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Tywin Manderly

Will We Stand The Corona Test of Time? - Covid #7

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46 minutes ago, Tywin Manderly said:

That smells like a racket! Some people are surely making a killing due to that broken process, and it is likely one of the many wasteful practices.

In my country health care actors are required by law to be frugal and efficient, so health care insurance companies and the various regulators overseeing the health care industry would have made short work of such a wilfully negligent health care provider. 

 

Healthcare in general is a racket. There is so much corruption in this industry, and I say that as someone who used to work in the fields of finance, banking and politics. Of the four, healthcare is absolutely the worst.

And I might be entering law next. I'm sure that's worse than the four combined.

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8 minutes ago, Tywin et al. said:

Healthcare in general is a racket. There is so much corruption in this industry, and I say that as someone who used to work in the fields of finance, banking and politics. Of the four, healthcare is absolutely the worst.

And I might be entering law next. I'm sure that's worse than the four combined.

I am retired from a hospital. I have seen it all, working there and as a union exec there. A complete racket. 

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I have just heard that last night one of my friends passed away (as a matter of fact a friend from another board). In his early forties, he left his wife and two kids. He had health issues, he was obese, so he was certainly in the risk group. Few days ago he got flu like symptoms, including high fever and complained he felt really bad. Just yesterday evening he posted a video of his kids of facebook, on which his heavy breath can be heard. Today he was supposed to go to the hospital just in case, and in the morning his kids found him dead. Noone performed any tests of course and the cause of death is unknown, but a certain educated guess seems obvious. Though we will probably never know for sure.

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23 minutes ago, maarsen said:

I am retired from a hospital. I have seen it all, working there and as a union exec there. A complete racket. 

Who would have though that an industry that makes up 1/6th of our economy could be subjected to corruption?  

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1 minute ago, 3CityApache said:

I have just heard that last night one of my friends passed away (as a matter of fact a friend from another board). In his early forties, he left his wife and two kids. He had health issues, he was obese, so he was certainly in the risk group. Few days ago he got flu like symptoms, including high fever and complained he felt really bad. Just yesterday evening he posted a video of his kids of facebook, on which his heavy breath can be heard. Today he was supposed to go to the hospital just in case, and in the morning his kids found him dead. Noone performed any tests of course and the cause of death is unknown, but a certain educated guess seems obvious. Though we will probably never know for sure.

My sincere condolences for your and your friend’s family’s loss.

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25 minutes ago, Tywin et al. said:

Healthcare in general is a racket. There is so much corruption in this industry, and I say that as someone who used to work in the fields of finance, banking and politics. Of the four, healthcare is absolutely the worst.

And I might be entering law next. I'm sure that's worse than the four combined.

There is a large group in the DOJ and FBI that specializes in Medicare fraud that claws back billions every year from health care providers.  They are probably only catching a fraction of the fraud.  I assume there fraudulent billing of private insurers as well.  And the bar of what is considered fraudulent is pretty damn low when it's OK to charge $100 to give a patient an aspirin, $50 for a pair of disposable latex gloves, and ten times what your competitor charges for the same service.

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Italy, and probably other countries too, are likely dealing with significantly more deaths than is being reported:

I saw a US-focused on this article too this morning, which I can't find now. But it was saying this is certainly happening in the US too. And its not an issue of authorities suppressing data on purpose, its an issue of lack of available testing and lagging data reporting systems.

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9 minutes ago, Fez said:

Italy, and probably other countries too, are likely dealing with significantly more deaths than is being reported:

I saw a US-focused on this article too this morning, which I can't find now. But it was saying this is certainly happening in the US too. And its not an issue of authorities suppressing data on purpose, its an issue of lack of available testing and lagging data reporting systems.

Part of that is the cost of hospitals being incredibly overstretched, which means that people can't get other health care.  Have a stroke or fall off your roof?  If the hospital is already at 130% capacity, your chances of dying go up dramatically.  Other things like getting a stint in your heart or getting your liver medication properly balanced can be put off for a little while, but not forever.  The longer our health system is in Red Alert, there are going to be more and more deaths that aren't even COVID related. 

