[001spartan]

Returning to normal is a terrible idea when COVID patients are overwhelming hospitals across the world. How can things be normal if our healthcare systems are nearing collapse?

You might be willing to accept the risk of getting sick on your behalf, but by advocating a return to 'normal' before we have the capabilities to deal with this virus, you are advocating for putting even more stress on healthcare systems across the globe already on the verge of failure. There are patients in heavily-impacted areas who cannot access healthcare for other life-or-death concerns because hospitals are crumbling under the workload of COVID cases.

The article even states this; COVID is likely to reach endemic status eventually, but we are still nowhere near that. Ignoring it will have enormous costs on vulnerable populations -- even more than it already has.

[bingohbangoh]

Are they really overwhelming hospitals?

This keeps being repeated but most hospitals operate at about 80% capacity as-is. Places in Tennessee and Florida are currently, with COVID-19, operating at about 80%. [0]

If we look at Israel, which has a very high vaccination rate, we see that they're supposedly running out of hospital space. [1] But the article linked doesn't say _anything about their actual numbers atm_ and points to a fiscal problem rather than a manpower problem.

There was a recent Science Magazine article that states that 13% of the hospitalized-and-vaccinated group are under 60. That amounts to 39 people in a country of 9 million. [2]

I've asked this before both here and elsewhere: If these vaccines aren't "good enough," what is? At what point does this become "zero COVID" in that "nobody can ever die from this disease again?"

[0]: this may have changed -- things are changing quickly -- so I'd be curious if you have any recent (<1 week old) information on this.

[1]: https://www.haaretz.com/israel-news/israel-s-public-hospital...

[2]: https://www.sciencemag.org/news/2021/08/grim-warning-israel-... -- and I took this from Louis Rossmann's video https://www.youtube.com/watch?v=mYtfT7HsJq0

[dragonwriter]

> Are they really overwhelming hospitals?

Yes.

> This keeps being repeated but most hospitals operate at about 80% capacity as-is.

They aren't overwhelming total hospital capacity, they are overwhelming specialized resource capacity, particularly ICU capacity.

> Places in Tennessee and Florida are currently, with COVID-19, operating at about 80%

In Florida and numerous other states (not Tennessee), there are significant areas over 95% ICU capacity. [0]

[0] https://www.nytimes.com/interactive/2021/08/17/us/covid-delt...

[zeku]

There are NO ICU beds in Tennessee.

https://www.tennessean.com/story/news/health/2021/08/19/tenn...

[ekianjo]

> there are significant areas over 95% ICU capacity

It's not like there is any large ICU capacity anywhere anyway.

[erhk]

Those patients simply go somewhere else and cause more strain. We on hacker knews should known the pain of cascade failures more than other platforms.

[dham]

Is every hospital getting overwhelmed though? I keep seeing reports of staff getting fired or quitting because of vaccine requirement. Maybe I'm getting fake news?

[dragonwriter]

> Is every hospital getting overwhelmed though?

In the country? No. In large areas? Yes.

> I keep seeing reports of staff getting fired or quitting because of vaccine requirement. Maybe I’m getting fake news?

There are vaccine requirements being adopted some places, and there are departures related to it. But if you are seeing news suggesting that that is the major source of capacity strain (or even the major source of COVID-related causes of people departing healthcare jobs), it is, at least, distorted news.

[bingohbangoh]

I'll throw in a anecdote: my family in nearby hospitals are *not* being mandated to get vaccinated.

This is precisely because there is high demand for registered nurses and other medical staff at the moment.

[qwerty456127]

> This is precisely because there is high demand

Ok. At least somebody can exercise reason when necessary.

By the way (I believe that's is nonsensical but I also believe I am probably wrong - I am far from an expert), what's the point of force-vaccinating people who have obviously contacted the infection on many occasions and still are Okay? To me this indicates their immune systems are doing a great job and we should rather avoid teaching them (their perfectly competent immune systems) how they should do it. And I don't know about any evidence of vaccinated people being less contagious than those naturally immune.

[bingohbangoh]

> what's the point of force-vaccinating people who have obviously contacted the infection on many occasions and still are Okay?

I don't know but, fwiw, Europe is considering prior infection proven by an antibody test as equivalent to being vaccinated.

[SamBam]

> To me this indicates their immune systems are doing a great job and we should rather avoid teaching them (their perfectly competent immune systems) how they should do it.

This makes no sense from an immunological perspective, and sounds like one of those pseudoscientific ideas that "natural" immunity is somehow stronger than "vaccination" immunity.

