
Coronavirus patients start to overwhelm US hospitals - ericdanielski
https://edition.cnn.com/2020/03/25/health/coronavirus-covid-hospitals
======
qubex
As an Italian (albeit one living abroad) I was expecting this, and hoping to
be wrong. So much advantage, squandered.

------
mapgrep
I am seeing a lot of comments on this story complaining that it is anecdotal
or that New York is extraordinary and thus this is implicitly less important
to people outside New York.

I live in the city of New York and I think it's important that everyone
nationally absorb what is happening right now and the "anecdotes" are
important. By anecdotes, I mean, in particular the New York Times story and
video published last night about Elmhurst Hospital in Queens (a very hard hit
borough)([https://www.nytimes.com/2020/03/25/nyregion/nyc-
coronavirus-...](https://www.nytimes.com/2020/03/25/nyregion/nyc-coronavirus-
hospitals.html)).

People are dying of Covid at this hospital in chairs or on floors ("Some have
died inside the emergency room while waiting for a bed"). People are dying
without their loved ones allowed or able to be present
([https://www.nytimes.com/2020/03/24/opinion/coronavirus-
hospi...](https://www.nytimes.com/2020/03/24/opinion/coronavirus-hospital-
visits.html?searchResultPosition=1)) (<\--link is about Boston but Elmurst
story above makes clear this is happening in NYC too, very much so). In his
briefing yesterday the governor of New York discussed people sharing
venilators (already happening per the Elmurst story) and bringing back retired
doctors (horrifying given the risk to the old -- in China older working
doctors were often kept off Covid wards).

The morgues are filling up and they are building outfoor refrigerators to hold
the bodies (this is in the Elmhurst story). People with babies due are giving
birth alone without their partners
([https://www.nytimes.com/2020/03/24/parenting/coronavirus-
lab...](https://www.nytimes.com/2020/03/24/parenting/coronavirus-labor-
birth.html)). People (including one in Elmhurst story with fever) are waiting
multiple days outdoors (including rain) for a test and being turned away day
after day after waiting all day.

Why talk about this? Is it for clickbait? To be dramatic? Because we're
_certain_ the NYC scale problems will spread to less dense areas?

No. It is because many many people in this country are continuing to not take
this situation seriously. Many people (including relatives of mine on
Facebook) think this is completely overblow, like the flu, not worth keeping
people at home for given economic cost.

Many of these people have already ignored the hard evidence, the numbers, the
consequences. Talking about terrible things that are starting to happen --
"anecdotes" \-- may help shake some of these people out of their denial. And
if they are prepared, and IF anything _approaching_ NYC scale problems happens
in their area, there is a better chance they will help rather than hinder
efforts to flatten the curve.

Please don't dismiss what is happening here as anecdote or irrelevant. Believe
me, I'm no better than you, I did this too, when this was "just" in Wuhan, or
"just" in China, or "just" in Italy. I took a trip at the end of February in
the U.S. on an airplane. I look back -- what was I thinking?! Now I'm locked
in my apartment going on three weeks. My wife had a fever for 6 hours a little
over a week ago, she's been coughing. Probably we're ok. But it's in the back
of your head: What if I get sick, and she gets worse, who will take care of
our kids? What if they close the stores and we can't get groceries?

I wish some of the anecdotes had reached me earlier. I hope some of these
anecdotes reach others.

~~~
circlefavshape
Here's my anecdote - I had to drive my wife to the emergency department
yesterday because she was having trouble breathing, and the ambulance service
was busy. She's been sick for 2 weeks. 47 years of age. Only for the fact my
sister-in-law is staying with us since the lockdown began I'd have had to
leave my 2 panicked kids (14 and 11) alone in the house

Wife didn't need to be ventilated, and is home and seems to be improving.
We're all still pretty on edge though. We live in Ireland FWIW

~~~
mapgrep
I am glad to hear your wife seems to be improving. I'm sorry you had to go
through that. Take care.

------
TomMckenny
Judging from the comments, explaining the severity of the epidemic is now
politically charged.

Epidemiologists and the medical field have made it clear we are _under_
reacting. But apparently some politicians want to down play the problem and
their obfuscation is echoed in every corner of the web with great zeal and
again drowning out reality.

It's like the climate change denial phenomenon but at high speed.

~~~
thomascgalvin
The fact that we're more likely to listen to a politician (or a media figure)
rather than someone who has spent the better portion of four decades studying
a topic is one of the most existential threats we face.

We need to figure out a way to get through the tribal mentality. Right now, a
significant plurality (if not an actual majority) of people are more concerned
about their side winning points than about effectively dealing with a crisis.

