For the past week it appeared that NY Governor Cuomo realized it was more important to be an adult and eschew partisan politics. That was then. He is now in full partisan panic pandemonium. He is now accusing the Feds of dragging their feet in getting NYC 30,000 ventilators. Here is the quote:
“What are you doing sending 400 when I need 30,000 ventilators,” Cuomo said. “You’re missing the magnitude of the problem.”
No Cuomo, you do not understand. For starters, you do not have 10,000 patients on a ventilator now. The number of patients who test positive does not mean that all will require a ventilator. The numbers available so far indicate most who test positive for corona virus are not being hospitalized. That means the numbers for ventilators are not going to skyrocket and immediately outstrip the existing capability.
But Cuomo is missing a more important point. Shame on him. He has a duty to help educate his constituency. Let us start with the production reality–you cannot magically produce ventilators overnight. The existing manufacturers have limited, not UNLIMITED, capabilities to expand production. Bringing other companies, like GM on line, will require about a month to retool and repurpose machinery and quality control techs.
Producing the machines is the easy part. It is the human infrastructure that is the problem. If there are 30,000 ventilators up and running then you need an additional 45,000 ICU qualified nurses and an additional 22,500 Respiratory Therapy Technicians. (I am assuming one ICU nurse can handle two patients per shift. There are three eight hour shifts per day. I am assuming that one Respiratory Therapy Tech can handle 8 ventilators per shift and there are three eight hour shifts per day).
Along with the ventilators and the nurses and the respiratory techs you will also need oxygen, vacuum and forced air lines for each ventilator station. The nurses and techs also will have to put on new personal protection gear and respirators for each patient encounter (normally, a nurse assigned to a patient can last about three hours in a PPE (Personal Protection Equipment) suit and mask). There is another major complication to consider–every time the nurse goes in and out of the patient room then the nurse (or tech) must put on and then take off the personal protection gear. This can be time consuming if done properly.
I have some background for opining on this topic. I worked my way through college as a Respiratory Therapy Tech and handled patients on ventilators. The ventilators require regular changes of the tubing that connects the patient to the machine. And there are also medications sometimes administered via the ventilator as an aerosol. Getting a trained, certified Respiratory Therapy Tech requires about two years of school/training. Even with that basic training the new Tech is not ready to handle ventilators. That requires additional training.
Getting a qualified ICU nurse is more daunting and more concerning. Ideally the nurse has a four year degree. But there are very sound ICU nurses now on the job with only two years of post-high school education. But to become qualified to work effectively in an ICU a nurse will have to have a minimum of one month of training. (That means the nurse has basic orientation to the policies and procedures for providing intensive or critical care to very sick patients). Ideally the nurse would have six months of training under her or his belt. (Note–my wife was the Nurse Manager for a very prestigious, internationally renowned critical care unit and I have interviewed her).
Someone needs to tackle Governor Cuomo and hit him with a tranquilizer. He needs to calm down and take some time to understand how complex this problem is. Providing a ventilator without having the nurses and technicians required to operate and maintain the ventilator is meaningless and futile.
UPDATE–There are 62 hospitals listed in NYC (see here). According to this data there are 23,762 beds. The vast majority of these are not, repeat NOT, Intensive or Critical Care beds. The number of ICU beds, which means they have the ability to use and maintain a ventilator, is probably about 1500 total.
As of Tuesday morning, New York State had 25,665 cases. Here is what we do not know:
- What percent of people who are tested positive for Corona are admitted to a hospital?
- What percent of those admitted to a hospital are then placed in a Critical Care or Intensive Care unit?
If all who test positive for Corona are admitted to the hospital then you can see how the existing hospital capacity can be quickly overwhelmed.
According to the New York Times (as of Tuesday), 12% of those who tested positive for Corona in the State of New York were hospitalized. That number is manageable at present. 23% (750) of those hospitalized in the State of New York were put into an ICU (or CCU). We do not know how many of those are in NYC hospitals.
Here is what we know with certainty:
- There are not enough ICU or CCU beds to handle more than 1500 patients in NYC right now.
- There are not enough ICU qualified nurses and Respiratory Therapists to handle more than 1500 critical care patients in respiratory distress from Corona.
- The real problem is not the lack of ventilators. It is the lack of personnel to set up and operate those ventilators.
It would be very helpful if Federal and State officials would provide concrete numbers on the percent of Corona patients requiring hospitalization and critical care intervention.
