> The possibility that patients may be suffering — and even dying — at home rather than going to a hospital led the American College of Cardiology to launch a “Cardiosmart” campaign last week, attempting to reassure a wary population and encourage those with symptoms to call 911 for urgent care and to continue routine appointments, through telemedicine when practical: “Hospitals have safety measures to protect you from infection,” it reads.
> “The emphasis here is safety,” said Harlan Krumholz, a cardiologist and health care researcher at Yale University and Yale New Haven Hospital, who advised on the campaign. “We want to make sure preventable deaths aren’t happening.”
> There is no pill, no action, no behavior, he said, that could account for the almost 40 percent drop in STEMI patients. “We don’t have a means to cut your risk in half,” he said. “Not even primary angioplasty or stopping smoking.”
Should the media have some of the blame for these deaths by scaring people? Cherry picking young corona deaths, up playing tenuous studies saying corona causes diabetes and strokes, replaying stock footage of overloaded hospitals.
If they gave people accurate statistics they could make an informed decision whether they want to go to a hospital.
People are failing to seek treatment for the acute life-threatening emergencies they are almost certainly still having. It’s good that they’ve been convinced of the seriousness of COVID-19, but not that they view the threat of potential infection in the hospital as more serious than an actually-occurring heart attack or stroke.
This is objectively wrong, just by numbers. Covid deaths alone, in areas where this has been studied, are routinely outnumbering deaths due to all other causes. Even granting the premise, there aren't enough heart attacks and strokes to make these deaths "not worth it".
Right, they're likely dying at home, and being counted as COVID-19 deaths. That's the safest guess, in the absence of epidemiologic data.
Even so, medical systems and coroners ought to be archiving samples for testing. Eventually there'll be adequate RNA and antibody testing capabilities. Without that data, we won't know what happened.
They’re not being counted as COVID-19 deaths; they’re not being counted at all. A lot of people are living in isolation right now, often with no regular contact with the outside world. The sad truth is that there are probably a lot of people lying dead in their homes right now, and they could go unnoticed for months.
Woah, I didn't think of that. I know that it happens, for those without close friends and family. But for many, the first clue has been failure to report for work. Which doesn't happen so much now. And it's eerie to think that it's become far more common.
Indeed. People aren’t working, aren’t seeing friends/family, and don’t have regular appointments. For many of us, if we died tomorrow, it’d take a while before anyone noticed. I have no idea how many of my friends are still alive; I assume most are fine because they're young, but I’ve lost contact with most of the people I normally see on a daily or weekly basis.
When we come out of this, who will be left behind? And how many of those lives could’ve been saved if we weren’t in quarantine? That’s not to say the quarantine isn’t necessary, but it’s an important question to ask, as its a significant cost that isn’t obvious.
> I have no idea how many of my friends are still alive
Where do you live ? They don't have phone or Internet ?
I exchange daily with every people I call friend; I exchange daily with my close family; I exchange weekly with the rest of my family and people I don't consider friends but still care about.
I'm not a health worker nor someone working in something that matters and I have the luck to still be able to work from home so I've seen as my duty to make sure everyone I care about doesn't feel abandoned and is okay.
I'm not judging or anything but it seems odd to me to call someone a friend and still don't make anything possible to be sure they're safe in those dark times.
Could relaxing still home and cooking your own meals reduce activity-causing heart attacks? It’s a trope in the North-East that middle aged men die shoveling snow.
Yeah, amazes me how many people think everyone is just relaxing at home playing Animal Crossing with paid time off wondering why we can't stay in quarantine indefinitely.
No country avoids lockdown. It happens controlled or uncontrolled. When control is back, everyone open up again. Nobody wants these adverse side-effects, and that they may be worse than the virus is nothing new. Our plight as society is find ways to cope with it and prepare better.
Possibly in the short term - in the long term the quarantine is likely going to increase heart disease due to people having more sedentary life styles... It's quite likely this is just a result of the math of going to a hospital shifting - a lot of folks decide not to go to the hospital with minor chest pain due to other obligations[1] and the addition of the outbreak likely adds to the reasons not to go to the hospital.
1. Don't do this, go to the hospital if you feel something different in your chest.
As a counter anecdote, I know many people that only leave their house a few times per week, including for walks. They are definitely more sedentary now.
one possible counterpoint: couples in healthy relationships could still be going out more, whereas those in dysfunctional ones might be fighting more due to more proximity or exascerbated economic hardship
That and I would suspect that people are eating more "junk", or carbs mixed with sugar and fat. I know I depression-ate out of my prepper stash for the first few weeks.
On the other hand, I think many folks are under a lot more stress in the current economic situation. That might have negative public health implications.
For the first few days maybe, but eventually you'll be throwing the frying pan at your others. Add lack of exercise, fresh air and there you have it. People also go nuts
Where's the source of "excess mortality is way up"? I didn't see it in the article, though it does suggest there may be fewer heart attacks and strokes because of "a decrease in air pollution and fewer high-fat restaurant meals".
