Friday, March 27, 2020

ERs Like "War Zones" So How Did Two Stanford "Medical" Profs Misfire On COVID-19's Real Threat?

"If you people and your governors treated me nicer I'd make sure you had enough masks!"

"It's just keeps getting worse and worse, today we had to get a refrigerated truck to store the bodies for the already dead patients.  The frustrating thing about all this is it just feels like it's too little. too late.  Like we knew it was coming and did little or nothing. Five ventilators is all we have." Dr. Colleen Smith, Elmhurst Hospital, NYC

"I fully recognize I am choosing between saving peoples lives and saving peoples' livelihoods. But ultimately you can't have a livelihood if you don't have your life." - Illionois Gov. J. B. Pritzker

"Nurses who are testing positive are actually being asked to come in and care for patients and to wear garbage bags for protective gear." - Dr David Agus, CBS, March 26

"We are standing on the edge of the ocean in the dark. We’re waiting for the wave to hit and we have no idea how high the wave is going to be.... You have trusted the system your whole life to keep you safe.  You keep waiting for the system to kick in. But you realize no one’s coming to save us.” Dr.Vicki Jackson, head of Palliative Care, MASS General, quoted in NY Times

"Have you seen the HBO show ‘Chernobyl’? There are invisible risks that trail you, just like with this virus...”  -   Dr. Michelle Au,  Anesthesiologist, Emory St. Joseph’s Hospital in Atlanta, Ga., quoted in NY Times

"We've ended up being far more unprepared than anyone expected,  and one of the main reasons for that is the failure of testing. None of the experts I talked to expected that America -with its biomedical power- would completely fail to roll out widespread testing for a new pathogen. The scope of that failure has really cascaded through the country's preparedness measures."  Ed Yong, Staff writer, The Atlantic

"When Trump stands in the White House briefing room and — in a performance that is played live for millions of viewers across the country — acts as though the situation is under control, there’s no sense of the devastation that is sweeping the country.  He fights with governors, he insults reporters, he attacks China, and he boasts about his own (rather disastrous) performance. Often, he flat-out lies. He misrepresents the science, frequently contradicting his own experts, and he twists facts to suit his preferred narrative." - Cody Fenwick,

"The inability of so much of the public to remember what Trump was saying just a month ago suggests that, in addition to the coronavirus crisis, we’re also experiencing a national amnesia pandemic."   - Bret Stephens, NY Times

Even as we learned yesterday the U.S. has now attained the dubious distinction  of having the most confirmed COVID-19 infections, millions of citizens remain stupefied like zombies in Trump's perverted orbit.  See e.g.

What gives?  One Gallup Poll - totally unbelievable given the times and Trump's total incompetence-  saw 60 % of voters now approving of Trump's shitstorm response.  As I read it I decided not to mention a word to Janice as it would be another piece of evidence for her that most Americans are cretins and morons. How could they not be? There is something especially infuriating as well as depressing when one beholds the interior of ERs with a shortage of ventilators, and the dead bodies having to be put into refrigeration trucks for storage. This was revealed via a jarring video released on CBS yesterday morning showing the inside of an overwhelmed ER at Elmhurst hospital in Queens.  This was compliments of Dr. Colleen Smith, who believes - as I firmly do - Americans need to see what the hell is going on in our overwhelmed hospitals, ERs.  (Described by one EMS worker as a "war zone" on CBS this morning.  Of course, yesterday we beheld the sorry spectacle of these front line doctors, nurses, having to use Hefty Trash Bags as protective gowns.)

ERs are overloaded specially in NYC now at the epicenter of this COVID-19 eruption, but New Orleans is soon to follow and likely Miami too. All over, but at different levels, medical personnel in the U.S., are still being victimized by the incompetent buffoon in the White House. A buffoon and traitor who insists on conducting a state vs. state  social Darwinian "free for all".  Having states  try to outbid each other for desperately needed N95 masks and ventilators, instead of delivering these critical supplies via a national coordination.  But see that would take too much leadership skill, and devotion to the welfare of the nation as opposed to oneself- which Capt. Bonespurs lacks. 

So this derelict, deranged  pretender would rather play favorites in a crisis - giving supplies to those like Reepo Gov. Ron Desantis in Florida (still keeping his state mostly open) -  but denying resources like N95 masks, ventilators  to the Blue states like NY, NJ and California. As he told FOX news Wednesday:  "I'd help these Dem governors but it's a two way street. They have to treat us well, also."