Re Andrew Cuomo, let me again point out this article:
https://theconservativetreehouse.com/2020/03/22/the-chosen-one-rises/
The central bankers (owners of the Federal Reserve who have had the power to create money out of thin air for 100+ years) want to use this virus psyop to bring in a new digital financial system:
https://www.forbes.com/sites/jasonbrett/2020/03/23/new-coronavirus-stimulus-bill-introduces-digital-dollar-and-digital-dollar-wallets/#6bb272394bea
Along with Agenda ID2020:
The Coronavirus COVID-19 Pandemic: The Real Danger is “Agenda ID2020” -Peter Koenig (former World Bank economist)
What is the infamous ID2020? It is an alliance of public-private partners, including UN agencies and civil society. It’s an electronic ID program that uses generalized vaccination as a platform for digital identity.
https://www.globalresearch.ca/coronavirus-causes-effects-real-danger-agenda-id2020/5706153 (please read entire article)
Bravo Zulu.
I agree with everything that Larry said regarding the inability to magically install ventilators. Ramping up production is a medium term goal but staffing these machines is going to be the real bottleneck. Cuomo is basing his need on the number of patients he is projected to have by the time they are up and running. There is a national stockpile but NY is not going to get what it wants or Chicago, Miami etc. will have to go without. If NY got all it wants it is going to be tricky reclaiming them if they are in use but desperately needed elsewhere. China might be able to pull that off but I can not see it working in the west.
Larry, are you aware of the pre-COVID19 occupancy rate of the nation’s existing ventilators?
Somewhat OT. I am a resident of Southern New Jersey. I just returned from a trip to the pharmacy to pick up some refills for my wife, and I observed a fair number of businesses that technically were not in compliance with Gov. Murphy’s restrictions on commerce in These Plague Times. For instance, a couple of garden centers/nurseries were up and running, as well as a tobacconist shop. Seems as if some folks are flipping the Gov off, likely owner-operated businesses. On the other hand, the Ace Hardware was closed, but I suspect that this was on advice of the legal department of Ace as prophylaxis against lawsuits.
BTW, is Mr. Danan any relation to Elora Danan? Heh.
Ked,
NY is typical of major cities across the US. ICU/vent room run at 80% “occupancy” in normal years.
IMO, Larry is correct in all he says. Most important being that Cuomo, like the insane media, WHO and CDC, is whooping up the public by equating testing positive with needing a vent. In fact, only a small proportion of those testing positive will even stay in a hospital let alone be on a vent.
Then you need to understand that many of those who will require a vent because of covid-19 would have required a vent anyhow – meaning absent covid-19 – because they are old and very sick with other conditions. So that lowers the number of extra vents needed as well. Caveat being that most covid ICU admissions may have ended up in the ICU on a vent anyhow, but it would have been spread out over a longer time frame; maybe a year. It’s hard to say because of all the bad reporting coming out of places like Italy where if you had 8 serious comorbidities and you test positive for corona virus and you die, you are counted as a victim of the new plague (probably if you test positive and get hit by a bus and die, you’re still counted as a covid-19 victim).
In reality very sick people have compromised immune systems and are far more likely to contract all manner of awful diseases. Until a month or so ago, this was a well established medical fact. It seems forgotten now that it might lessen the panic.
Does Cuomo have a crystal ball? Magic tea leaves? Perhaps he has developed remote viewing skills that he has had a terrible, yet certain, vision of ICU demand?
How many nurses, techs and physicians with the right training are in the states’ National Guard units? Maybe they could be mobilized to NYC should Cuomo turn out to be the Oracle at Delphi and get his vents on top of that. How about the regular military?
I know that Cuomo and others are spitting blood at the lack of ‘stuff’ provided by the Feds, but is there a responsibility or capability at State level to procure it as well?
Larry,
There is something that you must have missed. Cuomo, being a little dictator, has recently issued a number of laws, overnight, that he thinks will allow him to staff the vents. For example, he can, as of yesterday, commandeer any equipment or medical staff from anywhere in the state to serve any covid-19 related issue. So he thinks he can rob hospital staff and equipment and supplies from Upstate and Western NY to serve NYC’s needs. Western NY has several very republican counties. I guess taking their medical staff and equipment serves two purposes for Cuomo. It won’t hurt him, at least, because he is despised in those counties anyhow.
I do not like Andrew Cuomo. He is corrupt hack, that should have been set to jail based on the “Buffalo Billion” grifter scheme (along with his top aide Todd Howe, the SUNY-Tech president and Cuomo’s benefactors).
Having said that, COVID-19 in NYC is doubling every 3 days. Of those who test positive, 15-20% will need hospitalization (half below age 50) and a smaller fraction on ventilators. There were 25,000+ infections this morning statewide, 15,000 in the city and much of the non-city state total is in NYC suburbs (my county, Onondaga, has 60 cases this evening). Of course the hospitals are not overwhelmed… yet.
