Cuomo's Corona Panic by Larry C Johnson [UPDATED 8:40 PM]

For the past week it appeared that NY Governor Cuomo realized it was more important to be an adult and eschew partisan politics. That was then. He is now in full partisan panic pandemonium. He is now accusing the Feds of dragging their feet in getting NYC 30,000 ventilators. Here is the quote:

"What are you doing sending 400 when I need 30,000 ventilators," Cuomo said. "You're missing the magnitude of the problem."

No Cuomo, you do not understand. For starters, you do not have 10,000 patients on a ventilator now. The number of patients who test positive does not mean that all will require a ventilator. The numbers available so far indicate most who test positive for corona virus are not being hospitalized. That means the numbers for ventilators are not going to skyrocket and immediately outstrip the existing capability.

But Cuomo is missing a more important point. Shame on him. He has a duty to help educate his constituency. Let us start with the production reality--you cannot magically produce ventilators overnight. The existing manufacturers have limited, not UNLIMITED, capabilities to expand production. Bringing other companies, like GM on line, will require about a month to retool and repurpose machinery and quality control techs.

Producing the machines is the easy part. It is the human infrastructure that is the problem. If there are 30,000 ventilators up and running then you need an additional 45,000 ICU qualified nurses and an additional 22,500 Respiratory Therapy Technicians. (I am assuming one ICU nurse can handle two patients per shift. There are three eight hour shifts per day. I am assuming that one Respiratory Therapy Tech can handle 8 ventilators per shift and there are three eight hour shifts per day). 

Along with the ventilators and the nurses and the respiratory techs you will also need oxygen, vacuum and forced air lines for each ventilator station. The nurses and techs also will have to put on new personal protection gear and respirators for each patient encounter (normally, a nurse assigned to a patient can last about three hours in a PPE (Personal Protection Equipment) suit and mask). There is another major complication to consider--every time the nurse goes in and out of the patient room then the nurse (or tech) must put on and then take off the personal protection gear. This can be time consuming if done properly.

I have some background for opining on this topic. I worked my way through college as a Respiratory Therapy Tech and handled patients on ventilators. The ventilators require regular changes of the tubing that connects the patient to the machine. And there are also medications sometimes administered via the ventilator as an aerosol. Getting a trained, certified Respiratory Therapy Tech requires about two years of school/training. Even with that basic training the new Tech is not ready to handle ventilators. That requires additional training.

Getting a qualified ICU nurse is more daunting and more concerning. Ideally the nurse has a four year degree. But there are very sound ICU nurses now on the job with only two years of post-high school education. But to become qualified to work effectively in an ICU a nurse will have to have a minimum of one month of training. (That means the nurse has basic orientation to the policies and procedures for providing intensive or critical care to very sick patients). Ideally the nurse would have six months of training under her or his belt. (Note--my wife was the Nurse Manager for a very prestigious, internationally renowned critical care unit and I have interviewed her).

Someone needs to tackle Governor Cuomo and hit him with a tranquilizer. He needs to calm down and take some time to understand how complex this problem is. Providing a ventilator without having the nurses and technicians required to operate and maintain the ventilator is meaningless and futile.

UPDATE--There are 62 hospitals listed in NYC (see here). According to this data there are 23,762 beds. The vast majority of these are not, repeat NOT, Intensive or Critical Care beds. The number of ICU beds, which means they have the ability to use and maintain a ventilator, is probably about 1500 total. 

As of Tuesday morning, New York State had 25,665 cases.  Here is what we do not know:

1. What percent of people who are tested positive for Corona are admitted to a hospital?
2. What percent of those admitted to a hospital are then placed in a Critical Care or Intensive Care unit?

If all who test positive for Corona are admitted to the hospital then you can see how the existing hospital capacity can be quickly overwhelmed.

According to the New York Times (as of Tuesday), 12% of those who tested positive for Corona in the State of New York were hospitalized. That number is manageable at present. 23% (750) of those hospitalized in the State of New York were put into an ICU (or CCU). We do not know how many of those are in NYC hospitals.

Here is what we know with certainty:

• There are not enough ICU or CCU beds to handle more than 1500 patients in NYC right now.
• There are not enough ICU qualified nurses and Respiratory Therapists to handle more than 1500 critical care patients in respiratory distress from Corona.
• The real problem is not the lack of ventilators. It is the lack of personnel to set up and operate those ventilators.

It would be very helpful if Federal and State officials would provide concrete numbers on the percent of Corona patients requiring hospitalization and critical care intervention. 