Seriously,  Bonespurs?  They must  "treat you well"?    Are you suffering from the virus, on a ventilator? Are you having to wear trash bags in place of surgical protective gowns?  Are you having to re-use N95 masks over and over? Or  ask your relatives to sew them for you using Youtube instructions? Or is it you're not being "treated well" because those Blue state governors are more concerned with their citizens' lives than kissing your fat, orange ass? 

 But what would you expect from this narcissist, megalomaniac traitor who now asserts the media wants to keep the country shut down to hurt his re-election chances?  In the Turd -in -Chief's own words when asked about it:

"I think there are people in the media who want the country to do financially poorly because they think that would be very good in defeating me at the polls."

This shows the fetid, feral  imp cares more about resuming four more years of his traitorous, unconstitutional, authoritarian fascist regime than keeping Americans alive during this pandemic.  He is more obsessed with retaining unearned power than actually acting the part of a president who can coordinate national resources in a crisis. So ER Drs. like Colleen Smith don't have to make covert videos to reveal the actual situation in overwhelmed hospitals.

Meanwhile, on his 'All In' show Wednesday night, Chris Hayes featured ER Dr. Craig Spencer who noted:

"I've worked in West Africa during the Ebola outbreak, but there's something about this that feels palpably worse. One is knowing we're just at the beginning of this. Case numbers are increasing and you're already seeing hospitals without personal protective equipment, and ventilators and making these temporary morgues outside of hospitals.  This idea that in two or three weeks we're going to be somehow past this is just crazy, magical thinking."

And yet two Stanford medical professors (Eran Bendavid,  Jay Bhattacharya) in a recent WSJ op-ed ('Is COVID-19 As Deadly As They Say', p. A16, March 25) evidently think this is all huff and puff, no biggie. They write:

"If it's true that the novel coronavirus would kill millions without shelter- in -place orders and quarantines, then the extraordinary measures being carried out in cities and states around the country are surely justified. But there's little evidence to confirm that premise - and projections of the death toll could be orders of magnitude too high."

Going on to write that the fatality rate:  "is misleading because of selection bias in testing. The degree of bias is uncertain because the available data are limited."

Uh, whose fault is that? Three guesses, the first two don't count.  They then go on to make the point that "the differences in computation could make the difference in fatality rate, say between 20,000 and 2 million being killed.   Also "if the number of actual infections is much larger then the true fatality rate is much lower as well."

No argument from me there, but these two are guilty of overthinking re: fatalities,  and not keeping their eye on the actual "ball": COVID-19's  calamitous effects on hospitals, overrunning them with critical care patients - most of whom need to be on ventilators for 11-21 days. This compares to 3-4 days for patients recovering from ordinary flu, say, or other respiratory conditions.  The length of time for respiratory convalescence (on ventilators) means other patients - say suffering from cardiac arrest, car accidents, etc. are given short shrift- since there's no space in intensive care.  But when hospitals are slammed - everyone coming in at once- then too many will lose out, including COVID-19 patients.  As one nurse from a Madrid hospital  put it in a recent WSJ piece (March 24), referring to the surplus patients - many of them older:

"In normal conditions, we could have saved their lives. But now there's not enough space in the intensive care unit."

Reading the op-ed by the Stanford pair,  I concluded they have zero conception of the principle of  flattening the curve, the essential need to do so,  in order not to overwhelm health capacity to which the Madrid RN referred, e.g.

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Hence, the putative basis for social sequester  is not  totally preventing deaths per se  - as horrific and terrible as that aspect is - but rather avoiding an inundation of the health care system itself.  Often described by many drs. and nurses as an oncoming "tsunami". See for example:

With a Doctor in a Brooklyn E.R.: ‘We’re in Disaster Mode’

Inundation of medical treatment capacity arises from a sudden surge in COVID-19  patients needing critical care in ICUs. (See e.g. 'Intensive Care Bed Shortage Looms' WSJ,  March 25,  p. A6)  This is the aspect, including use of ventilators - which are in short supply-  these two supposedly educated profs miss. Evidenced on writing further:

"A universal quarantine may not be worth the costs it imposes on the economy, community and individual mental and physical health."

