Coronavirus

[bkp_duke]

View attachment 526547

I don't think we're going to be changing the national healthcare system before this pandemic is over.

Touche.

 

[EinSV]

According to worldmeters, Iceland has only 88 positives and 2 deaths today, so I don't see how you can draw any conclusions from that at all. Except maybe they are a late start.

I think you may have misread the chart -- worldometers reports 890 total cases in Iceland with 2 deaths (there were 88 new cases today, so that may be the cause for the mix-up)

Apparently they are not taking the delay of the death numbers into account. As Alan and me predicted, german CFR, when ignoring delay, is going up and now close to 0.7%. It will go above 1%, and I think quite a bit.

Based on worldometers data, it looks like the German CFR has increased to 0.67% from 0.59%. Perhaps CEBM will adjust their IFR estimate for Germany, or there may be other factors that come into play.

It's obviously an evolving story, as they note: "Estimating CFR and IFR in the early stage of outbreaks is subject to considerable uncertainties, the estimates are likely to change as more data emerges."

 

[N5329K]

If a Dr. there writes an order for you to go have an MRI or CT scan, that doesn't give you the right to go to the hospital and DEMAND it be done in a certain time frame. There is a hospital administrator that schedules that.

That seems to be the case for COVID 19 tests in a lot of places, too.
Robin

 

[jhm]

I have been computing the death rate of every report and it has consistently been 2.2%, NOT .2%. Your decimal is in the wrong place. In Italy right now, it has spiked to 10%. The guy in another post here said if 1/3 of the US population got the virus, 2.2 million Americans would die. That is correct, mathematically. That is why he was arguing to shelter in place NOW. We cannot allow 100,000,000 people to catch the illness.

Are you dividing by the number of confirmed case? There could be could be another 10 infections per confirmed case.

 

[Buzzz292]

That 80,000 assumes agressive self isolation and hospitals will not exceed capacity and have to let savable patients die because they don't have the ventilators. With COVID-19 the number of people who have life threatening cases and require hospitalization or they will die is much, much higher than any flu outbreak since the 1918 flu.

Look at the hospital situation in many places that are hardest hit. In some places in Italy they have had to let savable patients die because they didn't have the ventilators and other resources. New York City, Atlanta, and New Orleans are on the verge of that point right now with cases growing in every city.

If we do aggressive self isolation, we can keep the death rate down to 80,000 in the next four months. If we don't, there is a study out of the UK that showed if the virus was allowed to run its course. In the UK, they would see 500,000 dead. The US in the same scenario would see 2.2 million dead. We would be done with the virus by mid to late summer because almost everyone left alive will have had it and gotten over it.

Then there are the long term consequences. There is news coming out of China that about 20% of those hospitalized who recover have permanent heart damage. Some percentage (probably fairly high) will have permanent lung damage too. About 68 million Americans are vulnerable to get serious cases. If all of them got it at once, a huge percentage of them would die and most of the rest would be left with permanent, chronic health conditions that will require treatment the rest of their lives.

If you want to see millions die and the economy melt down for a generation, go back to business as usual.

 

[Oil4AsphaultOnly]

Don't put words into my mouth. Did I say I liked the current system? Did you forget to read the rest of this thread and see how much I LOATHE insurance companies?

Stop reading your personal preferences and prejudices into my post. If I want to say something, I'm always clear about it and don't mince words.


Single payer in this country would be a DISASTER for the following reasons:
1) you will see doctors retire in droves. This is not a guess on my part, this is well established given the insanely low reimbursement rates that Medicare currently pays for office visits.
2) you will see rationing of care because of #1 - Canada and the UK already have this and it's not called "rationing" it's called "extended wait times to see a specialist". Literally, costs are kept down because some of the sickest people in the system (that would use up the resources) cannot get the care they need in time before dying. This is evidenced by higher mortality rates in these countries for various diseases (see my post several pages back about cancers).
3) the US Government is HORRIBLY inefficient in everything it touches. So inefficient that the cost of care would probably go UP, instead of DOWN.
- When I was a medical student some of the WORST care I ever saw was in the VA medical system. That's 100% government run, and should be looked at CLOSELY as to how a bureaucratic system would run healthcare. I literally showed up for work one day at a VA facility and had a nurse look me square in the eyes and refuse to draw blood on a patient because she had "met her quota for the day".

I did not put words in your month. I'm just pointing out that in discouraging medicare-for-all, you are indeed supporting the existing system. Since any other alternative does NOT have the political support to displace the existing system. It's like encouraging people to vote libertarian or green party and if Trump gets re-elected then saying that you didn't support Trump. Literally, that is true, but without better alternatives, it is indeed a binary decision.

I wish I could offer a better alternative, but I can't and can simply choose amongst the rock or the hard place.

