I truly hope no substance abuse addiction ever hits your immediate family or any person you are close to because you will not be able to evaluate that properly...do you really think most people choose to stay hooked to drugs or alcohol without any influence from.their brain?
Tweet perspective on Coronavirius and health care
- Thread starter NYShoreGuy
- Start date
It hasn't and it won't.
That's not what I said. The choice is the very first time they do it. Just don't do it and it solves any potential problems. Really quite simple. I don't have much sympathy for those people to be completely honest with you.
Yes it is apparent your empathy level as a human lacks a median baseline
In this case though, it is not about them. Keeping liqueur stores open is only to keep alcoholics away from the hospital so they don't waste the resources we have. Not intuitive at first, but it makes sense.
I think too many politicians have been slow to act overall. More Dem politicians are taking measures sooner due to the fact that they are in charge of densely populated areas like NY and San Fran etc. Both the NY and CA governors moved first and you have to give them lots of credit for leading the way. Politicizing all of this is unfortunate but its gonna happen when our Prez makes so many stupid comments. It's good to see folks working together. I'm amazed that some Governors are just shutting things down now with all that we know today vs. even 30 days ago. Significant head scratcher in a big way for me. First job for government is always to protect the people.
Cuomo has done a good job and you have to give him credit. But he could be even better if he and DeBlasio (a total buffoon in my opinion like Trump) could bury the hatchet. They continue to bicker instead of coordinate. They avoid each other in person all the time and both sets of staff have to ensure who is going to be in the room and more. They have to clean that up and are struggling to do so even today. Overall I hate the discussion of which party is better because they all suck in different ways and none of it matters to the people getting sick. Protecting the people is all that matters IMO.
Cuomo has done a good job and you have to give him credit. But he could be even better if he and DeBlasio (a total buffoon in my opinion like Trump) could bury the hatchet. They continue to bicker instead of coordinate. They avoid each other in person all the time and both sets of staff have to ensure who is going to be in the room and more. They have to clean that up and are struggling to do so even today. Overall I hate the discussion of which party is better because they all suck in different ways and none of it matters to the people getting sick. Protecting the people is all that matters IMO.
Actually the resources that are used to treat alcoholics vs. COVID patients are completely different, but that’s another story for another day.
Excellent post and rising above the partisan nonsense. There will be plenty of time to play Monday-morning quarterback, but we also have to recognize that the culture has to be factored into these decisions and that you have 50 governors that are trying to balance their states needs (constituents) against national needs and other states. Shut things down to early and you may have a riot on your hands; shut down too late, you may have more fatalities. I'm not absolving any one Governor of their responsibility, but we (most of us at least) are looking at this through a NJ/NY-centric lens. Other states (and their leadership) may be looking at things differently.
For example, when Governor Wolf of PA shut down all non-essential businesses last week, construction and firearms stores were both restricted. Both petitioned the state for full waivers. Guess which one got one and which didn't?
The failure is state governments and their Certificate of Need laws:
https://reason.com/2020/03/13/ameri...-certificate-of-need-laws-are-one-reason-why/
Yes two moderates who have done a good job with their states neither of which gives a hoot about Trump.
I can see a hypothetical problem, but you'd think there would have to exist a real world example of a hospital or system which had requested to increase beds which was denied, or another hospital requesting to purchase enough ventilators to cover a pandemic which was denied?
Bluntly, if you remove all of those laws, I don't really see how hospitals would be prepared for a pandemic. Are hospitals itching to spend billions in capital investments for beds to be empty?
Current estimate shows New York needing up to an additional 60k beds and 10k ventilators. Are NY hospitals going to increase capacity by 100k beds to meet potential pandemic capacity?
We don’t necessarily have a shortage of beds. Hospital systems have restructured themselves over the past several years to prepare for the aging population and providing services closer to the population centralizing high intensity services at a mothership. The issue is really preparing for something not only as a system but in collaboration with other systems in a service market area and then also nationally to optimize those beds in times of crisis. States, cities, and systems in general have done a poor job of this. I can point to healthcare systems in a region that have worked in a very collaborative way and are doing things together in this crisis but it’s just not getting the press. There are other systems in areas that are in an every man for themselves mode and it shows. Finally you have to take into account with the public will accept. Would you be OK with a family member being shipped off to a hospital in Tennessee if ICU beds weren’t available here? That’s a scary and unacceptable solution for many Americans. Just like 9/11, and Hurricane Katrina, there will be lessons learned about our healthcare system readiness much like we found out with our homeland security and FEMA Resources in those other crisis.
