Sweden Did It Wrong

[berettafan]

Originally Posted by Jeff Higgins

It's time to move on, put this behind us - understanding that we are no longer in any danger of overwhelming our medical system - and let the chips fall where they may. We will almost definitely see one last surge, but that surge will be well within the capacity of our medical system to absorb, especially if we put another hold on elective surgeries to do so.

x2

i'll add the mental health and wellbeing of the working class in this country is at great risk right now. If the rowers stop rowing the boat ain't going nowhere.

[Mahler9th]

"It's time to move on, put this behind us - understanding that we are no longer in any danger of overwhelming our medical system - and let the chips fall where they may. We will almost definitely see one last surge, but that surge will be well within the capacity of our medical system to absorb, especially if we put another hold on elective surgeries to do so. "

"I agree. The initial goal is no longer the goal. We still need to be diligent and watch for areas that could be overwhelmed but those should be localized restrictions and not huge areas. "

Can you provide hospital admissions data that support the claim that increases are entirely or largely due to things like elective surgeries? Can you describe why you seem to think that "flattening the curve" is no longer relevant?

Can you describe these "other motivations to keep fear alive?" What are they? Whose motivations are they? Is there some sort of group that is behind this?

So what specifically do you think should be done that is not being done?

And for those in favor of a major US strategy being a drive toward herd immunity, can you describe how that would work with numbers and references? And please include some comments on who it is that should pay for the morbidity? Medicare? Private insurers? Individuals? And what laws would you change in terms of liability and how would you change them?

[Mahler9th]

"I'll just leave this here:

https://www.latimes.com/california/story/2020-08-11/san-quentin-coronavirus-herd-immunity-covid-19"

Thanks for posting that link.

[legion]

Originally Posted by Jeff Higgins

We succeeded in flattening the curve. Hospital admissions are up once again because, well, we are once again allowing elective surgeries. There is now room in our hospitals to do that. In other words, we have achieved the originally stated goals of all of the lockdowns. I think too many people have lost sight of that as the narrative has been constantly changing. We are now using far different justifications for the continued lockdowns. So, yes, while I agree with the original premise - that of flattening the curve, the seriousness of this virus, and all of the medically justifiable reasons for our initial lockdown strategies - we are now past all of that. It's becoming obvious that here in the U.S., at least, we are well past those medical justifications and have now moved on to other motivations for keeping the fear alive.

It's time to move on, put this behind us - understanding that we are no longer in any danger of overwhelming our medical system - and let the chips fall where they may. We will almost definitely see one last surge, but that surge will be well within the capacity of our medical system to absorb, especially if we put another hold on elective surgeries to do so.

This should have been done after the "three weeks to flatten the curve" was over at the beginning of April. It should have been long over when we fell below pandemic stage 75 days ago. The fact that more restrictions are being issued and things are being cancelled (like school for my children) has nothing to do with safety and is all about ensuring the country is in ruin for the election.

[Jeff Higgins]

The reopening for elective surgeries is pretty old news. Several months old, as a matter of fact.

https://wmc.wa.gov/news/gov-announces-restart-all-medical-services-washington

https://www.facs.org/covid-19/legislative-regulatory/executive-orders

https://www.aamc.org/news-insights/hospitals-cautiously-resume-some-surgeries

I could go on and on and provide an endless number of links supporting my statement. On a personal level, with a wife as a retired RN who maintains contact with many of her former colleagues, and a number of good friends and family members who are both doctors and nurses, each and every one of them have related to me how the initial rush has completely subsided. They are all back to seeing their "normal" cross section of patients. I find it a bit surprising that someone who presents himself as being in this industry appears so completely unaware of these developments.

I suppose, in light of that, maybe I should not be surprised that you are likewise completely unaware of the political "battle lines" that have been drawn over all of this. Apparently unique to the U.S., which is both disappointing and at the same time unsurprising, the raging political fight over this has been pretty difficult to miss. The voices of our politicians and news media have drowned out those of our medical community, at least here in the U.S. I don't have a dog in that fight, but I do find it all rather disappointing. I find it incredible that anyone following any of this even in the most cursory, detached fashion could be unaware of it.

