ICU admissions lag behind hospitalizations lag behind cases lag behind behaviors. So unless Oklahomans took major strides weeks ago, the roof is about to blow off its ICUs.
What do hospitals do in these cases? They get creative. Non-ICU spaces can get converted into ICU spaces, regional coordination can shift patients around to where space is most available. But space is not the only issue.
It’s also staffing: docs, nurses, RT’s. And that is harder to flex up. You can pull people to practice off-specialty, but as we saw in NYC, having to do so is one of the most stressful aspects of surge. Likely not great for patient care, either.
Medical personnel do come from out of state to help out hardest hit places, for limited periods of time. But with so many states hit hard consecutively this time, it’s different than when the whole country mobilized around New York.
Anyone who has a loved one who would be horrified to take them to a hospital and find there is no capacity to treat them the way they need to be treated should be behaving as if they are barreling towards that outcome with one chance to prevent it.
Healthcare workers have optimized what we can. We have plans, protocols. We’ve changed physical spaces. We’re using therapies to their max. We’ll squeeze our workers to the limit to get shifts covered, scramble to fill ever-present gaps in PPE, testing, meds, supply.
The rest is up to everyone out there.

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More from @choo_ek

12 Nov
Rest in power, Lucille Bridges: nytimes.com/2020/11/11/us/… "Ms. Bridges and her husband met with the school district superintendent before Ruby began classes. The superintendent explained that...they should pray, because things were about to get much worse, she recalled."
"The marshals who took Ruby to and from school were heavily armed and kept a machine gun in their car. 'And that’s the way we lived it for a whole year,' Lucille Bridges said."
"The N.A.A.C.P. supported Lucille and Abon Bridges for several years because they had lost their jobs when the integration of the school made headlines. Friends in their all-Black neighborhood took turns guarding their home."
Read 7 tweets
5 Nov
Stop counting cases and the pandemic will go away!

Stop counting votes and the losing will go away!

No counting! Counting shows bad things!
Wishing is better! And I wish... pandemic is now ZERO! Poof! Gone!

And I won everything! Massive numbers! Not the ones I counted, but the ones I wished into being! Everything so great when you STOP THE COUNT!
I’m about to go call my medical director and tell her not to worry about the waiting room: it’s empty now girl! Drop that full capacity protocol!
Read 4 tweets
29 Oct
This is wonderfully clear education on why it’s so key to layer on factors that prevent COVID spread: english.elpais.com/society/2020-1… @elpaisinenglish
Read 4 tweets
28 Oct
Nebraska has a test positivity rate of 20% - indicator for adequate testing is 5% or less - and over the past 2 weeks, cases have gone up by 24%, hospitalizations by 41%, and deaths by 105% (NYTimes).
The good news is that this is outdoors. The bad news is the close-packed crowed, the lack of masks, the extended time period, and the fact that 1/3 of the 64,000 cases in Nebraska thus far have been here, in Douglas County.
It's an exercise of vast carelessness and bravado, shot through with an utter lack of compassion.
Read 5 tweets
27 Oct
Do what you need to do to cope in the short term and then come back with the memory of this sham, rushed process and every hypocrite who supported it.
Read 5 tweets
25 Oct
Doctors Have Been Working Hard In This Pandemic And Do Not Appreciate Being Slandered: A Thread
First, @ACEPNow, which represents my specialty of emergency medicine:

“ACEP is appalled by President Trump's reckless and false assertions that physicians are overcounting deaths related to COVID-19. Emergency physicians and other health care workers have risked their lives...
“...day in and day out... battling the greatest public health crisis in a generation—all while watching countless patients die alone, going to work without sufficient protection equipment, and struggling with crushing anxiety about getting sick or spreading the virus...”
Read 13 tweets

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