COVID-19

[SonofOahu]

Officials say Hawaii’s health care system is under great stress (Honolulu Star-Advertiser)

The Governor believes the state will be dealing with the virus for twelve months.

Everyone will be dealing with this, I think, for years. QMC has been a juggernaut in this effort.

Our hospitalization numbers are improving, overall, but I'm a little concerned with Big Island. Their ICU beds are 75% full, and they have about 200 active cases. That doesn't sound like a lot, but they only have 24 ICU beds on the whole island. They need to lock down a little more.

 

[SonofOahu]

If you want a good source for current research, go to JAMA Online: https://jamanetwork.com/journals/jama/newonline

It's like porn for Legacy.

I don't think a vaccine is the answer, I think we need to focus on treatment options. Right now the standard trifecta at our hospital is a combination of remdesivir, dexamethasone, and plasma. None of these are evidence based solutions. It's the proverbial throwing of crap against the wall to see what sticks.

There was an article a couple of days ago that I found really interesting. They were looking at loperamide and other similar compounds for stopping SARS-CoV-2 replication. Loperamide is the active ingredient in Immodium AD. That would be a game changer, if true.

 

[SonofOahu]

You must be Canadian, no good American says pop.

North Dakota is just Canada without the charm and politeness. Why don't you guys just take it back?

 

[Cackalacky2.0]

If you want a good source for current research, go to JAMA Online: https://jamanetwork.com/journals/jama/newonline

It's like porn for Legacy.

I don't think a vaccine is the answer, I think we need to focus on treatment options. Right now the standard trifecta at our hospital is a combination of remdesivir, dexamethasone, and plasma. None of these are evidence based solutions. It's the proverbial throwing of crap against the wall to see what sticks.

There was an article a couple of days ago that I found really interesting. They were looking at loperamide and other similar compounds for stopping SARS-CoV-2 replication. Loperamide is the active ingredient in Immodium AD. That would be a game changer, if true.

My Dads youngest sister recently went to the hospital after having respiratory distress. Immediately put on ventilator and oxygen. Diagnosed with Covid. She was a lifetime smoker, overweight, enlarged liver and several other prexisting issues. They treated her with the things you mentioned and she returned home after a week and is now in quarantine. I spoke with her last night and she said she is better overall but her previously smoking related breathing issues are now much worse and unlikely to improve.

 

[Irish YJ]

Everyone will be dealing with this, I think, for years. QMC has been a juggernaut in this effort.

Our hospitalization numbers are improving, overall, but I'm a little concerned with Big Island. Their ICU beds are 75% full, and they have about 200 active cases. That doesn't sound like a lot, but they only have 24 ICU beds on the whole island. They need to lock down a little more.

I honestly kind of rolled my eyes with Legacy's link you're responding to (because of the headline - yes, everyone will be dealing with it like you said). Isn't Hawaii like the lowest, or one of the lowest cases and deaths per capita in the states. If that's true, I'm guessing Hawaii simply has one of the lowest beds per capita in the US. Not looking to argue, just an honest question/observation.

 

[Legacy]

If you want a good source for current research, go to JAMA Online: https://jamanetwork.com/journals/jama/newonline

It's like porn for Legacy.

What?? I have zero interest in porn.

Originally Posted by SonofOahu View Post
Everyone will be dealing with this, I think, for years. QMC has been a juggernaut in this effort.

Our hospitalization numbers are improving, overall, but I'm a little concerned with Big Island. Their ICU beds are 75% full, and they have about 200 active cases. That doesn't sound like a lot, but they only have 24 ICU beds on the whole island. They need to lock down a little more.

Irish YJ
I honestly kind of rolled my eyes with Legacy's link you're responding to (because of the headline - yes, everyone will be dealing with it like you said). Isn't Hawaii like the lowest, or one of the lowest cases and deaths per capita in the states. If that's true, I'm guessing Hawaii simply has one of the lowest beds per capita in the US. Not looking to argue, just an honest question/observation.

The one in the Honolulu paper? As I posted on how closed systems to greater and lesser degrees like the USS Roosevelt, prison systems, the meat packing plants in Grand Isle, NE, and the Navajo reservation, it's worth looking at the Hawaiian islands similarly both in hospital beds including ICU beds. The point is the staffing stress and costs w.r.t. Oahu's previous post of one of their costs - $125/hr for nurses. We can postulate that Oahu staffs at 70% capacity and is now facing 90-100% as he posted that they are converting floor beds to Covid wards as he posted they are seeing the surge hit them. They are limited in transferring patients. The Navajo rez patients would partially go to Gallup, NM which filled up and could not accept more, transferring them to Phoenix and Albuquerque. The islands have little way of doing that. Certainly you understand that, YJ?