There's nothing for the USA as a whole, it will be compiled from states' records and estimates eventually. But it already seems obvious to me that the excess deaths in the next few years from secondary effects (avoiding hospitals, drug overdoses, suicides, stress/panic attacks, less traffic/police on roads, etc) will far outnumber the deaths where COVID-19 took away more than one year of life. I'm probably still in the minority with that belief.
I don't envy those who have to make these decisions. I think the public health impact from prolonged isolation could actually outweigh the direct effects of the virus. Just mental health alone is going to be rocked to the foundations.
And, people are going to be very angry when they learn that you can get the coronavirus when locked up at home. [1] They will wonder why they had to lose their job from the quarantine.
As far as I can tell the numbers are statistically computed estimates, based on real reported deaths, so it's not actual counted deaths, and there's still reporting lag skewing the last couple of weeks.
Thanks, yes it looks like recent weeks are weighted for under-reporting (how to figure out the weighting with so much chaos is another question), and they're estimating that a little over 60% of excess deaths in the past few weeks were caused by COVID-19.
It's because they're not getting vaccinated, which makes a big difference.
Believe I also read that there's a vaccination window for TB--it doesn't work for adults. So each year of lowered vaccination coverage matters that much more. Globally a million people die of TB each year.
There is also another opinion: that many people go to the ER who don't really need to go there.
I had to visit the ER recently. I did not want to go but my doctor insisted. A family member who is also a doctor also insisted I go.
The ER was eerily empty. The ER doctor saw me immediately. There were only a couple of other patients that I could see. This contrasts to prior experiences in the ER where there is a long wait as I get triaged, with lots of people waiting to be seen.
Fortunately my situation was nothing serious. When I returned home and told my relative, he said his hospital's emergency department was also very light. In his opinion, there were a lot of people going to the ER who didn't need to go in the first place.
Edit: I am referring to non-trauma related admissions to the ER. E.g. I have a headache and I am going to the ER to be seen now.
A lot of people don’t have insurance. You can’t go to a doctor for a $150 appointment without insurance. But you can go to the ER when it gets really bad for a $2000 appointment (which you don’t pay. May go to court against you but if you are poor, they won’t collect)
At every one I have been to (not a lot I admit, maybe 4 in my life), I had to both provide insurance card AND pay my copay before a doctor would see me. Without payment, they send you to go to the ER.
How do you know they would send you to the ER? Did you not have insurance? Did they actually send you to the ER for not having it? Honestly, sounds like you simply had insurance, filled out a form and just assumed it was required. I've been to multiple walk-ins, and you can visit without insurance. They will ask for insurance up front, but you can simply say you don't have any. Then you will offer payment options. The average Urgent Care visit is under $200. The point of Urgent Care is literally to handle things that don't need ER visits, and at a much lower rate. I don't know why I've been down voted above, you can simply Google/Bing/Duck "no insurance Urgent Care" and find tons. The CVS MinuteClinic, which is everywhere, doesn't require insurance for instance.
The article addresses this. They expect fewer trauma patients as there are fewer people on the road, etc. but they expect the number of stroke, heart attack, etc. patients to remain constant, which hasn't been the case.
The article doesn't address the opinion that my doctor relative expressed: there were a lot of ER visits, not trauma related, that probably didn't need to happen.
But, of the normal ER visits, one would expect to have the same scalar number of emergency (stroke, heart attack) visits to STILL be happening, and we would expect those people to still be going to the ER. These are not "no insurance" people, they're people having an emergency situation.
If we don't see them in the ER, it makes sense that they're staying home on purpose, or not handling symptoms until it's too late (?).
Not really. It's often "convenient" relative to all the places that aren't open, and they won't turn you away until they've assessed your situation.
What's wild is that we structure payment and regulatory models where a walk in at the ER costs more than a walk in at the urgent care located literally next door. Gotta self assess how serious the situation is if you don't wanna contribute to the high risk revenue pool.
The urgent care clinic can assess you. In fact, they could probably assess you over the phone before you even arrive.
Kaiser heavily pushes their nurse hotline to help minimize costs. I can hardly fathom going to either the Kaiser emergency or injury departments[1] without calling the nurse hotline. The nurse, in consultation with a staff physician in the call center, does an assessment, tells you what to do next, if anything, and schedules any appointments--phone physician, in-person primary physician, or calls ahead to the emergency or injury clinic to minimize wait times.
Our current healthcare system is so fractured that most people have no idea how to go about seeking healthcare in the most convenient and smoothest way possible. Smaller regional hospitals and even some regional systems don't have the scale to do what Kaiser does, at least not nearly as efficiently as Kaiser. High costs are baked into the system.
[1] Injury department is for broken bones, cuts, etc that happen during the day. At the SF Geary medical center they're conveniently located across the hall from the imaging department.
I am a current Kaiser subscriber. (member?/customer?) Even despite the simplicity for which Kaiser is clearly striving, I had a tough time figuring out how it was supposed to work at first.
I was accustomed to urgent care without a phone call. I tried to apply that experience to Kaiser. I found a Kaiser facility, via their web site, that claimed to offer urgent care during certain hours. I even double checked the definition of "urgent care" on wikipedia. I arrived at listed opening hour. The security guard I found there didn't know anything about it, except that no one else would show up for another hour. Then I wandered around trying to figure out where "urgent care" was, but there was some confusion about it. Eventually, I got to a desk somewhere. I was told to call for an appointment, which I did from there. All in all I spent three or four hours waiting and shuffling around between different desks. It was a very frustrating experience.