~~~
seph-reed
Seriously, what is the analogous computer science problem to this? Why is it
that a lifetime of experiences, and I still draw blanks every time I try to
figure out what to do about this stuff. I mean... everything minus scenarios
which include massive amounts of death. Surely there's a better way though.

~~~
thomascgalvin
I don't think there is an analogy in computer science; that deals with data,
and this deals with emotion.

This is driven, as far as I understand it, by evolutionary psychology. It was
an advantage to be "right enough, and unified" as opposed to "completely
right, but divided", and an advantage to take care of "us" before taking care
of "them." As a result, we are hard-wired toward tribalism.

Smart people are able to set this aside and deal with the facts as they are,
but we still have to overcome the initial, emotional surge that takes offense
whenever something we hold true is challenged.

One of the big issues is that people don't see immediate fallout from this
sort of behavior on the national level. They vote for people who cut taxes for
the rich and gut worker protections, but never connect that to their own
financial ruin. The effect follows too far after, and too far from, the cause.

Politics, as a result, is treated like football: root for your team, because
the other team sucks.

We _might_ see some of that change as the bodies start piling up from
COVID-19, but I doubt that there will be a larger societal change.

------
VikingCoder
It's weird, it's almost like this is following the exponential growth that
literally everyone said it would.

~~~
thomascgalvin
Our current political process follows a simple loop:

1\. Experts describe the likely outcome of a course of action.

2\. Those experts are declared to be frauds, their views labeled a hoax or
fake news.

3\. We implement the policy the experts were trying to warn us about.

4\. The experts' warnings come to pass.

5\. We learn nothing, and repeat the whole cycle with the next issue.

~~~
summerdown2
From 'Yes, Prime Minister,' a comedy show in the UK in the 80s:

[https://www.youtube.com/watch?v=nSXIetP5iak](https://www.youtube.com/watch?v=nSXIetP5iak)

------
dreen
Judging by the history of most pandemics, I am currently more worried about
the capacity of morgues than hospitals. Maybe this one will be different
though.

~~~
slazaro
Really? You're more worried about lifeless atoms piling up than actual humans
dying?

~~~
3JPLW
I see a morgue at capacity and I think about the thousands of family members
who aren't able to properly grieve for, manage, and bury their deceaseds.

I wouldn't jump to accusations of callousness on the part of the GP quite so
fast.

------
js2
The 2017-2018 flu season also overwhelmed US hospitals:

[https://time.com/5107984/hospitals-handling-burden-flu-
patie...](https://time.com/5107984/hospitals-handling-burden-flu-patients/)

[https://www.cdc.gov/flu/about/season/flu-
season-2017-2018.ht...](https://www.cdc.gov/flu/about/season/flu-
season-2017-2018.htm)

My point isn't that we should take Coronavirus any less seriously this year.
Healthcare workers have no vaccine for it. It's on top of the flu. Etc.

My point is that we should take the flu more seriously every year. Everyone
gets their flu shot, right?

~~~
sg47
Got my flu shot last year, still ended up with severe flu in February. The flu
shot is not completely effective.

~~~
gridlockd
Its effectiveness has on average been less than 50% in the past decades,
sometimes far lower. There's just too many strains and to much seasonal
variability.

~~~
mohaine
But they usually also decrease the severity of the symptoms, even when they
don't completely block them. This is almost as important as the full
effectiveness as helps decreases death and hospital time.

------
JohnTHaller
It's bad here in NYC. I have multiple friends symptomatic after contact with
confirmed infected. One knows he was in contact with confirmed infected
because the one of their group that went back to Canada was tested there and
came back positive. Of all of sick friends with confirmed exposure, only a
single one has been tested and it's because he's currently in the hospital
under quarantine on oxygen with a tentative pneumonia diagnosis. We just don't
have test kits.

My partner and I are both sick and self isolating. My friends who are nurses
are saying it's bad where they are and they're running out of supplies. And
we're not due to hit the height of hospitalizations for another 3 weeks. 911
in NYC is already at Sept 11th levels.

Stay home, stay safe. Only call 911 in an emergency. Ignore the president,
listen to epidemiologists and medical professionals. "anybody that needs a
test gets a test. They’re there. And the tests are beautiful" \- Trump, March
6

------
tim333
What kind of amazes me about this is it was obvious this would happen if the
US didn't test as many people as possible early on to catch the virus. Yet the
CDC banned most labs from testing and when a researcher in Seattle tested
against permission and found the virus spreading tried to cover it up. Why?
Wasn't it obvious that that would result in the present mess? Why couldn't
they have just said yeah, test whatever?

~~~
smegger001
Because apparently even non evasive medial test are bound in ridiculous
amounts of regulatory red tape and pointless bureaucracy by the FDA.

------
dt3ft
Is there any data on how many people died which had no pre-existing medical
conditions?