A vaccine is nothing more than exposing the immune system to the antigens. If their immune systems are already geared up to fight Covid, they will simply respond to the vaccine as another Covid infection and fight it accordingly.

As for whether there is any benefit, there absolutely is. Multiple exposure events greatly increase the storage of the antibodies in the memory cells of the immune system. This is why most vaccines require at least two shots, and why the CDC is now recommending a third booster shot for some people.

Plenty of studies show that the immunity of people who are vaccinated is stronger than those who were infected naturally (e.g. [1]), and that the immunity of people who have had Covid is significantly more robust after subsequent vaccination (e.g. [2], [3]).

1. https://www.biorxiv.org/content/10.1101/2021.04.15.440089v2....

2. https://apnews.com/article/science-health-coronavirus-pandem... ("The survivors who never got vaccinated had a significantly higher risk of reinfection than those who were fully vaccinated, even though most had their first bout of COVID-19 just six to nine months ago.")

3. https://www.medrxiv.org/content/10.1101/2021.04.25.21256049v...

[sumnuyungi]

Do you have a non-paywall link to that article or a link to the actual data? The article should list sources.

[xadhominemx]

Have you tried Google?

[KaiserPro]

India: yes.

The UK: in local areas, patients had to be diverted sometimes hundreds of miles to a hospital with space. all non emergency hospital care was stopped, and some emergency routine care was delayed.

Belgium was overwhelmed.

The issue is this, we can't just not admit the over 60s. even if we did, that would only free up 50% capacity (ie you could go one more cycle of exponential growth, doubling every n weeks/days)[source https://coronavirus.data.gov.uk/details/healthcare?areaType=...]

filling hospitals means that the resources used to treat both sudden hospitalizations and long term are diverted. so car accident/drinking/heavy sports/DIY injuries have worse outcomes, and cancer outcomes drop off a cliff.

if the UK manages to keep the total number of patients in hospital with covid to less than 7-10k that would be a brilliant outcome for winter. we are currently at ~6k, and its still summer.

The issue is there are not enough trained doctors and nurses. They take at least 8 years to train. that's the main constraint. Suitable beds can be made up in a number of weeks (see china and the "nightinggale hospitals") but if there is no staff, they are pointless

[qwerty456127]

> you could go one more cycle of exponential growth, doubling every n weeks/days

I'm not sure a big percent- of people is prone to hard covid. I tend to believe the majority of people has already went through it asymptomatically/easily and so will the majority of those who still hasn't.

Exponential growth in positive tests doesn't imply infinite (limited only by the size of the population itself) exponential growth of severe cases or deaths.

[KaiserPro]

> Exponential growth in positive tests doesn't imply infinite (limited only by the size of the population itself) exponential growth of severe cases or deaths.

Correct!

but when in the growth phase we can't know when it will stop. We have a fixed[1] upper bound on the number of people we can deal with at one go. so when we see we are getting close, we have to take drastic action.

We know that testing in the uk is a proxy for actual infection, it tends to favour symptomatic as its "self selecting". The ONS survey is more accurate but has a significant lag.

I really hope that you are correct about asymptomatic. but we can't be sure, yet.

[starik36]

> At what point does this become "zero COVID"

In New Zealand, it already has. Every time there is a single case or two, the entire locale (Auckland in this case) fully locks down. This is the 5th time it locked down. https://www.nytimes.com/2021/08/17/world/australia/new-zeala...

It's ironic that Covid has been arguably more disruptive in NZ than in US, which has a ton of cases.

[DanielR31D]

This is untrue. In New Zealand we locked down a reasonable amount for the information we have on the case. With the current lockdown, there was a single case with no known link to the border which had traveled around the country while infectious. Knowing just this and that every case in managed isolation (iirc) was is the Delta variant, we went into lockdown. Also, '5 lockdown' is misrepresentive. We can see on this page https://covid19.govt.nz/alert-levels-and-updates/history-of-... that while some lockdowns were very restrictive, country wide, and long (2.5 months), most were short and regional (with other regions maybe going to lvl 2 alert)

[starik36]

How is that untrue. There were three Alert Level 3 and two Alert Level 4 instances.

> short and regional

Downplay it all you want. Auckland is a pretty big place. Alert Level 4 means that 1/3 of New Zealand population is locked down.

[xadhominemx]

Definitely not more disruptive in New Zealand over the entire course of the pandemic and also we have suffered 600,000 fatalities as a result of the virus.

