this is a very good thread--esp from someone not in health care--and makes a lot of great points about how bad ICU occupancy is
some things to add:
forget who I stole this from but hospital capacity is a lot like a tetris endgame -- you can be really full even when there is technically "space"
additionally, things don't happen instantaneously. even when there is space and everyone wants everything to move, things take time--turning over a room (ie cleaning), staff communication, patient transport
and that's just within a hospital! we haven't built a network of say, citywide ICUs that can flex to take patients when 1 hospital hits capacity and part of it is that it would take hours to make each move and there might be a space at the starting hospital by then anyway
(let alone all the financial incentives not to transfer patients, etc)
also lots of hospitals (esp bigger/urban/university hospitals) are pretty much *always at or near capacity* (in the tetris sense, at least, if not more)

hospitals deal with this by leaving postop patients in the PACU and admitted ER patients in the ER ("boarding") which...
...is a whole big conversation of its own but in general is not great
some of it strikes me like insurance: we conceive of a lot of insurance as healthy people subsidizing unhealthy people, which is essentially true, but some smart people suggest that it's more dynamic, and more like our healthy selves subsidizing our future unhealthy selves
hospital operations is a lot like that in that we may be full *right now* but there could be beds later as ICU patients get better and go to the floor and floor patients get discharged, but it all takes time

the takeaway here is that hospital capacity is about FLOW, not VOLUME
but, COVID is messed up and LOS is much higher than usual. COVID LOS averages to like 10 days, vs normal average is maybe 3-4?

COVID ICU stays easily average 8-11 days just in the ICU IIRC, plus there are weeks'-long outliers, and 8-11 day ICU stay is long!
another big point is:

RUNNING OUT OF ICU BEDS IN A GEOGRAPHIC AREA IS HORRIBLE

but the opposite: "oh we still have ICU beds" IS NOT REASSURING

if I called 911 because of a break-in and they said "did you get shot yet? call us back when you do" I would not be happy
remember that about 10-15% of people with COVID get admitted to the hospital

about 15% of those admitted for COVID die

"we'll be fine, there are ICU beds" is a really weird thing to say
"aren't you driving a little fast?"

"we'll be fine, there are ICU beds"

every health care worker I know who saw Palm Springs (great movie, btw) shuddered & nodded knowingly at this line:

"There’s nothing worse than slowly dying in the ICU."
I don't have a specific goal here, just adding more nuance and some health care worker experience to @asymmetricinfo's very good ICU capacity thread

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More from @MDaware

9 Dec
this is an excellent point

some of my COVID vaccine thoughts (thread)
bottom line:
vaccine, good.

I will get vaccinated as soon as I can, which, as an ER doc, will be "soon"
the data we have is very good & very reassuring. I suspect the pfizer data will be published soon, but the fact that they prioritized the EUA, knowing the FDA would release it as part of the process, seems reasonable
Read 24 tweets
7 Dec
what about the other 2 in 10 Image
x 283,000

which is

0.97 US deaths in the Vietnam war

or

19 x 9/11s

or

14,150 Benghazis
to be clear, this is just the deaths in Americans *under 65 years old*

whose lives this FDRLST author apparently does not think matter
Read 4 tweets
26 Jun
At this point many physicians and scholars have discussed how and why COVID-19 disproportionately affected black and brown folk. @ezekielRMed #ShareTheMicNowMed 1/
They’ve said it better than I have: decades (centuries) of systemic racism that created packed housing, chronic illness, and the lack of capital that disallowed many to adjust. @ezekielRMed @uche_blackstock @dn_charles @CamaraJones #ShareTheMicNowMed 2/
So what do we do about it? Why aren’t the issues that spread COVID like fire through kindling as central to the field of medicine as sterile technique? (serious question) @ezekielRMed #ShareTheMicNowMed 3/
Read 10 tweets
27 Apr
@GitRDoneLarry Larry the stuff in that video is just wrong, even some simple facts like "we've never quarantined healthy people before"

it's happened countless times across history including in the US during the Spanish flu in 1918 and various other outbreaks of smallpox and plague
@GitRDoneLarry I absolutely appreciate that millions of people are hurting economically and it's hard because the models looked worse than what we've experienced but a big part of that is because the shelter in place is working well!

and despite that, over 53,000 Americans have died
@GitRDoneLarry these guys are extrapolating out their experience from their urgent cares which is not at all representative of anything; epidemiology is a lot more complicated than multiplying out numbers particularly as we have been so far behind on testing
Read 6 tweets
21 Apr
@PA_Sertraline @j_thePA say you have a seismograph (earthquake detector). I don't know how they actually work but I assume it's fundamentally some sort of mechanism with a spring that detects the ground shaking --> draws a squiggly line
@PA_Sertraline @j_thePA for our purposes, it's an "earthquake test"

squiggle line = earthquake detected

no squiggle line = no earthquake
@PA_Sertraline put it in the desert in the Nevada where I dunno I guess there are earthquakes and if the ground shakes -> spring bounces, earthquake detected

it SENSES ground shaking and says YES EARTHQUAKE because it is SENSITIVE to earthquakes
Read 17 tweets
14 Apr
more terrifying data we're probably undercounting covid deaths
and for anyone else following along Image
Read 6 tweets

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