~~~
Redoubts
This twitter thread had some good info from NYC:

[https://twitter.com/ArmstrongDrew/status/1242648015959187456](https://twitter.com/ArmstrongDrew/status/1242648015959187456)

> Another common trend -- 95% of people who have died so far had an underlying
> health condition ... BUT

> Keep in mind those underlying health conditions include things like diabetes
> -- which affects about 10% of the U.S. population. Oh, and hypertension --
> 29% of adults. And cancer, heart disease, kidney diseae, etc. That's a LOT
> of people. Not some tiny, sick fragment.

-e- Direct Source ("Daily Syndromic and Case Data Update"): [https://www1.nyc.gov/site/doh/covid/covid-19-main.page](https://www1.nyc.gov/site/doh/covid/covid-19-main.page)

------
de_watcher
It was easy to see the future: you just look up on the wiki the evolution of
numbers of confirmed cases in the EU countries.

~~~
baron_harkonnen
Given that the US is now neck and neck with Italy to be the first country to
have more cases than China, we have been wildly exceeding any estimates based
on EU countries.

~~~
de_watcher
Bigger population means more movement and more points of entry so the absolute
numbers are proportionally bigger.

Growth percentages looked scary for several days. So probably there were
indeed some differences in the ramping up of testing.

------
0x38B
Pages with links to reliable sources, fact-checking:

\- "COVID-19 Resources for Reporters":
[https://www.sciline.org/covid](https://www.sciline.org/covid)

\- "More COVID-19 Resources for Journalists":
[https://www.sciline.org/covid/resources](https://www.sciline.org/covid/resources)

On Twitter have been following:

\- @AdamJKucharski - Mathematician/epidemiologist at @LSHTM
[https://twitter.com/AdamJKucharski](https://twitter.com/AdamJKucharski)

\- Kai Kupferschmidt - science journalist & molecular biologist reporting on
COVID-19 for Science Magazine
[https://twitter.com/kakape](https://twitter.com/kakape)

------
yters
How often do our hospitals get overwhelmed by endemics?

------
yters
another question i have is are positive tests being sent to icu even if the
symptoms are not bad?

~~~
ceejayoz
Not here in Rochester, NY. Our ICUs aren't full yet, and the county is giving
"number hospitalized" and "number in ICU" distinct numbers. Ours are about 50%
ICU right now.

[https://twitter.com/CountyExecBello/status/12431834845097861...](https://twitter.com/CountyExecBello/status/1243183484509786113)

------
DoreenMichele
_" To think that we're in New York City and this is happening," he added.
"It's like a third-world country type of scenario. It's mind-blowing."_

Historically, when sexually transmitted disease outbreaks occurred in the US,
social workers would ask for the names of everyone you had slept with if you
were infected and they would contact them and screen them and treat them. This
was effective in stopping outbreaks.

We largely abandoned this approach after AIDS became a thing. In the US, AIDS
was mostly a disease of IV drug users and gay men, both of whom were highly
stigmatized populations. They understandably did not wish to give up the names
of people they had slept with (or shared needles with).

Although I think we got a lot of human rights gains out of the battle to
protect those populations, the downside is that we largely abandoned a proven
method for putting a stop to disease outbreaks. Instead, we now default to
trying to find drugs and vaccines rather than trying to stop the spread via
"social" means (for lack of a better word).

There is a book called _The Hot Zone_ that similarly describes non-
medical/social interventions that helped stop the spread of Ebola. Among other
things, tribal elders in Africa blockaded the roads so outsiders couldn't come
in, they told their people "Don't go to the white man's hospital" because you
go with a broken leg and die of Ebola and they began quarantining the sick.

You were forbidden from leaving your hut. They would leave food on your front
doorstep for you to provide for you. If it sat there for three days in a row
untouched, they burned the hut down without going in to check if you were
still alive.

We are currently focusing a lot on ventilators. I've seen numerous articles on
ventilators on HN and there are numerous projects trying to develop open
source ventilators. Meanwhile, we are apparently largely overlooking
noninvasive lung clearance techniques that can help with less extreme cases
and may help prevent them from becoming such.

In human history, epidemics tend to mostly get stopped with non-medical
interventions. Yes, I know, there are states under lock down. I'm in one of
them.

But I feel I am seeing inadequate emphasis on prevention, changes in
lifestyle, promotion of remote work as a solution, non-medical home care
options so fewer people end up at the overwhelmed hospitals where care is
getting rationed etc.

I have been saying for some days now that high use of ventilators will promote
a rash of antibiotic resistant secondary infections. There has been at least
one article posted to HN that suggested that antibiotic resistant infections
may be a factor in the high death rate in Italy.

I think we can do better. I think that's not going to happen as long as we
continue to worship medical intervention as the answer here.

I think lifestyle and procedural changes are needed. An ounce of prevention is
worth a pound of cure and prevention doesn't require you to see a medical
professional or get prescribed anything, yet everyone acts like either that's
not going to be effective or it is too objectionable to embrace or making
suggestions of that sort amounts to practicing medicine without a license.

\-----

Previous comment about the history of AIDS in the US:
[https://news.ycombinator.com/item?id=22658583](https://news.ycombinator.com/item?id=22658583)

PDF version of _The Hot Zone_ :
[http://projectavalon.net/THE_HOT_ZONE_Richard_Preston.pdf](http://projectavalon.net/THE_HOT_ZONE_Richard_Preston.pdf)

Previous comments by me about about air clearance techniques and ventilators:
[https://news.ycombinator.com/item?id=22651884](https://news.ycombinator.com/item?id=22651884)

To the people inclined to harass me and threaten to sic the mods on me for
commenting here, the mods appear to be well aware of my comments and have
already asked someone to please cease and desist harassing me:
[https://news.ycombinator.com/item?id=22660362](https://news.ycombinator.com/item?id=22660362)

