COVID-19 Thread

[Fear The Chorizo]

It's tough to really pin down what a "normal" hospital/ICU bed usage rate is prior to COVID-19 in the US because it does vary seasonally and from year to year, but conventional wisdom has that percentage hovering around 75%. If hospital bed capacity is far lower than that for too long, the hospital system suffers because it isn't making enough money with surgeries or procedures that require hospital bed use/equipment and staff to administer care to those patients - and medical costs as a whole increase to make up for lost revenue from too many empty beds. As hospital systems have gradually reopened for conducting non-COVID19 related procedures, we're now seeing concern about hospital bed capacities from people tracking daily tallies similarly to how they were tracking them in late March, but that data isn't being fully put into the context of what it means in late June. As far as I can tell, none of these apparent hot spot states with shrinking hospital system capacity are urgently requesting military/field hospitals be constructed, or even putting wheels into motion to get their untapped surge ICU bed capacities dusted off for use. This is in large part due to many of these COVID-19 hospitalization patients not showing up at hospitals with just COVID-19 symptoms requiring intubation - there are a large number of patients coming in for other surgeries, childbirths, other critical care that were set to take up a hospital bed for a few days anyways. These people are all tested (in part for infection safety but at this point equally for financial purposes), and a decent chunk have become COVID-19 positive cases who also are logged as hospitalizations even though they're not symptomatic.

 

Arizona is presently one of these apparent alarm bell states, which happens to have roughly 80-85% of its beds in use, both from a general hospital bed and ICU bed capacity. In a vacuum that number is indeed alarming, especially considering how many snowbirds may be spending the summer down there because it was difficult for them to travel back north. However digging more into AZ's numbers, the state still has roughly 60% of its ventilator capacity available and plenty of emergency department bed capacity. Also, daily COVID19 hospitalization discharges are spiking right along with the increases in both daily overall and COVID19-positive hospitalizations while COVID-related deaths are holding steady or even declining - indicative of patients who were admitted to a hospital for something other than COVID19 who tested positive for the virus while taking up a hospital bed until they were discharged a few days later because they were asymptomatic or simply didn't require continued hospitalization due to the virus.

 

I'm not saying AZ's numbers aren't worth watching closely in the coming weeks and months, but there's alot more to the data being looked at than what is being reported by those who are chasing where the 'next New York' is going to happen. Frankly, hospitalizations specific to COVID19 symptoms should be closely tracked everywhere - however the growing disconnect between case counts and the percentage of cases that require hospitalization entirely due to COVID19 symptoms needs to be better explained to the general public. Otherwise there will continue to be unnecessary panic every time a hospital system has more than 3/4 of its beds occupied. The steady rise of hospital bed use, including ICU bed use, is part of the medical system getting back to its business and the country as a whole maintaining its overall health due to all things non-COVID.

[logan82]

Once you get out of larger cities you have less interaction with people. Not less chance to spread but if it does spread it will spread to fewer people.

[PeaveyFury]

It's tough to really pin down what a "normal" hospital/ICU bed usage rate is prior to COVID-19 in the US because it does vary seasonally and from year to year, but conventional wisdom has that percentage hovering around 75%.

 

I'm certainly interested in reading up on this as well and it would be helpful to know where the conventional wisdom is coming from here. It would be interesting to review the source data as well.

[reillymcshane]

I live in a smaller community in north central Wisconsin, and we have a lot of older residents. Just based on my own observations, the elderly have been more diligent than younger people about using masks. A couple of 40 year olds walking into the grocery store are far less likely to be wearing a mask than a 60 or 70 year old. I'm surprised at how many families are out doing things who don't wear masks. 40 year old mom in the grocery store with four kids running around - stuff like that.

 

I'm guessing a lot of this comes from the fact that the elderly are far more vulnerable to the virus than young people. They don't want to die - makes sense.

 

It also might be that the older a person gets, the more likely he/she knows of someone who has gotten COVID - and in some cases, died from it.

 

Men seem to the more likely not to wear a mask (again, just from my observations). Especially (as I said before), younger men (below 50ish).

[CheezWizHed]

Especially (as I said before), younger men (below 50ish).

 

Best thing that I've read in a long time! Not that younger men don't wear masks...but that you consider under 50 to be younger-ish.

[Ron Robinsons Beard]

I live in a smaller community in north central Wisconsin, and we have a lot of older residents. Just based on my own observations, the elderly have been more diligent than younger people about using masks. A couple of 40 year olds walking into the grocery store are far less likely to be wearing a mask than a 60 or 70 year old. I'm surprised at how many families are out doing things who don't wear masks. 40 year old mom in the grocery store with four kids running around - stuff like that.

 

I'm guessing a lot of this comes from the fact that the elderly are far more vulnerable to the virus than young people. They don't want to die - makes sense.

