shoshin

Right now at least in Texas, ICU usage is exponentially up, which is why it's worth watching. And in AZ, theirs is also continuing to rise and this is not just ICU new patients, which I agree could be OK if they are in ICU for short periods of time, but total ICU patients currently in the hospital--that's the rising statistic and it's only the covid cases that are contributing to the rise--not others. If it levels out where we are in Texas, it's manageable. AZ needs it to decline. FL is fine for now.

I worry about HCW/other healthcare resource limitations, which are well-represented by ICU bed capacity. It's purely an economics approach to it. HFNC is just one treatment modality. I have not heard (and admittedly don't have any idea) if there's a shortage there. I doubt it because those machines are pretty simple.

Making conversation here: At what point would you think they should be worried in TX? Using up 1/3 of the currently available ICU beds in the last 4 days doesn't concern you much so I'm genuinely curious.

Sorry, I maybe didn't phrase it well. I think Trump and Cuomo did the right thing in the moment in pushing for more capacity as they saw exponential rises and lack of projected ventilator capacity. What I'm saying about "not scoring political points" was a doomsday scenario (that I don't think we will see) where we find our current ventilator usage maxed out. If we get to that point, it will be very bad news and I'd hope we had all hands on deck in unity, not prodding each other about politics.

There's unlikely to be any ventilator shortage anywhere. Cuomo and Trump made political decisions on what they knew at the time. Turns out we shouldn't see a ventilator shortage or put it this way, if we do, things have gotten really, really, really bad and we shouldn't be excited about scoring a political point over it. The ICU bed measure is one that is more than just "a bed." It's a human measure of HCW capacity too because ICU patients need a lot of human care.

Do you follow the progress in medical treatments for Covid? If you don't you can find plenty of sources. I'm not going to google a ton of articles on point for you. Pretty basic knowledge at this point that we've gotten a lot better at treating a novel disease over the 6 months we've been treating it. The early ventilator panic was based on a lack of understanding that more critical patients needed more oxygen than just plain inhalation support.

ICU covid usage went up by 130 beds in 4 days. There is a total operational capacity of 200 ICU beds free and 450 nonoperational more across the entirety of Texas. That's not panic porn: That's "pay attention to these numbers." Ventilator usage is down everywhere because we are much better at treating this with other modalities. I don't see that as a limiting resource and don't really track it. And I agree about that site. I wish every state had that exact chart.

Numbers above about TX current patients in the hospital for covid and here is the ICU usage for everyone and COVID, showing 130 new covid ICU beds in use in the last 4 days (an increase of 40% in 4 days) with a current operational capacity to accept 200 more into ICU beds. The info on that page shows a surge capacity (which means it would take some time to set up) that could handle about 450 more. When you see 130 new ICU beds used in 4 days in an exponential rise, and you have 200 free beds across the entire state--remember these are distributed resources--this isn't panic porn but surely attention-worthy. I'd really like to see that TX hospitalization curve flatten, as well as the ICU bed one. The case spike precedes the hospitalization spike precedes the ICU bed spike precedes the death spike. No place has set a different pattern than this to date.

These numbers in Texas look a lot like where AZ hospitals were a few weeks ago. Exponential looking rise starting there. We will see if FL follows suit in the coming days--their case rise was a little behind Texas and a few weeks behind AZ. The thing to really watch for is whether these states can flatten the hospital usage resource curve while remaining open.

Contact tracing didn’t start finding new cases in the last 6 days after not finding them before. A couple weeks. Hopefully cases will settle and this is short-lived. Because if not, it will bode ill for the northeast and other reopening places, especially with fall coming. She would be the first documented person to get hit a second time after recovering. I have my doubts. Sounds like panic porn or just a simple resurgent case that they thought went dormant. With all the cases so far worldwide, whatever she is is an outlier.

So far huge rises in cases preceded mass hospitalizations, as most recently seen in Arizona where the big case rise started a couple weeks ago. Case spikes have preceded deaths. This would be the first time anyplace has seen a case spike without deaths Coming later. It might happen and it would be great to be the first place to see rising cases and not deaths.

I hope this is true and their curve stays flat-ish.

