[bhb916]

Fragile systems are generally built using single points of failure. Centrally planned solutions are generally rife with them. I will trust the robustness of a system made up of 327.7M individual plans then the command solutions you are suggesting. We will fair much better than Italy even if the disease is more widespread here.

[entee]

That's not likely. Italy has more hospital capacity per capita than we do [1], has lower cost hospital care, and has been more proactive about testing (almost 8x tests performed) [2]. More beds means less strain when things get bad. Lower costs means people don't wait to get care when needed. More testing means we know where to dedicate resources.

The US is flying blind with a fragmented, expensive medical system that discourages those who need care or testing from getting that care. What might save us (marginally) is that much of the country is fairly rural, and we're far less dense so the spread rate might be lower. However strictly none of the doctors I've spoken to (one of whom is an infectious disease specialist at SF General) believes we have the capacity to deal with the crisis. To a person they say that if it starts spiraling in the US it will get very bad, very fast.

By the way, those countries or areas that avoided the worst of it (Taiwan, Singapore, several provinces in China outside Wuhan, to a limited extent South Korea) have taken centralized, planned, dramatic action to do so. This is one place where central planning is probably the better choice.

[1] https://en.wikipedia.org/wiki/List_of_OECD_countries_by_hosp... [2] https://www.worldometers.info/coronavirus/covid-19-testing/

[kxyvr]

Not to delve too deeply into this, but I believe you're factually incorrect about the hospital capacity of Italy versus the United States. What matters in the number of critical care beds because they have the equipment available such as a ventilator. A study from 2012 has Italy at 12.5 beds per 100k people, which puts them at the high end of middle for Europe. For example, Germany has 29.2 per 100k according to that study, which is more than double. The United States has 34.9 per 100k people in 2009 [2] and I believe that number has continued to go up. Also, to be clear, a better number is probably number of critical care beds per 100k of people over 65 due to how more likely they are to be affected. I don't know the current number for Italy, but the United States according to the link above is at 189.4.

[1] https://www.researchgate.net/publication/229013572_The_varia...

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4351597/

[elhudy]

Not sure why you are being downvoted. What interests me most is does the US have the infrastructure in place to ramp up production as needed? While Italy might have to "place an order" for more ventilators, there is at least one if not more companies in the United States that can manufacture them. Staffing nurses and doctors might be the bottleneck in the US, not the specialty equipment. ICU travel nursing in NYC is already up to 20k+/mo in pay and that number is steadily going up.

[kxyvr]

My understanding that a number of things contribute to this difficulty:

- What are the number of critical care beds in the hospital?

- What are the number of negative pressure rooms in the critical care unit? Negative pressure rooms help keep a contagion contained.

- Critical care rooms typically have a ventilator, but they require a critical care physician to determine the correct parameters for the vent and a respiratory therapist (RT) to set and monitor the vent

- Does the critical care physician have the appropriate personal protective clothing (PPC)? I believe the norm is some kind of suit along with an N95 mask. I'm not sure if this disease has something extra required.

Mostly, I mention this because the equation of what is necessary is complex and breakdowns in this can cause problems. For example, if there's not enough PPC, then the RT and physician can become ill, which means they can't treat patients. At least in the U.S., critical care is a fellowship on top of a residency, so you can't exactly replace them quickly. If there are not enough negative pressure rooms, then the disease can spread more easily in the hospital.

Now, that said, I don't know enough about Italy and their system to fully explain what happened there. I do know that it's not as simple as number of hospital beds, which is why I replied in the first place. This makes a direct comparison to the U.S. at best difficult.

Anyway, there's a lot of dramatically incorrect information being thrown around. There's a lot of people claiming to be physicians and saying some really hyperbolic things. I'm not happy about that, so my small contribution is to at least provide a better reference for something concrete, which is number of ICU beds in the U.S. and elsewhere within the last decade.

[kxyvr]

For posterity's sake, one correction: Not all critical care rooms have a vent. There's a certain number in the unit that are then pulled in.