 

It also might be that the older a person gets, the more likely he/she knows of someone who has gotten COVID - and in some cases, died from it.

 

Men seem to the more likely not to wear a mask (again, just from my observations). Especially (as I said before), younger men (below 50ish).

 

I live in a (very) small town in northern Wisconsin. I think most people around here are going pretty well safety-wise. One thing I have noticed, though, is in the touristy-type towns like Eagle River and Minocqua, people are basically operating like normal on weekends (i.e. large groups, no masks, in and out of every store downtown). I assume most of these people are vacationers and second homeowners from downstate or Illinois/Minnesota, but to me, that seems odd, as I would think if you live in an area where the virus is more prevalent, you'd be more precautious. But no ... I guess when you take a vacation from work, you take a vacation from safety as well. I've heard some rumblings that the majority of the ICU beds available at our hospitals up here (there aren't many) are filled with people who don't actually have a home address here.

 

This hasn't happened to me personally, but I've heard several reports of people actually being shamed for wearing masks some places around here. Like men walking up behind women and Baaaaing like a sheep, or people continuing to claim that you've "fallen for the hoax". If that happened to me in a store or out in public, I don't know how I would react, but it wouldn't be pleasantly.

[tmwiese55]

Good post Chorizo. I saw some yesterday where some of these spots do show other trends to show its more than "we're testing more" where things like hospitalization and such are more, there was one other factor I'm forgetting. But like you said, at this point I don't think it's freakout stage or anything, watch it closely and keep getting data and maybe specific spots need to clamp down a bit more. But seems early right now to make too much of it yet. One I've watched for a while is the active cases number/trend, after peaking and starting to dip that has been rising again. Overall not good sign, but again we are going to have spikes/blips or whatever especially since so much has reopened. Hopefully the next week or two the concerning numbers we've all been seeing pushed out there lately start to turn in a good way. If not, yea maybe some tweaks needs to be put in.

 

For masks discussion yesterday I did get an update and some clarification. About a week ago they were told they can ease up and not push it anymore. It's still not back to the old days of one per case but having to use for days isn't needed anymore. And yea the push before would be to keep using with some spatters of blood or whatever fluids, but if it was legit "wet" you could get a new one. Also had to go to sign out process for a while on it. Also to note, these are surgical masks not N95, this group only needs N95 if they haven't been able to covid test someone first, which is basically only in true emergency situations.

[Machu Peach]

And yea the push before would be to keep using with some spatters of blood or whatever fluids, but if it was legit "wet" you could get a new one.

 

I don't really care to discuss it further other than to say that this is a highly unusual and very dangerous practice even by COVID-emergency standards.

[tmwiese55]

I mean, that's the point isn't it? That it isn't right and they were forced to do it by the situation and lack of supplies. Said some would go up to a week with 1 mask. Maybe their management were being overly worried on it though, or maybe since this group doesn't deal with covid patients they got the short end of the stick on priority, idk.

[PrestigeWorldwide]

This hasn't happened to me personally, but I've heard several reports of people actually being shamed for wearing masks some places around here. Like men walking up behind women and Baaaaing like a sheep, or people continuing to claim that you've "fallen for the hoax". If that happened to me in a store or out in public, I don't know how I would react, but it wouldn't be pleasantly.

 

I've thought a bit about this too, because I have definitely received some dirty looks while wearing a mask and wondered what I would say if someone said something to me. To those people I think "I'm not wearing this to protect me, I'm wearing it to protect you. You can fall into one of three buckets: gratitude, apathy, or disdain. While I would prefer bucket #1 and can at least understand bucket #2, how can you be so out-of-touch as to end up in bucket #3?"

[LouisEly]

It's tough to really pin down what a "normal" hospital/ICU bed usage rate is prior to COVID-19 in the US because it does vary seasonally and from year to year, but conventional wisdom has that percentage hovering around 75%. If hospital bed capacity is far lower than that for too long, the hospital system suffers because it isn't making enough money with surgeries or procedures that require hospital bed use/equipment and staff to administer care to those patients - and medical costs as a whole increase to make up for lost revenue from too many empty beds. As hospital systems have gradually reopened for conducting non-COVID19 related procedures, we're now seeing concern about hospital bed capacities from people tracking daily tallies similarly to how they were tracking them in late March, but that data isn't being fully put into the context of what it means in late June. As far as I can tell, none of these apparent hot spot states with shrinking hospital system capacity are urgently requesting military/field hospitals be constructed, or even putting wheels into motion to get their untapped surge ICU bed capacities dusted off for use. This is in large part due to many of these COVID-19 hospitalization patients not showing up at hospitals with just COVID-19 symptoms requiring intubation - there are a large number of patients coming in for other surgeries, childbirths, other critical care that were set to take up a hospital bed for a few days anyways. These people are all tested (in part for infection safety but at this point equally for financial purposes), and a decent chunk have become COVID-19 positive cases who also are logged as hospitalizations even though they're not symptomatic.

