This will potentially affect you, your kids, you parents. They don’t even have to get sick. It all has to do with TOO MANY PATIENTS TOO SICK AT ONE TIME.
Here’s what we know. One person in a community gets sick and they infect others. Most people don’t get too sick and they get better.
They are not “safe” though. Read to the end.
A smaller percentage of people do get hospital sick. They show up and need to be admitted. Beds are filled. Still business as usual.
A small percentage of them get sicker and need the ICU, a ventilator to breathe. We still have capacity. Until...
For a short time—maybe even just a few weeks—too many people get sick.
Too many people come to the ER.
Of the people in the hospital, too many get sicker. We will need one more ventilator than we have.
Then we need 10 more than we have.
A month or two later, everything will be fine. If you get in a car crash and need a surgery for a broken bone, you will get it.
If your kid has appendicitis, they will schedule the operation and everything will be fine.
Not in The Pinch. In The Pinch, it’s not like you live in the USA any more. It’s not like you live in the modern world at all.
In The Pinch, simple, basic medical personnel and technology that has been available for 50 years won’t be available. You’ll be outside. Waiting in line. The supply closet will be empty. The ventilator machine will already be in use.
A routine problem will not be routine.
It will become untreatable.
There are things the USA should probably be doing to slow down the rate of spread of #codiv19. Nothing new or creative.
Just all the stuff they are already doing in Northern Italy #Lombardia and China, South Korea, etc.
We should be doing all the things those doctors wish their countries had done weeks ago.
Once you are in The Pinch, there is nothing you can do. It’s too late. You can’t build a hospital bed in a day. We can’t make ventilator inside the building.
It’s not “the media.” It’s not fear mongering. It’s not a hoax. The Pinch is real and people are dying in it all over the world this morning.
There are things you can do. The most important thing is not to get sick when everybody else gets sick. I’m not going to tell you how here. That is your responsibility to go figure out.
In case you aren’t familiar with the use of the word “pinch” outside of salt for cooking or annoying your 3rd grade classmate...
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Here’s the K-M survival curve from the recent #semaglutide #ozempic paper in non diabetics from the NEJM.
I’m going to teach you how to read a KM curve in a few steps.
First, let’s discuss the deception presented here.
Lincoff AM, Brown-Frandsen K, Colhoun HM, Deanfield J, Emerson SS, Esbjerg S, Hardt-Lindberg S, Hovingh GK, Kahn SE, Kushner RF, Lingvay I, Oral TK, Michelsen MM, Plutzky J, Tornøe CW, Ryan DH; SELECT Trial Investigators. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. N Engl J Med. 2023 Nov 11. doi: 10.1056/NEJMoa2307563. Epub ahead of print. PMID: 37952131.
This is actually 2 KM curves superimposed on one another. The honest KM curve is shown here.
If you are reading this correctly, you should be unimpressed. Which is why the authors chose to add a magnified version on top of all that white space.
Here’s what they added. It’s like a photo of the other curve taken under a microscope.
It makes the effects look much bigger (and faster). Which is a fair goal if you are trying to impress…
I take a call from the ER about Miguel McJohsonberg in room 13. While I’m on the phone I open up his chart and start reading his personal business. His labs. His meds. The DC summary of his last admission. …
All the while he has not given me expressed permission. It is a violation.
We all agree to this violation. He bought his ticket. He knew what he was getting in to. …
Twelve hours later he is unconscious and intubated and the surgeons get permission from his friend to disarticulate his left leg at the hip for a necrotizing skin and soft tissue infection. …
(For those who don’t know my schtick, I often start with a controversial statement like this. While it’s true, it’s not the point of this essay. You have to keep reading…)
Your employer is smart.
They know what they sell—completed, signed notes. They need lots of them. Big ones. Procedural ones. It doesn’t actually matter at all who is writing them as long as they are good enough to sell for revenue. 2/x
The one thing your employer does not want is a bunch of expensive grey haired doctors shuffling around caring about stuff. That business model stinks.
The work is slow. They cost of labor is high. Old doctors are finicky. What a disaster.
3/x