[dcolkitt]

I'm virtually certain that the pandemic disrupted everyday life in NZ more than it did in Florida. Now more people died, but Florida demonstrates that even at the height of the pre-vaccine pandemic it's perfectly possible to live a lockdown free life post-Covid without society collapsing.

[mbesto]

Here ya go in Texas:

https://www.texastribune.org/2021/08/10/coronavirus-texas-ho...

As the pandemic started, ~70% of ICU bed use was normal, since then its been around 80~90% and now approaching 100%.

https://covid-texas.csullender.com/

So yes it is overwhelming hospitals. Even if you're vaccinated, this should scare you.

[cogman10]

So, the anecdotal evidence would be to visit /r/medicine and /r/nursing on reddit.

It may not be universal, but it certainly appears to be the case that many hospitals are being pushed over the limit due to covid patients.

Part of the issue, though, appears to be the fact that hospital admins are unwilling to raise salaries on essential employees like nurses.

[bingohbangoh]

I know many nurses and doctors who work at hospitals in and around the NYC tristate area -- they all say capacity is well under the normal rates for them.

Note: last April (2020), they said it had exploded due to COVID-19.

[cogman10]

Yeah, the main difference appears to be states that have high vaccine participation and states that don't.

[sreque]

This is just your bias showing, nothing more. COVID has been shown to be seasonal and to hit different parts of the world at different times of the year. Southern states appear to get hardest hit in the summer, while the colder Northern states are harder-hit in the winter.

Florida has the second-oldest population in the U.S., but it's death rate per 100,000 is average among the states. NYC and NJ are two states with the highest death rate per 100,000.

[bingohbangoh]

So what is there to say about Israel or Gibraltar?

Both have very high hospitalization rates. Both also have very high vaccination rates.

[cogman10]

IDK, hard to say what's going on there.

In the worst case, it may just been that the vaccine effectiveness wanes over time.

[spookthesunset]

What is a covid patient? One that tested positive and is in the hospital for something else? Or one that is actually sick from covid? Because absolutely none of these articles I read clarify that tidbit and it is very important.

Positive covid tests require a hell of a lot more hospital overhead to deal with, even if they don’t have symptoms and are in for something else. It could very well be the case that this is a self made problem. We very well could be artificially overloading hospitals because we dictate that every positive test, regardless of symptoms, invokes massive overhead.

And again, every article I read never clarifies this. In fact many conflate “people with covid but there for something else” and “people sick with covid”.

I am fully inclined to believe that this hospital shortage is a self inflicted problem. If this was literally a hospital full of people choking on their own ooze, the media would be all over it like moths to a flame.

[cogman10]

> What is a covid patient? One that tested positive and is in the hospital for something else? Or one that is actually sick from covid? Because absolutely none of these articles I read clarify that tidbit and it is very important.

The stories on the reddits I suggested are all pretty much the same. Patient comes in struggling to breath, tests positive for covid, ends up with blood clots or pneumonia which pushes them into the ICU.

Here's just one of many stories of burnout [1]

[1] https://www.reddit.com/r/nursing/comments/p9ps06/the_burn_ou...

[spookthesunset]

Those are anecdotes not data.

[cogman10]

Clearly.

> So, the anecdotal evidence would be...

I'm not trying to represent it as anything other than that.

[kxyvr]

Yes. Unquestionably.

Here are a few different articles from around the gulf coast states that speak to this:

https://www.khou.com/article/news/health/coronavirus/houston...

https://www.npr.org/2021/08/19/1029260134/alabama-hospitals-...

Something that may be a little confusing as well is what does "full" mean. Both morally and legally, it is very difficult for a hospital to turn someone away. Rather than turn someone away, the hospital will have new people wait, attempt to make more room, and provide less care to more people. This leads to the question: Is a hospital full if they're stashing patients in hallways and providing hallway care? Within an ICU, typical care is either one nurse to two patients or one to one depending on the reason for the ICU stay. At the moment, the ratios are 3-4 to 1, which is not the standard of care, but the best they can do. Does this count as a hospital being full?

On a more personal note, my wife is an ICU physician. At the moment, I'm writing this from a hotel room because I started traveling with her to help alleviate the stress from her work. On this trip, she will do seven days of twelve hour shifts in a row. The hospital has asked us to stay for longer, but we're exhausted and have work elsewhere. This sort of thing does not happen during flu season, so I will assert strongly that we are still not close to the realm of normal.

In a direct answer to your manpower question, this hospital does not have enough staff. They don't have enough physicians and they don't have enough nurses. Recently, this particular hospital acquired multiple new ECMO units, which do absolutely help with care. They can't use them. They don't have the nurses.