I have a relative who is an administrative position with a large hospital system in the Eau Claire area. He said their ICU is full, but only four of them are COVID patients. I asked if they have had an abnormal amount of accidents, heart attacks, etc., and he said that most of them were people who waited to get treatment (assuming out of fear of coming into a medical facility) and waited too long.

[tmwiese55]

Same info my friend has said on people not coming in (no info on ICU numbers). Basically, it was super slow during April to mid May for emergency heart issues. Like why would heart issues stop? They didn't really know why and best guess they could come up with is what you said in that people didn't come in and powered through some things (or passed at home) and subsequently it's now been really busy in the last few weeks (combined with planned procedures that were delayed). With the guess being what you said, things that have been building up due to not coming in are now hitting the wall. Again, they don't really know, it's pure speculation and best guess.

[homer]

These people are all tested (in part for infection safety but at this point equally for financial purposes), and a decent chunk have become COVID-19 positive cases who also are logged as hospitalizations even though they're not symptomatic.

 

I missed this first time around. Are you saying people that test positive and are sent home are counted as a hospitalization? Or are you saying that people that are not symptomatic are admitted because they have a positive test? I don't believe either case to be true but happy to be proven wrong.

[CheezWizHed]

These people are all tested (in part for infection safety but at this point equally for financial purposes), and a decent chunk have become COVID-19 positive cases who also are logged as hospitalizations even though they're not symptomatic.

 

I missed this first time around. Are you saying people that test positive and are sent home are counted as a hospitalization? Or are you saying that people that are not symptomatic are admitted because they have a positive test? I don't believe either case to be true but happy to be proven wrong.

 

I read his statement as people coming in for other reasons, but being logged as COVID-positive, despite being asymptomatic and not there for COVID reasons. The statement just before the part you quoted:

 

This is in large part due to many of these COVID-19 hospitalization patients not showing up at hospitals with just COVID-19 symptoms requiring intubation - there are a large number of patients coming in for other surgeries, childbirths, other critical care that were set to take up a hospital bed for a few days anyways.

[homer]

These people are all tested (in part for infection safety but at this point equally for financial purposes), and a decent chunk have become COVID-19 positive cases who also are logged as hospitalizations even though they're not symptomatic.

 

I missed this first time around. Are you saying people that test positive and are sent home are counted as a hospitalization? Or are you saying that people that are not symptomatic are admitted because they have a positive test? I don't believe either case to be true but happy to be proven wrong.

 

I read his statement as people coming in for other reasons, but being logged as COVID-positive, despite being asymptomatic and not there for COVID reasons. The statement just before the part you quoted:

 

This is in large part due to many of these COVID-19 hospitalization patients not showing up at hospitals with just COVID-19 symptoms requiring intubation - there are a large number of patients coming in for other surgeries, childbirths, other critical care that were set to take up a hospital bed for a few days anyways.

 

 

OK, so people are coming in for a sprained ankle, testing positive for Covid despite being asymptomatic, and then being logged as a Covid case instead of as a sprained ankle. Am I understanding this correctly?

 

Also, AZ ICU bed capacity is at 88% as of this morning.

[tmwiese55]

Seems not so much that it's fudging. But that they came in for something else, and since everyone is tested now they find out they have it. That's the way I interpret what he posted anyway. I mean you can't not count it.

[CheezWizHed]

I didn't that they were fudged either. Just that they came to the hospital for something else (i.e. baby) and tested positive for COVID. (note that I'm just reading the OP, not bringing in other knowledge of the situation).

 

Statistics always need to be interpreted with the reality of what is going on. A month ago, MN numbers were spiking...but we also started increasing the test rate by 10x, so of course they were finding more people. But at the same time, hospitalization rates were steady, so they were finding people with minimal symptoms or asymptomatic as they just tested more.

 

So I think his point was that hospitalization rates might be influenced by the number of people coming in for something else and incidentally being (correctly) tested positive for COVID, rather than simply coming in for COVID related reasons. For example, if I went in for an appendectomy and tested positive for COVID (though no symptoms), I'd be counted as COVID positive in a bed and on a respirator, but not because of COVID. I don't know if the statistics are that "dumb" or if they can filter more intelligently. But it wouldn't surprise me if statistics were being "polluted" this way.

[homer]

Ok I understand now. Obviously yes that should be counted as a positive case. But I don't think that accounts for all that many positive cases or ICU beds. That would be a crappy thing to hear though "Hey we need to remove your liver....also you have Covid."

[tmwiese55]

Agree. It's probably some here and there but one would guess it's not a huge part of it. And seems to me the right way to count it imo as it takes out gray areas. Assuming we're interpreting OP correctly here anyway.