[Mahler9th]

Thanks for those links. I did not need them. Anecdotally, my neighbor just had his ankle fused. His son is an ER nurse at the hospital around the corner. They are not being overwhelmed.

We are in county with a lot of virus around, and it has been around for a long time (first US death was a woman that worked here and worked out at the same gym I used).

Apparently, I misunderstood you... that happens with Forum posts. So let's be clear: what do you think should be done that is not being done given that hospitals in some, many or most localities are not being overwhelmed by Cov-19 patients?

I am not unaware, I am paying attention. More so that can be simply expressed via Forum posts. But I do not see them as "battle lines."

[Jeff Higgins]

Originally Posted by Mahler9th

Thanks for those links. I did not need them. Anecdotally, my neighbor just had his ankle fused. His son is an ER nurse at the hospital around the corner. They are not being overwhelmed.

We are in county with a lot of virus around, and it has been around for a long time (first US death was a woman that worked here and worked out at the same gym I used).

Apparently, I misunderstood you... that happens with Forum posts. So let's be clear: what do you think should be done that is not being done given that hospitals in some, many or most localities are not being overwhelmed by Cov-19 patients?

I am not unaware, I am paying attention. More so that can be simply expressed via Forum posts. But I do not see them as "battle lines."

You appeared to be refuting the fact that hospitals had reopened for elective surgeries, hence the links. But then you turn right around and say you did not need them, thereby indicating you were indeed aware of this... I'm afraid it appears you are merely being argumentative. I hope that is not the case - like you say, however, much is lost in our forum posts.

What do I think we should do? I think we should fully reopen - all businesses, schools, public gatherings - all of it. There is little doubt that "the word is out" re the dangers of this pandemic, the at-risk populations, personal measures we should all be habitually observing by now, etc. The populace at large has been well educated with regards as to how they should be conducting themselves to minimize their risk. We should, as Sweden has from the beginning, trust them to be responsible and protect themselves. We should not be continuing to use even the slightest uptick in cases as justification to prolong our current state, much less, as as happened in some jurisdictions, use them to justify regressing to previous stages of lockdown or other restrictions.

And that returns to my original point - we have "flattened the curve" enough to where it appears we are in no danger, going forward, of once again "overwhelming" our health care system. If we ever really did that to begin with - I'm reminded of cases like the much ballyhooed hospital ship arriving to help in New York, and soon leaving for a lack of patients.

A couple of my doctor friends were actually furloughed for over a month earlier in the spring for that lack of patients. The hospitals in which they had admitting privileges were all but shut down, awaiting patients that never came. So they were allowed to reopen for elective surgeries. That was months ago, and our numbers of cases, much less hospitalizations, have been in steady decline ever since.

Washington State, where I live, dropped down into single digit daily deaths in July - from a population of 7.6 million people. Yet we hear about every single one of them, often to great fanfare if it happened to be some kind of an outlier, like a younger person. This in a state that averages 150 deaths per day by all causes, most of which obviously never will make the news. Yet every single COVID related death is still being reported.

There is no explanation for this outsized coverage of what has become such a rare occurrence. No other explanation other than our insatiable desire for shocking or distressing news - both on the part of those consuming the news and those providing the news coverage. I'm no "conspiracy theorist" - I do not believe in this oft referred to, never named "they" - but there is certainly a human condition that drives this sort of thing. It's a self feeding cycle. We need to move on to the next "shiny object" and give this one a rest.