But do the Math, Larry. If infections continue at the same rate, there are a million in 2 weeks. Even if social distancing and the partial economic shut down slows transmission, there will still be hundreds of thousands positives and hospital admissions. And it won’t die out until there is “herd immunity”.
It bothers me that you can post yesterday about individual deaths being tragedies. Surely they are — I have an elderly mom and in-laws, all very vulnerable.
But it isn’t it a Stalinist mentality the “One death is a tragedy but a million deaths are a statistic”. Isn’t it?
COVID isn’t a political problem, it is a public health problem. Unfortunately there isn’t a dime’s bit of difference between the two parties in politicizing this very serious matter. The US will prove to the world that it is utterly incapable of managing this pandemic. We’re #1! USA!USA!
Maybe it’s time to return to Hill-Burton and eliminate medical- care for-profit institutions.
upstater is correct on the math. The CDC failed back in February and allowed infected persons to continue daily life in a dense metropolis. Cuomo has been briefed on very unsettling contingencies in the near future, as has Newsom in California.
“The authors of the smaller study also found that 30 (81%) of 37 patients requiring mechanical ventilation had died by 28 days.”
http://www.cidrap.umn.edu/news-perspective/2020/02/study-72000-covid-19-patients-finds-23-death-rate
“Talking with one of the nurse practitioners in our hospital’s new Covid-19 I.C.U. one recent night, I asked what worried her most. “Patients dying alone,” she replied quickly.
A doctor next to her nodded in sad agreement. On a recent shift, he had intubated an elderly husband and wife, both of whom had severe respiratory failure from coronavirus. Their daughter asked if she could come in to see them. Though we will make exceptions for many end-of-life visits, in this case, he had to say no…”
https://dnyuz.com/2020/03/24/when-you-die-of-the-coronavirus-you-die-alone/
https://www.theamericanconservative.com/dreher/coronavirus-what-it-feels-like-to-be-on-a-ventilator/
Not sure if most people know this, when you mobilize the Guard, you have next to zero increase in the numbers of nurses, doctors, medical technicians – these are their civilian jobs as well. And, they can only do one at a time.
Sweden chooses to keep things open, business as usual. But does expect people to act responsibly. Imagine that. So far it is working. From the Daily Wire: https://www.dailywire.com/news/while-europe-locks-down-sweden-keeps-schools-restaurants-open
Upstater, where are you getting that 15%-20% needing hospitalization? I have not seen that number or any other number anywhere. People without symptoms are not tested, and are therefor not included in counts of infected persons. Most epidemiologists admit we have no idea how many actual cases there are, and I have not seen one citation anywhere of percentages requiring hospitalization. I would very much like to know your source.
Ratios of infections to hospitalizations and need for ventilation are numbers I have been searching for since this thing began, and I have been shocked by the total lack of that information.
The numbers still seem to be causing some problems in these threads. How many infected with SARS-2 go on to develop COVID symptoms is not known but will become clear once the serology testing results start being published. Of those who become symptomatic 80% develop mild to moderate disease (including pneumonia) but should still be able to recover without any outside medical help. 20% will require hospitalization and some treatment or they are likely to get worse and may well develop to a life threatening stage. Of the 20% a quarter will still get worse and will require critical care without which they have little chance of survival. The most in demand ICU equipment is invasive mechanical ventilation and the staff to run it – which is what Larry has been writing about.
The problem that lies ahead is due to the fact testing and contact tracing capacity dropped below demand for a while leading to lots of undiagnosed community spread. The infections caused by this have not yet developed to the point they are needing ICU beds, which may be a month after initial infection. For which it can be seen that current ICU demand is based on the infection rate about 3 or 4 weeks ago when the US was reporting 20 cases a day not 10,000 (which is still an undercount). All this hidden transmission needs to work its way through the disease progression timeline so it is the 5% of 10,000 who will want ICU next month Cuomo is worrying about (or, if undercounting as bad as it was, 2500 times more case than today). 500 a day for the whole US may not seem too bad but as each new ventilator patient may be on it for a month that becomes, 15,000 or if you assume 80% occupancy by non COVID patients, 75,000 ICU beds. The 10,000 a day will keep rising exponentially until the isolation measures begin to slow new infections (about a week) but will not begin to show reduced ICU demand for a month after that.
Upstater – hope you’re not right. I’ve just sent a comment to an English web site saying I wish we in the UK could show half the drive they’re showing in the States! Grass greener the other side of the fence?