A different article and headline?

 

[Irish YJ]

What?? I have zero interest in porn.

Bots typically don't.

The one in the Honolulu paper? As I posted on how closed systems to greater and lesser degrees like the USS Roosevelt, prison systems, the meat packing plants in Grand Isle, NE, and the Navajo reservation, it's worth looking at the Hawaiian islands similarly both in hospital beds including ICU beds. The point is the staffing stress and costs w.r.t. Oahu's previous post of one of their costs - $125/hr for nurses. We can postulate that Oahu staffs at 70% capacity and is now facing 90-100% as he posted that they are converting floor beds to Covid wards as he posted they are seeing the surge hit them. They are limited in transferring patients. The Navajo rez patients would partially go to Gallup, NM which filled up and could not accept more, transferring them to Phoenix and Albuquerque. The islands have little way of doing that. Certainly you understand that, YJ?

A different article and headline?

I should have said you're choice of quote (dealing with it for 12 months).

Open or closed system, given the low case and death rate in Hawaii, I was guessing the underlying issue might be Hawaii simply has a low hospital bed per capita. And I just checked. They have 1.9, which only 5 states have lower. And I would imagine that an island setting should have higher than the average given it's inability to move/share. North Dakota for example who is one of least dense states, has a 4.3, more than double Hawaii.

You must miss me from the political section.

 

[notredomer23]

https://twitter.com/andrewbostom/status/1302047711131308032?s=21

 

[Irish YJ]

https://twitter.com/andrewbostom/status/1302047711131308032?s=21

<blockquote class="twitter-tweet"><p lang="en" dir="ltr">1/ Very Reassuring U.S. Return To Campus C19 News: ZERO reported C19 hospitalizations despite >11,000 students testing C19+, i.e., being declared “C19 cases” <a href="https://t.co/XrGlWddlsd">pic.twitter.com/XrGlWddlsd</a></p>— Andrew Bostom (@andrewbostom) <a href="https://twitter.com/andrewbostom/status/1302047711131308032?ref_src=twsrc%5Etfw">September 5, 2020</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>

 

[Legacy]

Bots typically don't.



I should have said you're choice of quote (dealing with it for 12 months).

Open or closed system, given the low case and death rate in Hawaii, I was guessing the underlying issue might be Hawaii simply has a low hospital bed per capita. And I just checked. They have 1.9, which only 5 states have lower. And I would imagine that an island setting should have higher than the average given it's inability to move/share. North Dakota for example who is one of least dense states, has a 4.3, more than double Hawaii.

You must miss me from the political section.

Roll my eyes.

I figured you probably missed his post about seeing the surge beginning to hit Hawaii. I imagine he'll update him from the clinical standpoint as it proceeds. I know you rely on those stats that are delayed.

As far as the political threads, meh. Post and you engage - or not - when you wish.

 

[Irish YJ]

Roll my eyes.

I figured you probably missed his post about seeing the surge beginning to hit Hawaii. I imagine he'll update him from the clinical standpoint as it proceeds. I know you rely on those stats that are delayed.

As far as the political threads, meh. Post and you engage - or not - when you wish.

So you'll just ignore the disparity of beds per capita?
Same ol Legacy. meh

 

[Legacy]

The point of the article I posted said the Islands had enough bed capacity, not enough staff. Thus the prohibitive costs of contract nursing from the mainland which hospital administration must anticipate. Whatever the costs of critical care nurses they are contracted for a period of time - 3 months, 6 months - even if they are not needed for that time.

Beds per capita or even beds per positive Covid is not only foolish but costs lives. Oahu said that fortunately they've had time to prepare. I know of a hospital who cut staffing despite warnings that the surge would overwhelm them and they would have no staff. They could not get those contract nurses back when they were overwhelmed.

The article pointed out that health care personnel get sick, need to be quarantined for positive tests. Basic hospital admin planning and management for the personnel department.

 

[Irish YJ]

The point of the article I posted said the Islands had enough bed capacity, not enough staff. Thus the prohibitive costs of contract nursing from the mainland which hospital administration must anticipate. Whatever the costs of critical care nurses they are contracted for a period of time - 3 months, 6 months - even if they are not needed for that time.