Eventually, I found out that everything in Kaiser starts with a phone call. But I don't think I was ever told that. What you're supposed to do, as far as I can tell now, is just call the number on your card any time you want to do anything.
Right, my point is, why isn't the nurse line also standing at the door to the single walk in access point for the hospital? Because we are wild fools, that's why.
The hospital is liable for the costs in the ER, so fuck no are they going to tell you go home and get some rest if they can charge you $2000 to do that after taking your insurance.
Except with something like Kaiser, they are the insurance provider and the hospital system. You only pay a copay for the ER, and that’s it. There’s no incentive to push unnecessary medical services.
The realization that the median doctor is probably about as good at their job as the median techie makes me shudder at the thought of going to the ER. Yeah, I'll do it if I have to.
I unfortunately came to this realization as I was graduating college. A decent number of my less-than-stellar high school acquaintances were going to be attending medical school.
You not have overlooked these details when you read the article:
> One study collected data from nine hospitals across the country, focusing on a crucial procedure used to reopen a blocked cardiac artery after a heart attack. The hospitals performed 38% fewer of those procedures in March, compared with previous months.
> At Harborview Medical Center in Seattle, Dr. Malveeka Sharma has tracked a 60% decline in stroke admissions in the first half of April compared with the previous year
There's one obvious possibility... there's some evidence that flu triggers heart attacks in people already at risk for one, Covid-19 also seems to do the same, lockdowns have cut short the flu season but are less effective against Covid-19, and I've seen suggestions elsewhere that doctors are refusing to even consider doing this kind of procedure on people who test positive for Covid-19. It's possible the heart attack patients are right there in the hospitals dying untreated.
Stroke patients are definitely just leaving it far too late to seek treatment. It's been happening in multiple countries. There was even an unfortunate New York Times article where a doctor talked about seeing strokes of a severity they wouldn't expect in people so young, which was spun as proof the coronavirus was causing the strokes - and it just happened to mention in passing that those patients had ignored their symptoms and taken far longer than usual to seek treatment. Of course, if coronavirus was causing strokes we'd expect an increase in stroke patients rather than a decrease.
> MUSC, a major stroke center, averaged 550 calls per month over the past four months about possible stroke patients from the 45 to 50 emergency rooms that refer patients. But it has seen just 100 in the first half of April, said Alex Spiotta, director of neurovascular surgery.
This is not just happening at ERs, this is happening at the places ERs will refer you to, usually after checking whether you do in fact need immediate care.
Doctors in California went on strike and mortality dropped.
One reason for the drop may be due to elective surgeries not being performed. And since more people at staying at home in a safe environment, due to COVID there will be fewer accidents. And far fewer medical mistakes too, not COVID related.
"The third-leading cause of death in US most doctors don’t want you to know about"
My personal take on this based on statistics and observation is that many medical procedures are not very effective.
Or trade short term risk, for long term benefit.
Eg. Those that survive a bypass surgery may live longer. But it will shorten the life of those that it kills.
Chemo therapy can kill you immediately, but if you survive the procedure, it may have also killed the cancer that then will increase your life expectancy.
I also think many medical procedures are not really changing the course of the disease.
And being in a hospital is inherently risky. You are exposing yourself to other very sick people, and possible human errors in treatment.
ITs easy to fool yourself into thinking that what you are doing is having an effect. Consider the thousands of football fans in stadiums thinking they are changing the course of the game with cheering or booing.
IMO, there is a lot of hocus pocus going on in the "medical error is the 3rd leading cause of death" statistic, and the case they chose to highlight is extremely atypical. The vast majority of health care spending and the vast majority of medical resources are spent on old people in their last 18 months of life. Most deaths due to medical error are very old people undergoing risky and invasive surgeries they demand to have and are unlikely to have a great outcome in, not children. How much of the blame should be placed on the doctor when the patient is 80+ years old, has comorbidities, has been counseled on the risks, and wants to proceed with treatment? Bypass surgery is quite effective on someone younger than 60 who is also put on a diet and exercise regimen, and doesn't have diabetes. Bypass surgery is not effective for someone over 60 who is obese and has diabetes and will not change their diet habits.
Most interventions are for something that's not going to kill you right away, so I would guess that seeking intervention for a medical problem I'm having would increase my odds of dying right now (due to a mistake, or exposure to other wick people) while increasing my long term odds. I would not expect an increase in mortality when non-emergency doctors go on strike.
And I hope to someday live in a world where medical error is the #1 cause of death. I hope we also focus on quality of life and not just quantity -- but if medicine seeks to continue extending life then the success case is that error is essentially the only cause of death.
Those articles, and especially their headlines, are sensational and misleading.
There is also another possibility. If you kill of the weak, the remaining strong will show better health outcomes.
And if you are a drug company, you can tout that as proof of the success of the treatment.
And I suspect that is exactly what is happening with some of these medical treatments. They take out the weakest patients (with for example chemo therapy) and the remaining stronger ones will do better. But really its a statistical effect.
