Please consider ‘You Pick the People Who Are Going to Die’.
Gov. Andrew Cuomo sounded his loudest alarm yet on New York’s coronavirus crisis Tuesday, warning the curve was showing no signs of flattening out and was in fact rising faster and more dangerously than projected. He said last week that peak infection was 45 days out; now, he says, the state may see it in two weeks.
It looks like the wave will be bigger, and crash harder, than expected. “We have exhausted every option available to us,” Cuomo said Tuesday, declaring with unprecedented urgency that New York needs help now — and far more than it has gotten to date.
“The apex is higher than we thought and the apex is sooner than we thought. That is a bad combination of facts,” the governor said Tuesday. The rate of infection is doubling every three days. “We’re not slowing it — and it is accelerating on its own. We’re not looking at a freight train. We’re looking at a bullet train, because the numbers are going up that quickly.”
New York state saw its case total hit 26,348 by Tuesday as the death toll climbed to 271. New York City has more than 15,500 cases alone, adding another more than 3,000 since Monday as its death toll surged to at least 192. The five boroughs now account for 60 percent of the state’s total and about 35 percent of all cases in America.
Cuomo initially projected the state would need 110,000 hospital beds at the peak of the crisis. Now he believes New York will need up to 140,000 hospital beds. That’s more than double current capacity. The intensive care situation is worse; the state has 3,000 ICU units and may need up to 40,000, Cuomo said.
“What are we going to do with 400 ventilators when we need 30,000? You pick the 26,000 people who are going to die because you only sent 400 ventilators,” Cuomo said.
Western Country Cases
https://twitter.com/kr3at/status/1242602541218705414
New York Cases Doubling Every Three Days
Both Italy and Spain are so short of supplies, both countries are deciding who get treatment and who doesn’t.
https://twitter.com/kr3at/status/1242603378431201281
Shortage of Supplies
The chart of acute care beds shows the dire setup for the United states.
We are short of beds and short of respirators.
That relatively few in the US have died (so far) from the coronavirus is not the issue.
When you run out of beds and respirators deaths soar.
Calling Next of Kin
Without enough ventilators, NYC doctors now calling next of kin to EXTUBATE (remove breathing tube) of low probability survivors to help save high chance survivors.
1 Million US Cases, By When?
For further discussion, please see 1 Million US Cases, By When?
Mike “Mish” Shedlock
Will anyone ask the darn question “What is the survival rate of people on ventilators?” The answer is Wuhan was 5%, crappy odd. Even if we are better I still bet it’s less than 10% which will only marginally change the rate of deaths
Now Cuomo, slammed the door on anti-viral that drugs that have some old positive clinical data and directional success in other countries – the death are on his hands.
Let the front line doctors and patients make the decision – not governments.
Pretty clear what’s going on here. Cuomo didn’t plan or think clearly to protect his people, so before he gets crucified he starts shouting, “It’s the President’s fault! It’s the federal government’s fault!” Typical politician. We will be waiting forever for Cuomo, or any of his ilk, to say, “I blew it.”
“When you run out of beds and respirators deaths soar.”
That is not actually known. Just how many people are being saved by getting a ventilator? How many are dying even with a ventilator? Probably the most important therapy is antibiotics against opportunistic secondary infection (let’s hope the supply of antibiotics lasts). I haven’t seen a single stat on the effectivity of ventilation for surviving, as opposed to a last good will gesture to those who have few life years left anyways.
I thought New York was rich enough to order these equipments with a massive expedite fee. Cuomo is just another socialist bum crying for free stuff. Pay $500k per respirator, they will appear from every state in the union and every nation on the planet. Just sell some NY Bonds to fund it. Cuomo is only willing to pay $10k per respirator so he’s going to let New Yorkers die. It’s his own fault.
Cuomo is an idiot. God chooses who lives and who dies. Blame the folks who didn’t even care enough to take care of themselves when they had the chance, big fat obese smokers. Now folks blame trump or whomever. Let the fat folks reap what they sow.
False narrative
Most the people who need a ventilator will die even if they get it.
You’re not choosing who lives and dies with those, you’re choosing who is treated, with a historically low success rate of treatment
At least for those treated, they get to make one last 6-figure donation to our health care system
If it is a false narrative, why is the death rate 10% in countries where the health care system is overloaded, but only 1-2% elsewhere?
The health care system can be overloaded in many more ways than just a lack of ventilators, which was the only aspect he addressed.
Indeed it can, and perhaps the greatest damage is the damage to the morale of the medical staff, when their willingness to help turns to despair at being unable to give proper care. In any case, it all seems to hit at the same time, shortage of ventilators, morale, and higher death rate.
Realistically 50% survival on ventilators seems valid, that is what Italy is experiencing apparently. Long intensive care is needed sometimes also, well over a week. There are patients from Diamond Princess still severe, occasionally some recover, some not.
In Spain 14% of infected are medical staff, 20% in Andalucia, they will show a higher percentage because they have a certain priority to tests (often with delay though), but the number infected is what it is. A lot of complaints in Spain for lack of basic supplies to staff, the government has banned release of info on material requisitioned because taking supplies from one part of the country to another has led to complaints. E.g. they took the order due to be delivered to a regional authority and sent that elsewhere where it was deemed more nescessary.
I’m just quiet and watching what goes on at the moment, I don’t have much to add, as now what goes on is frontline/headline anyway. Keep up the good work all. Thanks Mish.
