Coronavirus

[Bullfrog]

Nice. Although based on the mother's day timeline we probably shouldn't get too excited until we see what the numbers are next week.

Not to worry. I am resolute in my determination to stay depressed and fearful.

Same here. If restrictions are lifted, I can no longer use Cov-19 as an excuse for why some of my work projects aren't done.

 

[Bender]

A very good podcast with an interview with Dr. David Fisman, who I think Herman mentioned earlier, about why Ontario isn't handling the crisis very well:

https://thebigstorypodcast.ca/2020/05/27/what-is-ontario-doing-wrong-on-covid-19/

He's been a great listen. He also has some great zingers on twitter.

 

[Bender]

Big changes need to happen to our nursing home system.  The problem is that requires a considerably infrastructure investment and that will come at the cost of other health care expenses unless society as a whole embraces big tax increases.

I don't think there's a real choice there. Because realistically the public has three options:

1) Leave things as they are
2) Embrace some sort of spending increase to fund a public system
3) Maintain a private system but have enough enforceable regulations so as to raise standards to acceptable levels

I guess a fourth would be to divert money away from other aspects of the health care system as you suggest but I think that's a non-starter. Assuming #1 isn't really an option, #3 would almost certainly mean much higher costs at the point of use because higher standards cost money(as does enforcement). So people would be paying for increases regardless, the question is just whether or not you want to socialize those costs and I think our health care system generally tells us it's better to do that than not. At least with the right sort of tax increases, a higher chunk of the burden can fall on the wealthy and corporate profits.

Number three is precisely why we are here right now.  Before Ford the Liberals weren't willing to hire more regulators to do inspections.  The Ford government just cut them back further.  We have chronically underpaid HCW in the nursing homes so they don't want to work there and can easily get a job elsewhere because the environment is pretty toxic for employees.

Is it just about inspections? I mean the reports say that private care facilities are far worse than public in general and this was ushered in by Mike Harris from what I understand although I was too young at the time when he was running the show. It's kind of fishy to me that he's on the board for Chartwell imo.

And to some extent if these are organizations that should be of some repute why does it take inspections to ensure they do a baseline level of work? I.e. if the system was half decent shouldn't there be fewer findings in audits in the first place?

 

[Bender]

You know, over in the thread about the NHL's return someone made the case that no reasonable person could ever be surprised by people who were primarily driven by a profit-motive caring more for that profit than for health and safety.

So, you know, it is a bit strange to see so many headlines in the newspaper about just how shocked, shocked, our Premier is that people running care homes for the elderly in the interest of making money cut corners and jeopardized safety in the interest of their own profitability.

It's almost like the market-based economy doesn't handle important social dynamics well. Whoda thunk it?

I'm not surprised because this is generally what society does but this isn't a new problem with our nursing homes.  Some of them are absolutely great.  Others are abysmal.  From my limited experience doing some coverage work for them, more often seeing their patients on ER visits, we all know the ones that are good and which ones are garbage.  Skills have been downgraded.  Far too many buildings are going to fail accessibility and code standards come 2024.  Every year when dozens of residents die from the flu or a norovirus outbreak noone bats an eye. 

Big changes need to happen to our nursing home system.  The problem is that requires a considerably infrastructure investment and that will come at the cost of other health care expenses unless society as a whole embraces big tax increases.

This is going to sound a bit harsh, but imo boomers, probably the largest and most influential cohort up to now, know their time is coming after this exposed how bad things have become and they don't want their kids do to them what they've done to their parents. If it's not accepted by boomers then they're accepting a bad future that they're already witnessing in real time.

 

[Bender]

As long as the hospitals don't get swamped with new admissions I think they will just ride it out.

This is one of the things that is getting left out of the discussion too much.  Shutting things down wasn't about preventing COVID cases.  It was from preventing overrun ICUs.  Having an uptick in cases if they are primarily mild isn't going to be the limiting factor on whether things get shut back down.  Besides we are still on the early wave of seeing if opening things back up causes a problem.  It's going to be next weekend and the week after that that will be a much better indicator of whether we are heading for another problem.

Are they not to some extent one and the same? To prevent ICU admissions wouldn't you also have to prevent cases in the first place?

I also don't see things backsliding into lockdown unless ICUs start to fill up but that doesn't seem like an elegant solution since ICU admissions and death are lagging indicators.

 

[OldTimeHockey]

You know, over in the thread about the NHL's return someone made the case that no reasonable person could ever be surprised by people who were primarily driven by a profit-motive caring more for that profit than for health and safety.

So, you know, it is a bit strange to see so many headlines in the newspaper about just how shocked, shocked, our Premier is that people running care homes for the elderly in the interest of making money cut corners and jeopardized safety in the interest of their own profitability.

Who ever said Doug Ford was a reasonable person.
That being said, he has to feign shock. He can't come out and say "I knew it was that bad..."

 

[OldTimeHockey]

To prevent ICU admissions wouldn't you also have to prevent cases in the first place?