Comments

[oldman22]

Scott Ritter analyzes coronavirus and USA government secrecy and failures.
https://www.theamericanconservative.com/articles/the-staggering-collapse-of-u-s-intelligence-on-the-coronavirus/

[Deap]

Needing also to be explored is what drugs and combinations of drugs were these "elderly" patients taking prior to their alleged death from corona virus. Did anything else predispose them to more fatal reactions to this virus which is almost inconsequential in younger persons.

When seniors today are taking on average 7-9 additional RX drugs, what more can we learn from normal biological systems that these drugs have have unintentionally compromised.

What are the "angio-tension" pathways that has been briefly hinted, related to this viral transmission - very sketchy reference only. But this needs to also be explored, considering the wholesale use of blood pressure drugs among seniors.

Legal pot sellers in California are publicly claiming dope "boosts the immune system", yet the weak science so far is finding just the opposite. My own suspicion is this may well become the "co-morbidity" virus; not the corona virus. Yet, media never questions their "puff" pieces and pot sales are going through the roof in this state- deemed essential services not to be shut down.

PS: wholesale use of mega-dose "supplements" needs to also be considered when doing these post-mortam evaluations.In the name of "health" did we do things to our normal immune function to make ourselves more vulnerable. It will be a long time before this analysis can be done; if ever.

[Bobo]

Go to experience.arcgis.com and you will note the State of Florida statistics updated quite often during the day.

You get everything one would need to make a good assumption of numbers and ratios.

NY has never been transparent.

[David K]

WE in New Zealand are in full lockdown, after 202 reported cases of Covid-19 (No deaths yet) .
Everyone confined to their homes, except for essential services (Food/Medical)
Allowed out for a walk around the block; or a food trip..thats it..
Police/ Army out checking that 'no one breaks their bubble'

I was in China when Xi JinPing stepped up and stepped out to lead his country into a
largely successful campaign against Covid-19.
He emphasised that truthful reporting of facts was mandatory.. Try

https://asia-review.com/2020/03/20/no-china-didnt-cover-up-the-covid-19-outbreak/

In my view PM Jacinda Adern's magnificent speech on 23rd was its equal in terms of leadership.

https://www.newsroom.co.nz/2020/03/23/1096999/pm-jacinda-arderns-full-lockdown-speech..

An epic moment in our country's history :-)

[casey]

Cuomo and DeBlasio locked in a battle of egos to see who will get the same treatment Guiliani, rightly or wrongly, received after 9/11, hailed as "America's Mayor" on the cover of Time magazine, if I am not mistaken.

[Norbert M Salamon]

Please compare the reaction of President Putin to the corona virus issue
His Address to the nation March 25, 2020 in English transcript :

http://en.kremlin.ru/events/president/news/63061

[Fred]

David K,

Congradulations on the abortion up to birth bill that PM Jacinda Adern signed into law. That's sure to save lives.
https://www.christian.org.uk/news/nz-allows-abortion-up-to-birth-for-any-reason/
"I was in China when Xi JinPing stepped up and stepped out to lead his country into a
largely successful campaign against Covid-19. "
Congradulations on traveling back just in time to avoid the ban, unless you are a Citizen of New Zealand(?). Enjoy the self quarantine.
https://www.immigration.govt.nz/about-us/covid-19/coronavirus-update-inz-response

So glad somebody from 'down under' (jr. member) is helping Comrade Xi spread the word, not the virus! Communism is such a great system, it's not like they kept the information from anybody or put Dr. Wenliang in jail. Special kudos to Sundar Pichai and the many, many H1B visa holders of Google for ensuring "arrested" has to be in the search command about Dr. Wenliang to bring up that fact rather the CCP agitprop.
https://www.latimes.com/world-nation/story/2020-02-06/coronavirus-china-xi-li-wenliang

[David Koepke]

Few people who died of COVID were “sick” and about to die anyway. But most of them did have a chronic comorbid condition.

Patients had much higher mortality rates if they had diabetes (7.3X), hypertension (6.0X), COPD (6.3X) or cardiovascular disease (10.5X) in data reported from China, Korea and Italy.

In the US from the most recent CDC statistics:
34.2 million Americans—just over 1 in 10—have diabetes.
108 million, or 45% have hypertension defined as a systolic blood pressure ≥ 130 mm Hg or a diastolic blood pressure ≥ 80 mm Hg or are taking medication for hypertension. [i.e. a statin]
15.7 million Americans (6.4%) report having a COPD diagnosis (chronic bronchitis, emphysema).
Millions of Americans have some form of cardiovascular disease.
So half of Americans have a chronic comorbid condition that would put them at higher risk of death if they developed COVID - but few of them would be considered "sick".

In today’s Korean CDC statistics, 1.73% of patients 60-69, 6.38% of those 70-79 and 13.55% of those 80+ have died so far. (Most diagnosed people are still active cases so a larger percentage may die in each age group.) These percentages of 60-80 year olds were not about to drop dead anytime soon.