Same way you can improve test scores in a class, by getting rid of students with low IQ and work ethic. All of sudden, the average test taking ability will go up.
Survivor effects like you're describing are controlled for in clinical trials for chemo and other drugs by comparing outcomes for the entire control and treatment groups.
This is really frustrating, as we were told over and over again from the media of this huge surge of cases that would overload hospitals. Stay away from the hospital we were told over and over, the "worried well" are overloading our medical system and its professionals. Well guess what, people did just that, they avoided the hospitals to allow for a surge. That's why these hospitals are ghost towns now. I had a tele-visit with my physician and he said both covid cases and visits themselves in his location have dropped off a cliff in recent weeks(sfbay area location). The tents they erected in the hospital parking lot to treat the legions of sick are being taken down at another hospital in San Jose. A friend who worked in radiology is now on partial furlough due to such low patient counts(Stanford, Palo Alto) so I guess this avalanche of cases never materialized at least not in the bay area(NY is a different story).
Are just the ERs empty? Or the whole hospital as well? If hospitals are empty, it's time to stop sheltering in place, because it means it's working too well. What's the endgame? We can't just keep the country shut down indefinitely. Life must move on. Even though there's still a lot of fear, I think reopening the country is the best option (while still maintaining social distancing, etc).
In New South Wales, Australia the medical sector had 1000 ICU bed capacity in January. When covid hit, it was rapidly expanded and currently over 2000 ICU beds are available.
At the same time all elective surgeries got banned (e.g. hip replacements etc) because some of those would end up in ICU.
At the peak of the outbreak NSW used 100 of those 2000 beds. Currently only about two dozen ICU beds are occupied. About 1% of capacity.
The good news for Australia is that you are probably eliminating the virus and will be able to reopen everything soon, safely. The key point of the comment you are responding to --- "If hospitals are empty, it's time to stop sheltering in place, because it means it's working too well" does not apply to Australia, because it assumes a "flatten the curve until we reach herd immunity" strategy which is not Australia's strategy.
The real problem in the USA and most other Western countries is that there is no clear strategy to defeat the virus. The actions being taken are mostly consistent with "flatten the curve and wait for herd immunity", but that pretty much guarantees crippling economic damage and mass death.
Australia (and New Zealand) have no clear strategy to defeat the virus. They have won the opening battle and are claiming the war is over. Unless Oz and NZ cut themselves off from the rest of the planet, no, the virus war isn't over.
Herd immunity through vaccine or infection is the only rational strategy for a disease like C19. There is no vaccine, and possibly will never be a vaccine. Sorry to be a realist.
Australia's strategy started off as 'flattening the curve' and as far as I know officials never stated that eradication is now the strategy. There's still about a thousand confirmed live cases and of course there's many thousands more that are not symptomatic or otherwise carrying covid without being diagnosed. Eradication as far as I can tell is not realistic.
NZ, at least, has a clear strategy to defeat the virus: eradicate the virus internally, mandatory 14-day quarantine for everyone entering the border (and only NZ residents plus a few essential workers are allowed to enter) to keep it out, intense contact tracing and testing to snuff out outbreaks from cases that slip through. (I think this is also the Australian govt strategy but I haven't been watching their press conferences.)
Sure, the war isn't over, but it's at least plausible this will be effective for a long time. Versions of it are working in China and a number of other countries that were able to stop the spread in time.
If there is never a vaccine, then there will be harder decisions for all these countries in the future about how to deal with countries that failed to defeat the virus. It seems fine to worry about that later.
No, it doesn't mean "stop sheltering in place," unless cases of COVID-19 have peaked. In order to tell whether they've peaked, you need testing in place, as well. Even if they have peaked, it could mean "relax some of the restrictions, but not fully end SIP, while monitoring cases." Opening things back up prematurely, without sufficient testing, is just going to get people killed.
Why do cases matter? It should be the death rate that peaks, and that's measurable without testing. In fact it seems to be over-attributed since many deaths are now being classified to Covid even if there are many other factors.
I think this is backwards. We have been using infection rates as a proxy for death rates, since deaths are a lagging indicator. It is certain we are missing a huge percentage of cases, and expanding testing will uncover those. It is completely unclear that uncovering more mild and asymptomatic cases will result in more deaths, so new cases are a bad proxy for future deaths.
Maybe in an ideal world, but we're not actually measuring infection rates. Dead is pretty objective, and easy to measure, and, we know that the number of deaths will roughly track the number of infections. That's why things like deaths and hospitalizations are what the state of California is watching closely.
Is that the actual goal? Seems like we're well past containment now with infections in the millions. But if death rates are staying low and healthcare has enough capacity, then what does widespread testing accomplish?
Might as well save it for the people who actually get sick and need confirmation for treatment or cause of death.
Well, do you have research on how many excess deaths there would be if states started opening up now? California is taking a cautious approach by only opening in stages after cases have stabilized, and only after testing is present. Do you have a better plan than what a group of public health experts have come up with?
> Do you have a better plan than what a group of public health experts have come up with?
