties?

It's a fair question at this point.

From what I read, the rates among homeless people appear to be lower than once feared.

https://apnews.com/article/ap-top-news-san-francisco-understanding-the-outbreak-health-public-health-595410c64aff65fd0e053e9657e7f928

At a guess, this might be because homeless people have less extended social circles. Also, they may be spending less time indoors with multiple people.

[Pat]

This takes us back to the early pages of this thread (or maybe the thread that was the precursor to this one). Those insisting that this is just "the sniffles" don't want to look at the ripple effects on the capabilities of the healthcare system even though they want everyone to look at the ripple effects of the lockdowns on the economy. Both are important, and while any sane person should be looking at both, every person's situation (location, demographics, occupation, etc.) are going to make value calls. That's not entirely bad. What is bad is the assholes trying to ignore the other side and dismiss their concerns. Here we have a lot more people wanting to point out the economic risks while brushing off the strain to the healthcare system than we do the reverse.

BTW, it can't help that California is having some strikes among their nurses. I've seen offers for 2-week stints paying $1500/day for scabs.

I would believe the "strain on the healthcare" line 9 months ago.

If you have strain on your healthcare now then what the fuck was your state doing for the last 9 months while there was a pandemic raging through the world?

It was reasonably assumed the lockdowns would in fact keep the levels well below the ICU bed numbers we have, or at least below the level we've been ramping up for all along (and we have added ICU slots all along). And it did. For 9 months. And then massive spike on top of massive spike. Which was not predicted. By anyone.

Did you imagine we would what, import more ICU-level emergency doctors just in case? Where would we get them? It's not a matter of physical beds, it's a matter of the people able to deal with an ICU-level situation.

And remember this is WITH LOCKDOWNS. SHARK is advocating no lock-downs So the number of needed ICU beds would be even more than the number needed now.

Half the world predicted it. The news has been full of dire warnings for months. They've been talking about a second fall surge, wondering whether the disease is seasonal, discussing lockdown fatigue, and expressing concern about people moving inside with poor ventilation and dry air due to the cold weather. We know seroprevalance was low in many areas that are being hit hard.

And lockdowns have not kept it down. We have plenty of examples around the world of places without a lockdown, and few cases; and places with severe lockdowns, where they're overwhelmed by cases. Lockdowns do probably have an effect, but it doesn't seem to the driving factor. Humidity, cultural mores, genetics, cross-immunity, and so on all may be much more important. And lockdowns also have numerous negative effects. People lose jobs, lose insurance, have to move in with relatives, and so on. The supply chain breaks, impacting essential supplies for everything from individuals to labs. Education suffers, domestic abuse increases, suicides rise. And people get tired of not being able to go out and being cut off from human contact, start ignoring the guidelines, and any benefit from the lockdowns starts to be lost. Or worse, inverts, because they start slacking on the other precautions, like physical distancing or hygiene.

Lockdowns are political theater, to make it look like the politicians are doing something so they can claim credit for any eventual downturn. That's why there are highly destructive blanket lockdowns instead of targeted ones, or targeted ones that completely miss the target. Look at NYC, where Cuomo is proposing closing down restaurants again. Which will kill them, at least the ones that haven't been killed off already. And why? Cuomo's own contract tracers say that restaurants are responsible for 1.4% of the spread. It ignores that 74% of the cases have been traced back to social gatherings in homes.

[HappyDaze]

You're showing yourself to be a fool. ICUs are not intended to be run at a sustained 100% capacity. But you think it's OK to just move to where the beds are, and that (if possible) creates all sorts of additional stresses to the system. Besides, it's a pandemic...that means that all of those capacities are going to be strained (not that 98% capacity is a normal load--it may not even leave a dedicated code bed in some cases). But, by all means, keep going on about shit you don't understand.

ICUs are not designed to run at 100% of capacity?

I already answered your question. They are not intended to be run at a sustained 100% capacity. When you do that, you don't leave any flex room for OR cases that go bad, ED traumas (they have to go somewhere post-stabilization or else they block up your trauma bay), adverse outcomes in cath labs, etc. Many of these services have a small but significant chance of going bad and you need somewhere for those patients to go immediately in such situations. That place is the ICU, so most ICUs typically run at well below 100% so that the other necessary services can continue with the required safety net in place. Without it, interventions for trauma, cardiac events, and cerebrovascular events, as well as many non-elective surgeries get slowed down. This is also why (along with cost issues) there is such a push to downgrade patients and get them out of the ICU. With COVID-19, there are a great many such patients taking up progressive care/stepdown and medical/surgical beds for > 1 week, leading to a lot of throughput issues.

[Kyle Aaron]

There are a couple of issues with lockdowns and their effectiveness.

The first is that lockdowns restrict large parts of the population, but not all of it. You still need your healthcare workers, people producing and transporting food, people making the electricity and water go, rubbish disposal and so on. About 20% of adults will keep moving around and being in some contact, and those people tend to contact a lot of other people. A healthcare worker or supermarket staff sees more people in a day than does an accountant, for example. So those 20% of people make up much more than 20% of the interactions - probably 50%.

The second is that those 20% who keep moving around also tend to be the more vulnerable ones. Apart from the doctors and nurses, those essential workers are more likely to be working class, more likely to be obese, and more likely to live in poor housing with large families. So they get infected and then infect their large families.

A corollary to these two points is that essential workers know other essential workers. For example, here in Victoria the second wave was sparked by a single family in hotel quarantine. After a couple of weeks locked inside a hotel room, their kid went mental and smeared his shit on the walls, the hotel night manager came along to clean it up and got unknowingly infected, went and had lunch with 7 security guards in the lunchroom and infected 5 of them, one of them went home and infected their housemate who worked in aged care, who then went and infected other aged care staff and residents.

Security guards tend not to share homes with doctors and accountants and lawyers, they share homes with other working class people. So you have one group of people who move around a lot and encounter a lot of other people, who live and socialise with other people who move around a lot and encounter a lot of other people. And those people are mostly working part-time casually - they don't want to take time off work, they still have to pay rent and buy food. So the virus spreads among minimum wage workers really, really well.

Thus, lockdowns don't suppress the infection as much as you might expect. If the lockdown is strict and long enough, it will actually work, as we've demonstrated here in Victoria. Though obviously the lockdown has other effects, many of them bad, and so some of us might not think they're worth it - but putting the entire state under house arrest can and will eventually bring down infection numbers greatly, if not reduce it to zero.

Of course, this supposes that you bring no fresh sources of infection into that state or country. This is one of the reasons island nations have been able to control things - Australia, NZ, Taiwan, Japan and South Korea (RoK's sole land border with DPRK is covered by minefields, drones and armed guards). But countries with large land borders like the US and EU have found it much more difficult, especially when some neighbours had strict rules and some didn't. It's a bit pointless (for example) the Czech Republic locking down strictly if they still have free travel from Slovakia, and Slovakia doesn't lock down at all.

As we have had to explain to people here in Victoria, there is not really any question that putting an entire state or country under house arrest will eventually drop infection numbers, and thus deaths. The question is whether it's worth it.