I don't know that they necessarily go hand in hand. If the cases are spread out over a much longer period you may still get the same number of cases in the end, but the health system won't be overrun.

 

[Highlander]

100 million lockdown in China;

https://www.unknowncountry.com/headline-news/china-is-fighting-a-new-covid-19-outbreak-has-the-virus-changed/

 

[Bender]

To prevent ICU admissions wouldn't you also have to prevent cases in the first place?

I don't know that they necessarily go hand in hand. If the cases are spread out over a much longer period you may still get the same number of cases in the end, but the health system won't be overrun.

But isn't that the point? Maybe you don't stop everyone from getting infected eventually but you do prevent infections that would normally happen all at a much faster rate, so in that sense you are preventing cases or at least holding them off. If hospitalizations are just a mathematical fraction of number of cases then it stands to reason that the lower overall case count will lead to lower overall ICU count, so in that sense reducing case count (300 cases a day vs 3000 cases a day) matters.

 

[bustaheims]

Are they not to some extent one and the same? To prevent ICU admissions wouldn't you also have to prevent cases in the first place?

Yes and no. Obviously, preventing them from happening now is what helps to limit ICU admissions, but, in order to achieve herd immunity (absent a vaccine, at least), it's really just a matter of spreading the cases without lowering the end total of infections. So, instead of 100,000 cases in a 2 month period, it's 100,000 cases in a 6 month period - or whatever the real numbers and timelines end up being. Same number of people getting sick, just less of them being sick at the same time.

 

[herman]

A very good podcast with an interview with Dr. David Fisman, who I think Herman mentioned earlier, about why Ontario isn't handling the crisis very well:

https://thebigstorypodcast.ca/2020/05/27/what-is-ontario-doing-wrong-on-covid-19/

Haha what did I mention now? I have no recollection of this, but thanks for the share!

We're several months past it now, but there was a huge window of opportunity for North America to handle this properly, but due to leadership being what it is here...

A) Asian countries were raising the alarm bells back in October. Most of them knew SARS up close and personal and put measures in place after they recovered to ensure this didn't catch them off guard again; i.e. lots of examples of procedure and messaging and equipment; western nations seemingly scoffed from afar and said, that wouldn't happen here.

B) It did. Italy, Spain, UK, all got thrashed thoroughly for taking it chill, and their subsequent warnings to the rest of the world went mostly unheeded. Those Twitter threads from front-line workers were chilling and heart-breaking.

C) It was WINTER when the virus started to appear more serious here. If our governments took the warnings seriously: manufacturing should have been leveraged immediately towards masks, tests, care facilities, ventilators (a bit late for that); distancing measures should have been spun up when it was cold and snowy anyway instead of... March Break.

Is there significant economic impact to shutting things down so early? Um yes, but you know what else is a significant economic impact? Letting things drag out over 2-3 years with periodic shutdowns because either people are buttholes and selfish, or there are no social infrastructures for supporting/sheltering all citizens in times of need.

 

[Kin]

Haha what did I mention now? I have no recollection of this, but thanks for the share!

My mistake, it was Bender. In my defense you both have 6 letters in your name and I very rarely listen to people who aren't me.

 

[L K]

As long as the hospitals don't get swamped with new admissions I think they will just ride it out.

This is one of the things that is getting left out of the discussion too much.  Shutting things down wasn't about preventing COVID cases.  It was from preventing overrun ICUs.  Having an uptick in cases if they are primarily mild isn't going to be the limiting factor on whether things get shut back down.  Besides we are still on the early wave of seeing if opening things back up causes a problem.  It's going to be next weekend and the week after that that will be a much better indicator of whether we are heading for another problem.

Are they not to some extent one and the same? To prevent ICU admissions wouldn't you also have to prevent cases in the first place?

I also don't see things backsliding into lockdown unless ICUs start to fill up but that doesn't seem like an elegant solution since ICU admissions and death are lagging indicators.

Not really.  In the early stages of COVID the threshold for Intubation was set incredibly low.  The hospital alliance I work with basically suggested if you went past 4 litres of oxygen by nasal prong, start thinking early intubation.  For COPD/long term smokers/people with bad hearts, that's really a low threshold for even healthy individuals wiht a bad pneumonia.  Now we are doing a lot more to prevent intubation with patients so that has made a big transition point for how quickly we need to access ICU beds for even sick COVID patients. 

We also just don't have a bed crisis in the hospitals at this point in time. If we ended up with a massive influx of cases, we potentially would have to reconsider going back to more extreme precautions, but at this point in time we are dealing with 70+ percent of our cases coming from the GTA and those numbers are steadily in the 3-400 range a day.  That just isn't the volume to justify keeping everything closed. 

We have also increased our ventilator access so should things actually get worse we have more bed availability than we did at the onset of the COVID pandemic so we have more wiggle room to handle an influx of cases. 