As far as I can tell, public health experts (and basically all medical experts) are in over their heads on this one. It's like 1970s computer scientists issuing guidance on a stuxnet-esque infection. Sure, they are the experts in that they know more about computer science than other people, but they also have no experience with something like stuxnet-esque worms and so... how valuable is their expertise? "We recommend turning off all computers until further notice to stop the spread of stuxnet. Meanwhile, we will take 6-12 months or more to try and reverse engineer it and then we will issue further guidance." Except... "turn off your computer for a year" isn't going to fly with the general population. After so many months there will be riots and people will start disobeying.
And, what knowledge and/or credentials do you have to base the conclusion that "public health experts (and basically all medical experts) are in over their heads" on? Do you know what contained the outbreak in China, South Korea, and other countries?
> Do you have a better plan than what a group of public health experts have come up with?
Sweden's response is also based on public health experts. And in Sweden, the apolitical public health agency is fully in charge, politicians meddling with their work is against the Swedish constitution. And the Swedish public health agency has stated that their response takes into account comprehensive long-term public health and not just short-term.
Is Sweden's response wrong? Maybe. But do you have a better plan than what a group of public health experts have come up with?
I think that, instead of requiring locking everyone in their homes to save a few, we should give people the option to isolate themselves from everyone else. This would entail free rent and clean food delivery sponsored by the government.
This would then reduce covid-19 to a risk factor on par with every other self-inflicted risk. If you worry about your health, stay home, if not go live your life. It would actually be compatible with our constitution as well, which would be nice.
One thing I'm not seeing happening is surveys and epidemiology related to impact of various measures undertaken, to keep the ones most effective and lose the others that are superfluous.
This could be done by comparing measures taken in a big random sample of confirmed cases with big random sample of general population.
> Opening things back up prematurely, without sufficient testing, is just going to get people killed.
Yep, some people will die. That's unavoidable. Tens of millions die every year. Hundreds of millions will die per year in a few decades. That's life.
If you are at-risk, you should continue to avoid contact with others. But there's currently no cure for covid-19 other than your own immune system. The sooner the disease runs its course, the sooner we can return to normal. Sheltering in place forever means you prolong the propagation of the disease to excruciatingly long timescales.
No, it's entirely avoidable. I'm referring to unnecessary deaths from COVID-19, which, as we've seen here in California, and the Bay Area specifically, have not hit numbers suggested by initial models because we implemented shelter in place.
I don't see anything more to your argument than what the woman standing with a sign saying "I want a haircut" is saying. Your attitude is dangerous. People will die unnecessarily if state leaders do as you suggest. This is what the modeling says, and you have offered nothing to suggest otherwise.
Bold of you to assume that a disease can just run its course and then end. Would you say the same thing about the Chickenpox or some of the earlier flu pandemics we've seen? Are you willing to bet on a far deadlier second wave not occurring?
> Bold of you to assume that a disease can just run its course and then end.
Not that bold, since it is how most diseases/viruses work (with a few exceptions like HIV, and there's no reason to assume covid-19 is an exception)
> Would you say the same thing about the Chickenpox
Yes, chickenpox is one-and-done. Once you've had it, you (basically) can't get it again.
> Are you willing to bet on a far deadlier second wave not occurring?
Yes - "Survival of the fittest"
If there is a second wave, it will only affect survivors of the first wave, and as far as I can tell, the vast majority of first-wave survivors had mild-to-no symptoms. Kids are barely affected at all, it seems.
Are you suggesting that people who have the ability to isolate themselves at home while still earning a living are somehow "fitter"? As I suggested before, your argument as a whole amounts to nothing more than the woman who waves the sign saying "I want a haircut". Is your life more important than your barber or stylist's? If not, why are you asking them to risk it for you?
> Not that bold, since it is how most diseases/viruses work (with a few exceptions like HIV, and there's no reason to assume covid-19 is an exception)
This is objectively wrong and I'll lead into why in the next point.
> Yes, chickenpox is one-and-done. Once you've had it, you (basically) can't get it again.
Chickenpox is not one-and-done. If you catch chickenpox, the virus remains latent and can manifest itself as Shingles.
And to explain a bit of history here: I'm not talking about a second wave of the current strain. I'm talking about a deadlier strain. That was what my reference was to earlier flu pandemics and I highly suggest you do a bit of reading on that. The Spanish flu had mutated to a far deadlier version during the second wave and spread all over the world.
For all the comparisons people make with the flu virus, people seem to ignore that viruses can come and go in waves. The flu did not 'end', it mutates every season and the reason why we're able to keep it under control is because of widespread vaccination preventing it from growing exponentially. You claim that's how most diseases work, but that's not how the flu works. The danger of letting the coronavirus run rampant is severely understated by our complete inability to control it right now.
I'm going to keep repeating this until people understand the risks: Opening up too early without adequate testing in place means we go through the same problem that Hokkaido did. Which is that you get a second wave of infections and are forced to back into lockdown.
As for the article itself: Reopening the country wouldn't fix that either because it's a catch-22 situation. The people most at risk of dying from COVID-19 don't want to go to the hospital because of the risk. So they put off emergencies until it's too late. You don't solve this problem by reopening the country because the fear and the risk for said people is still there.
My parents are a great example. They have breathing issues which makes them especially at risk. They're afraid of getting routine tests done because catching the coronavirus could be very deadly.