And, finally, I think it is all too apparent that there are those in power in this country who desire to make some "political hay" over all of this. They have found eager allies in the press, a press that, in my humble opinion, has, for the most part, devolved into more sensationalism than factual reporting. No one planned any of this - there is no "conspiracy" driving any of it - it's just a symbiotic relationship that has developed over time between the press, politicians, and a public all too eager to lap it all up. No one could have planned and organized this current situation - there are far too many "moving parts" - but it does exist. And it is feeding the panic because, well, that what it does best. Because it "sells"...

[gsxrken]

https://www.technologyreview.com/2020/08/11/1006366/immunity-slowing-down-coronavirus-parts-us/

MIT Biotechnology Review:
“Immunity may play a significant part in the regions that are declining,” says Gu. At least until the fall, which is how far his models look forward, he says, “I don’t think there is going to be another spike” of infections in southern states.”

Living just outside NYC I saw this firsthand in April and May. Now it’s almost non-existent here. Hand washing and masks didn’t suddenly start working in July after failing to work in April-June...
I’m optimistic my area has seen the worst of it.

[Mahler9th]

"I think we should fully reopen - all businesses, schools, public gatherings - all of it."

Do you think the number of Covid-19-related lawsuits would increase if this were the case? If so, do you think anything should be done about it? If so what?

Pretty sure that concerns over liability related to Covid-19 sequela had something to do with recent Big 10 and Pac 10 decisions to cancel Fall sport (I was a college athlete so I have perhaps more personal thoughts about this).

Do you think that the fact that Sweden has different legal and healthcare systems makes comparisons more difficult or challenging in any way? If so how? If not why not? I think these things may matter.

Same questions about culture in Sweden versus US?

"Yet every single COVID related death is still being reported."

Why would you expect otherwise? We don't have "state" news. We have capitalism. If humans "like" this kind of news, shouldn't Fox, CNN, MSNBC, et cetera be allowed to do whatever they want to optimize their businesses without government intervention of any kind? Folks can always turn of their televisions and/or shut down their computers, right?

We'll certainly see what happens.

[Mahler9th]

"At least until the fall, which is how far his models look forward, he says, “I don’t think there is going to be another spike” of infections in southern states.”

So the Fall is about what, 6-7 weeks away? Then what happens?

[Mahler9th]

"We should not be continuing to use even the slightest uptick in cases as justification to prolong our current state, much less, as as happened in some jurisdictions, use them to justify regressing to previous stages of lockdown or other restrictions."

Why not? Don't hospitalizations and deaths automatically follow such upticks?

[Sooner or later]

Every hospital system should put out info similar to Texas Medical system. They track cases, percent positive, ICU, hospitalizations, and other metrics. There showed their plans to handle any surge, if needed.

They never made it to half of Phase II intensive care. All metrics have been on the decline for a couple of weeks and are now back into Phase I.

There is enough info available to make determinations in advance on what needs to be done.

https://www.tmc.edu/coronavirus-updates/

[Mahler9th]

Thanks for posting. Impressive. They seem to have commitment and resources. Good for them.

But likely not every hospital or hospital system's priority for expenditure of resources.

I used to visit there a lot in the mid-80's.. I was there so often that the guy at the Marriott with the white hat and red feather always remembered my name. I think I still have a towel or bar of soap from that Marriott (a corporation that I am sure is hurtin' big time).

I took a run at lunch time today and there were youth programs in the park and the tennis courts seemed open. That's good.

What if we "knew" that with "everything" open, folks would still not crowd onto planes or into bars or restaurants? So with "open" GDP takes $X hit with Y deaths and Z costs of hospitalization, and with "not everything open," GDP takes $X hit with A far less than Y deaths and Q far less than Z hospitalization costs?

Now if we had "state" media and a "state" healthcare system and a different legal system, we could control all of this.

[Mahler9th]

Yeah Marriott has some challenges.

https://www.cnbc.com/2020/08/10/marriott-posts-first-quarterly-loss-in-nearly-nine-years-as-virus-hits-bookings.html

[Sooner or later]

Originally Posted by Mahler9th

Thanks for posting. Impressive. They seem to have commitment and resources. Good for them.