[RobertR]

I suppose it depends on what you're trying to measure. If you're measuring risk to health care workers, then absolutely count everyone in the hospital. If you're measuring severity of the disease, then possibly a hospitalization for something else might not count. Albeit, removing judgement from whether it counts or not is usually a good thing.

 

I'm pretty pessimistic about things at the moment. Yeah, I'm stir crazy too, but wearing a mask and keeping some distance would allow things to approach a semblance of normalcy. And it clearly seems like Americans are incapable of it.

[RobertR]

Texas has shut down their bars. And dialed back restaurant occupancy.

[PeaveyFury]

It really is sad that a lot of the states that unwound restrictions did so with the noble intent to help businesses survive, but the haphazard way things opened too quickly is likely going to end up harming a lot of those businesses more in the long run than if they had just stayed closed a bit longer.

 

Which is literally the argument that health officials were making back in May....

[reillymcshane]

The thing about the COVID stuff with businesses is that - from my observations - it's really hurting the little guys the most. I just feel for the small businesses.

 

I was out of state a couple of weeks ago, and had dinner at a big chain restaurant. They did the distancing thing pretty well. Every other booth empty. Everyone with masks. That sort of thing. I then went to a small craft brewer, and talked with the owner (from about 20 feet away). He had just reopened, but it was hard. His revenue was really low, so he couldn't bring back all his staff. Meaning he was working all day, seven days a week, just to make things feasible. And he was terrified of what would happen if he got sick. And not just the possibility of having a serious health issue - but what would happen to his business if he was knocked out for 2-3 weeks or more.

 

The big chain places are built for turnover. And no one person is essential. It's these smaller places that - I think - are going to suffer the most when all is said and done.

[Fear The Chorizo]

It really is sad that a lot of the states that unwound restrictions did so with the noble intent to help businesses survive, but the haphazard way things opened too quickly is likely going to end up harming a lot of those businesses more in the long run than if they had just stayed closed a bit longer.

 

Which is literally the argument that health officials were making back in May....

 

I don't think it has a whole lot to do with if/when states unwound restrictions on businesses/activities that aren't obvious large indoor crowd gathering events. Even states that never shut down imposed and continue to impose strict social distancing measures and don't have huge community events going on. If statewide business reopening policy was more prevalent then California wouldn't be exploding in their daily case totals, WI would be going nuts, etc. This recent surge in certain states seems to have alot more to do with areas requiring heavy AC use for common life - i.e., people staying indoors breathing largely recycled air rather than mostly fresh air. Summer weather doesn't do people much good if it drives them inside more. Nationwide, the average age of confirmed cases is also plummeting due in large part to working age demographic testing increases. There are a ton of employers requiring testing before going back to work. These people were likely getting infected 2 months ago, they just weren't being tested on a community-wide scale because they weren't symptomatic and testing elderly/at risk demographics was far more important. The last thing I'd add to this is even with the shutdowns, there was going to be a time a few months after they ended when the virus would "peak" - many times that peak was forecast to be in June/July even with stay at home measures. We are basically at that point on the calendar, so it's not exactly a surprise that other parts of the country appear to be "peaking" regardless of what they did back in April or May. Stay at home wasn't intended to eliminate the spread, it was intended to get areas to a place medically where they could manage care through its inevitable outbreak and not have the entire country in flames at the same time.

 

Also, there's growing anecdotal evidence that both positive test count and infection rate parameters aren't closely tied to individual cases to the point of accurately projecting COVID-specific hospitalizations and most importantly COVID-linked deaths - especially if trying to use the rates initially established this spring while using results of very limited to no population-wide testing. Hospitals test patients multiple times, especially if a person tests positive initially. How various states report these totals from hospital systems and labs is not entirely consistent in both information sources and timing of how data is reported/tallied on a daily basis - that helps to explain some of the discrepancies with ICU/hospital bed use/hospital discharges/specific dates of COVID-related deaths, etc.

[Fear The Chorizo]

Ok I understand now. Obviously yes that should be counted as a positive case. But I don't think that accounts for all that many positive cases or ICU beds. That would be a crappy thing to hear though "Hey we need to remove your liver....also you have Covid."

 

Sorry for the lag in responding, but yes...this is happening - but the reality in climbing ICU capacity in states like AZ is definitely of concern, as it's a combination of "normal" hospital function but also trying to accomodate the added stress COVID patients requiring substantial hospital care.

 

I just hope when the liver transplant patient is notified about having COVID, they are kindly reminded they are an asymptomatic case and wouldn't ever need to be in a hospital for it for their own peace of mind...IMO needing a new liver sucks way worse! However, a patient in a hospital for a liver surgery that happens to have asymptomatic COVID is logged as a COVID hospitalization until they get discharged - as it's likely they would need to recover in a COVID-specific section of the hospital because they are potentially infectious despite being asymptomatic.