~~~
chkaloon
Interesting points (not sure why you're getting downvotes here). I also wonder
if it would help if the medical "establishment" encouraged people to stay home
even if they get symptoms, and only seek medical care for serious shortness of
breath or if you have co-morbidities that are life-threatening. There is not
effective treatment yet, so what is the point of standing in line at the ER?
It would also have the effect of freeing up healthcare capacity.

NY Times yesterday had an article about people standing in line outside at the
ER for hours. If you can stand in a line outside for hours, you probably don't
need admission to the hospital and should leave that capacity for those that
really need it.

~~~
DoreenMichele
The medical establishment is already encouraging people to stay home and not
seek medical care if it isn't overly severe. This is making people very upset,
and understandably so, because it boils down to a big fat "fuck you."

What we actually need is a list of medically approved home care options to
empower people to deal with this on their own to some degree. We mostly aren't
getting that.

If you don't give people actual solutions for how to cope effectively without
seeing a doctor, then everyone wants to see a doctor because it's their only
hope. Duh.

~~~
chkaloon
People outside of the healthcare system don't realize that even in non-
pandemic times, ERs and hospitals are some of the most dangerous places to
spend your time. Doctors won't say that publicly, but the ones I worked with
all had that sentiment.

~~~
DoreenMichele
Yes, hospitals actively breed antibiotic resistant infections. They are a
primary source.

This is another point I have made in prior discussions that people didn't like
hearing.

------
noads
All the emergency managers did a great job posting videos and FAQs, which are
completely useless now. We should have been building massive free clinics in
every city starting two weeks ago. This is a failure of imagination.

~~~
jfkebwjsbx
More like two months ago.

~~~
VikingCoder
More like shortly after 9/11\. Or after the 1918 flu. Or...

------
falcolas
Like most other for-profit enterprises, there is little incentive to maintain
capacity greater than what is needed needed to handle the "average" demand. So
when something exceptional happens, of course the capacity is inadequate.

You can also (likely successfully) argue that this will also happen in a
government run healthcare system, but the situation has certainly not been
improved by capitalism as implemented in the US.

~~~
makomk
Oh, it definitely happens in government-run healthcare systems. Remember how
proponents of single-payer government healthcare in the US used to point to
the amount of money that the UK spends on the NHS and argue that the US would
save money by switching? One of the ways the NHS keeps costs down is by not
maintaining excess capacity, meaning that even a moderately bad flu season is
a major struggle.

~~~
MereInterest
Doesn't that apply to for-profit hospitals as well? In both cases, there is an
incentive to avoid paying for excess capacity.

The cost advantage of a single-payer system is in larger negotiation. A single
person has no leverage at all in negotiating with a hospital. An insurance
network has some leverage when negotiating with hospitals, but results in
user-complexity trying to navigate the in-network and out-of-network
agreements. A single-payer has a large amount of leverage when negotiating
with hospitals, and can avoid price gouging from manufacturers.

------
Someone
_”The state is home to more than 6% of the world 's confirmed cases so far”_

World population: 7½ billion. 6% of that: 450 million. Population of New York
State: 20 million.

⇒ overrepresentation factor: 22½.

Open question: how much of that is due to more testing being done in New York
State, compared to, say, India or Pakistan (large, less wealthy countries that
may skew the statistics)