But might I put a question to Eric Newhill? Eric – you’re familiar with health systems. Given the wildly different health services in the various Western countries, is there anything one is doing better than the others?
To add to upstarters comment, people that are presenting symptoms now were most likely infected 1 – 14 days ago. That means that the rate of infection will not be flattening out immediately.. with 15 to 20% of the cases requiring hospitalization and taken into account that other needs for hospital beds are still there (all ICU beds and ventilators are not laying there unused), the projected scenarios are probably whats panicking some people. Still, if anything, public servants are elected to maintain cool heads, specially under a crisis situation. Panicking doesn’t help anypne, but nor does minimizing the situation (which other elected officials seem to be doing)
Soon enough, our Navy ships will be having to return to port to avoid the spread of the virus.
What this situation reminds me of is the H.G. Wells novel The War of the World’s
https://en.wikipedia.org/wiki/The_War_of_the_Worlds_(1938_radio_drama)
Keith,
What a brilliant idea, lets bring everyone into port, let them go home, then see what happens! The risk profile is a whole lot different than amongst passengers on that the cruise ship in Japan and even they did not experience 100% infection nor a 4% fatality rate. But thanks to the fine career professionals of our federal bureaucracy they got sent home early over Trumps objections. Congrats to the “resistance” for scoring another victory against the Trump.
BillWade,
The national guard units from states that are not impacted can be sent to states/cities that are impacted.
There are also agencies with substantial numbers of traveling nurses that can send staff.
JJackson,
I think you are just wrong about the disease in every aspect of it.
It is causing ICU hospitalizations and deaths among a very few who are elderly and already quite sick with other conditions. It is not causing morbidity in the young and healthy. The analysis I’ve ben waiting for out of Italy confirms what I’m saying.
https://swprs.org/a-swiss-doctor-on-covid-19/
“Less than 1% of the deceased were healthy persons, i.e. persons without pre-existing chronic diseases.
Only about 30% of the deceased are women.
The Italian Institute of Health moreover distinguishes between those who died from the coronavirus and those who died with the coronavirus. In many cases it is not yet clear whether the persons died from the virus or from their
pre-existing chronic diseases or from a combination of both”
Many of these people were already going to be in the hospital, in ICU on vents,dying, etc.
You’re double counting, something that the panic mongers have been doing all along.
If you’re concerned about morbidity and mortality among the infirm elderly, then there are ways to isolate them without interfering with life as usual for the rest of us. It’s relatively easy to do.
EO,
They should be making data based decisions, not freaking out.
Isolate the elderly and infirm.
The US has 34 critical care units per 100,000 population. You guys have 6.6 (Italy 12).
The costs twice as much and delivers worse care argument is about to become destroyed once and for all in ways that even socialists can understand.
The outcomes in the US will be the best because we invest way more in our system.
Sorry, friend. I call ’em like I see ’em
Eric, yes but not sure if state governors are going to be too keen on the moving of their troops to other states short of them being federalized. I can’t remember where but I saw a chart this morning that showed of the elderly deaths in Italy, roughly 1/3 had 3 underlying condition, 1/3 had two underlying conditions, 1/3 had one underlying condition.
Scott Ritter analyzes coronavirus and USA government secrecy and failures.
https://www.theamericanconservative.com/articles/the-staggering-collapse-of-u-s-intelligence-on-the-coronavirus/
Needing also to be explored is what drugs and combinations of drugs were these “elderly” patients taking prior to their alleged death from corona virus. Did anything else predispose them to more fatal reactions to this virus which is almost inconsequential in younger persons.
When seniors today are taking on average 7-9 additional RX drugs, what more can we learn from normal biological systems that these drugs have have unintentionally compromised.
What are the “angio-tension” pathways that has been briefly hinted, related to this viral transmission – very sketchy reference only. But this needs to also be explored, considering the wholesale use of blood pressure drugs among seniors.
Legal pot sellers in California are publicly claiming dope “boosts the immune system”, yet the weak science so far is finding just the opposite. My own suspicion is this may well become the “co-morbidity” virus; not the corona virus. Yet, media never questions their “puff” pieces and pot sales are going through the roof in this state- deemed essential services not to be shut down.
PS: wholesale use of mega-dose “supplements” needs to also be considered when doing these post-mortam evaluations.In the name of “health” did we do things to our normal immune function to make ourselves more vulnerable. It will be a long time before this analysis can be done; if ever.
Go to experience.arcgis.com and you will note the State of Florida statistics updated quite often during the day.
You get everything one would need to make a good assumption of numbers and ratios.
NY has never been transparent.
WE in New Zealand are in full lockdown, after 202 reported cases of Covid-19 (No deaths yet) .