Yes, this should go into the market politics thread, but I don't know how to move it. Mods, can you help?

 

[AlanSubie4Life]

"Estimating CFR and IFR in the early stage of outbreaks is subject to considerable uncertainties, the estimates are likely to change as more data emerges."

You'd hope they would take into account the obvious errors in their methodology though, before publishing their data. Maybe they are hunting for clicks?

 

[bkp_duke]

I did not put words in your month. I'm just pointing out that in discouraging medicare-for-all, you are indeed supporting the existing system. Since any other alternative does NOT have the political support to displace the existing system. It's like encouraging people to vote libertarian or green party and if Trump gets re-elected then saying that you didn't support Trump. Literally, that is true, but without better alternatives, it is indeed a binary decision.

I wish I could offer a better alternative, but I can't and can simply choose amongst the rock or the hard place.

Yes, this should go into the market politics thread, but I don't know how to move it. Mods, can you help?

Alright, we're (somewhat) on the same page. We're stuck with a known shitty solution, and an unknown, but IMHO doesn't appear to be a good replacement.

 

[Daniel in SD]

Mods, can you help?

Please save us @ohmman!
Proposed thread title: "What's the best health care system and why?"
Posts will grow exponentially and overload the server.

 

[Buzzz292]

The U.K. study said do nothing and 500000 will die or do the isolation strategy and stop the economy with the resultant unemployment and necessary multi billion £ economic intervention and 250000 will die you do the math. Option one takes 3 months option two takes 10 months to a year medically with 5 years for economic recovery. Remember we have no treatment except ventilators and over 80 % of victims hospitalised on a ventilator die ( a pretty slow terrible death). These are the facts ask any knowledgable medic. In Spain they have video of the first patient who recovered on a ventilator and had it removed the whole hospital was cheering and clapping him. Only one so far.

 

[dhanson865]

Actually, I did read it. The most important line in the article is this one:
"The medical staff then told the child to go to a local public hospital."

An urgent care is a private entity, and is not like an ER which has a mandate that they cannot turn anyone away until they are "stabilized".

The devil is in the details. Did he immediately go to the local public hospital? Did he go home for a period of time beforehand and his condition worsen? That's not in there, and it is critical information.

your own words were

"This one is a failure of the hospital to pursue proper coverage for an emergent patient. The family should seek legal counsel here, as I believe this might fall under malpractice.

There ARE safety nets in place, and a hospital social worker should have been able to assist the family, given the limited information presented in the article.

which both imply you thought that a hospital turned him away, yet no hospital did. If you don't think a hospital did wrong why did you write such in post #4598874

I then provided you a video of the public official giving more details, which was also linked in the article.

You say Did he immediately go to the local public hospital? Did he go home for a period of time beforehand and his condition worsen? But if you'd just watch the 2 minutes of video you'd have those details.

 

[EinSV]

You'd hope they would take into account the obvious errors in their methodology though, before publishing their data. Maybe they are hunting for clicks?

They did recognize this issue (see third bullet point below).

There are also other issues that may skew CFR and IFR up and down, which is why their estimates have fairly large error bars.

"What is affecting the case fatality rate?

• The number of cases detected by testing will vary considerably by country;
• Selection bias can mean those with severe disease are preferentially tested;
• There may be delays between symptoms onset and deaths which can lead to underestimation of the CFR;
• There may be factors that account for increased death rates such as coinfection, poorer healthcare, patient demographics (i.e., older patients might be more prevalent in countries such as Italy);
• There may be increased rates of smoking or comorbidities amongst the fatalities
• Differences in how deaths are attributed to Coronavirus: dying with the disease (association) is not the same as dying from the disease (causation).

Global Covid-19 Case Fatality Rates - CEBM

 

[Daniel in SD]

you do the math

I'm all for doing math but there may be some things missing in your analysis.

• costs of permanent heart and lung damage for survivors
• economic effects of people sheltering in place voluntarily because there is no hospital system (look at hospitalization rates for all age groups).
• how are you calculating economic recovery time? Some recessions have very fast recoveries, some much more slow. My understanding is that slower recoveries tend to follow financial crisis.
• the plan in the UK is that only 20,000 people die. How are you calculating 250k?
• I'm not sure the 500k number takes into account complete collapse of hospital system.

 

[bkp_duke]

your own words were

which both imply you thought that a hospital turned him away, yet no hospital did. If you don't think a hospital did wrong why did you write such in post #4598874

I then provided you a video of the public official giving more details, which was also linked in the article.

You say Did he immediately go to the local public hospital? Did he go home for a period of time beforehand and his condition worsen? But if you'd just watch the 2 minutes of video you'd have those details.

Point taken.

 

[Daniel in SD]

They did recognize this issue (see third bullet point below).

There are also other issues that may skew CFR and IFR up and down, which is why their estimates have fairly large error bars.