As one more anecdote, a friend of my wife who is also an ICU physician called the other day with a story from her unit. She just admitted a patient who spent six days waiting in the ER with COVID. They had no available, staffed beds until then.

Now, to be sure, I am just another voice on the internet. You can choose to believe me or not and that's fine. I will say that getting news from what actually occurs in the hospital is difficult. Reporters are people too and they're not necessarily trained to understand the nuance of hospital reality. That doesn't mean what they report isn't useful, but it may be frustratingly incomplete.

Some questions that may help with any personal investigation:

1. What are the number of staffed bed available in the hospital? Beds are different than staffed beds, but they are sometimes used synonymously. Right now, with the lack of staff, it may not be.

2. Are the ICUs in the Level 1, 2, or 3 trauma centers full? Trauma center designation gives information about the number and type of staff that a hospital is required to keep available 24-hours a day. Generally speaking, the large trauma centers have better staff and better equipment. Even if there is an ICU bed available in a regional medical center, it doesn't mean it can provide the care required. Simply, they may not have the equipment or specialists required for care. As long as the large hospitals in the cities are full then transfer is not possible and overall medical care in that region is reduced.

[aero142]

From what you are hearing, are staffing levels the same as pre-covid, and how much is reduced staff vs increased COVID patients contributing?

[kxyvr]

That, I don't know. Since we've been together, prior to COVID, I never recall her mentioning they had trouble getting nurses. If there was a particularly busy night, the nurse manager had a number of nurses on-call who would then come in to staff beds. Now, that's impossible. They're not there. On top of that, the nursing staff calls out sick far more often now than before.

Are these difficulties because there are fewer nurses on the market, the existing staff are burned out, there are better opportunities to work locums, or some other factor? Not sure. Mostly, it's to say that there was never a conversation between us on the lack of nurses prior to COVID.

As far as physicians, also not sure. I will say that demand was consistent prior to COVID, but now demand for both temporary and permanent positions is extremely high. They won't stop calling. Something to understand here is that the supply of new critical care physicians takes a very long time to ramp up, four years of medical school, four years of residency, and two years of fellowship. They're not easy to replace.

As a final side note, whether they do or not, they would all like to quit. They're burned out. This has gone on too long. The families dealing with end of life care are often abusive. Virtually all of their patients are unvaccinated, which means that this is preventable. They're frustrated that their professional opinion has very little impact on the public discussion of COVID, especially when they deal with the issue so intimately and they spent a good portion of their life dedicated to understanding and treating the issues behind illness.

[kolanos]

> More than 260 hospitals and health systems furloughed workers in the last year, and many others implemented layoffs.

[0]: https://www.beckershospitalreview.com/finance/20-hospitals-l...

[spookthesunset]

Those articles never define what “covid hospitalization” means. Is it people in the hospital because of covid or is it people that test positive for covid and are there for something else? There is a big difference between the two. Covid positive test results probably invoke a lot of extra overhead even if the patient has no symptoms and this could be a self made problem.

[kxyvr]

If someone is COVID positive, then they are likely contagious even if they have no symptoms. This means that they must be isolated from the other patients that do not have COVID or else there is a high risk of infection spreading to other patients. In places like the ICU, where all of the patients are critically ill, any additional infection will likely kill them.

Isolation from other patients means that they need other rooms and other nurses. It is not safe to have a nurse go from a clean room to a COVID room repeatedly if they don't have enough PPE to fully gown between rooms. Otherwise, there is cross contamination. Currently, there is not enough PPE. If a hospital has the staff, they will also isolate the physicians to either COVID or non-COVID wards to prevent cross contamination. Often, they do not have the physicians, so there is a time cost to constantly changing PPE. Time spent changing PPE means time not taking care of patients.

When a patient dies in a COVID room, the room must be cleaned. This takes time and staff. Failure to do so can also lead to increased infections.

To be clear, infections that spread in the hospital are very well studied. It's the reason why hospitals have very strict rules about things like hand hygiene. It's one of those inspections that can cost a hospital a lot of money.

That's a long way to say, it's not a self made problem. A patient that comes in for something like a heart stent who is also COVID positive is far more work than one who does not have COVID. I do not know if these news articles are referring to these cases as COVID hospitalizations. In some sense, it doesn't impact the broader issue: In a good number of states, hospitals are effectively full. The reason behind this issue is unvaccinated people catching COVID.

[spookthesunset]

It is a self made problem. Imagine if we tested people for every infectious disease and put them into crazy protocol-land even if they don’t have symptoms. Nothing would ever get done!