Everyone confined to their homes, except for essential services (Food/Medical)
Allowed out for a walk around the block; or a food trip..thats it..
Police/ Army out checking that ‘no one breaks their bubble’
I was in China when Xi JinPing stepped up and stepped out to lead his country into a
largely successful campaign against Covid-19.
He emphasised that truthful reporting of facts was mandatory.. Try
https://asia-review.com/2020/03/20/no-china-didnt-cover-up-the-covid-19-outbreak/
In my view PM Jacinda Adern’s magnificent speech on 23rd was its equal in terms of leadership.
https://www.newsroom.co.nz/2020/03/23/1096999/pm-jacinda-arderns-full-lockdown-speech..
An epic moment in our country’s history 🙂
Cuomo and DeBlasio locked in a battle of egos to see who will get the same treatment Guiliani, rightly or wrongly, received after 9/11, hailed as “America’s Mayor” on the cover of Time magazine, if I am not mistaken.
Please compare the reaction of President Putin to the corona virus issue
His Address to the nation March 25, 2020 in English transcript :
http://en.kremlin.ru/events/president/news/63061
David K,
Congradulations on the abortion up to birth bill that PM Jacinda Adern signed into law. That’s sure to save lives.
https://www.christian.org.uk/news/nz-allows-abortion-up-to-birth-for-any-reason/
“I was in China when Xi JinPing stepped up and stepped out to lead his country into a
largely successful campaign against Covid-19. ”
Congradulations on traveling back just in time to avoid the ban, unless you are a Citizen of New Zealand(?). Enjoy the self quarantine.
https://www.immigration.govt.nz/about-us/covid-19/coronavirus-update-inz-response
So glad somebody from ‘down under’ (jr. member) is helping Comrade Xi spread the word, not the virus! Communism is such a great system, it’s not like they kept the information from anybody or put Dr. Wenliang in jail. Special kudos to Sundar Pichai and the many, many H1B visa holders of Google for ensuring “arrested” has to be in the search command about Dr. Wenliang to bring up that fact rather the CCP agitprop.
https://www.latimes.com/world-nation/story/2020-02-06/coronavirus-china-xi-li-wenliang
Few people who died of COVID were “sick” and about to die anyway. But most of them did have a chronic comorbid condition.
Patients had much higher mortality rates if they had diabetes (7.3X), hypertension (6.0X), COPD (6.3X) or cardiovascular disease (10.5X) in data reported from China, Korea and Italy.
In the US from the most recent CDC statistics:
34.2 million Americans—just over 1 in 10—have diabetes.
108 million, or 45% have hypertension defined as a systolic blood pressure ≥ 130 mm Hg or a diastolic blood pressure ≥ 80 mm Hg or are taking medication for hypertension. [i.e. a statin]
15.7 million Americans (6.4%) report having a COPD diagnosis (chronic bronchitis, emphysema).
Millions of Americans have some form of cardiovascular disease.
So half of Americans have a chronic comorbid condition that would put them at higher risk of death if they developed COVID – but few of them would be considered “sick”.
In today’s Korean CDC statistics, 1.73% of patients 60-69, 6.38% of those 70-79 and 13.55% of those 80+ have died so far. (Most diagnosed people are still active cases so a larger percentage may die in each age group.) These percentages of 60-80 year olds were not about to drop dead anytime soon.
Unlike other countries, Korea’s targeted comprehensive testing means there should be few undiagnosed asymptomatic or mild cases. In Korea over 34 have tested negative for each person tested positive.
Cuomo is in a panic over the Federal stimulus bill also:
This crisis has only just begun and the Federal government is about to be deluged with petitions for alms. And of course notwithstanding pre-existing fiscal conditions, every state’s financial ailments will be because, muh corona virus.
But then it’s an election year and when the death toll starts to climb, saying “no” is gonna get real hard. The mother of all moral hazards is on the horizon. And when Trump does have to say “no” to blue states who don’t get every cent they ask for to fill the bottomless hole in their finances? I can hear the calls of quid pro cuomo already.
https://www.zerohedge.com/political/cuomo-stimulus-deal-terrible-would-leave-ny-drop-bucket
The forced unemployment of millions and bankruptcies of thousands of small businesses by government edict. In time we will know if it was over-reaction or an appropriate reaction.
My gut tells me if it turns out to be a nothingburger those that fanned the hysteria will claim that without “social distancing” it would have been catastrophic.
If you’re conspiracy minded then it will not be too far fetched to believe that authoritarians will use similar methods to control a population who want to overturn oligarchies.