Thanks for this, I was unaware of such laws. Absolutely ridiculous. Hopefully these laws are purged from the books moving forward. Somehow I doubt that.
The CON regulations are a bit archaic and were put in place when we had a bunch of stand alone hospitals in a region. Designed to prevent a well run hospital from getting an advantage by building out services and overwhelming competitors. With M&A and mega-systems it’s become useless red tape.
Has in been a problem for expansion in practice?
like if that law was not in place, would NJ / NY be more prepared for an pandemic?
That’s a nice sound byte, but a leader of a hospital preparing for a pandemic investing billions into unused resources would be fired fairly quickly.
just saying, I don’t really feel this hypothetical problem is a real life problem.
And that’s fine... I’m not against criticism for bad leadership... I just don’t see this law in question really preventing us from having a better pandemic response which is why I was asking.
I used to audit hospitals. They didn’t seem concerned about this in their expansion plans, but they were concerned with capacity to meet need... not pandemic need but actual need that would be paid for.
I’m not disagreeing with you. I don’t think the CON regulations necessarily prevented hospitals from implementing pandemic capacity, but it also certainly didn’t encourage it either. To me it’s a good example of things Congress and government should be working on....Eliminating existing legislation when it becomes outdated and irrelevant. Sometimes you have to clean out the basement.
On the leadership front, I have had the opportunity to work with several hospitals on their mass casualty event procedures. Some put in an incredible amount of effort and even pressure test it with live/surprise practice events with local and federal agencies. Some do it to just check the box.
our system is not designed to create a lot of excess capacity in an acute care setting. We have few were beds per thousand because our healthcare system pushes the patient out of the hospital to ambulatory care settings as soon as possible. More efficient, cost-effective and better care. Emergency capacity and adequate equipment stockpiles should be the role of FEMA, state and the federal government. Let’s play devils advocate. We have seen global pandemics that kill tens of thousands over the past two decades. Why doesn’t Congress or any president or presidential candidate talk about this. But, but, free college.
On the leadership front, I have had the opportunity to work with several hospitals on their mass casualty event procedures. Some put in an incredible amount of effort and even pressure test it with live/surprise practice events with local and federal agencies. Some do it to just check the box.
our system is not designed to create a lot of excess capacity in an acute care setting. We have few were beds per thousand because our healthcare system pushes the patient out of the hospital to ambulatory care settings as soon as possible. More efficient, cost-effective and better care. Emergency capacity and adequate equipment stockpiles should be the role of FEMA, state and the federal government. Let’s play devils advocate. We have seen global pandemics that kill tens of thousands over the past two decades. Why doesn’t Congress or any president or presidential candidate talk about this. But, but, free college.
It’s not accurate to say politicians weren’t talking about pandemic response. They were, it’s just not an issue Americans care about until they have to. You can find many bills proposed, studies completed and task force appointments all on the subject of pandemic response over the last 20 years...
I'm just saying that there is no free market solution to preparing for a pandemic that occurs every 50-100 years... I'm not taking issue with your post here, I just don't see how the law SPK posted impeded our response.
I have to disagree that politicians have been responsible for just talking about it and proposing bills. It's there job to serve their constituents and sometimes that means they need to be out in front of issues that pose a real threat to our country, even if the public is more concerned about short term or popular issues. Global pandemics are a real threat as we've seen multiple ones in a relatively short period of time. What would happen if we had a biological weapon introduced?
And I'm not making this a partisan discussion, because they are both guilty. Political investigations, wasting time on bills that are feel good crap, etc. And there are segments of the population is cool with this because it's all about their side and keeping them in power.
After having between 3-5 hospitals on the Divert list (mostly some combination of the hospitals from the earlier list), we have shot back to 9 hospitals over the last 18 hours. No major hospitals have appeared yet but the trend line is going in the wrong direction.
Yeah, saw that. Governor said today that we have 2400 ventilators across the state, 1600 in use and 1200 of them related to Covid. He mentioned we got 800 from the government so I am assuming our total available now is 3200?
