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

[Keith Harbaugh]

CNBC has published a nice, easy to understand, comparison of various pandemics in history:
https://www.cnbc.com/2020/03/26/coronavirus-may-be-deadlier-than-1918-flu-heres-how-it-stacks-up-to-other-pandemics.html

[Deap]

March 26 - the day a few notables are walking back their Zombie Apocalypse pronouncements - UK Imperial College and Stanford - ooops, looks like math turned out to be as hard for them as it was for the twits who claimed Bloomberg spent $1 million dollars per voter.

First error was relying on data from China, second was calling those dying with three underlying co-morbidities "corona virus deaths. Then falling in love with being in the spotlight and finally being 100% wooden headed about downstream consequences of not getting these projections 100% right - even in times of uncertainty.

Saving grace is to remember France always shuts down their whole country for the month of August -so we too shall survive our Miserable March. But only if we finally reject MSM and its rabid hounds from hell.

[Fred]

BillWade,

There are plenty of other businesses in SW Florida that don't rely on retirees, tourists or out of state snowbirds.The Corportate HQ for Hertz is Estero, just North of Naples as well as US Sugar. There'splenty of other agriculture including the very powerful A Duda & Sons (or whatever they are callled now). And of course don't for get real estate, lawyers and financial firms. The hourly staff in the restraunt business certainly need help, but I can't think of any doctors, lawyers or financial advisors that can't go a month without a paycheck. BTW let me know when AOC and the Squad get the Trump Bux out there 'cause what I saw in their bill was the same crap they put in the GND.

[Robert Miles]

Instead of fretting about the number of ventilators, maybe Cuomo should focus first on getting gowns for his hospital workers, so they won't be forced to wear trash bags:

https://nypost.com/2020/03/25/worker-at-nyc-hospital-where-nurses-wear-trash-bags-as-protection-dies-from-coronavirus/

[BillWade]

Yep Fred, it did slip my mind, plenty of big ag going on in DeSoto county right next to me, although it's a 40 minute drive I enjoy going to Arcadia (you almost feel like you're in south Texas as you approach the town). You can get lots of fresh food there, meats as well for a good price.

Our restaurant folks in Charlotte county are hurting. Many restaurants are doing takeout but a few drop off everyday. The remaining ones should do well,though I suspect owners are just trying to get rid of inventory and won't re-order till this is over. Friend of mine works for a large food distributor and she relates that orders are way down.

Rumors are leaking out about growing riots in Wuhan, a dispute with a neighboring town and dissatisfaction with their govt's response to the virus. Police on the side of the rioters.

[BillWade]

For anyone in the USA feeling antsy:

www.CovidMedicalTest.com

I think it's legit,hope so.

[Fred]

Bill,

I'm sure orders for fresh perishables are way down, the rest probably just pushed back. There have been some restaurants putting together 'crisis kits' as a way to get multiple days of food for a family in one 'to go' order. Incuding - the TP or napkins. They get those by the pallet full so I'm sure they probably have some on hand. It won't replace table service but it does help both parties out.

[optimax]

PepeEscobar writing about hydroxychloroquine and azithromycin in France, its efficacy and its strange disappearance from Frances' pharma. Doctors in the US to Trump instead of Fauci about using it earl and often. We can't wait for FDA approaval.

https://www.unz.com/pescobar/why-france-is-hiding-a-cheap-and-tested-virus-cure/

[English Outsider]

Eric - it's a bigger deal than is being made out, and that irrespective of what governments do.

Full testing and tracing and isolation Wuhan style, or more or less let it rip, which was the earlier approach of the European governments - that's under government control to an extent.

What isn't under government control is consumer reaction. With this virus going around a great number of those who could be killed by it aren't buying a whole lot of stuff they usually do - they're more interested in keeping out of the way of infection, whatever governments say.

That's a lot of the economy put on hold and it's entirely outside government control. That spoils business for those who aren't that vulnerable, so they order less stock or in some cases close down for the duration.

The shock this is going to give the economy is great - and there's not a lot Trump or Merkel or Johnson etc can do about it. Except pump money around and hope that doesn't finally put paid to our shaky financial system.

So we're in for trouble. You're seeing it from the point of view of the health professional and going by the stats. From that point of view it seems ridiculous that a disease that mainly kills the economically inactive and leaves the bulk of the workers unharmed should cause such economic damage.

But look at it from the point of view of the private businessman. If I were still running my small business I wouldn't be sending men out to site. Many customers are elderly and wouldn't want them around. Few small businesses can pay men who aren't working so some would have to be laid off. I'd be purchasing less.

All this would happen - and is happening with a great number of businesses in the UK - whatever HMG does. Is it not so in the States?

On the health side we're also on a loser whatever the governments do. Go for suppression Taiwan style and 1, it'll not be 100% and 2, the bulk of the population won't be immune so they'll be fighting new outbreaks until a vaccine or other treatment comes along.

Let it rip and isolate the vulnerable - 1, isolation is imperfect especially in the inner cities and 2, that has to be kept up for longer than just a few weeks.

There's also the effect on morale if a government isn't seen to be doing all it can. Not as if most of us are that fond of whatever government we're landed with anyway.

There is therefore no way of avoiding the disruption this virus will cause and that disruption will be severe.

[Terence Gore]

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30633-4/fulltext

"However, it is important to bear in mind that the current best estimate is that about 81% of people with COVID-19 have mild disease1 and never require hospitalisation."

"Their cohort had many characteristics in common with other reports3, 4, 5—a median age of 56·0 years (IQR 46·0–67·0), a high percentage (62%) of men, and nearly half (48%) of patients with comorbidities. In-hospital death was associated with, on admission, older age (odds ratio 1·10, 95% CI 1·03–1·17; p=0·0043), a higher Sequential Organ Failure Assessment score (5·65, 2·61–12·23; p<0·0001), and blood d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033), findings known to be associated with severe pneumonia.6, 7 The study also presents early data on changes in clinical and laboratory findings over time, which could help clinicians to identify patients who progress to more severe disease. In-hospital mortality was high (28%), much higher than in other reports that had incomplete follow-up data,3, 5, 8 and was very high among the 32 patients requiring invasive mechanical ventilation, of whom 31 (97%) died. This might reflect a higher proportion of patients admitted with severe disease in the early stages of the outbreak. In another report from Wuhan, mortality was 62% among critically ill patients with COVID-19 and 81% among those requiring mechanical ventilation."