And then ignored the issue. They moved outside their error bar for CFR in 4 days! I'm sure if you backtested their analysis you would find that they moved outside their error bars the vast majority of the time. They're either idiots or being intentionally deceitful.

 

[Oil4AsphaultOnly]

Alright, we're (somewhat) on the same page. We're stuck with a known shitty solution, and an unknown, but IMHO doesn't appear to be a good replacement.

It seems we might not need that new thread after all.

Yes, I think the potentially shitty unknown situation is worth the risk over the known shitty situation. I don't think we'll be able to cross that last bridge, but I'm satisfied with this understanding.

 

[SO16]

Don't put words into my mouth. Did I say I liked the current system? Did you forget to read the rest of this thread and see how much I LOATHE insurance companies?

Stop reading your personal preferences and prejudices into my post. If I want to say something, I'm always clear about it and don't mince words.

Single payer in this country would be a DISASTER for the following reasons:
1) you will see doctors retire in droves. This is not a guess on my part, this is well established given the insanely low reimbursement rates that Medicare currently pays for office visits.
2) you will see rationing of care because of #1 - Canada and the UK already have this and it's not called "rationing" it's called "extended wait times to see a specialist". Literally, costs are kept down because some of the sickest people in the system (that would use up the resources) cannot get the care they need in time before dying. This is evidenced by higher mortality rates in these countries for various diseases (see my post several pages back about cancers).
3) the US Government is HORRIBLY inefficient in everything it touches. So inefficient that the cost of care would probably go UP, instead of DOWN.
- When I was a medical student some of the WORST care I ever saw was in the VA medical system. That's 100% government run, and should be looked at CLOSELY as to how a bureaucratic system would run healthcare. I literally showed up for work one day at a VA facility and had a nurse look me square in the eyes and refuse to draw blood on a patient because she had "met her quota for the day".

I don’t know of anyone advocating for government to be involved with direct health care like the VA. Just the payer side. And if physicians would retire in droves as you say, adjustments would most likely be made with the Medicare system. But right now the goal for so many is to defund Medicare but yet still pay for seniors. Well...when you do that, the payout per event is going to be less.

As you mentioned earlier, you don’t like people doing wasteful work. And then you mentioned the coders and billers on your side. I agree. Well also double that for the insurance side along with all the extra corporate overhead. Medicare does pay too low I agree. But that should be an easy solution to resolve if funded properly and the bloated insurance waste is cut. Overall it seems Medicare is pretty well run all things considered.

Along with this, would be great if certain highly desirable fields of study would also be fully covered. Get rid of the crushing student debt if students stay in that field for X years and are competent.

But none of this will ever happen. So no point in even worrying about it.

 

[TheTalkingMule]

If you want to see millions die and the economy melt down for a generation, go back to business as usual.

This is the next phase of the conversation. As we're seeing in NYC and I'm seeing in Pennsylvania, locking down is slowing but certainly not stopping spread. People are still walking around in supermarkets, most epidemic specialists agree this is going to spread through half the population in relatively short order.

The UK study was flat out wrong. Under no scenario, short of leaving patients in the street, were we going to see 2.2M deaths in the US. Could we still get to 400k is we really really tried to screw this up? Perhaps. But that doomsday scenario of 120M infections and 2% death rate has been completely disproven. We're now looking at 120M infections and something south of .2% death rate.

If you don't believe me, the author of the original report said so in front of Parliament 2 days ago.

 

[Mushygirl]

That 80,000 assumes agressive self isolation and hospitals will not exceed capacity and have to let savable patients die because they don't have the ventilators. With COVID-19 the number of people who have life threatening cases and require hospitalization or they will die is much, much higher than any flu outbreak since the 1918 flu.

Look at the hospital situation in many places that are hardest hit. In some places in Italy they have had to let savable patients die because they didn't have the ventilators and other resources. New York City, Atlanta, and New Orleans are on the verge of that point right now with cases growing in every city.

If we do aggressive self isolation, we can keep the death rate down to 80,000 in the next four months. If we don't, there is a study out of the UK that showed if the virus was allowed to run its course. In the UK, they would see 500,000 dead. The US in the same scenario would see 2.2 million dead. We would be done with the virus by mid to late summer because almost everyone left alive will have had it and gotten over it.


That model has been greatly revised by the author of it. He now says up to 20,000 may die in the U.K. ; a downward revision of 96%. On average, 150,000 people die EVERY DAY worldwide. Approx 22,000 have died since November from Covid19. Get some perspective. TAKE A BREATH.

 

[Daniel in SD]

If you don't believe me, the author of the original report said so in front of Parliament 2 days ago.

False. And his numbers certainly don't agree with yours. Since you never actually provide any analysis to back up your claims I think we should stick to believing the experts. Where is that SARS data you promised?