Unlike other countries, Korea’s targeted comprehensive testing means there should be few undiagnosed asymptomatic or mild cases. In Korea over 34 have tested negative for each person tested positive.

[Barbara Ann]

Cuomo is in a panic over the Federal stimulus bill also:

"What does it mean for New York state?" the governor asked. "It means $3.8 billion. $3.8 billion sounds like a lot of money, but we’re looking at a revenue shortfall of [as much as] $15 billion. This response to this virus has probably already cost us $1 billion, and it will probably cost us several billion dollars when we’re done."

This crisis has only just begun and the Federal government is about to be deluged with petitions for alms. And of course notwithstanding pre-existing fiscal conditions, every state's financial ailments will be because, muh corona virus.

But then it's an election year and when the death toll starts to climb, saying "no" is gonna get real hard. The mother of all moral hazards is on the horizon. And when Trump does have to say "no" to blue states who don't get every cent they ask for to fill the bottomless hole in their finances? I can hear the calls of quid pro cuomo already.

https://www.zerohedge.com/political/cuomo-stimulus-deal-terrible-would-leave-ny-drop-bucket

[blue peacock]

The forced unemployment of millions and bankruptcies of thousands of small businesses by government edict. In time we will know if it was over-reaction or an appropriate reaction.

My gut tells me if it turns out to be a nothingburger those that fanned the hysteria will claim that without "social distancing" it would have been catastrophic.

If you're conspiracy minded then it will not be too far fetched to believe that authoritarians will use similar methods to control a population who want to overturn oligarchies.

[Fred]

Barbara Ann,

The states with the harshest and longest planned economy shutdowns are all run by Democrats. In addition they have self created budget problems, police policies that coddle criminals - which they are making worse by pulling police off the beat and/or promising not to enforce 'non-violent' offenses. Setting the stage for "worse is better" so they can enact socialist agenda by fiat or crisis management. Most of this stimulus bill can wait at least a month, and be discussed at length and in public. God forbid the professional politicians do that.

[Jack]

“St.Louis Fed's "back-of-the envelope" calculation on Unemp Rate in 2q....32%”

https://twitter.com/spomboy/status/1242810024847695877?s=21

This is like Depression era unemployment! If this shutdown of our economy runs another quarter we’ll be looking into the abyss. Small businesses can’t turn on a dime and just restart like nothing happened. Many would be bankrupt.

While financial assets could resume their upward trajectory as the Fed prints money and covers all of Wall St’s speculative losses, Main St can be pummeled to the floor.

[Jack]

Nassim Taleb’s take:

“Corporate Socialism: The Government is Bailing Out Investors & Managers Not You”

https://medium.com/incerto/corporate-socialism-the-government-is-bailing-out-investors-managers-not-you-3b31a67bff4a

To apparently save us from a purported pandemic the government has deemed our economy shutdown. Now those in power want the government to borrow trillions from future generations to handout to a small favored class.

[Alves]

Things will start to snowball now with the number of infected doubling every 3 or 4 days and ending up in hospitals 10 or so days later. There is little point in looking to the recent past in NYC and say Cuomu is panicking for nothing.

[anon]

60 minutes is fairly reputable

https://youtu.be/Y7nZ4mw4mXw

[Leonardo]

Eric, according to the data aggregation on Wikipedia, updated yesterday, here in Italy about 6% of total discovered active cases necessitate of ICU support.

Up to 19 march 2020, people under 40 years of age represented about 25% of total active cases.

I don't know exactly how many excess deaths the coronavirus is causing in my country. I don't even know if those kind of data are available yet. Empirically speaking, in Bergamo (one of the hardest hit provinces) the obituary pages of a local newspaers went from one and a half on 9 february up to about ten on march 13th. So, it seems the epidemic is definitely taking a toll.

While you are right in observing that mostly old and/or sick people die because of the virus, even younger people might get hit hard and end up needing ICU life support. Younger people tend to recover in the long run but if the healthcare system gets locally saturated and ICU units becomes unavailable, even young people will start dieing when they can't breath without the help of a machine.

In my opinion that's what is scaring the hell out of the Authorities (and people alike). Every restriction in place is meant to slow down the rate of contagion so that the healthcare system can make do with the limited resources that are available.

[Fred]

Jack,

Please remind me which democratic governor in 1929-33 was ordering business shutdowns? The Democrats are shutting down the economy, not "the government". Nassim should re-read his own peice, "The Most Intolerent Win" because that is what governors on the left are doing to their fellow Americans. You guys on the left should be quoting Philippines.