There was a doctor who treated some 350 patients with hydroxychloroquine. The group of patients required no hospitalization, thus no need for ventilators and there were no deaths among the group.
Cuomo banned the use hydroxychloroquine – CRAZY!
Which 26,000? Are there not that many at risk Social Justice Warriors in New York who like AOC? Can we get Breyer and RBG to visit NYC?
Well NJ top health official said everyone in that state would get it .
Newsome said 26 million in California would be infected .
Obama ex Health guy said 150 million plus .
So when all is said and done we will see about all those predictions holding up.
NC as of 2 days ago had around 250 cases and when ask they said only about
a dozen hospitalized 0 deaths
NY got 4k ventilators yesterday so do the math what number did they have
before and how many of the 20k plus are in the hospital and or ventilators needed
plus more ventilators are on the way . The numbers don’t add up .
I can see if this gets in the California homeless population that could really cause problems out there .
They do have studies that do indicate that heat and humidity inhibit the virus .
I’ve yet to find data that people who reach the ARDS stage with COVID-19 and get placed on a ventilator actually survive. I believe the prognosis for this situation is quite poor. Maybe Mish can use his skills interpretating data to enlighten us? Are we shutting down our economies to try and control something we cannot – the outcomes for the unlucky few who get the most severe cases?
I read recently that around 90% who are on a vent with Covid-19 die anyway. No I don’t have a link and I’m not going to go hunting for it. I think I read it here in a previous post.
However, the reality is that for all patients who end up on a vent – regardless of why or how – the mortality rate is over 50%.
I think you have to differentiate between mechanical ventilation (“life support”) and positive pressure ventilation (eg masks and those weird bubble helmets).
A lot of patients are needing and benefiting from the latter.
The one study I read on the former referred to a small number – maybe 26 – and all but one died.
Mechanical ventilation is tough on the body in the best of times. When docs talk about whether a patient will benefit from it, that’s a key issue.
In Wuhan, 95% of those who were ventilated died anyway
Small sample size, around 65 people.
Ventilators get a lot of attention, but in Italy now, even pure oxygan bottles, which the Chinese indicate was necessary, and helpful, for lots of patients, are now in short supply. Oxygen is also less demanding personnel wise, than ventilation.
Ramping up producing and filling tanks with oxygen, is preparation which near “any” state and locality can encourage. Ditto producing disinfectant, and repurposing sprayers from agriculture and vector control, to do battle against the virus. And also producing and securing antibiotics to combat any secondary infections arising.
The impact of proper medical care is visible clearly in the death statistics. In Wuhan, when they didn’t have care, the death rate was up around 10%, but once they built new hospitals and temporary hospitals in fell dramatically. In the rest of China, where it never got out of hand, it stayed around 1%.
Or, we can ignore the Chinese numbers, since no one believes them. In Italy, San Marino, and Spain, where their hospitals are over capacity, the death rate is going towards 10%. In countries where that is not true, the death rate runs between 1 and 2%.
Yes, proper medical care does save lives.
I think the “hospital beds” chart is very misleading. We have thousands of outpatient clinics that other countries simply don’t have. They “hospitalize” their patients for everything – even out patient procedures. So when taking this into account we have MORE hospital beds per capita than any other country. As for ventilators, we have more of those per capita as well.
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There is a tsunami coming for large metropolitan areas. It will start on the coasts and work its way inland once people start traveling again in the spring. Expect multiple outbreaks from coast to coast over the next few months IF normal life is resumed. We should be in a country-wide lockdown right now but we aren’t. Fortunately where I live things are not too bad because 85-90% of people are in a lockdown. This is an upper to upper-middle class suburb where college educated people don’t want to inundate our hospitals. I feel bad for any place where state or local government is not taking this seriously. Poorer areas will tend to fare worse because they are less educated and have sicker people in general. Good luck to all here regardless of what you believe, where you are or what you think.
There are some smaller hospitals with maybe just a few
ventilators. Small towns may experience some sad events if things aren’t well coordinated through their state authorities. We are incredibly fortunate to have Cuomo leading the charge.
Don’ t worry the virus will come to your area. Most college educated folks in upper middle class are obese and probably stuffing themselves even further. Drinking alcohol in your areas is the highest. so these fat gluttonous slobs should stay inside since they would be most vulnerable. The virus will wait though. so stay inside for several years
Not really. We were rated one of the 20 healthiest suburbs for the last 15 years running and it has only gotten healthier. People in older age groups run marathons and some of my colleagues at work run ultramarathons. This isn’t your typical suburb. People here continue their outdoor activities while staying safe.
Being in good shape is great, but I’m not sure if older ppl who can run marathons makes them any less susceptible for having serious complications from covid. My advice to any senior would be avoid social interactions.
In NYC The Bronx, the poorest boro, has the fewest cases. Prob b/c there are a lot of immigrants and they tend to be younger so they either dont show symptoms and/or dont require hospitilization.
They’re also the least affected by, in particular, European travel. “Everyone” who visits the US, visits Manhattan. Increasingly Brooklyn. And “everyone” on Manhattan either travels overseas, or work next to someone who does. Ditto “Every” hipster in Brooklyn, although their “work” may be a bit less structured.
IOW, part of the discrepancy could be just timing. But it does seem like youthful populations are better off.
Puerto Ricans put Garlic in everything and Mexicans put peppers in everything.