So... you propose just staying on lockdown indefinitely until "adequate testing is in place?" And when will that be? It could be 6 months from now or more so long as the Trump administration is running things.
Lockdown isn't "free" like you seem to think. It has a very heavy cost. And some day (if not already), that cost will outweigh the lives saved from doing it in the first place. Because the combined suicides/mental health/homelessness/domestic violence/etc. increases from lockdown will be greater than [people at risk of covid-19] deaths.
Plus, if lockdowns are keeping hospitals empty, social distancing and masks without the lockdown part would allow us to utilize them more (without them going over capacity).
I have yet to hear anyone explain how we’re going to lose millions of lives due to the lockdown, whereas the risks of opening up without sufficient testing include that as a very real possibility.
Yes, it stinks that people are suffering due to the lockdown, but the government could (if it were so inclined) pay people to stay home indefinitely. It clearly can’t manage the virus, however.
>the government could (if it were so inclined) pay people to stay home indefinitely
I'm a bit skeptical, and would be even if instead of "indefinitely" we were just talking about a couple of years. I'm not necessarily disagreeing, but I'm curious about how the math would work out, in your opinion.
The Federal reserve pumped, I believe, about 1 trillion dollars into the economy in March. That would pay every unemployed worker somewhere around 80k.
Yes, that’s somewhat apples to oranges due to the way the reserve operates, but the money is available if the will is.
[IANAD] Diabetes, hypertension and cardiovascular issues are among the frequent issues in serious covid cases. If covid is that widespread as some studies suggests, may it be that covid triggers the hospitalization earlier than the heart attack/stroke/etc. would have happened to that person otherwise. US heart attack rate is 2K/day, ie. on a scale of covid deaths and significantly less than covid hospitalizations.
Some other factors to consider - much cleaner air these days, no traffic/noise/rush and associated stress, and you can even hear birds singing through the day. Personally i find it very relaxing to not spend the days in our tightly packed badly air-conditioned to the point of serious sweating (our BigCo. is very big about its "green" energy saving chops) horrendously lit (those lights burn the eyes and make bright spot reflections on monitor, and the half-transparent blinds kill when afternoon Sun gets into those windows) "collaboration and communication stimulating" (read - very stressful) very modern open floor office.
I would assume indeed that your first point is the most important-one: people already in bad health, susceptible to heart attacks and strokes also have a much higher chance of getting seriously affected by covid with fatal consequences in the first place.
This is also something you see in statistics, that after any large flu epidemic, the general population mortality figure drops to something significantly below average, especially for people in the 65+ age group.
You can see this very well on EuroMOMO [1] - check out the numbers for the Netherlands in 2018 from week 10 throughout 13. This is a flu epidemic there, and the aftermath.
Yes, Stanford Hospitals actually sent about 20% of their staff home.[1]
Stanford was prepared for a huge influx of coronavirus patients, but they only have 20-30 in the hospital. This despite a steadily climbing death toll. My own GP says, if you get it, go to Stanford; they have the investigational drugs, and they're not overloaded.
Nationally, the US death toll continues to climb. Currently somewhere between 69,000 and 74,000, depending on the source. The SF Bay Area's shelter-in-place thing seems to have helped. We need to get more people wearing masks, though. Seeing too many people without masks. More of the good masks, too. You really need N95 or ASTM Level 3 masks to protect yourself; the cheapies only protect other people. That only works if almost everybody wears the things.
What's happening outside the US? The Financial Times tracker, which has been updated every day for months, shows the US death rate flat. Most other countries have peaked and decreased substantially.[2]
Don't discount the impact of reduction of air pollution on all causes of mortality. It's not often discussed, but every so often someone makes the connection between small particulates and heart attacks, etc.
Pretty sure any impact from that would be a very long-term thing. A lifetime without particulates might have an effect; a month seems pretty far-fetched.
"In 2004, the American Heart Association issued a scientific statement concluding that exposure to air pollution contributes to cardiovascular illness and mortality. A 2010 update elaborated on those risks.
Short-term exposure can increase the risk of heart attack, stroke, arrhythmias and heart failure in susceptible people, such as the elderly or those with pre-existing medical conditions, according to the statement."
Seems like a pretty subtle and non-acute thing. Maybe even analogous to smoking: something that gradually erodes your health, not something that suddenly kills you.
I would tend to think there is both long term damage and chance of increased immediate death due to things like asthma and heart attack triggered by polluted air.
Cars kill us: Far fewer car crashes, more sleep as no need to commute so early in the morning, no horrible drive into the office screaming and honking at the idiot driver, no horrible drive home while texting.
Alcohol kills us: no drunk fights at bars, drunk driving, falling in front of moving vehicles.
Not saying it explains it, but a lot of people get hurt and die for stupid reasons.
Then they're "just" pickling their liver at home instead of also getting into fights at bars, driving drunk, and falling down in front of moving vehicles on top of that.
It wouldn't reduce all of the incidents, but heart attack risk is higher in those who don't get enough sleep, so he's not wrong on that, if people are getting more sleep at the moment.
