UNDfaninMICH

Around here students on clinical rotations are still attending them.

Where did I say that all people should be seeking care? I am not in a rural area, I accept patients from rural areas. When we’re very busy, patients sometimes wait hours in ER’s of rural hospitals for an EMS crew to transport them to us. Maybe things aren’t that way in MN/ND, but I didn’t realize the discussion was limited to specific geographic areas. 100% agree that people shouldn’t call an ambulance to their homes for a large amount of the things they do call for, and that people go to the ED way too often when they have zero emergency, but that’s not changing.

So why do we have medical care at all?

WTF. If my loved ones are going to die I want them to die on the utmost amount of support that they choose, within reason. I sure as hell don't want them to die because there was no ICU bed, or no ventilator, or because the ER wait time was too long.

I have grave concern about fever being the marker that should lead to quarantine/isolation/testing. Chinese data showed 84% of their patients who were positive for Covid-19 had fever. I don't know to what degree they were testing the ambulatory person with simple cold symptoms. If we could be confident that fever is the indication that a person is shedding, we could get back to business as usual aside from screening everybody for fever as they're queuing up for whatever public gathering they're wanting to attend. People don't want to hear this message because it's a nightmare for hospital staffing. Fortunately it sounds like my hospital system will have on-site testing soon, so I'm hopeful that's true for other areas as well.

Can we stop with this? It is recognized that viruses will kill people, and to stop that from happening would require virtually complete isolation. People who have died from influenza in recent years have by and large died while receiving maximum therapy for their degree of illness, assuming they didn't elect personally to just let the flu kill them without intervention. The H1N1 outbreak may be an exception, and one could argue that more should have been done back then. The concern with a pandemic from a novel virus strain is that the volume of patients needing major interventions to keep them alive will be greater than the number of beds, staff, and equipment available to provide them that care. EMS transport crews may be overwhelmed, requiring people chill at home for a while if they have rapid onset of symptoms, or requiring people to wait in their doctor's office or rural hospital for hours until a crew can transport them. Yes, this stuff is already happening far more than it should happen, but there is potential for a huge increase in these issues, leading perhaps to people dying not because there was nothing more technology and medical care could do for them, but because we ran out of technology for them.

I'm more on the side of infection being pretty damn hard to prevent, but let's not get entire communities infected at once so that we don't run out of beds, staff, equipment, etc.

I don't know that access to testing is going to be a panacea. Get tested now, be negative. Maybe your next illness is coronavirus. How many resources are we going to plow into repeatedly testing each person each time he or she has a cold?

Supply: Here's what happens in my community: Get extensive training in medicine, become a practicing physician. Get put on a committee or two, do things that please the higher ups, like find ways to get the grunts to do even more work. Maybe have some connections to wealthy donors. Get sent to an MBA program at the expense of the hospital system (truly, at the expense of the general public who pay for it via their insurers). That MBA will be from a school that is not at all respected outside of our little community. Finish MBA, become a newly minted executive, abandon your clinical practice that you were heavily trained for and experienced in, double your salary. Demand: Who is creating this demand? The executives who want to decrease their workloads, so they find a few sub-executives? Again, the growth in executive positions in healthcare systems (including medical schools) is growing at a staggering rate, at least around here. Someone retires, and his job is then split into two brand new positions. Add in the executives at the medical board for each specialty, as well as the executives in professional organizations for each specialty. Oh, and look out for NEW subspecialties to be needlessly created so that people in academic medicine can have new ways to make money without seeing patients. https://www.kevinmd.com/blog/2014/05/physician-regulators-paid-front-line-doctors.html

So if it doesn’t make sense, should healthcare be a business venture? The number of “executives” at my institution has grown by leaps and bounds over the last 15 years, with little improvement in delivery of care. I assume the same is true across the country. There are quite a few people who perform huge roles related to service for the people of our country without the expectation of seven figure salaries. Hint: look north of Minot and west of Grand Forks.

That is exactly true. Why do we run healthcare enterprises as "businesses" rather than entities for the good of our citizens? Right now the "things" being bought with the money "saved" by remaining in a reactive state are big salaries to executives in hospitals, pharma companies, and insurance companies, to name a few. Hospital execs are being compensated in the millions, yet heaven forbid there be a nurse working a shift without a packed full assignment.