But if one grasps that the universal quarantine IS working, in relation to keeping medical resources from being surged into oblivion - then the claim is pure codswallop.    We KNOW it's working because one can easily see the data presented at the Johns Hopkins website, where it's glaringly obvious which nations (and states) are practicing successful social separation and which aren't.   E.g.

 Further, one can also go to the Kinsa Health website,  e.g.

And see clearly where (using the company's smart thermometer real time data) the atypical fevers are surging and which states are facing hospital and medical resources apocalypses - such as described by Dr. Colleen Smith at her ER in Queens, NY.

The two Stanford Profs are also clueless in respect to two, cold brutal facts that cannot be diminished by use of a PR puff piece on the op-ed pages of the WSJ (always glad to get PR from those with any medical credentials eager to play into the Murdoch company's spin game.)

1) It will take over a million confirmed cases and a ghastly number of deaths before we reach any "herd immunity" - the threshold pivot at which people can really be expected to return to open, non-quarantined living.

2) It will be from 12-18 months before we get a workable, feasible vaccine  And we know from  existing Kinsa fever and Hopkins data that if we rush back like Dotard wants, 2.2 million Americans alone could pay the price. Again, the fatalities are only one part of the story. With such a scale of deaths from COVID-19 the infections and critical patients would be 10-20 times more, from 10 - to 22 million. Effectively sending the U.S. health system as it is into the dumpster.

Again, it is the inundation of medical resources and hospitals that these two clowns fail to appreciate.    For example, as Atlantic Health Staff writer Ed Yong pointed out to Chris Hayes on 'All In' last night, because of the flubbed testing rollout we never got a handle on the virus' whereabouts. Hospitals with stored supplies to be distributed (and especially in case of a pandemic) had plans  "but which couldn't be enacted because we had no idea where the virus was or how many people were infected."

Adding: "By the time we did know it was everywhere  which sent states into a situation where they had to compete with each other for precious few resources from dwindling international supply chains."

Yong also observes, as I have, that too few Americans are able to process exponential growth, especially in terms of a disease quickly overrunning medical resources even if relatively few die. As he told Hayes:  

"Too few understand how quickly things can go wrong. This is exacerbated by the nature of this virus itself.  The virus has a very long fuse to it. So it takes a long time for symptoms to show up during which time people can spread the virus. Then it takes a long time for those symptomatic cases to end up in the ICU on ventilators.

What that means is we underestimate the proportionality of the response that's required. People see social distancing, they stay in their homes for several days and they think:  'What is this for?',  'Why am I doing this?'.  The reason we're doing this is to give the rest of the health care system enough time to prepare themselves.  

It takes so long for these events to develop and unfold that we need to instigate these social distancing measures  ahead of time, before they feel proportionate and for a long time during which they might not feel like they're working. Only then can we slow the spread enough.''

Incredible that an Atlantic Staff journalist has more depth of insight and understanding than the two Stanford medical profs, but there it is.  He gets it, and why we need the quarantine, they don't.  Neither does Dotard, who ought to be issuing an Executive order for a national quarantine, not calling for a premature end that will cost many more American lives.

Johns Hopkins real time data currently shows the actual number of Americans infected  by COVID-19 is probably 500,000.   If 80 percent have only light symptoms, but 20 percent are "moderate to severe" (including any respiratory distress) that is already 100,000 likely needing ventilators for at least 10 days- 2 weeks That is an incredibly intense hit on ICUs, given the total ventilator supply in the U.S. is estimated at only 160,000 - and if the worst infections soar to 2 million (not deaths just moderate to severe effects) the medical system is totally overwhelmed.  

They also fail to recognize a universal quarantine would not have been required if we had acted early and competently - with actual leadership- as opposed to frittering away the 40 odd day head start the Chinese provided with their strict lockdown, e.g. of Wuhan.  Having wasted that time, the only tool left in the tool box became the blunt one of quarantine.  It is the only one we have left now to prevent 160- 210 million Americans being infected - in the worst case projection of the CDC.  If even 5 % of the lower limit become critical, needing ICUs and ventilators, we are looking at 8 million critical care COVID -19 patients, enough to overrun and scuttle the whole U.S. health system. (Let us also please bear in mind while the COVID -19 patients occupy hospital beds there is no chance of other critical procedures being done. These may range from cardiac procedures, to gall bladder removals, to appendectomies, to cancer surgeries.  Hence, the more COVID patients occupying rooms the more the ancillary deaths will increase, i.e. from delayed but critical operations. )

A Harvard Global Health Institute analysis released last week examined several scenarios to estimate how hospitals in each of the U.S. health regions wold cope with surging COVID-19 patients.  It focused on adults and the results revealed the biggest shortfall in ICU capacity were consistent with those in an earlier WSJ analysis.  