Beds per capita or even beds per positive Covid is not only foolish but costs lives. Oahu said that fortunately they've had time to prepare. I know of a hospital who cut staffing despite warnings that the surge would overwhelm them and they would have no staff. They could not get those contract nurses back when they were overwhelmed.

The article pointed out that health care personnel get sick, need to be quarantined for positive tests. Basic hospital admin planning and management for the personnel department.

Doesn't matter if it's staffing, or beds. The issue is preparedness by the state. Not only does Hawaii have fewer beds, they have the fewest nurses in the US by a wide margin. I'll use N Dakota again. Hawaii has twice the population of ND, but ND has almost 4x the amount of nurses.

 

[Legacy]

Doesn't matter if it's staffing, or beds. The issue is preparedness by the state. Not only does Hawaii have fewer beds, they have the fewest nurses in the US by a wide margin. I'll use N Dakota again. Hawaii has twice the population of ND, but ND has almost 4x the amount of nurses.

Staffing is based on projected needs considering acuity for different levels of care and type of hospital. You need ACLS certified nurses to staff your ICU and ER at recommended national nurse to patient ratios. Population density and higher risk individuals like minorities as well as the distribution of nurses throughout the state are factors in a pandemic. Preparedness is key as well as the willingness of your population to adopt mitigation measures.

North Dakota may have four times as many nurses, but if they are scattered throughout the state with a large number in rural hospitals any comparison is moot. Stats for empty beds in North Dakota must consider where those are in relationship to need in a pandemic.

Hawaii as a state has the same ICU bed per capita as Atlanta does.

 

[Irish YJ]

Staffing is based on projected needs considering acuity for different levels of care and type of hospital. You need ACLS certified nurses to staff your ICU and ER at recommended national nurse to patient ratios. Population density and higher risk individuals like minorities as well as the distribution of nurses throughout the state are factors in a pandemic. Preparedness is key as well as the willingness of your population to adopt mitigation measures.

North Dakota may have four times as many nurses, but if they are scattered throughout the state with a large number in rural hospitals any comparison is moot.

It's up to each state to take their isolation, population density, and needs into account, to ensure the proper level of support. Hawaii is near the bottom in levels of support. It's that simple. You can spin it any way you want, but that's the issue here.

 

[SonofOahu]

<blockquote class="twitter-tweet"><p lang="en" dir="ltr">1/ Very Reassuring U.S. Return To Campus C19 News: ZERO reported C19 hospitalizations despite >11,000 students testing C19+, i.e., being declared “C19 cases” <a href="https://t.co/XrGlWddlsd">pic.twitter.com/XrGlWddlsd</a></p>— Andrew Bostom (@andrewbostom) <a href="https://twitter.com/andrewbostom/status/1302047711131308032?ref_src=twsrc%5Etfw">September 5, 2020</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>

Hate to burst everyone's bubble, but the schools wouldn't be able to report the number of hospitalizations even if they wanted to. Not to the media (except for exceptional cases) anyway.

 

[SonofOahu]

So you'll just ignore the disparity of beds per capita?
Same ol Legacy. meh

The point of the article I posted said the Islands had enough bed capacity, not enough staff. Thus the prohibitive costs of contract nursing from the mainland which hospital administration must anticipate. Whatever the costs of critical care nurses they are contracted for a period of time - 3 months, 6 months - even if they are not needed for that time.

Beds per capita or even beds per positive Covid is not only foolish but costs lives. Oahu said that fortunately they've had time to prepare. I know of a hospital who cut staffing despite warnings that the surge would overwhelm them and they would have no staff. They could not get those contract nurses back when they were overwhelmed.

The article pointed out that health care personnel get sick, need to be quarantined for positive tests. Basic hospital admin planning and management for the personnel department.

Doesn't matter if it's staffing, or beds. The issue is preparedness by the state. Not only does Hawaii have fewer beds, they have the fewest nurses in the US by a wide margin. I'll use N Dakota again. Hawaii has twice the population of ND, but ND has almost 4x the amount of nurses.

Y'all arguing about Hawaii as if I wasn't sitting right here. I've gone down a deep discussion into utilization rates, CONs, etc. so you can look back on some of my earlier posts. Hawaii is well situated to handle normal patient needs, as we should be. A high number of beds per capita does not necessarily mean a well-run system, it could mean waste and underutilization of resources.

