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[McTraveller]

I guess my point, although there's no real solace in it for those who need treatment but can't get it, is that being overrun is different than collapsing. 

Collapsing is when the hospitals close, they turn off all the lights, and all the staff decide to screw it and walk off into the sunset.  Overrun is where the hospitals are still "functioning" but can't meet demand.  I can see how being overrun can lead to collapse, but...

There is a difference between those two situations, and I daresay that one is preferable to the other.

[bloop_bleep]

I'm not the one taking instruction from the government on what to believe. You and all the rest are suddenly activated on China now for a reason, and it's not your own reason.

You are arguing in bad faith and making incorrect assumptions and you know it. I'm not taking any "instruction." You need to unsaddle yourself from your high horse and recognize that other people are also capable of independent thought.

I am not just "activated" on China now. Muslim concentration camps didn't just happen now. Organ harvesting didn't just happen now. Those things were revealed by Chinese dissidents; the US media picked up on it afterwards.

[Bumber]

I've heard that very few hospitals in the US have even come close to collapsing so far. New York (the worst hit state) didn't come close to needing all the ventilators they got, and appear to have passed the peak. If the goal of the lockdown was to prevent hospitals from overflowing, we seem to have done that. It would seems reasonable that we could start to open up some places so we could start to gain herd immunity without overrunning the hospitals. We can't get immunity without exposure and a vaccine could still be nearly a year away.

One big problem with the lockdown is that hospitals stopped performing "elective" surgeries. This includes stuff like cancer screenings, tumor removal, heart and brain surgeries, and hip replacements. We could start having a bunch of people dying of strokes and cancer as the result of trying to prevent coronavirus deaths.

[wierd]

There's one small problem with that idea Bumber...

https://www.npr.org/sections/coronavirus-live-updates/2020/04/25/844939777/no-evidence-that-recovered-covid-19-patients-are-immune-who-says

[Trekkin]

a vaccine could still be nearly a year away.

That's not necessarily true of entry inhibitors, though.

[Bumber]

There's one small problem with that idea Bumber...

https://www.npr.org/sections/coronavirus-live-updates/2020/04/25/844939777/no-evidence-that-recovered-covid-19-patients-are-immune-who-says

Absence of evidence is not evidence of absence.

[TD1]

Besides, isn't the WHO director a China-man?

[wierd]

Entry inhibitors would be DAMN helpful for acute patients in the throws of a cytokine storm. It would let you step down their immune response to avoid multiple organ failure, without deciding to just let the virus fuck their lungs to death; The inhibitor (if reasonably effective) would retard rate of production in the patient, so that heavy immune reaction is not needed so strongly, allowing that down-regulation to be an option.

@bumber

No, no it's not.

But there are reports of reinfection, or at least testing positive again, of recovered patients.
https://www.cnn.com/2020/04/17/health/south-korea-coronavirus-retesting-positive-intl-hnk/index.html

"Herd Immunity" might not be a thing.

[TamerVirus]

But there are reports of reinfection, or at least testing positive again, of recovered patients.

Recently the South Koreans have said that the 'reinfection' numbers come from the PCR tests picking up inactivated virus fragments in recovered patients.

I still think it's too early to be sure

[TD1]

I think one of you - Poo? - posted an article about monkeys which were given the virus not catching it again. Hardly indicative of universal truth, but still.

[misko27]

This "so what?" summarizes the attitude of many governments.

Oh come on. Why must we have this attitude in all things. Governments are like families: they are all broken in their own, unique way. In Brazil's case, Bolsonaro holds the distinction of being the highest-profile "coronavirus don't even fucking real" in the world, although Belarus' Lukashenko has recently become competitive for the title. More generally Brazil's handling of the outbreak has mimicked Russia's most closely, with local leaders mostly taking the lead while the central government eventually deciding to stay quiet and periodically comment gravely about the seriousness of things (this is similar to the US response, but the comparison is complicated by the US Federals govt. vacillating wildly between "literally giving everyone cash" to "this is a state problem, we did what we could." day-by-day; while Russia and Brazil have seen more consistent, if not better policy).

I mean understand what healthcare collapse means,  not that the public doesn't hear about "healthcare collapse" in the news.

For instance, healthcare collapse doesn't mean zero healthcare - it really just means that resources are exhausted so triage will have to take place and people will be turned away for certain conditions.  It also probably means lower total capacity because some of the health care providers are "out of service" due to illness or refusal to work. 

But the public hears "collapse" and I guarantee many of them think it's like a bridge that collapses and can't be used at all until it's entirely rebuilt.

What I mean is the term "collapse" itself causes anxiety.  If they would have just said "reached its capacity" or something less alarmist, the anxiety could be reduced.

I'd be so bold as to suggest that anxiety has a negative correlation with deathrates in this pandemic.

Also, hospitals *did* reaching their capacity in New York. They didn't massively exceed them as predicted in the worse case scenarios, but the number of people who died alone at home is a significant percentage of the total death toll in the city.