Barbara Ann,
The states with the harshest and longest planned economy shutdowns are all run by Democrats. In addition they have self created budget problems, police policies that coddle criminals – which they are making worse by pulling police off the beat and/or promising not to enforce ‘non-violent’ offenses. Setting the stage for “worse is better” so they can enact socialist agenda by fiat or crisis management. Most of this stimulus bill can wait at least a month, and be discussed at length and in public. God forbid the professional politicians do that.
“St.Louis Fed’s “back-of-the envelope” calculation on Unemp Rate in 2q….32%”
https://twitter.com/spomboy/status/1242810024847695877?s=21
This is like Depression era unemployment! If this shutdown of our economy runs another quarter we’ll be looking into the abyss. Small businesses can’t turn on a dime and just restart like nothing happened. Many would be bankrupt.
While financial assets could resume their upward trajectory as the Fed prints money and covers all of Wall St’s speculative losses, Main St can be pummeled to the floor.
Nassim Taleb’s take:
“Corporate Socialism: The Government is Bailing Out Investors & Managers Not You”
https://medium.com/incerto/corporate-socialism-the-government-is-bailing-out-investors-managers-not-you-3b31a67bff4a
To apparently save us from a purported pandemic the government has deemed our economy shutdown. Now those in power want the government to borrow trillions from future generations to handout to a small favored class.
Things will start to snowball now with the number of infected doubling every 3 or 4 days and ending up in hospitals 10 or so days later. There is little point in looking to the recent past in NYC and say Cuomu is panicking for nothing.
60 minutes is fairly reputable
https://youtu.be/Y7nZ4mw4mXw
Eric, according to the data aggregation on Wikipedia, updated yesterday, here in Italy about 6% of total discovered active cases necessitate of ICU support.
Up to 19 march 2020, people under 40 years of age represented about 25% of total active cases.
I don’t know exactly how many excess deaths the coronavirus is causing in my country. I don’t even know if those kind of data are available yet. Empirically speaking, in Bergamo (one of the hardest hit provinces) the obituary pages of a local newspaers went from one and a half on 9 february up to about ten on march 13th. So, it seems the epidemic is definitely taking a toll.
While you are right in observing that mostly old and/or sick people die because of the virus, even younger people might get hit hard and end up needing ICU life support. Younger people tend to recover in the long run but if the healthcare system gets locally saturated and ICU units becomes unavailable, even young people will start dieing when they can’t breath without the help of a machine.
In my opinion that’s what is scaring the hell out of the Authorities (and people alike). Every restriction in place is meant to slow down the rate of contagion so that the healthcare system can make do with the limited resources that are available.
Jack,
Please remind me which democratic governor in 1929-33 was ordering business shutdowns? The Democrats are shutting down the economy, not “the government”. Nassim should re-read his own peice, “The Most Intolerent Win” because that is what governors on the left are doing to their fellow Americans. You guys on the left should be quoting Philippines.
Time Machine:
2015 – Governor Cuomo’s state budget mandates the purchase of 16,000 ventilators. Governor refuses, decides it’s a much better idea to invest a slightly larger amount into his brother’s “Solar Power Project”. Solar project eventually fizzles out into nothingness.
2020 – Governor Cuomo insists on Federal govt to get them some respirators, asap!!!!
My prediction: 2020 – Deplorables win low-intensity civil war in November.
NYers: we know your are flying out of Providence, we know you are flying into Atlanta and renting a car to drive down here. We do not know why you are coming here, our restaurant, bars, and beaches are closed. Please stay where you are, thanks.
I call ‘em like the many expert sources in the Public Health, Medical & Emerg. Response communities see ‘em. Plus, analysis by personal friends who are MDs and (like me) nearing retirement. My friends have always been practicing physicians – not in the Big Biz side of medicine. A GP, GI, Neurologist, & Pulmonary-Thoracic surgeon. They have each independently raised an alarm over ventilators already being near-fully utilized (due to the financial/business model of the industry + the strong US flu season prior to the rise of COVID19). Many elderly are on ventilators for extensive periods… they do not “rotate out” except by death. There is a quite large supply of susceptible elderly in the US – enough to overwhelm the available “seats”. I didn’t make this up.
My concern is not “is it real?” but how to manage this perfect storm – wherein old old folk + new old folk + new younger folk all contend for access to the life-saving machinery.
Larry,
I will not defend Cuomo, but I do want to raise some key issues about ventilators. I offer these points as a retired hospital planner and from many conversations with my infectious disease doctor daughter who is leading her hospital efforts in responding to the various. One, the make up of hospitals are changing as routine and non-urgent procedures/surgeries are postponed. This frees up many anesthesiologists, nurse anesthetists, pre- and post-op nurses, ICU nurses, etc. Two, I respect that respiratory techs go through a rigorous training in medical/clinical as well as the technical aspects of the ventilators. But, the freed up personnel already have the medical/clinical and many are familiar with similar if not identical equipment.