The latter in tandem with the Harvard analysis disclosed the greatest vulnerabilities - chances of running our of bed space in ICUs-  were in those areas with the fewest existing ICU beds.   These are currently the states with the preponderance of Trump voters, rural voters who are given to believe any quarantine is a case of "liberal media hysteria."  Well thanks to their boy Donnie, they will soon find out just why that "hysteria" exists.

The report by Dr. Colleen Smith,

 In her jarring video at Elmhurst hospital in Queens NY,  showed how dark those WSJ, Harvard projections really are - and also how many other hospitals (in Louisiana, Michigan, New Jersey etc - in last night's news) - are near the breaking point.  Once that breaking point is reached, as it will be throughout the nation because of Bonespurs' failure at national coordination, will we see more twaddle from the likes of the Stanford geniuses? Time will tell.

All of which also underscores the argument (by Jeffrey Lewis of the Bulletin of the Atomic Scientists) that the COVID-19 pandemic  is akin to a slow moving nuclear war or disaster, e.g.

Recognition of this by Scripps infectious disease researcher Kristian Anderson, led her to acknowledge (WSJ, March 26, p. A8):

"Life is not going to be back to what we consider normal for years to come. We need to figure out how we are going to function as a society for the next three years."

This sober take, let us note, is also one that any professional medical person would take in the wake of a limited nuclear war, or one in which a Chernobyl -scale accident occurred on every continent. Sadly, too many still are not processing this pandemic in those stark terms, for whatever reasons. Among those is the WSJ hack and flake Kimberley Strassel ('Big Government Contagion',  today, p. A15), who unleashes petty howls of objection at the House Dems for including (in the emergency aid package):

"$25 billion more for food stamps and child nutrition, $12 billion more for housing, $3.5 billion for child care,  and $900 million more for low income heating assistance."

Which she condemns as "a massive expansion of the welfare state."  In other words, let the lower tier unemployed plebes starve, go homeless, and freeze, but don't give the money proportional to the crisis we're in.  But why be surprised? All you need to know about Strassel is how she pumped the cockeyed conspiracy twaddle about Hillary, Fusion GPS, the FBI, Mueller and the Dems plotting to bring Dotard down, i.e.

Meanwhile, the latest poster boy for pandemic imbecility  - or maybe the "Kim Strassel Buttbrain Award of the Day"- goes to Mississippi Gov. Tate Reeves. This cornpone yokel with maybe three brain cells in all, recently issued an executive order to keep his state open for business - even overriding a local lockdown ordered by Tupelo mayor Jason Shelton. Shelton was trying to do the right thing for his citizens, in line with current science as opposed to Trumpian fantasy, and was overturned by Little Boy Tate.  As Janice put it, "I just hope that redneck has enough ventilators, and if not, then body bags."  

The U.S. and many of the other nations now on the exponential  upswing could have avoided mass shuttering had they not fumbled the response at the outset.  That fumbling included screwing up delivery of proper tests - without which we are blind to the virus' whereabouts-  as well as capable contact tracing.  See, e.g.
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Thus our stats will grow worse while those nations (like Taiwan and Japan)  that had the sense to enact a national response and organized  a timely distribution of medical supplies are already recovering. Alas, the U.S. is not in that company as one can see by noting the infections curve which has a slope higher than even Spain and Italy.  Hopefully,  the two illustrious Stanford profs will process all these stats (and Ed Yong's points) which overwhelmingly confirm the benefits of social distance.  Yes, we can remove these restrictions - the "universal shutdown" (or what ought to be if Trump wasn't such an ignorant, compromised dolt) - but that can only be when either: a) herd immunity arrives, or b) an effective vaccine emerges.

See Also:



Trump Wants to ‘Reopen America.’ Here’s What Happens if We Do.

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