Health Nerd Profile picture
3 Nov, 8 tweets, 2 min read
There is, I think, an ongoing and pervasive misunderstanding about hospital 'capacity' during COVID-19

Capacity is NOT the TOTAL NUMBER of beds

It is the number of FREE beds

This is a very important point
So, for example, England had around 4,000 ICU beds at the start of the year

But they were operating at 85% capacity! So in fact they had more like 600 FREE ICU beds to treat COVID-19
What I mean by this is that, on any given day, 85% of the critical care beds were occupied by people - heart attacks, car crashes, urgent surgeries and the like
Now, capacity has been increased over the course of this year, and there are many contingency plans for a flood of patients, but it's worthwhile noting that COVID-19 can push a place 'over capacity' with a 15% increase in the number of patients going to ICU
Think about that context when you see numbers like 1000 patients in ICU in England. In a normal year, that would push hospitals over capacity across the country 😬
Oh, and important to add (as many have already) that a free 'bed' is not just the physical bed, but the expert staff to manage the patient and stop them from dying
Having worked in hospital finance, it is easy to use the shorthand 'beds' when I really mean 'everything that goes into treating a patient' because we usually measure all that stuff with bed numbers
Something further to add - the free bed capacity is not a fixed number, and usually varies over the seasons. Most hospitals operate at close to 100% capacity during winter ALREADY, which makes the COVID-19 situation in Europe even more worrying

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More from @GidMK

4 Nov
Thoughts on the American election:

- it is a shame the meteor didn't run again
- too many states start with M, not enough with E or Y, this strikes me as unfair
- red and blue remain boring colours, why not try a nice fuschia?
- if you were to combine the Midwest into one state you could call it Megahio. This is very ridiculous, but quite a good name
- New York is similarly a silly name. Presumably it came into being at roughly the same time as Old York when the Earth's crust was formed, and so it should be renamed Also York

- counting votes is meant to take time, unless we reimagine time as non-linear
Read 12 tweets
3 Nov
At least once a month in 2020:

"CASES ARE RISING BUT DEATHS AREN'T. PANDEMIC OVER"

"But there's a death lag - often of 6-8 weeks! It'll happen soon"

"NAH BUDDY PANDEMIC OVER"

*6-8 weeks later*

"FUCK"
Partly, this is because cases don't have a big reporting lag but deaths do - because certifying an infection takes very little effort but certifying a death takes quite a lot more
Add to this the fact that the MEDIAN time from infection to death for COVID-19 is 3 weeks, and you get a 5+ week lag from when cases first start to rise to when deaths do (in many cases, not all)
Read 4 tweets
3 Nov
Ugh this is an irresponsible headline and a pretty dubious study. Compared NHANES to an internet survey conducted in April that used a 13-point rating of depression *symptoms*, not depression diagnoses 🙄
One big issue with this is that transient depression symptoms do not meet the criteria for a diagnosis of depression in most cases, and a single survey done at the start of the pandemic may not be sufficient to describe the true situation
I think all you could reasonably say from this is that people in this particular survey were experiencing a high burden of worry in April in the U.S., but what this means for mental health issues long term is quite hard to discern
Read 4 tweets
1 Nov
One thing that I rarely see mentioned is the context for a "herd immunity" style strategy of doing nothing at all about the pandemic

In particular, how long will it take?
The REACT studies from the UK offer some information on this. Recently, they have estimated ~100,000 people being infected a day, with a robust estimate of 6% population prevalence prior to this outbreak
imperial.ac.uk/media/imperial…
imperial.ac.uk/media/imperial…
Some simple calculus, then, gives us about 4 million infections prior to September, in a population of about 67 million

So how long to go at 100,000 infections a day?
Read 7 tweets
1 Nov
It is perfectly reasonable to describe negative consequences of govt action like lockdowns, however it is totally nonsensical to compare this to life as normal when in reality the alternative is an out of control epidemic
If you pretend, in the face of all evidence, that there are no negative economic and social outcomes that can be attributed to a massive rise in COVID-19 cases, then you are just being intellectually dishonest
Moreover, I think there's a matter of scale that people don't really understand - despite the enormous ongoing epidemic in the United States, it's unlikely that more than 20% of the country has been infected with COVID-19

The epidemic could still take months/years to resolve!
Read 4 tweets
29 Oct
You have to wonder at what point all of the people proudly proclaiming over the last 4 months that Sweden is at herd immunity will admit that they were wrong
Should be noted for the people who misunderstand - herd immunity is about CASES. By definition, if you have a massive epidemic, the population is not at herd immunity
A simple way to explain this is the common cold. No one claims that we have "herd immunity" to the cold, despite it being relatively mild. It's just an endemic disease
Read 4 tweets

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