We need to accept that vaccines exist and work. It shouldn’t matter if the dude in the hospital has a positive covid test because everybody in that room can be vaccinated if they want to.

This mass testing created a bunch more problems than it solved.

[kxyvr]

No. It is not.

The difference between COVID and something like cancer is that cancer is not highly contagious. COVID is. Further, it's contagious and deadly. That's why it requires special care. COVID is also not the only disease where these kind of precautions are taken. Another one is TB. Now, there are other diseases that are contagious, but not right now. For example, syphilis is both contagious and deadly. However, you're not going to catch syphilis when you're sitting next to someone who is positive. With COVID, you potentially will. That's why they have to test for it in the hospital.

Now, I will agree that vaccines exist and work. In the sense that there are people who choose to refuse vaccination, I will also agree it is a self made problem. However, this affects everyone to a high degree and not just the vaccinated.

Case in point, my wife and I are vaccinated. If she gets COVID, she most assuredly won't die, but she can't work in the ICU. She would risk getting her patients infected even though she is vaccinated. That means the hospital loses a physician in short supply. They're going to test you in the hospital because they can't afford you getting their staff sick.

This also affects you. You're vaccinated. However, say you're appendix bursts, you may or may not be able to get into the ER before you become septic. Yes, the ER will triage based on need. However, if there's no beds there's no beds and you will not be seen.

However, to reiterate, the hospital will always test you for diseases that they believe will affect their staff. You come in with respiratory symptoms. You're getting a COVID test. Having surgery? They'll test you for HIV. It's a protection issue. COVID is a pain because airborne infections are hard to contain.

[zeku]

Here is the Tennessee reporting. NO ICU beds.

https://www.tennessean.com/story/news/health/2021/08/19/tenn...

[JamesSwift]

Anecdotal, but an acquaintance here in Florida had to wait over 14 hours to get an emergency appendectomy (and over 12 hours to get from check-in to a bed in the ER) recently, due to both COVID protocols as well as COVID workload.

[Calavar]

Total bed usage is a very poor metric for this.

The bottlenecks here aren't total capacity, they are (in order of importance) 1. the number of vents, 2. the number of nurses with ICU level training, and 3. the number of ICU beds. The total number of hospital beds doesn't even factor in.

Source: I am a physician.

[onlyrealcuzzo]

Vaccinated Covid patients are NOT overwhelming hospitals. LA county isn't that extraordinarily highly vaccinated. It's a county much denser and with a greater population than a lot of countries in Europe. There's been <4000 fully vaccinated people in 8 months admitted to the hospital. Only 36 have died. Not a lot more have needed ventilators.

This is a blip in the ocean of hospitalizations in LA county.

[hncurious]

It does sound like they are on the verge of collapse...

"Tallia says his hospital is 'managing, but just barely,' at keeping up with the increased number of sick patients in the last three weeks. The hospital’s urgent-care centers have also been inundated, and its outpatient clinics have no appointments available.”

"Dr. Bernard Camins, associate professor of infectious diseases at the University of Alabama at Birmingham, says that UAB Hospital cancelled elective surgeries scheduled for Thursday and Friday of last week to make more beds available"

“We had to treat patients in places where we normally wouldn’t, like in recovery rooms,” says Camins. “The emergency room was very crowded, both with sick patients who needed to be admitted”

"In CA… several hospitals have set up large 'surge tents' outside their emergency departments to accommodate and treat … patients. Even then, the LA Times reported this week, emergency departments had standing-room only, and some patients had to be treated in hallways.”

“Hospitals across the state are sending away ambulances, flying in nurses from out of state and not letting children visit their loved ones for fear they’ll spread… Others are canceling surgeries and erecting tents in their parking lots to triage the hordes of… patients.”

“We’ve never had so many patients,” said Adrian Cotton, chief of medical operations at Loma Linda University Health in San Bernardino County.”

...but then again, maybe not. These are all quotes from 2018, flu season.

https://twitter.com/justin_hart/status/1422243808536715265

[umvi]

> How can things be normal if our healthcare systems are nearing collapse?

Why are healthcare systems unable to scale (horizontally or vertically) to meet demand unlike every other industry in the world? That should be a red flag that you don't have a robust system when it is unable to scale. We've had nearly 2 years since the start of covid to make healthcare systems more robust. Why haven't we? Maybe we should focus on that instead of telling people to mask up from cradle to grave.

Imagine if the computer industry were the same and we asked people to limit their internet time for 2+ years because the servers and routers that make up the internet were always on the brink of collapse? Like... wouldn't we just build more servers and routers until demand could be met?