YJ, I know you're citing either the numbers put out by KFF, but their data was off. The Queen's Health System has about 4K nurses just on their own. Numbers from a different source: https://www.ncsbn.org/Aggregate-RNActiveLicensesTable.pdf

Now, what that doesn't tell you is the amount of RNs out of acute practice. There are many administrators, post-acute RNs, or advanced practice RNs who also have an RN license. Hawaii also has a large amount of RNs in case-management, informatics, and quality.

Hawaii uses a lot of travel nurses. A LOT. This pandemic cut off that supply, so it left us in a bad way. Our numbers are relative, but to suggest that we are in the position we're in because of a lack of planning and support, that's incorrect.

 

[SonofOahu]

My Dads youngest sister recently went to the hospital after having respiratory distress. Immediately put on ventilator and oxygen. Diagnosed with Covid. She was a lifetime smoker, overweight, enlarged liver and several other prexisting issues. They treated her with the things you mentioned and she returned home after a week and is now in quarantine. I spoke with her last night and she said she is better overall but her previously smoking related breathing issues are now much worse and unlikely to improve.

Glad to hear she's better. The long-term effects of this illness are still unknown, and I'm really concerned for those with pre-existing conditions involving the cardiopulmonary system. One of the biggest gaps in our care system is managing the health of people who are really ill, but not ill enough to stay in a hospital. That coordination of care is just lacking, not because we're not trying, but because it's just so hard from a business/operational perspective.

Mayo Clinic is investing a lot in the "hospital at home" model, and I think the COVID pandemic will really push the need for well-coordinated services between acute and community-based services.

 

[SonofOahu]

For YJ: https://www.cnn.com/interactive/2020/health/coronavirus-us-maps-and-cases/#!

Yes, when you look at the national numbers on a per-100k basis, Hawaii is still one of the tops for total deaths. That's why I keep saying that our surge (and panic) is relative. That's not to say that we're not getting pounded at the hospital level, though. However, the messaging in the media and the messaging within the system are two different things.

I don't think the overall message of "hey, dummies, stay home or we may die" is wrong. Like I said, controlling public behavior and attitudes for the greater good is a responsible course to take. What I don't like is the "you don't know what you're doing" from parties who are not in the shit... like Tulasi Gabbard. Fuck her.

Between hospitals, we're not likely to show panic, but I think we're all still handling okay. There's one hospital that is tapping out, but that hospital is a smaller one and it's understandable that they can only do so much. Overall, there's been strong communication and collaboration in the system.

 

[TorontoGold]

Oahu, what's your take on the Plasma treatments? My friends in AZ have been doing this with their patients since April. Makes sense to use it (albeit to a person with a grade 11 biology understanding)

 

[notredomer23]

Hate to burst everyone's bubble, but the schools wouldn't be able to report the number of hospitalizations even if they wanted to. Not to the media (except for exceptional cases) anyway.

Not looking to argue really but the twitter thread cites all the sources. I clicked a couple of them and each included zero hospitalizations from edu websites.

 

[Legacy]

Hawaii has a new Covid dashboard from which I took the screenshot in #4569. Lots of good info

Dashboard link - https://hawaiicovid19.com/dashboard/

This Tracking Covid in Hawaii was also very informative. - https://www.hawaiidata.org/covid19
- 7 day moving averages, testing
- ICU admissions Covid and non-Covid
- By Risk Factor including Travel
- Daily Passenger Arrivals
- Unemployment Claims

In the "Tracking Covid 19 in Hawaii" a dropdown under "Covid 19" is "Tracking Federal Funds". I've not seen that before elsewhere. Very cool. Very well done.

https://www.hawaiidata.org/hawaii-covid-federal-funding

 

[NDVirginia19]

https://www.aljazeera.com/news/2020...us-vaccine-kamala-harris-200905183355046.html

Anti Vaxxer Kamala Harris

 

[Legacy]

Glad to hear she's better. The long-term effects of this illness are still unknown, and I'm really concerned for those with pre-existing conditions involving the cardiopulmonary system. One of the biggest gaps in our care system is managing the health of people who are really ill, but not ill enough to stay in a hospital. That coordination of care is just lacking, not because we're not trying, but because it's just so hard from a business/operational perspective.

Mayo Clinic is investing a lot in the "hospital at home" model, and I think the COVID pandemic will really push the need for well-coordinated services between acute and community-based services.