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38 minutes ago, Mudguard said:

There is a large group in the DOJ and FBI that specializes in Medicare fraud that claws back billions every year from health care providers.  They are probably only catching a fraction of the fraud.  I assume there fraudulent billing of private insurers as well.  And the bar of what is considered fraudulent is pretty damn low when it's OK to charge $100 to give a patient an aspirin, $50 for a pair of disposable latex gloves, and ten times what your competitor charges for the same service.

Can only speak for my facility, but the only time management actually cares to look and act like management is when Joint Commission might be inspecting the building. They're the federal investigators, and it's night and day how the place runs when it's expected that they might show up.

The funniest thing is when they coach the staff to give panned answers to potential regulators while stressing they're not coaching us and that we're allowed to give honest answers, but then punish you on the back end in subtle ways if you actually do.  

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10 minutes ago, Maithanet said:

Part of that is the cost of hospitals being incredibly overstretched, which means that people can't get other health care.  Have a stroke or fall off your roof?  If the hospital is already at 130% capacity, your chances of dying go up dramatically.  Other things like getting a stint in your heart or getting your liver medication properly balanced can be put off for a little while, but not forever.  The longer our health system is in Red Alert, there are going to be more and more deaths that aren't even COVID related. 

I wonder how much that is counterbalanced by reduced need for hospitalization from things like traffic accidents; or the regular flu. Keeping more people safely ensconced in their homes can prevent a lot more than just COVID-19.

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22 minutes ago, Fez said:

Italy, and probably other countries too, are likely dealing with significantly more deaths than is being reported:

I saw a US-focused on this article too this morning, which I can't find now. But it was saying this is certainly happening in the US too. And its not an issue of authorities suppressing data on purpose, its an issue of lack of available testing and lagging data reporting systems.

I can only speak about rumors, but many in the network across several sites are worried that medical staff are trying NOT to find positive diagnoses of COVID-19 and administrators are trying to find reasons to attribute sickness and death to other causes. It will be interesting when I go into work in a bit because now I'm looking at some of the sickest patients. I expect more to die in the days and weeks to come, and not necessarily because of the virus. There are simply less staff paying attention to them ATM, and I'm sure a number of the front line staff are scared at this point.

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Just now, Fez said:

I wonder how much that is counterbalanced by reduced need for hospitalization from things like traffic accidents; or the regular flu. Keeping more people safely ensconced in their homes can prevent a lot more than just COVID-19.

Hard to say.  But if I were to make a guess, I would say not nearly as much.  People get injured a lot at home, and flu season is waning in most of the country. 

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Given how widespread the flu is, I wonder how many people get both influenza and coronavirus at the same time.  Prognosis probably would be pretty bleak.  

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17 minutes ago, Tywin et al. said:

I can only speak about rumors, but many in the network across several sites are worried that medical staff are trying NOT to find positive diagnoses of COVID-19 and administrators are trying to find reasons to attribute sickness and death to other causes.

I can only speak for my health system, but that's not the case here. If you've had contact with someone affected or traveled, you get tested for COVID. For inpatients, if you're coming in without that but have a cough, they do a respiratory viral panel first, because COVID is still not the only thing out there, then test for COVID if that's negative. For outpatients we've set up mobile and drive-through testing sites, and there are a number of steps taken to identify patients in all other outpatient areas. It's taken time to get all this set up, and there's still changes ongoing, but there's a lot of effort going into correctly identifying these patients and cohorting them appropriately.

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Posted (edited)

Here's an attempt at a database of US results.

Some states (DE, MI, MD, MN, MO) are being stupid and only reporting positive cases, not total/negative cases.  Other states don't have full information on testing at private labs.  Which makes it impossible to say for sure how much testing is going on in the US.  But the lower bound of how much testing is going on in the US:
3/22 - 46k

3/23 - 54k

3/24 - 64k

3/25 - 74k

Given that 5 states don't report negatives and those are mostly average sized states, you could increase that total by ~ 10%.  No idea how much testing at private labs isn't captured.  There's also a big lag in some states while people are waiting on results, so I suppose we should caviat that these are test RESULTS, not tests taken.  But on the whole, these numbers are still at least an order of magnitude lower than I'd like them to be.  It is highly likely that the total number of tests (418k) is lower, and possibly a lot lower, than the number of infected in the country (estimates vary but most are above 500k). 

Edited by Maithanet

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Posted (edited)

Undercounting? No way! Only bad Commie Chinese, or evil Iranians, or Russians are doing this. Or ze Germans, those insufferable smart asses.