[switch007]

> COVID patients are overwhelming hospitals across the world

Extraordinary claims…

[hcurtiss]

It seems one option is to increase hospital capacity. There should be ways to do this without needing more RNs and MDs.

[treesknees]

This is a pretty ignorant suggestion. It's like saying that my company should dramatically increase its software output without hiring software engineers. These are people, not robots. You must hire more skilled labor if you wish to expand the capacity which requires that labor.

If you're saying we should fill that labor requirement with low-skill medical technicians, you're misunderstanding the needs of the hospital. If you are ending up in the ER or ICU with covid, or any other cause, you are beyond the help of an at-home med tech, which is why you're at the hospital in the first place.

[bko]

We get more efficiency out of nearly every sector of the economy. We grow more food despite an ever decreasing number of farmers.

The problem is that the incentives aren't aligned with health care primarily due to third party payer system and onerous regulations.

You ever wonder why there is a line of people outside of urgent care every day to get tested for covid? Presumably, there are cheap tests that be administered at home without having to see a nurse or doctor. Or if you really can't do that you can train someone how to administer tests in a few hours and have that as a service. But in the US at least, it's nearly impossible to do these things. It took until April 2021 for the FDA to approve at home covid tests, and they're still not popular or available (at least I haven't seen them)

https://www.npr.org/sections/coronavirus-live-updates/2021/0...

[treesknees]

COVID testing is not the same thing. You don't need ER or ICU experience to administer one.

[tomp]

Medicine is a field notorious for its gatekeeping.

But a lot can be done. In Italy during the height of the pandemic, they "emergency graduated" 5th (or maybe 6th ... near the end) year medical students. I really wonder if there's any data whether they provided worse care after some on-the-job training than "fully educated" practitioners.

[treesknees]

It's not gatekeeping when you're talking about life or death emergency medical care. Taking students out of school isn't a solution, it's an act of desperation.

If I have a private pilots license and the pilot of my commercial aircraft is incapacitated, sure I'm technically more qualified than the others on the aircraft to try to perform an emergency landing. But that doesn't mean American Airlines should be expanding their routes because I could land a plane.

[rabboRubble]

duuuuuuuuude do you have any idea how labor intensive care for ICU patients is? ICU patients can't move. Requires staff to turn them so they don't get bed sores and to prone them stomach down for lung function.

If the ICU patient can't breathe on a vent and are able to secure ECMO, the ECMO specialist ratio is ideally 1:1. Under a crush of patients maybe 1:2 patients. A 1:3 ratio is risking all the patients under that specialist's care because the patients are all too tenuous. Let me reiterate and restate: 3 ECMO patients are too much for a single ES to support.

The ECMO specialist isn't the only person caring for the patient. There is the ICU nursing staff, the pulmonary therapist, plus the actual pulmonary doctors, the renal doctors, plus plus plus. You are talking decades if not a hundred+ years of study just to take care of a single ICU patient.

Labor and not beds is the bottleneck.

[mywittyname]

That's not an option. Hospitals in many were already understaffed before the pandemic. And the pandemic has caused such a severe worker shortage that traveling RNs are getting paid upwards of $200/hr in remote parts of the USA.

The only way to deal with this pandemic is to vaccinate as many people as possible. It's the best way that we know of to reduce spread of, and the effects of catching covid-19.

[qwerty456127]

> Hospitals in many were already understaffed before the pandemic. And the pandemic has caused such a severe worker shortage that traveling RNs are getting paid upwards of $200/hr in remote parts of the USA.

This has always been a systemic problem of how hard medical education and license are to get. I'm pretty sure medical personnel can be trained to reasonable (mediocre but better than nothing) skill level much faster and for much cheaper than it normally is.

[xyzzyz]

Yeah, if the problem is lack of staff in COVID wards, just start COVID-specific training programs and hire COVID-specific personnel, who are only allowed to work with COVID patients. That should reduce training time a lot.

This approach might sound like some completely out of the box, untested and extreme approach, yet it’s completely standard in industries that are not as heavily regulated as medicine is. Alas, healthcare has its Rules and Procedures and Best Practices, and as a result, everyone else must adjust and implement novel approaches, so that the healthcare industrial and regulatory complex doesn’t have to.

[TheCapn]

The vast majority of COVID patients aren't just "COVID patients". They're people with comorbidities that put them in a more serious position than a regular (otherwise healthy) individual with a respiratory illness. To "specialize" in COVID you likely need to have training on diabetes, neuro, renal, cardiac and other systems. To a certain point, you just need a fully trained nurse because you can't specialize too deeply on "COVID" without needing training on the comorbidties that come along with an ICU patient.