But likely not every hospital or hospital system's priority for expenditure of resources.

I used to visit there a lot in the mid-80's.. I was there so often that the guy at the Marriott with the white hat and red feather always remembered my name. I think I still have a towel or bar of soap from that Marriott (a corporation that I am sure is hurtin' big time).

I took a run at lunch time today and there were youth programs in the park and the tennis courts seemed open. That's good.

What if we "knew" that with "everything" open, folks would still not crowd onto planes or into bars or restaurants? So with "open" GDP takes $X hit with Y deaths and Z costs of hospitalization, and with "not everything open," GDP takes $X hit with A far less than Y deaths and Q far less than Z hospitalization costs?

Now if we had "state" media and a "state" healthcare system and a different legal system, we could control all of this.

I don't see where it would be much of a resource drag. All of the data is simple and easily found. Initial set up of the charts might take some time, but shouldn't be overwhelming. That is the type of info we need to know what needs to be done.

[Mahler9th]

"I don't see where it would be much of a resource drag. All of the data is simple and easily found."

I can easily see how it would be a resource drag. Hospital and hospital system margins are thin. And not every hospital or hospital system might highly prioritize direct-to-public reporting right now.

I take a look at Sutter Health's web site, which is in our local area. Not for profit. One of my Porsche friends/racing competitors just finished a stint as Chairman of the Board at Sutter Health. Really nice man-- very accomplished and a helluva racing driver. Sutter seems to focus on their patients... not acting as a general clearinghouse of Covid-19 stats.

I met the Sutter CIO last Fall. Their innovation program was funded by a $20m gift from a local couple I know. Good on them.

I also look at UCSF, and the same seems true. They seem to focus on patients.

These enterprises are not run by inexpert folks. They have a lot of expert, accomplished professionals.

I think in some cases, they are leaving public health data reporting to public health entities. That is what I would expect.

Look at Hopkins: https://coronavirus.jhu.edu/about

They have a Covid Resource Center. Looks like philanthropic backing, at least in part.

Bloomberg is related to one of those philanthropic organizations: "The Center is supported by Bloomberg Philanthropies and the Stavros Niarchos Foundation, both long-term philanthropic partners of the university."

TMC is the largest medical city in the world. Not just a hospital... really a medical city. Different scale.

And in any case, I think what needs to be done is well known. In reality, I don't think there is much ambiguity. Public health to me is "where its at."

[Sooner or later]

Come on. They can track billing down to a q tip and issue pages of detailed charges but their IT can't set up a few simple data systems based on less than a dozen key metrics?

They have to have that type data collection or they have no idea one what near term needs might be.

[Mahler9th]

"They have to have that type data collection or they have no idea one what near term needs might be. "

Why should they spend $0.01 reporting it to public? They have their own businesses to run.

As I think has been discussed in numerous threads, plenty of people are frustrated by the non-centralized public health reporting situation we seem to be in. I am not.

A well-sorted set up might be a matter of national security... heck-- it may be and we just don't know about it. Perhaps something that the NSC would be concerned about. My best friend worked in support of NSC on counterterrorism in the West Wing...

Anyway, I find this interesting from the way way back machine...

https://www.npr.org/2020/03/27/822728420/member-of-now-disbanded-national-security-council-pandemic-response-team-speaks

My buddy's time in West Wing did not apparently overlap with hers...

[Sooner or later]

They have to have that data for themselves to efficiently operate. It is nothing to make it public.

It would bring out facts. When the media was screaming about Houston hospital ICU's being filled the data from TMC showed otherwise.

Transparency is important to the public.

[Sooner or later]

All they need on a daily basis are the simple basics that they must know each and every day to operate efficiently.

Daily hospital admissions and discharges
Daily ICU admissions and discharges.
Daily Covid tests given
Daily positive Covid results.

Slap those few metrics in a database and link them to charts and we have the majority of what TMC is presenting on their Covid page.