Mexico from google today at 8:06 am 3/26
cases p/m rec deaths
475 3.93 4 6
“We are probably in a full-blown epidemic now, but we just don’t know it,” he said.
https://www.aljazeera.com/news/2020/03/local-mexico-gov-ramp-covid-19-responses-amlo-holds-200323150122699.html
“Mexico ranks number 10 in the list of countries (and dependencies) by population. The population density in Mexico is 66 per Km2 (172 people per mi2). The median age in Mexico is 29.2 years.”
https://www.worldometers.info/world-population/mexico-population/
anomaly?
Ron Unz has done (on 3/25) some analysis on the numbers here:
https://www.unz.com/runz/correctly-estimating-coronavirus-infections/
What do you folks think of his methodology?
RESPONSE FROM LARRY JOHNSON:
Unz is hysterical and lacking in logic. He clearly has no background with infectious diseases. As I point out in my piece above, which is based on real numbers, only 12% of those who test positive are hospitalized and only a fraction of those wind up in an ICU.
Keith,
This is really simple. The bottom line here is that covid-19 has been confirmed in the US for over two months and as of today there are a mere 1,046 deaths in the entire country attributed to the virus; not even a blip on the mortality radar in light of the 7,500 +/- people who die every day. The nightmare panic scenarios just aren’t happening. And that’s going along with the assumption that all 1,046 dead since January 19th – when the first case appeared – would not have been killed by the flu or some other condition during the same time frame; an assumption I find faulty.
As far as hospitals being overwhelmed, since Jan 19, there have been < 70K cases of covid-19 identified in the US. Most not requiring hospitalization of any kind, let alone a vent. Compared to the seasonal flu, this is nothing; barely a blip on the infectious disease radar, if that. If not for media hype (+hype from CDC and WHO), no one outside of the CDC would even know the virus existed. There really no "curve" to flatten. Hospitals are not going to be overwhelmed. Bodies are not going to be piling up in the streets.
Both the UK and Russia have stated that the virus is no longer much of a concern. I wonder if President Trump will join that thought. I would think so.
Experts at legislation are having an awful hard time figuring out how, and if, we’re going to get those “TrumpBux”.
I suspect there’s an awful lot of local restaurant workers thinking a check is forthcoming very soon. I really really hope they are not disappointed. Our local economy (SW Florida) really has only two “industries”: health care and restaurants/bars/golf (all of which are shut down)
Eric,
“The nightmare panic scenarios just aren’t happening.”
Wrongo my friend. The nightmare is the destruction of the US economy at the lower middle and middle class level. That proceeds apace thanks to the Dream Killers of the Democratic Party.
CNBC has published a nice, easy to understand, comparison of various pandemics in history:
https://www.cnbc.com/2020/03/26/coronavirus-may-be-deadlier-than-1918-flu-heres-how-it-stacks-up-to-other-pandemics.html
March 26 – the day a few notables are walking back their Zombie Apocalypse pronouncements – UK Imperial College and Stanford – ooops, looks like math turned out to be as hard for them as it was for the twits who claimed Bloomberg spent $1 million dollars per voter.
First error was relying on data from China, second was calling those dying with three underlying co-morbidities “corona virus deaths. Then falling in love with being in the spotlight and finally being 100% wooden headed about downstream consequences of not getting these projections 100% right – even in times of uncertainty.
Saving grace is to remember France always shuts down their whole country for the month of August -so we too shall survive our Miserable March. But only if we finally reject MSM and its rabid hounds from hell.
BillWade,
There are plenty of other businesses in SW Florida that don’t rely on retirees, tourists or out of state snowbirds.The Corportate HQ for Hertz is Estero, just North of Naples as well as US Sugar. There’splenty of other agriculture including the very powerful A Duda & Sons (or whatever they are callled now). And of course don’t for get real estate, lawyers and financial firms. The hourly staff in the restraunt business certainly need help, but I can’t think of any doctors, lawyers or financial advisors that can’t go a month without a paycheck. BTW let me know when AOC and the Squad get the Trump Bux out there ’cause what I saw in their bill was the same crap they put in the GND.