I guess I'm bias because my spouse is an ICU RN, but the ignorance of HN comments boggles my mind. Do all the hackers try to solve domain problems they have absolutely 0 experience in? I don't pretend to have solutions for the healthcare system because I don't work in the healthcare domain. I can assure you, the red tape that exists is there for very good reasons, because we've tried "unregulated" systems and they were a disaster. We've learned from our mistakes, and that means rigor that can't be replaced by some keyboard jockey writing webdev or embedded systems for unrelated fields.

[selimthegrim]

And knowing they are going to get laid off when COVID dies down, do you expect people to be stampeding to be hired to a job with no transferable skills? Have you seen the Medicaid nursing home labor pool?

[kolanos]

> That's not an option. Hospitals in many were already understaffed before the pandemic. And the pandemic has caused such a severe worker shortage that traveling RNs are getting paid upwards of $200/hr in remote parts of the USA.

How did this understaffing happen?

> More than 260 hospitals and health systems furloughed workers in the last year, and many others implemented layoffs.

[0]: https://www.beckershospitalreview.com/finance/20-hospitals-l...

[mywittyname]

As someone whose partner is a med-surg nurse, and whose extended friend circle contains a lot of current and (mostly)former nurses, that post is not really the case. That's like saying that the shortage of software engineers is down to InfoSys having a bunch of IT layoffs.

The big issues are: the job sucks, the patients suck, the insurance companies suck, the hospital administration sucks. It's a hard, thankless job, where you get shit on all day by everyone, figuratively and literally, and for not much pay. Pre-COVID, pay was maybe $30-35/hr for most floor jobs. Or you could get an hospital office job, making more than that working a basic 9-5, no shit, no working holidays, no lawsuits (due to bone-headed coworkers fucking up), no feeling like a waiter, or being groped by patients.

Nursing is a terrible career anymore.

[greedo]

Hmm, who provides care at a hospital? Wow, RNs and MDs. Do you expect a janitor to intubate you? Increasing hospital capacity is hard, expensive and takes time.

[qwerty456127]

I don't need a person with a doctorate degree to treat me. I just need a person who has a reasonable understanding of how does a human body work and a reasonable skill of doing particular medical procedures.

[greedo]

Doctors generally don't have doctorate degrees. That's a Ph.D which is a doctor of philosophy degree. A physician becomes a doctor by earning degrees as an M.D., doctor of medicine, or D.O., doctor of osteopathic medicine.

What you're describing is either an MD, a NP, or a traditional nurse/specialist.

[nradov]

Intubation procedures are often performed by respiratory therapists.

[HarryHirsch]

You go first! We'll give you 6 weeks training, and then you can go work in intensive care around infectious patients.

[nradov]

You seem to be ignorant about health care. Respiratory therapists have at least 2 years of training.

[ekianjo]

There's never been a better reason to start building capacity.

[TomVDB]

Spend a bit of time on the /r/nursing subreddit and weep.

ICU nurses have been worked to the bone for 18 months now, and often already at higher patient/nurse ratios that customary.

The coming problem won’t be one one of insufficient beds but insufficient people to care for them.

[001spartan]

I agree! But the issue is that where these processes exist they are not designed for the scale of the current pandemic, are too inconsistent when implemented, and rely on spare personnel that do not currently exist.

[anthomtb]

Do you believe that expensive cures are preferable to cheap preventions?

[qwerty456127]

Politicians say this all the time. I doubt anything we can do can change this. Just build more hospitals. We have resolved the masks shortage, we will resolve the shortage of ventilators and hospitals also. We can even soften the shortage of medical personnel by directing the unemployed to paid full-time medical boot camps.

I understand this is much easier said than done but we hardly have a choice if we actually want to do something useful.

[nradov]

There was never a real ventilator shortage. Doctors figured out quickly that mechanical ventilation does more harm than good for the vast majority of COVID-19 patients. It's only used on a few percent of hospitalized patients now.

https://www.cdc.gov/nchs/covid19/nhcs/intubation-ventilator-...

[001spartan]

Building more hospitals is a long-term process. Training medical personnel is a long-term process. Emergency measures intended to bridge the gap are untenable politically, and people are dying because of it. Thousands of them per day.

The answer to this is not to say 'we can't fix the underlying issues right now, so we're not going to do anything'. The answer is to take measures that we _can_ implement until those longer-term solutions can come into play.