Hospital at Home is an innovative concept that addresses the health needs of certain chronic condition patients to prevent them from frequent and expensive hospitalizations that the hospital has to eat the costs. For people who live at home with a high level of chronic disease who need more frequent visits than home care and need physician visits to manage their acute swings of the disease, this may work.

Patient selection, home situation, selecting the right staff and reimbursement are key components to deciding on implementation of Hospital at Home.

Patient selection - A COPD (usually long term smoker) who frequently shows up at the ER and needs intubation) patient might qualify. One of the CMS changes at the time of the Affordable Care Act was that hospitals was that the feds would not pay for rehospitalizations within 30 days of discharge for the same diagnosis. Within that time frame, they return, get intubated and sent again to the ICU for another ten days with no reimbursement. Sometimes, a hospital system will justify the costs spent vs the overall costs saved. A physician and a nurse will visit regularly at the home. Treatments usually given in the hospital are given at home.

With Covid, CMS expanded payments for Hospital at Home. These patients would be at high risk for catching Covid in the hsopital. During Covid, many rehab and home care (RN visits usually limited to once a week) have closed.

Hospital at Home - CMS Expands Payments to Hospitals for Care Provided in Patient Homes

Other CMS changes due to Covid
https://www.cms.gov/files/document/covid-hospitals.pdf

These are patients who are not on traditional community.-based programs - home health care, adult living facilities, rehab facilities, home hospice. This service has demonstrated improved outcomes and significant cost savings.

 

[Irishize]

Why isn’t this being reported? I can’t vouch for the owner of the tweet...never heard of him. But what about the info he is providing?

There’s a UK article that parses this data for those who don’t want to read through this tweet thread. I’ll try to find it & post as well.


<blockquote class="twitter-tweet"><p lang="en" dir="ltr">New article in journal published by Cambridge Univ Press says that testimony to House Oversight Committee in March 2020 mixed up case fatality rate (CFR) and infection fatality rate (IFR) for influenza, resulting in major error. (I report this w/o parsing)<a href="https://t.co/3Dpmc7kCPN">https://t.co/3Dpmc7kCPN</a> <a href="https://t.co/FQ8XGCRjjY">pic.twitter.com/FQ8XGCRjjY</a></p>— Stephen McIntyre (@ClimateAudit) <a href="https://twitter.com/ClimateAudit/status/1303024247510503424?ref_src=twsrc%5Etfw">September 7, 2020</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>

 

[Irishize]

Here’s a link to the article that focuses on the IFR/CFR error reference in previous post.

https://www.rt.com/op-ed/500000-covid19-math-mistake-panic/

 

[Legacy]

Here’s a link to the article that focuses on the IFR/CFR error reference in previous post.

https://www.rt.com/op-ed/500000-covid19-math-mistake-panic/

Thanks for the link to the article. Did you notice it came from RT (Russian media)?
Perhaps the author - a GP in Scotland - may be an expert in statistics.

Clearly, CFR differs depending on population studied, compliance with mitigation measures, population density, co-morbid conditions and a number of other factors that make it difficult to model. The CFR for the closed systems of the Princess Cruise was different than the U.S.S. Roosevelt.

At this point, the U.S. CFR is 3%. I've been seeing that another factor is that we're getting better at treatment

https://ourworldindata.org/mortality-risk-covid

 

[Sea Turtle]

A co-worker who I work closely with every day now has it.

 

[Cackalacky2.0]

http://ftp.iza.org/dp13670.pdf. Here is a study linking 250,000 new cases with Sturgis.

 

[Irishize]

Thanks for the link to the article. Did you notice it came from RT (Russian media)?
Perhaps the author - a GP in Scotland - may be an expert in statistics.

Clearly, CFR differs depending on population studied, compliance with mitigation measures, population density, co-morbid conditions and a number of other factors that make it difficult to model. The CFR for the closed systems of the Princess Cruise was different than the U.S.S. Roosevelt.

At this point, the U.S. CFR is 3%. I've been seeing that another factor is that we're getting better at treatment

https://ourworldindata.org/mortality-risk-covid

So what’s the final conclusion? Are you debunking the article in the journal published by Cambridge University Press that says that testimony to House Oversight Committee in 3/20 mixed up CFR & IFR (a major error if true) b/c a Russian media outlet picked it up & posted it on Twitter? Did Fauci or someone else simply make a mathematical error in regards to IFR & CFR? Looks like mostly folks from the UK & Scotland are tweeting about it so I have no idea of the veracity of it but if you read the tweet thread, it’s pretty detailed.