Please move along, nothing to see here. 
 

Seriously, yes, excess death calculations will be the only viable way to truly assess the human cost and tragedy of all of this. 

The „let’s move along“ faction is always so eager to tell us that it’s not „really“ that bad because there are sooooo many unknown cases out there. Every analyst could have told you that „estimates“ of a factor 7 or even factor 10 is nothing more than a political motivated calm down pill. It’s based on no empirical data. None. 
 

South Korea is the Benchmark. Systematic testing (600k+), best prepared, no relevant dark figure. Still 1.2% CFR as of now.

I digress. Let’s all get to BAU. Who thinks of those poor millionaires and billionaires. 

Edited by Arakan

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6 minutes ago, Maithanet said:

Here's an attempt at a database of US results.

Some states (DE, MI, MD, MN, MO) are being stupid and only reporting positive cases, not total/negative cases.  Other states don't have full information on testing at private labs.  Which makes it impossible to say for sure how much testing is going on in the US.  But the lower bound of how much testing is going on in the US:
3/22 - 46k

3/23 - 54k

3/24 - 64k

3/25 - 74k

Given that 5 states don't report negatives and those are mostly average sized states, you could increase that total by ~ 10%.  No idea how much testing at private labs isn't captured.  There's also a big lag in some states while people are waiting on results, so I suppose we should caviat that these are test RESULTS, not tests taken.  But on the whole, these numbers are still at least an order of magnitude lower than I'd like them to be.  It is highly likely that the total number of tests (418k) is lower, and possibly a lot lower, than the number of infected in the country (estimates vary but most are above 500k). 

Given the population of the US and the economic resources, the minimum should be something like 250k/day. Hopefully it will happen soon. 

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Interesting. One of the lead scientists behind the Imperial College model has significantly scaled back his estimates of the damage the UK will face.https://www.newscientist.com/article/2238578-uk-has-enough-intensive-care-units-for-coronavirus-expert-predicts/

Quote

 

The UK should now be able to cope with the spread of the covid-19 virus, according to one of the epidemiologists advising the government.

Neil Ferguson at Imperial College London gave evidence today to the UK’s parliamentary select committee on science and technology as part of an inquiry into the nation’s response to the coronavirus outbreak.

He said that expected increases in National Health Service capacity and ongoing restrictions to people’s movements make him “reasonably confident” the health service can cope when the predicted peak of the epidemic arrives in two or three weeks. UK deaths from the disease are now unlikely to exceed 20,000, he said, and could be much lower.

The need for intensive care beds will get very close to capacity in some areas, but won’t be breached at a national level, said Ferguson. The projections are based on computer simulations of the virus spreading, which take into account the properties of the virus, the reduced transmission between people asked to stay at home and the capacity of hospitals, particularly intensive care units.

 

His comments also have relevance for the rest of the world as well...

Quote

New data from the rest of Europe suggests that the outbreak is running faster than expected, said Ferguson. As a result, epidemiologists have revised their estimate of the reproduction number (R0) of the virus. This measure of how many other people a carrier usually infects is now believed to be just over three, he said, up from 2.5. “That adds more evidence to support the more intensive social distancing measures,” he said.


 

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32 minutes ago, AverageGuy said:

I can only speak for my health system, but that's not the case here. If you've had contact with someone affected or traveled, you get tested for COVID. For inpatients, if you're coming in without that but have a cough, they do a respiratory viral panel first, because COVID is still not the only thing out there, then test for COVID if that's negative. For outpatients we've set up mobile and drive-through testing sites, and there are a number of steps taken to identify patients in all other outpatient areas. It's taken time to get all this set up, and there's still changes ongoing, but there's a lot of effort going into correctly identifying these patients and cohorting them appropriately.

As far as I can tell, we’ve suspended the mobile test sites, but are clearing out four facilities specifically for testing and rehabilitation. However, three of them are well outside the metro, which accounts for four of the roughly eight million people in our state.

One of the complicating factors though is arguably the best hospital in the world is also located in my state. I have no clue what they’re doing.

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I don’t want to sound like a smartass but what those British scientists say is nothing what the „rest of the world“ doesn’t already know. It rather seems this is just confirmation what Asian experts already knew six weeks ago. 

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