[N1H1L]

> Building more hospitals is a long-term process. Training medical personnel is a long-term process. Emergency measures intended to bridge the gap are untenable politically, and people are dying because of it. Thousands of them per day.

It's like the whole chip shortage thing. Most people ask why aren't we building more chip-building plants? The answer is we are doing that, but it takes billions of dollars and a lot of trained manpower to set up such a factory, and all of that takes a lot of time.

These are what are called in economics as highly inelastic supplies, which it seems is unknown to many commentators, who BTW have a habit of quoting Econ 101 in every discussion.

[qwerty456127]

What measures we can implement doesn't matter if these measures don't work.

[001spartan]

Vaccines work. Vaccinated people are far less likely to contract COVID, and when they do they are far less likely to require healthcare resources beyond the standard treatments for someone who has the flu (stay home, rest, treat symptoms as needed).

Social distancing and masking work. They reduce the possibilities for spread between people -- not perfectly, but enough to reduce it to a manageable level for our current healthcare resources.

Saying that our current measures to combat the virus don't work is disingenuous at best, and a blatant disregard for everything we've learned from the past year and a half at worst.

[qwerty456127]

> Vaccines work.

I have always been a vaccine enthusiast but now I see infection surging even in the most vaccinated areas.

> masking work

I have always been saying this, even when officials denied. Yes, mandatory masks in public transport and grocery stores are the only of all the deployed measures I recognize as actually working.

> blatant disregard for everything we've learned from the past year and a half at worst.

I actually don't think we have learnt much.

[001spartan]

The vaccines are not failing. They are incredibly effective at preventing infections _and_ reducing severity of breakthrough infections. The Delta variant is more easily transmitted and more likely to cause breakthrough infections, but that does not account for the majority of the surge [0]. It's largely a surge amongst unvaccinated populations, buoyed by a smaller proportion of breakthrough infections. The ease with which Delta spreads, combined with relaxed restrictions on gatherings and masking, accounts for the surge in infections.

Despite the decline in vaccine effectiveness (I've seen conflicting studies of how much this has changed), they're still incredibly effective compared to any other protection we have at the moment.

None of this changes the fact that people are going to continue to die until a higher proportion of the population receives a COVID vaccine -- and that we _can_ mitigate this through other measures. None of these things lead me to the conclusion that we should return to normal and accept an increased healthcare system burden and death rate.

[0] https://www.cdc.gov/mmwr/volumes/70/wr/mm7034e1.htm?s_cid=mm...

[drunner]

> I have always been a vaccine enthusiast but now I see infection surging even in the most vaccinated areas.

https://www.kff.org/policy-watch/covid-19-vaccine-breakthrou...

    The reported share of COVID-19 cases among those not fully vaccinated ranged from 94.1% in Arizona to 99.85% Connecticut.


    The share of hospitalizations among those with COVID-19 who are not fully vaccinated ranged from in 95.02% in Alaska to 99.93% in New Jersey. (Note: Hospitalization may or may not have been due to COVID-19.)


    The share of deaths among people with COVID-19 who are not fully vaccinated ranged from to 96.91% in Montana to 99.91% in New Jersey. (Note: Deaths may or may not have been due to COVID-19.)

[gunshai]

My company had out local health official come to our town hall meeting at talk. About covid.

Over 94% of patients are unvaccinated... It's pretty clear in my mind what's happening here.

[jrockway]

If medical boot camps are as effective as Javascript boot camps... you may want to wait a while before exposing yourself to other people's germs.

[tharne]

> If medical boot camps are as effective as Javascript boot camps... you may want to wait a while before exposing yourself to other people's germs.

This line made me both laugh and cry a little.

[spiderice]

This is an incredibly bad faith argument. There is a whole lot of room between a 6 week bootcamp and a 12 year medical program. I'm pretty confident someone would learn to treat Covid patients in 2 years.

edit: your comment did make me laugh though. So perhaps you were just going for humor, in which case you succeeded and I apologize for being a wet blanket.

[zzt123]

So, the initial job will get done, but please don’t look under the covers, and please do not attack it with anything infectious?

Might be better than having nothing, in the case of ICUs being overwhelmed and overcapacitied.

[vanattab]

Lol homeless people with scalpels what could go wrong?

[qwerty456127]

Besides hardcore homeless drunkards there is a sufficient population of totally reasonable people who have just lost their jobs because of the crisis and can totally do nurse/paramedic job if taught for free and supported financially. I would steadily go for this if I had lost my job.