I'm not the one taking instruction from the government on what to believe.

Oh China did horrifically if we're going to compare it to "fair" things and not simply the US today, as you are, as Americans often do (do not make the classic mistake of going full anti-American and still being Amerocentric!). Yugoslavia is an excellent example of the power of an authoritarian government to stop an epidemic in its tracks, one far deadlier than Coronavirus, and the PRC does not come off well in that comparison. An outbreak of 140 cases of Hemorrhagic Smallpox on one day. Admittedly, a vaccine existed, but the response rested on immediate declaration of martial law, numerous cordons sanitaires, roadblocks, nationwide lockdown and heavy quarantining. From March to May. The Chinese government acted on January 23rd, the outbreak started in December, with the virus identified on January 7th. I'm not speaking as an American, I'm speaking as an exile of an authoritarian state that was proud to be the last smallpox outbreak in all of Europe. By that standard no, they did a pretty awful job. So did everyone else, sure, but as I've said before and I'll say again, everyone pays the debts of an individual person, state, or nation's refusal or inability to act, and it must be paid with steep interest.

But there are reports of reinfection, or at least testing positive again, of recovered patients.

Recently the South Koreans have said that the 'reinfection' numbers come from the PCR tests picking up inactivated virus fragments in recovered patients.

I still think it's too early to be sure

Well yes that's what everyone has said. No one has come out and said "Here is definitive proof that you can catch it again", people have said "proof that you can't get it again has not been found yet." Which is, ah, significantly less committal.

[scriver]

Fauci is pronounce Fawzi? I thought it was pronouned Fawchi

[ChairmanPoo]

Afaik most people in the field agree there will be some form of immunity. The real question is how good it will be and how long it will last.

But you can't really rely on herd immunity. You need 60% upwards of immune people for that. And we're very far from there

I've heard that very few hospitals in the US have even come close to collapsing so far. New York (the worst hit state) didn't come close to needing all the ventilators they got, and appear to have passed the peak. If the goal of the lockdown was to prevent hospitals from overflowing, we seem to have done that. It would seems reasonable that we could start to open up some places so we could start to gain herd immunity without overrunning the hospitals. We can't get immunity without exposure and a vaccine could still be nearly a year away.

The situation in NYC hospitals (and, well, everywhere) was and is far worse than you are saying, with material shortages and thousands of staff infected. If it didn't become worse, that is no reason to dump social distancing, because it was social distancing that prevented that in the first place.

Would you dump your parachute midjump because you didn't immediatedly splat after jumping out of a plane?

One big problem with the lockdown is that hospitals stopped performing "elective" surgeries. This includes stuff like cancer screenings, tumor removal, heart and brain surgeries, and hip replacements. We could start having a bunch of people dying of strokes and cancer as the result of trying to prevent coronavirus deaths.

Yes. And they were cancelled precisedly BECAUSE there was a significant risk of healthcare collapse. If you want those to go ahead you need to keep social distancing up, so that there is not a second peak, and hospitals both have the resources to spare for elective procedures, and  have a safe environment for the patients

[Starver]

I look forward (though with little expectation) to this little episode resulting in future planning for the health service no longer running it at nearly 95% capacity, defacto, and then getting nearly up to 100% (or worse) when seasonal increases kick in.

It'd be nice to justify something closer to 75% usage as a norm and 90% as 'normal' high utilisation peak.

In this emergency we assembled/equipped[1] the Nightingale Hospitals, their beds overwhelmingly (and fortunately) laying idle, so there's the equipment in them that is usable, but staffing them was always going to be a problem with having to leech some away from pre-existing clinical locations before having to consider those that had to absent themselves for COVID reasons (or hospitalised!).

Spare capacity (in all elements) isn't something you should skimp on. Safety factors in building design is usually around 2, in cars it is around 3. In civil aviation it may be 1.5 (because of weight premium, but some elements that can he are lower because other elements still must be higher). Less than 1.1, which seems to be what we were operating at in the public healthcare 'machine', is less than even the (overall) military aviation limit of aprox 1.25, where the designed strength is raised greatly compared to civilian equivalents, but then so is the expected maximum overload they encounter.


So, what will change, afterwards? I don't know. I'm perhaps somewhat pessimistic about it, though.


[1] Not 'built'. It was no easy task to get various exhibition centres (that were going empty, under the circumstances) and set up medical facilitiee in them, but it wasn't a building of new hospitals like the Chinese did.

[McTraveller]

Safety factors in ... in cars it is around 3.

Hahaha what!?  What cars are you talking about?  If they had a safety factor of 3, no car would ever have a part fail*.  I think on paper the safety factor may be 3, but it's using some questionable assumptions about expected loads.

(All the rest are quite accurate, incidentally.)

*I think the safety factor of 3 may only be for safety components, not for all parts.