[BillWade]

Time Machine:

2015 - Governor Cuomo's state budget mandates the purchase of 16,000 ventilators. Governor refuses, decides it's a much better idea to invest a slightly larger amount into his brother's "Solar Power Project". Solar project eventually fizzles out into nothingness.

2020 - Governor Cuomo insists on Federal govt to get them some respirators, asap!!!!

My prediction: 2020 - Deplorables win low-intensity civil war in November.

NYers: we know your are flying out of Providence, we know you are flying into Atlanta and renting a car to drive down here. We do not know why you are coming here, our restaurant, bars, and beaches are closed. Please stay where you are, thanks.

[ked]

I call ‘em like the many expert sources in the Public Health, Medical & Emerg. Response communities see ‘em. Plus, analysis by personal friends who are MDs and (like me) nearing retirement. My friends have always been practicing physicians - not in the Big Biz side of medicine. A GP, GI, Neurologist, & Pulmonary-Thoracic surgeon. They have each independently raised an alarm over ventilators already being near-fully utilized (due to the financial/business model of the industry + the strong US flu season prior to the rise of COVID19). Many elderly are on ventilators for extensive periods... they do not “rotate out” except by death. There is a quite large supply of susceptible elderly in the US - enough to overwhelm the available “seats”. I didn’t make this up.
My concern is not “is it real?” but how to manage this perfect storm - wherein old old folk + new old folk + new younger folk all contend for access to the life-saving machinery.

[PJ20]

Larry,
I will not defend Cuomo, but I do want to raise some key issues about ventilators. I offer these points as a retired hospital planner and from many conversations with my infectious disease doctor daughter who is leading her hospital efforts in responding to the various. One, the make up of hospitals are changing as routine and non-urgent procedures/surgeries are postponed. This frees up many anesthesiologists, nurse anesthetists, pre- and post-op nurses, ICU nurses, etc. Two, I respect that respiratory techs go through a rigorous training in medical/clinical as well as the technical aspects of the ventilators. But, the freed up personnel already have the medical/clinical and many are familiar with similar if not identical equipment.

[Terence Gore]

Mexico from google today at 8:06 am 3/26

cases p/m rec deaths
475 3.93 4 6

"We are probably in a full-blown epidemic now, but we just don't know it," he said.

https://www.aljazeera.com/news/2020/03/local-mexico-gov-ramp-covid-19-responses-amlo-holds-200323150122699.html

"Mexico ranks number 10 in the list of countries (and dependencies) by population. The population density in Mexico is 66 per Km2 (172 people per mi2). The median age in Mexico is 29.2 years."

https://www.worldometers.info/world-population/mexico-population/

anomaly?

[Keith Harbaugh]

Ron Unz has done (on 3/25) some analysis on the numbers here:
https://www.unz.com/runz/correctly-estimating-coronavirus-infections/
What do you folks think of his methodology?

RESPONSE FROM LARRY JOHNSON:
Unz is hysterical and lacking in logic. He clearly has no background with infectious diseases. As I point out in my piece above, which is based on real numbers, only 12% of those who test positive are hospitalized and only a fraction of those wind up in an ICU.

[Eric Newhill]

Keith,
This is really simple. The bottom line here is that covid-19 has been confirmed in the US for over two months and as of today there are a mere 1,046 deaths in the entire country attributed to the virus; not even a blip on the mortality radar in light of the 7,500 +/- people who die every day. The nightmare panic scenarios just aren't happening. And that's going along with the assumption that all 1,046 dead since January 19th - when the first case appeared - would not have been killed by the flu or some other condition during the same time frame; an assumption I find faulty.

As far as hospitals being overwhelmed, since Jan 19, there have been < 70K cases of covid-19 identified in the US. Most not requiring hospitalization of any kind, let alone a vent. Compared to the seasonal flu, this is nothing; barely a blip on the infectious disease radar, if that. If not for media hype (+hype from CDC and WHO), no one outside of the CDC would even know the virus existed.

There really no "curve" to flatten. Hospitals are not going to be overwhelmed. Bodies are not going to be piling up in the streets.

[BillWade]

Both the UK and Russia have stated that the virus is no longer much of a concern. I wonder if President Trump will join that thought. I would think so.

Experts at legislation are having an awful hard time figuring out how, and if, we're going to get those "TrumpBux".

I suspect there's an awful lot of local restaurant workers thinking a check is forthcoming very soon. I really really hope they are not disappointed. Our local economy (SW Florida) really has only two "industries": health care and restaurants/bars/golf (all of which are shut down)

[Fred]

Eric,

"The nightmare panic scenarios just aren't happening."
Wrongo my friend. The nightmare is the destruction of the US economy at the lower middle and middle class level. That proceeds apace thanks to the Dream Killers of the Democratic Party.