Instead of fretting about the number of ventilators, maybe Cuomo should focus first on getting gowns for his hospital workers, so they won’t be forced to wear trash bags:
https://nypost.com/2020/03/25/worker-at-nyc-hospital-where-nurses-wear-trash-bags-as-protection-dies-from-coronavirus/
Yep Fred, it did slip my mind, plenty of big ag going on in DeSoto county right next to me, although it’s a 40 minute drive I enjoy going to Arcadia (you almost feel like you’re in south Texas as you approach the town). You can get lots of fresh food there, meats as well for a good price.
Our restaurant folks in Charlotte county are hurting. Many restaurants are doing takeout but a few drop off everyday. The remaining ones should do well,though I suspect owners are just trying to get rid of inventory and won’t re-order till this is over. Friend of mine works for a large food distributor and she relates that orders are way down.
Rumors are leaking out about growing riots in Wuhan, a dispute with a neighboring town and dissatisfaction with their govt’s response to the virus. Police on the side of the rioters.
For anyone in the USA feeling antsy:
http://www.CovidMedicalTest.com
I think it’s legit,hope so.
Bill,
I’m sure orders for fresh perishables are way down, the rest probably just pushed back. There have been some restaurants putting together ‘crisis kits’ as a way to get multiple days of food for a family in one ‘to go’ order. Incuding – the TP or napkins. They get those by the pallet full so I’m sure they probably have some on hand. It won’t replace table service but it does help both parties out.
PepeEscobar writing about hydroxychloroquine and azithromycin in France, its efficacy and its strange disappearance from Frances’ pharma. Doctors in the US to Trump instead of Fauci about using it earl and often. We can’t wait for FDA approaval.
https://www.unz.com/pescobar/why-france-is-hiding-a-cheap-and-tested-virus-cure/
Eric – it’s a bigger deal than is being made out, and that irrespective of what governments do.
Full testing and tracing and isolation Wuhan style, or more or less let it rip, which was the earlier approach of the European governments – that’s under government control to an extent.
What isn’t under government control is consumer reaction. With this virus going around a great number of those who could be killed by it aren’t buying a whole lot of stuff they usually do – they’re more interested in keeping out of the way of infection, whatever governments say.
That’s a lot of the economy put on hold and it’s entirely outside government control. That spoils business for those who aren’t that vulnerable, so they order less stock or in some cases close down for the duration.
The shock this is going to give the economy is great – and there’s not a lot Trump or Merkel or Johnson etc can do about it. Except pump money around and hope that doesn’t finally put paid to our shaky financial system.
So we’re in for trouble. You’re seeing it from the point of view of the health professional and going by the stats. From that point of view it seems ridiculous that a disease that mainly kills the economically inactive and leaves the bulk of the workers unharmed should cause such economic damage.
But look at it from the point of view of the private businessman. If I were still running my small business I wouldn’t be sending men out to site. Many customers are elderly and wouldn’t want them around. Few small businesses can pay men who aren’t working so some would have to be laid off. I’d be purchasing less.
All this would happen – and is happening with a great number of businesses in the UK – whatever HMG does. Is it not so in the States?
On the health side we’re also on a loser whatever the governments do. Go for suppression Taiwan style and 1, it’ll not be 100% and 2, the bulk of the population won’t be immune so they’ll be fighting new outbreaks until a vaccine or other treatment comes along.
Let it rip and isolate the vulnerable – 1, isolation is imperfect especially in the inner cities and 2, that has to be kept up for longer than just a few weeks.
There’s also the effect on morale if a government isn’t seen to be doing all it can. Not as if most of us are that fond of whatever government we’re landed with anyway.
There is therefore no way of avoiding the disruption this virus will cause and that disruption will be severe.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30633-4/fulltext
“However, it is important to bear in mind that the current best estimate is that about 81% of people with COVID-19 have mild disease1 and never require hospitalisation.”
“Their cohort had many characteristics in common with other reports3, 4, 5—a median age of 56·0 years (IQR 46·0–67·0), a high percentage (62%) of men, and nearly half (48%) of patients with comorbidities. In-hospital death was associated with, on admission, older age (odds ratio 1·10, 95% CI 1·03–1·17; p=0·0043), a higher Sequential Organ Failure Assessment score (5·65, 2·61–12·23; p<0·0001), and blood d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033), findings known to be associated with severe pneumonia.6, 7 The study also presents early data on changes in clinical and laboratory findings over time, which could help clinicians to identify patients who progress to more severe disease. In-hospital mortality was high (28%), much higher than in other reports that had incomplete follow-up data,3, 5, 8 and was very high among the 32 patients requiring invasive mechanical ventilation, of whom 31 (97%) died. This might reflect a higher proportion of patients admitted with severe disease in the early stages of the outbreak. In another report from Wuhan, mortality was 62% among critically ill patients with COVID-19 and 81% among those requiring mechanical ventilation."