How is that related to the lockdown? Hospitals are open. People are staying home because they're scared of getting sick, that's not something that can be fixed by public policy.
>> People are staying home because they're scared of getting sick, that's not something that can be fixed by public policy.
Staying home IS the public policy in many places right now. Mere weeks ago, my social media feed was full of information about hospitals cancelling all non-emergency procedures, being overrun, doctors flying to New York, PPE shortages, etc. I wouldn't be at all surprised if a lot of people who would normally go to the ER just in case are trying to tough it out at home. Or perhaps they're more alone and the person who would normally call 911 because they're having a stroke / heart attack simply isn't with them - because isolation and social distancing is also the public policy.
No, because I don't care and I'm just going about my life mostly as normal. Many people have missed the context, and that's either a massive failure of education or a massive failure in communication, and the mere fact we're having this discussion is evidence of that. Isn't it?
Public policy right now is to stay home or die of Covid 19. Many people are scared to even go outside or go to a hospital if they don't have the virus.
Starting to open businesses again and requiring social distancing would definitely help with the fear and more people would actually go to the hospital for non-covid health issues.
I don't follow that. Can you walk me through how making people go to work is going to make them less afraid? You make people less afraid by reducing the risk they'll get sick, not increasing it. Releasing lockdowns before the pandemic is controlled increases risk, by definition.
This is the big flaw with the "open up" notion: it fundamentally won't work anyway. How is "opening up" the economy going to help Jet Blue when no one is willing to fly? Who is expected to fill those movie theaters and sports arenas? Who's going to sit in a crowded restaurant?
At best, opening up will get us a half-alive economy. And at the price of a much longer time until a true recovery starts.
Stay home. We can beat this. The regions that started lockdowns early (c.f. Europe, New York, the west coast) are well on their way to containment. It's the "open up" regions and the ones with partial lockdowns[1] that are the stragglers.
[1] I make this point every time it comes up: but for goodness sake something needs to happen in Nebraska. It's right on the cusp of exploding into a worst-than-NY disaster and no one is talking about it.
California is split. The Bay Area is past peak, socal is still growing. Washington and Oregon are well past peak, around half of their peak new infection rate. New York is crossing under 1/3 now. Likewise New England and a few other smaller states are clearly over the hump.
This stuff works. All these places could have easily blown right through health care capacity like Milan, but they didn't. The really frustrating thing is watching it work, then watching everyone figure things aren't so bad and demand that we "open up", when the only reason things aren't so bad is because we didn't.
Another month for these early states. Just be patient. As for everyone else, it's going to be much longer than if they had just followed the lead of the lockdown set.
I for one will be feeling less safe love we start opening things again. Nothing has changed in the US except that people are getting tired of the situation. We have enough idiots walking around without masks or who aren't distancing as it is. Once we start opening up there is only now risk in going to places where there are other people.
I don't think people fear that they'll die if they step outside, but they are afraid of catching coronavirus if they go to a hospital, and in some hot spots that's been a real risk. But it's a lower risk than dying of a heart attack because you refuse to seek care.
A solid month of messaging “stay at home” and “hospitals are overwhelmed” and ratings driven fear-mongering been far more effective than policy makers ever intended.
Hospitals were overwhelmed in many places in the world. People absolutely should have stayed home.
Or are you trying to claim that the virus is a hoax or something? This is a real risk. We've seen what happens in Madrid and Milan if you lock down just ~10 days too late.
My anecdata confirms your view exactly. My wife was concerned a few weeks ago that she might have a heart attack (she did not). I suggested to go to urgent care, but she was more concerned about COVID and wanted to just take Aspirin and monitor the situation. She also is in a group vulnerable to COVID, so this might be skewed.
Government closure had nothing to do with this decision. In fact I've zero trust in US government recommendation around this and don't factor their recommendation into any of my personnel decision making around this topic.
"In 2004, the American Heart Association issued a scientific statement concluding that exposure to air pollution contributes to cardiovascular illness and mortality. A 2010 update elaborated on those risks.
Short-term exposure can increase the risk of heart attack, stroke, arrhythmias and heart failure in susceptible people, such as the elderly or those with pre-existing medical conditions, according to the statement."
Of course, people hesitate to go to the doctor. But I see a second factor: Maybe it’s because of a slowing down in many regards. Hence, less stress, and less heart attacks?
But fewer externalities like bars, parties, stupid accidents with friends, rushing to meetings, traffic, physical work env stress, in some cases work altogether. Not to minimize the mental torment some people feel but I think o there is a huge reduction in certain kinds of stress.
Here's some context: both you, me and a majority of HN readers have decent lives and cushy tech jobs (I'm a student and have the luxury of coding all day).
Think of everyone else: those relatively regular/average people in America, the average Joe. They have bills to pay for, but living paycheck to paycheck, they can't pay any of it. So now they're seeing whats the best way to get income. Unemployment check? Website is down. Where to get food? Food banks are barely sustaining.
Yes, there's definitely a reduction of stress in some areas, but I believe that thinking of everyone, I mean everyone not just in tech, makes you realize that as a whole, a lot of people are stressed out of their minds when this can end.
Yes I agree... but let me add some color to me personally.
Me = small business owner. Revenue less than 2mm per year.