The widespread opinion amongst experts in epidemiology, infectious diseases, and public health is that the containment measures will reduce the number of dead as compared to what would happen with no containment measures. We will never know how bad things "could" have been if we chose to just live life as usual. But we can get some ideas of that from Italy, where the response to the initial cases was rather passive. Anyone who has an understanding of science will acknowledge that we can't truly know how bad things would have been by doing nothing. On the flip side, people who don't understand science are going to look at the numbers when/if this pandemic ends and say, "See, I told you it wasn't that bad!". I agree that hoarding foods and other items with a "me first" attitude is ludicrous, but that is a microcosm of American behavior as a whole. When public events were shut down in China, Italy, and South Korea were there riots? People shouldn't panic to that degree. Some people seem to be saying that public health experts are advocating for such panic, but that is patently false. My snarky side would say that apparently the bar for acceptable deaths is anything less than caused by H1N1 flu, so as long as the stabbing victim didn't die, things are apparently ok and stabbings should be tolerated as "not that bad" for now. When things settle down, will Americans be ready to have a conversation regarding why hospitals operate on very thin margins when it comes to resources like ICU beds, staffing, isolation gear, diagnostic test kits, devices, etc? Here's a starter: even though a pandemic from viruses like coronavirus has widely been anticipated, pharma companies have little motivation to work on medications that "might" be needed and won't see daily ongoing use even if they are needed, because such work isn't profitable to them. *Edited because I didn't mean to imply that there were in fact riots in China and South Korea.

What if... just what if Dr. Carlson based his data on the experience in China and South Korea, where containment measure were rapidly put into place and more widespread testing was available? Some people may have called those containment measures “panicking” at that time.

I can tell by the headline that this article won’t support my narrow worldview, so I’m not going to read it. Or maybe I will read it, but I will reject it as fake news.

Rather than testing the elderly and people with chronic conditions, I’m interested in testing the people who have some symptoms but are not all that sick. This would help us know the extent to which it may be spread by people who feel good enough to leave the house, as well as help guide which hospitalized patients should be maintained in special isolation. My local health department has said to test patients with symptoms who have risk by contact with known cases or by travel, or patients with severe illness even in the absence of other risk factors. Makes no sense to me.

Maybe the CDC will be hiring and you can make change.

I said that perhaps it will be right. In the end we’ll never know, unless we match regions of the country into social distancing vs life as usual groups, and introduce the same number of infected people into each.

And if some of the public health actions cut down on deaths, some around here will point at the total number of deaths and say, “See, I told you it wasn’t that bad!”, rather than acknowledging that perhaps officials made the right call.

You missed the big "if" in that article, which was if the bird flu virus mutates and becomes readily transmissible between people.

The president of Michigan State University just announced suspension of in-person classes until April 20, at a minimum. Some of his credentials follow: "Dr. Stanley has served as chair of the National Science Advisory Board for Biosecurity, which advises the U.S. government on issues related to the communication, dissemination and performance of sensitive biological research. He was a member of the National Advisory Allergy and Infectious Diseases Council at the NIH and a member of the NIH director’s Blue Ribbon Panel on the National Emerging Infectious Diseases Laboratories. He also served as an ambassador for the Paul G. Rogers Society for Global Health Research and has received an Honorary Doctorate in Science from Konkuk University in South Korea. He is a member of the Board of Directors of the Association of American Universities and has served on the NCAA Board of Directors and NCAA Board of Governors."

Not really. Slowing down the rate means ER wait times will be less, EMS crews won’t be as overwhelmed, and medical equipment like ventilators will be more readily available. Medical systems are generally not built with a lot of excess capacity.

If only everybody in THIS country was younger than 60 and in good health. Neither of those viruses are terribly likely to be harmful to that crowd. It’s the potential spread to vulnerable populations that should have people concerned. Most people with flu are (hopefully) wise enough to avoid others when they are experiencing the fever, chills, and cough that come with flu. I’m concerned that younger, healthy people with Covid-19 are going to simply have colds, and they’re going to want to keep on living their lives, putting others at risk.

I do not think people over 60 aren’t at risk from flu complications, I’m well aware that they are. How about addressing the other part of my post?

Perhaps because those people who aren’t severely affected are going to think that since they’re not very sick, it’s okay for them to go to work, school, church, public gatherings, etc. This would lead to spread to the elderly. Do people who are saying, “It’s not that bad if you’re under 60!” not care about older citizens?

I think that requirement starts October 1. https://www.syracuse.com/us-news/2019/10/what-is-real-id-enhanced-drivers-license-what-you-need-to-know-to-travel-next-year.html