Categories of who is getting infected still play a big role as well.  Our largest death populations have come from the nursing homes.  Deaths have obviously happened in other populations but the elderly have been our biggest risk population.  Expanding people back to work and out in the day to day while keeping restricted visiting in the homes isn't likely to cause the same problem as just outright opening everything up into a free for all.

 

[Highlander]

Thanks for your insights LK, they hold a lot of weight with you working in the front line of this.  Thanks

 

[Kin]

I really worry that what we see in Minnesota and other US cities as well as in the UK is a sign of things to come. The financial and emotional stresses people are under are going to lead to serious issues if Governments don't realize that things can't be business as usual right now with regards to how people are treated.

In its way, the Trinity-Bellwood stuff is a similar symptom of it. I don't think it makes those park-goers any less stupid but we had a few solid weeks of Doug Ford explaining why it was ok for him to drive up to his cottage for a bit or for his Daughters to come over on Mother's day and what Governments need to realize is that while those things might not be big deals in and of themselves, they really weaken the message of all of us having to make the same sacrifices. It can't be one set of rules for the politically connected and another for everyone else.

 

[Arn]

In Northern Ireland we posted our first day without a death reocorded yesterday (back up to 2 today) but our last few days have been 1,1,1,8,2,0,2 So that little zero was a nice light at the end of the tunnel

 

[Bender]

Are they not to some extent one and the same? To prevent ICU admissions wouldn't you also have to prevent cases in the first place?

Yes and no. Obviously, preventing them from happening now is what helps to limit ICU admissions, but, in order to achieve herd immunity (absent a vaccine, at least), it's really just a matter of spreading the cases without lowering the end total of infections. So, instead of 100,000 cases in a 2 month period, it's 100,000 cases in a 6 month period - or whatever the real numbers and timelines end up being. Same number of people getting sick, just less of them being sick at the same time.

I understand that part of flattening the curve etc. etc. but there are areas that have been able to suppress to a great degree and therefore have few if any deaths. I think it depends to what extent you believe we can thread the needle with high mitigation while still revving up the economy. I think we (GTA/Ontario) can do better than just saying well, 400 cases a day is just the way it is.

 

[Bender]

As long as the hospitals don't get swamped with new admissions I think they will just ride it out.

This is one of the things that is getting left out of the discussion too much.  Shutting things down wasn't about preventing COVID cases.  It was from preventing overrun ICUs.  Having an uptick in cases if they are primarily mild isn't going to be the limiting factor on whether things get shut back down.  Besides we are still on the early wave of seeing if opening things back up causes a problem.  It's going to be next weekend and the week after that that will be a much better indicator of whether we are heading for another problem.

Are they not to some extent one and the same? To prevent ICU admissions wouldn't you also have to prevent cases in the first place?

I also don't see things backsliding into lockdown unless ICUs start to fill up but that doesn't seem like an elegant solution since ICU admissions and death are lagging indicators.

Not really.  In the early stages of COVID the threshold for Intubation was set incredibly low.  The hospital alliance I work with basically suggested if you went past 4 litres of oxygen by nasal prong, start thinking early intubation.  For COPD/long term smokers/people with bad hearts, that's really a low threshold for even healthy individuals wiht a bad pneumonia.  Now we are doing a lot more to prevent intubation with patients so that has made a big transition point for how quickly we need to access ICU beds for even sick COVID patients. 

We also just don't have a bed crisis in the hospitals at this point in time. If we ended up with a massive influx of cases, we potentially would have to reconsider going back to more extreme precautions, but at this point in time we are dealing with 70+ percent of our cases coming from the GTA and those numbers are steadily in the 3-400 range a day.  That just isn't the volume to justify keeping everything closed. 

We have also increased our ventilator access so should things actually get worse we have more bed availability than we did at the onset of the COVID pandemic so we have more wiggle room to handle an influx of cases. 

Categories of who is getting infected still play a big role as well.  Our largest death populations have come from the nursing homes.  Deaths have obviously happened in other populations but the elderly have been our biggest risk population.  Expanding people back to work and out in the day to day while keeping restricted visiting in the homes isn't likely to cause the same problem as just outright opening everything up into a free for all.

Right, obviously everything's a matter of degrees. I just wonder to what extent things get loosened are we able to be agile enough to dial things back if required or does it just start to rip and we lose some level of control we once had. It doesn't sound like reporting is all that good in Ontario....

I'm also just speaking out loud as someone with a predisposition to bronchitis from bad colds so maybe I'm a bit more on edge than others.

 

[Bender]

Haha what did I mention now? I have no recollection of this, but thanks for the share!

My mistake, it was Bender. In my defense you both have 6 letters in your name and I very rarely listen to people who aren't me.

LOL!! He's one of  many in regards to good local/Canadian commentary and analysis on things right now.

 

[Bender]

In Northern Ireland we posted our first day without a death reocorded yesterday (back up to 2 today) but our last few days have been 1,1,1,8,2,0,2 So that little zero was a nice light at the end of the tunnel

Cheers!! [emoji482]