Cases in NJ have been growing by almost 20% per day.
Not sure what the trend line looks like for critical cases, but from the data I have seen from other states, the growth is usually along the same line. Assuming 20% growth for critical cases, hospitals are all going to be maxing out within the next few days.
Scary stuff.
The larger systems in the states are averaging about 100 to 150 admissions. ICU’s in relatively good shape though. Holy Name and Valley are struggling. When the dust settles, you’re going to see another wave of hospital M&A and standalone hospitals will virtually disappear. They are just so poorly equipped to deal with a crisis like this. And they won’t be able to afford the measures they will have to put in place to prevent it from happening again.
I don't blame Trump for a lack of testing. There were some early warning signs that we would not have enough testing capacity if this becomes a pandemic within the US... but it still would have been difficult to predict what would happen for any president.
What I do blame him for is that he was publicly downplaying this through March. He made it worse.
Little doubt in my mind that he was being briefed on how bad this could be. I think he made a gamble that the potential would be wrong, it wouldn't hit us hard and he could go on continuing to blame democrats and the MSM for trying to cause hysteria. I think he lost that gamble unfortunately.
It hasn't hit us hard. 99.9% of Americans do not have the virus (300,000 / 327,170,000).
The divert list dropped as low as three but is now back to 7 hospitals. Hackensack UMC in Mountainside just made its first appearance on the list. Essex County has 4 hospitals on the list. That bears watching.
Side note - you and I were discussing this issue this morning, and this afternoon at the Murphy press conference Commissioner Persichilli made the same comment.
"Persichilli said nine hospitals were put on “divert” status Friday night, primarily because of staffing issues and critical care capacity."
https://www.nj.com/coronavirus/2020...hs-and-4331-cases-reported-by-gov-murphy.html
Remember when I posted the divert link a week ago and got a lecture about how I don't know know anything because he has friends at the regional hospitals? I try to bring facts for people to look at and interpret, not name drop so everyone knows how important I am.
What defines hard for you?
In 2 weeks there have been 280,000 new cases and 8,000 deaths and it is still very early for this virus.
Can you quantify how many people need to die in the united states to think this hit us hard?
Personally I think a virus that is going to kill over 100k people considering we shut down most of the country means it hit us pretty damn hard.
I don't know, maybe something that affects 10-20% of the population or more. That would be a meaningful number. This is a tiny fraction of the population. Here in NJ, about 0.5% of our population has the virus. We're ahead of the national average because we're more densely populated and our outbreak started earlier.
It is not very early. We are nearing the peak in NJ, based on the scientific models. This next week will get worse as we hit the peak, and then I expect it will get better starting the following week. A bit of evidence that it's happening in today's numbers. Total new positives dropped ever so slightly from Friday, but deaths continued to increase. When deaths keep increasing day over day and new cases fall day over day over a 3-5 day stretch, we'll know we have peaked.
So assuming the fatality rate holds true at around 1.5% - you are talking about a minimum of 500k people dying?
Around 100k will die and we shut down our economy and are spending trillions of dollars to keep us somewhat moving while we all stay home so the virus doesn't grow to the numbers you are talking about and you don't think it hit us hard?
I honestly just don't understand that position at all.
Merge shu09 is like Drago in Rocky IV after the creed fight, "if he dies, he dies"
Not going to play your hypothetical game because it won't get to 10-20%.
Over 7,000 people die every day in the US from various natural causes, sickness, accidents or crime. We can't prevent every untimely death. I suspect the increase in deaths from this pathogen will be offset by the reduction in deaths from accidents and crime (due to the shutdown) when the numbers are reviewed months and years from now.
Another thing to consider: how many people will die in the long run because of the man-made shutdown? Lack of movement/exercise could contribute to more deaths over the long run. More importantly, the economic and mental toll on some people. For example, I suspect you will see an increase in suicide due to these conditions and the economic toll.
I have said for a while on these boards: the economic toll will be far greater than the human toll when this is over and done with. Governments don't realize this now, sadly.
economic toll is short term. Human toll is permanent. The economic toll is to prevent a death toll in the millions.
yep, we just aren’t going to agree on this.
in any case my point about Trumps gamble was that the virus wouldn’t impact us... clearly it has.