At the moment, they are a somewhat ***** but leading indicator. FL is up 3x in 10 days. That's not just more testing and contact tracing, it's not just one day's data, and it's not a decelerating curve but one that has gone exponential. I'd be a lot happier if we were seeing what we see in the NE states, which is dropping and/or leveling cases. We all would be happy to see that and we're not. Whether this translates into increasing hospitalizations in the next ten days, whether the curve slows, I have no idea but I wish it wasn't so damn steep in its growth.

Be nice if those FL cases wouldn't keep popping up like this. It's not like they discovered contact tracing and tripled testing capacity 7 days ago. The trajectory of this curve is not the one anyone wants to see.

In PA, the Director of Health pulled her mom out of a nursing home right before they started discharging hospital patients back to homes. Bad look.

Depends on the place. Things are a bit more serious in Arizona, and their case jumps started before Florida. I understand DeSantis's point but I also think there's something to watch in FL and TX.

That was without distancing and really early numbers out of China only. Modeling a brand new virus's impact is a tough game, but we still need to try to do it. Modelers predicted high (most in the 300K range very early) and deaths came in low...imagine if modelers predicted 15,000 deaths by June and we were looking at 350,000 because no one took any precautions. See the link I gave that compares the models over time. Most have been accurate since March/April and well within their error bars. Lots of articles on this topic. It's impressive that they came up with accurate models in just 2-3 months.

Take a look at my edit. Someone has to do the modeling and it's not been as wrong as everyone thinks. Some were off, some were not. Welcome to modeling. The good models should get more attention. How's the upcoming hurricane season going to go?

Yeah, but I'm reluctant to ***** on the modelers. It's a no-win situation with a new virus, rapidly changing data, and new treatments weekly. The scientific models have swung about but there have been several studies showing most of them safely within their margins of error, but all the public seems to note is the line through the middle of the error bars. This page has a good interactive graph. If you look at the models from mid April, almost all of them predicted that we'd be crossing 100K deaths around May 30, which is pretty accurate.

I don't think we disagree here. I said early on that the only reliable statistic was deaths and bemoaned that it was the only reliable thing (though many here shot it down). But it's a trailing statistic and by the time you see deaths rising, you've lost weeks of potential remedy, which is why backtracking in time to hospitalizations is a next critical statistic to monitor. Cases still suck until we can feel confident that we are testing almost anyone at risk of infection (not everyone).

Arizona total people hospitalized with Covid still increasing at a high rate. Now 50% higher than two weeks ago. Definitely a state that needs some good news. FL and TX, while seeing rises, are in nowhere near the same situation as AZ.

The weekend thing is one of the most consistent and amusing data trends. One thing this entire pandemic system has revealed (no ***** Sherlock coming) is how awful our medical reporting is, and that is in spite of the minutia of reporting that providers have to do. I hope that we as a country come up with a better system so that the next time this happens, we can make more informed decisions. I will use hospitalizations as the latest and most critical example. Most states have this data, but many (like PA that I know well), were klooging it together for weeks and only just now have it together in a close to real-time basis. And it would be great if those data streams fed a central one so we could see if we have statewide issues or regional ones, ie, does what's happening in Philadelphia extend to nearby Camden NJ or are their situations different (turns out they were pretty different but it took a long time to get to see that).

The midweek rise happened if you're comparing it to the weekend. 2x the deaths. And deaths aren't leveling, they are falling noticeably. Unless something happens today where where get an out of character jump on a Thursday, we will finish the week with zero days over 1000 deaths for the first time in 11 weeks. 1000 is just an arbitrary number but it is nice to say. Good deaths/million-pop graph.

Only 4 of us were talking about India. None of us said it was homogenous. I’ve always said Indians must have a good guffaw at America calling itself a melting pot. During one 4 year stretch From 2013 to 2017, I went to India 17 times, no trip shorter than 2 weeks. I made some of the best friends I’ve got in that time. Sadly I haven’t been there in a couple years. Was supposed to go in May but Covid ***** it up. The work was super intense and rewarding but the people are just incredible. The home dinners, weekends with friends, late night deep conversations, trips to temples of several faiths...it’s a special place. It’s a bit of a mess too, but I love it. Different strokes for different folks. My wife is dying to go to Australia. Her top choice for our next trip. It’s about 25 on mine. I’d rather return to many places I’ve been before than go there. Not against it, just not that interested.