Wednesday, March 25, 2020

Last Call For The Curve Flattened Us

Welcome to hell.  It is here, now in NYC.  Soon it will be all over.

In several hours on Tuesday, Dr. Ashley Bray performed chest compressions at Elmhurst Hospital Center on a woman in her 80s, a man in his 60s and a 38-year-old who reminded the doctor of her fiancé. All had tested positive for the coronavirus and had gone into cardiac arrest. All eventually died.

Elmhurst, a 545-bed public hospital in Queens, has begun transferring patients not suffering from coronavirus to other hospitals as it moves toward becoming dedicated entirely to the outbreak. Doctors and nurses have struggled to make do with a few dozen ventilators. Calls over a loudspeaker of “Team 700,” the code for when a patient is on the verge of death, come several times a shift. Some have died inside the emergency room while waiting for a bed.

A refrigerated truck has been stationed outside to hold the bodies of the dead. Over the past 24 hours, New York City’s public hospital system said in a statement, 13 people at Elmhurst had died.

“It’s apocalyptic,” said Dr. Bray, 27, a general medicine resident at the hospital.

Across the city, which has become the epicenter of the coronavirus outbreak in the United States, hospitals are beginning to confront the kind of harrowing surge in cases that has overwhelmed health care systems in China, Italy and other countries. On Wednesday evening, New York City reported 20,011 confirmed cases and 280 deaths.

More than 3,922 coronavirus patients have been hospitalized in the city. Gov. Andrew M. Cuomo on Wednesday offered a glimmer of hope that social-distancing measures were starting to slow the growth in hospitalizations statewide. This week, the state’s hospitalization estimations were down markedly, from a doubling of cases every two days to every four days.

It is “almost too good to be true,” Mr. Cuomo said.

Still, hospitals are under siege. New York City’s hospitals run the gamut from prestigious teaching institutions catering to the elite to public hospitals providing care for some of the poorest communities in the nation. Regardless of whom they serve, few have been spared the impact of the pandemic: A flood of sick and fearful New Yorkers has besieged emergency rooms across the city.

Working with state and federal officials, hospitals have repeatedly expanded the portions of their buildings equipped to handle patients who had stayed home until worsening fevers and difficulty breathing forced them into emergency rooms. Elmhurst, among the hardest-hit hospitals in the city, is a prime example of the hardships medical centers and their staffs are facing across the country.

“Elmhurst is at the center of this crisis, and it’s the number one priority of our public hospital system right now,” the city’s public hospital system’s statement said. “The front line staff are going above and beyond in this crisis, and we continue surging supplies and personnel to this critical facility to keep pace with the crisis.”

Dr. Mitchell Katz, the head of the Health and Hospitals Corporation, which operates New York City’s public hospitals, said plans were underway to transform many areas of the Elmhurst hospital into intensive care units for extremely sick patients.

But New York’s hospitals may be about to lose their leeway for creativity in finding spaces.

All of the more than 1,800 intensive care beds in the city are expected to be full by Friday, according to a Federal Emergency Management Agency briefing obtained by The New York Times. Patients could stay for weeks, limiting space for newly sickened people.

Expect this to be duplicated in hundreds of hospitals around the country in the next few months.  Unless the curve is flattened on the spread of COVID-19, the casualties will be catastrophic, and every single indication I have seen is that Trump's failure is so utterly complete that there is no possible way to avoid massive casualties from this virus.

It will be the worst event of your lifetime, bar none.

Let's Make A Deal

The Senate is voting on the big $2 trillion COVID-19 aid package, and it's still very much a Big Casino moment for the banks in particular.  The bottom line is while small businesses are going to get loans and most Americans will get that $1,200 check, the banks and hedge funds will benefit the most, and they'll have the first crack at gobbling up what resources remain when all of this is over.

Businesses controlled by President Trump and his children would be prohibited from receiving loans or investments from Treasury Department programs included in a $2 trillion stimulus plan agreed to early Wednesday by White House and Senate leaders in response to the coronavirus crisis.

The provision, which was touted by Senate Minority Leader Charles E. Schumer (D-N.Y.) in an early-morning letter to colleagues, would also apply to Vice President Pence, members of Congress and heads of federal departments, as well as their children, spouses and in-laws.

During a television interview Wednesday morning, Schumer stressed that the provision applies not only to Trump but to “any major figure in government.”

“That makes sense. Those of us who write the law shouldn’t benefit from the law,” Schumer said on CNN.

The Senate plans to vote later Wednesday on the massive package, which aims to flood the economy with capital by sending $1,200 checks to many Americans, creating a $367 billion loan program for small businesses and setting up a $500 billion fund for industries, cities and states. The House is expected to act in coming days.

Trump’s dual roles as both chief executive of the nation and owner of a sprawling business empire has been frequently criticized by Democrats, who accuse him of trying to profit from the presidency.

Shutting Trump, the cabinet, and Congress from profiting off this is a good thing, and checks will be cut on April 6 under this legislation, it does increase unemployment insurance and laid off workers will get paid for up to four months.  That part is fine.  But the GOP gets their slush fund anyway.

Wall Street is going to make trillions off this, and everyone knows it.

It's a bad bill.  It's precisely what I expected the Senate GOP to create.

Nancy Pelosi and the House now get their crack at this, and it's time to bring the GOP to their knees.

The Worst-Case Scenario, Con't

Understand something, guys.

If we don't practice social distancing, if we don't flatten the curve, if we don't prevent hospitals from being overwhelmed, then people are going to start dying by the thousands.

Your state already has instructions on who lives and who dies in a COVID-19 overload situation with limited respirators.  Alabama certainly does, and it will be replicated nationally.

In the coming weeks, difficult decisions about who will live and who will die in Alabama may hinge on a little-discussed document outlining the state’s suggested “criteria for mechanical ventilator triage” during pandemics like the current COVID-19 outbreak.

According to the state document, any of a wide range of underlying health conditions – such as metastasized cancer, AIDS, “severe mental retardation,” advanced dementia and “severe burns” – could disqualify patients from being put on potentially lifesaving ventilators if a pandemic grows dire enough. And some people already on ventilators could be removed from them to make space for people impacted by the pandemic, according to the guidance.

Over the past two weeks, doctors in Italy have called on the world to take the disease more seriously, sharing horror stories about having to choose which people to put on ventilators. They have had to make those dire decisions based on patients’ age, underlying health problems and other considerations.

Under the triage criteria, which the Alabama Department of Public Health initially drafted in 2009, many patients could be denied access to ventilators and instead relegated to in-patient or home palliative care.

In April 2010, the State Committee of Public Health approved a revised version of the protocol detailing the exact processes hospitals and health care facilities should follow when making such decisions during a deadly flu outbreak or other major pandemic.

“ADPH suggests that hospitals utilize this criteria as a template for local and regional disaster management plans,” according to a 2009 ADPH study on the ethics of disaster response that analyzed the draft version of the protocol.

Let me reiterate.

The triage code blue people get palliative care.  That means end-of-life.  That means they die.  The red people get moved to blue if there aren't enough respirators.  The yellow are saveable to an extent but if they get worse and slip into red, they risk a doctor saying "We need this respirator to save someone who has a better chance of surviving."

And then they die.

When I say "hospitals are going to be overloaded" I mean they will be forced to make decisions like this.  Decisions where people no longer get treatment and are made comfortable in their final moments.

And then they die.

Do we understand now about why social distancing is important?

Stay home.
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