Major public company clients moved payments to net 60 and net 90 from net 30
2 clients emailed April 1st (emailed) effective immediately no contractors or agencies effective immediately.
1 major retailer we have done WiFi access point metrics for all stores in North America (roughly 4k stores) had an invoice bounce back to me. After researching I find on LinkedIn my stakeholder is no longer with the company. I push hard to get someone in AP to reply and finally I hear they stopped the entire program and didn’t think to tell us. 11 years of providing this monthly data analysis and collecting roughly a billion data points a month... gone. Without a heads up.
2 new prospective projects set to kickoff April May moved to June July.
PPP covers last years salaries. We have sizable raises to key staff (project managers in January) . 60% of my workforce if outside of the US and can’t be covered under current monetary relief. I’ve not taken a check now in almost 2 months.
Entire line of business (WordPress) is now zero.
So yes stress is in relative forms. for me it’s confining, silent, and endless.
For me I’ve been running this company for 21 years now (started in college). I’ve hit a couple of near breaking points (08 and now). And it’s an unbelievable amount of stress. I sympathize, empathize and understand what people are going through.
What gets me through this is the following:
- The time I’ve gotten to spend with my family, my kids is absolutely amazing and I will treasure it forever
- I love my team and I’ll do what I can to keep them employed and without disruption
- Even with the stress and uncertainty I still love my job and what I’ve built
On the business side:
- As a service business I now fully and completely understand that I need to figure out how to make a more resilient business that can weather business interruption to this degree and scale. It’s easy to blame covid but it’s inevitably my job to have considered this and prepared for it. This is everything from specific contract language changes to planning cash flow for a 40-60% reduction in business for maybe 6 months.
Anyway, I thought I’d share, maybe someone finds solace in knowing they aren’t alone and that they don’t need validation for how they feel.
My mental stress level is wayyy up – but I think I still feel less stressed overall, because I get more and better exercise, I cook a lot more and that means cheaper but somewhat healthier food on a schedule that better suits me in portion sizes that I choose myself (as opposed to the guy at the cafeteria counter), I have a lot less work-related stress due to remote work (everything feels somewhat more distant), no stressful commute, more flexibility with bedtimes (which suits me as a total owl) ... there might be lots other things, lots other external stressors, hard to tell. It's at the same time nerve-shredding and very relaxing. I wouldn't be totally surprised if a lot of people were living lives so unhealthy and harmful that the current situation would end up being a net improvement in that one way, terrible as it is in lots of others.
My first thought was more sleep. Without a commute in the morning I have to imagine most people are getting an extra 30 minutes at least. Maybe even an hour.
Were people going to the doctor and ER less before covid? As employers move to offer only high deductible health insurance, the cost to see a doctor is increasing quickly. When a single doctor visit can cost from $150 to $1500 depending on what they talk about and you're paying that entire amount, one tends to put of seeing a doctor unless it's a true emergency.
It'd be interesting if the quarantine from the coronavirus has also quarantined us from the ravages and stresses of day to day life, leading to improved cardiovascular outcomes.
I'd be curious about suicide statistics as well--would they be going up or down right now?
Anecdotally, I feel like stress has gone way up for most people, not down. Not sure it's that's true or not on the larger scale, but it definitely seems true for me and most of the people I know.
Interesting. For me, it's involved a sharp decrease in stress, though that's overlapped with quitting my job and having a substantial financial cushion.
It's early days, but I suspect suicides will approach actual COVID-19 deaths in the end, at least in places and cultures where suicide is "acceptable". Even the most stable will have trouble with financial ruin and watching their children go hungry, and most of the newly jobless are not that stable.
if you go to the ER, is it still the case you could up alone in the hospital without ever seeing a family member? and possibly die alone?
i wonder if a “bad death” is also a deterrent if you thought you were dying. or if emergencies don’t come with those kinds of calculations. not sure if/why covid calculation would be any more likely, though.
Maybe working from home is just less stressful. Or, maybe they are finally getting time to exercise, thus putting of the strokes (I don't know if exercise will put off a stroke, but maybe). I know I see a magnitude more people around my neighborhood out walking, jogging, etc. than I ever saw before.
If CoViD-19 turns out to primarily be a pathogen that most negatively affects people with CardioVascular Disease then the short answer is, they're probably already dead.
(CVD - CVD, uncanny coincidence?)
https://www.washingtonpost.com/health/patients-with-heart-at...
> The possibility that patients may be suffering — and even dying — at home rather than going to a hospital led the American College of Cardiology to launch a “Cardiosmart” campaign last week, attempting to reassure a wary population and encourage those with symptoms to call 911 for urgent care and to continue routine appointments, through telemedicine when practical: “Hospitals have safety measures to protect you from infection,” it reads.
> “The emphasis here is safety,” said Harlan Krumholz, a cardiologist and health care researcher at Yale University and Yale New Haven Hospital, who advised on the campaign. “We want to make sure preventable deaths aren’t happening.”
> There is no pill, no action, no behavior, he said, that could account for the almost 40 percent drop in STEMI patients. “We don’t have a means to cut your risk in half,” he said. “Not even primary angioplasty or stopping smoking.”