~~~
jai_
They claim 6% of confirmed cases not 6% of the world's population.

~~~
viklove
Yes, so 6%/22.5 is the percentage of cases NY _should_ have, given a uniform
distribution. They're overrepresented by 22.5x.

------
brenden2
While I'm not questioning the truth of these accounts, what annoys me about
all these reports is that they seem to be anecdotes rather than hard data.
It's really difficult to understand what's actually going on because the data
sucks. It's hard to assess just how full hospitals are, which hospitals are at
capacity, how many patients are actually testing positive vs. showing up at
the hospital because they feel a bit off that day, how many require
hospitalization, how these cases are affecting other patients, and a whole lot
of other things.

I'm still kind of on the fence about this whole situation. The panic is
undoubtedly real and serious, but the seriousness of the virus itself seems
questionable. I don't think we'll really know what's actually going on for a
few more weeks or months.

~~~
luckydata
It's kinda hard to get "hard data" in the middle of a shitshow. This comment
sounds like someone watching a school shooting live and asking "yeah but
what's the % of kids that got shot".

Show some humanity dude.

~~~
karaterobot
I think that's a bit of an overreaction. The way I read that comment was very
similar to your response to it: it's hard to get hard data in the middle of a
crisis. The difference is that the commenter was also expressing the very
natural, human response of frustration at this fact. A lot of people are
feeling that way.

~~~
simonh
The serious problem with the comment is that it's saying these reports are
annoying, however it is not the job of the providers of these reports to
provide hard statistics, it's not as if any of them have the option to do that
themselves instead. So it's basically just saying, shut up. I don't want to
hear your annoying report of actual effects on human beings.

~~~
StrangeDoctor
A more charitable reading of the comment would be an annoyance of anecdotes
without underlying prevalence data to contextualize the info.

It would be all too easy for the media to pick a healthy senior with a mild
case and tout “it sucks but it’s not so bad” or find cases of healthy 18yo
dying in horrific conditions to fit their overall narrative.

~~~
simonh
Data by itself doesn't cut it. That nurse in London didn't commit suicide
because of data. She did is because she couldn't face the reality of treating
so many patients dying in agony.

~~~
StrangeDoctor
I’m not arguing for just data, I’m arguing for both. I would be equally
“annoyed” if it were just data.

Just data wouldn’t give me sympathy/empathy and not being a medical
professional I’m not familiar with diagnostic or clinical language. Data won’t
properly convey the suffering unless you’ve seen it.

I’m weary of just anecdotes because it is impossible for me to be able to
allocate my limit resources efficiently. I’m not saying this isn’t important
or can only be validated when enough people are devastated.

------
vnchr
Well, that’s some fear mongering.

The article is all anecdotes. Most of the nurses and doctors they talked to
are anonymous sources.

According to the AHA[1], there are 6,146 hospitals in the US. There are 68,000
confirmed covid-19 cases in the US, and 33,000 of those cases are all in New
York—almost 10x more than the next states (4.4k NJ, 3.2k CA)[2].

I don’t know the rate of hospitalization for the infected, but symptoms are
mild enough for home recovery for at least 80%.

So this is bad in NY. But even the next most affected state, NJ, we’re looking
at a worst case of ~880 covid-19 patients across 70+ hospitals[3].

Bad situation in NY. No need to say it’s like that across the whole US.

-

[1] [https://www.aha.org/statistics/fast-facts-us-
hospitals](https://www.aha.org/statistics/fast-facts-us-hospitals)

[2] [https://www.theguardian.com/world/ng-
interactive/2020/mar/26...](https://www.theguardian.com/world/ng-
interactive/2020/mar/26/coronavirus-map-of-the-us-latest-cases-state-by-state)

[3]
[http://www.njha.com/media/316774/2014EconomicImpactReportFIN...](http://www.njha.com/media/316774/2014EconomicImpactReportFINALwtabsupdated.pdf)

~~~
enchiridion
Remember the US is short on tests, so I would assume a greater than 20%
hospitalization rate because only the most severe cases are being reported.

~~~
vonmoltke
According to data from the COVID Tracking project, the hospitalization rate
nationwide is a bit under 10%[1], with NY at about 13%[2]. No doubt they are
missing some cases, since theirs is an exercise in piecing together multiple,
manually-curated sources. It seems to be a good ballpark estimate, though.

[1] [https://covidtracking.com/us-daily/](https://covidtracking.com/us-daily/)

[2] [https://covidtracking.com/data/#NY](https://covidtracking.com/data/#NY)

