Medical care, under dire circumstances

[peter m]

Re: Medical care, under dire circumstances

according to these statistics, figuring that 1 out of every 124 people are going to die from not having enough ventilators,

this is an estimate of what to expect in the top Metro regions in the US

these numbers were from a 2000 census, just glancing at the population of a few Metros I know, they are way off... San Diego over 6M Phoenix over 7M etc

2 Los Angeles--Riverside--Orange County, CA CMSA 16,373,645 132,046

Actually that is the correct estimate of the polulation of the three mentioned Scal counties for 2009, give or take a million or so. So we will have 132,046 deaths without sufficent ventilators. 1 out of 124 case end up fatalities. not good.
OC is the richest county by average income per capita so it will likely meet it needs in supplies before all the other Scal countes. LA county will not fair so well unless the ample supporters of Obama in this county can manage to politize the swine flu pandemic and LA can siphon off the limited Obama med emergency stimulus funds from other regions. LA county already receives a dispoportionate share of stimulus monies for affordable housing, road building, worker retraining programs, medi-cal shoring, ect. It has powerful Obama supporters especially the unions & teachers who are a powerful force in La as in Ca, and they will be heard in Wshington.

Never underestimate the power of politics in the shifting and allocation of funds in meeting emergency needs.

 

[AlaskaDenise]

Re: Medical care, under dire circumstances

We can assume they made the expenditures in that old article, so at least that much has been added, but yes California is hurting. I recently spent some time with California relatives who work as a corrections officer and a teacher. I got an earful.

I would agree that the federal government needs to step into areas unable to care for themselves - California, Detroit, etc.

I wonder how many respirators are even available and where they are built. Will they be held for use in the country where they are manufactured?

.

 

[Evelyn]

Re: Medical care, under dire circumstances

A general comment: the ventilators themselves are useless without highly trained personnel to run them. The availability of respiratory therapists will be another limiting factor. Alas.

 

[tropical]

Re: Medical care, under dire circumstances

#18:
"To allocate ventilators, beds and intensive-care equipment doctors would have to 'score' patients on their health and prognosis as well as seriousness of their conditions.

Those who failed to respond to treatment would be subject to 'reverse triage' - in which they were taken off ventilators and left in NHS 'dying rooms' with only painkillers to ease their suffering.

Patients with underlying illness such as advanced cancer or the last stage of heart, lung or liver failure - and those unlikely to survive even if they were given treatment - would not be given an intensive-care bed."


God and ...

Doctors would NOT have!

This is an twisted brainwashing advice from weak health chains, who have no willingness to drag more money for lifeboat issues!

Doctors would have to push the system to get all the needed equipment and staff - not the oposite.

Nobody subscribe special rights to the system to eutanased him by doctors triages instead of giving treatments, because of economic based wrong previous advising decisions, and without to gave to the citizens the possibility of sufinance by additional money tickets the production of additional ventilators, and staff engaging, now when it is plenty of time to ensuring that needs!

 

[german-docter]

Re: Medical care, under dire circumstances

#18:
"To allocate ventilators, beds and intensive-care equipment doctors would have to 'score' patients on their health and prognosis as well as seriousness of their conditions.

Those who failed to respond to treatment would be subject to 'reverse triage' - in which they were taken off ventilators and left in NHS 'dying rooms' with only painkillers to ease their suffering.

Patients with underlying illness such as advanced cancer or the last stage of heart, lung or liver failure - and those unlikely to survive even if they were given treatment - would not be given an intensive-care bed."


God and ...

Doctors would NOT have!

This is an twisted brainwashing advice from weak health chains, who have no willingness to drag more money for lifeboat issues!

Doctors would have to push the system to get all the needed equipment and staff - not the oposite.

Nobody subscribe special rights to the system to eutanased him by doctors triages instead of giving treatments, because of economic based wrong previous advising decisions, and without to gave to the citizens the possibility of sufinance by additional money tickets the production of additional ventilators, and staff engaging, now when it is plenty of time to ensuring that needs!

Doctors would NOT have!

Yes, that's it. :iagree:
tropical, thank you for your wake up call !

 

[peter m]

Re: Medical care, under dire circumstances

I wonder how many respirators are even available and where they are built. Will they be held for use in the country where they are manufactured?

Normally we outsource productiion/ manufacturing of industrial goods to areas of cheaper labor to countries such as china. This has been how US companies have operated last 20-30 years, shifting all manufacturing to China and other far eastern coountries.. I don' think that Vents and ICU beds production will be outsourced but the feds need to put together a crash production program very quick. A public/ private partnership, and they need to do it quick. Convert a former shuttered GM plant into a medical products manufacturing plant.

Time is running short, the fall outbreak is 2-3 months away.

 

[peter m]

Re: Medical care, under dire circumstances

The provision for more ventilators and ICU beds to deal with a massive fall ouitbreak will be haphazardous and slipshod, as the Fed and other gov entities, like all of us, do not know exactly how bad this sw flu will get. They can base their planning(the worst case scenario) on the 1918-1919 pandemic and plan for est 2.1 million US deaths, based on the recorded deaths back then - 700.000 US deaths. US poplulation was 105 million back then, now is has almost tripled so the pandemic fatalities will likewise triple(700,000 x 3 = 2.1 miilion) . If u factor in that we have far greater technogical skills and superior medical knowhow to deal with this Pandemic then we can drop down the total fatalities to between 500,000 and 1 miilion. That would be the adjusted worst- case scenario, which would be catastrophic if Us has severe shortage in hospital emergency medical devices, and critical shortages of trained ER techs and nurses to run them.

We will need to train large nos. of new nurses now. This winter likely 10% of available nurses will themselves be ill and incapaciated from the coming fall wave,or tsunami.

 

[Rocky]

Re: Medical care, under dire circumstances

one other critical point to remember is the nurses from ground zero here in Arizona said a Majority of the complications from swine flu come from dehydration...

are 30-40 IV Drips available to go with each ventilator? Will someone be sitting in the back room filling them from the tap?

In Paraguay, 1 out of 10 confirmed cases so far have ended up in death...

has anyone looked to see what is missing in their treatment that has caused a higher fatality rate?

(I just noticed rhizalabs totals on the map aren't subtracting from confirmed on the deaths, it is adding....)

 

[liam]

Re: Medical care, under dire circumstances

Another consideration is that delivery is not the only 'just in time' aspect of the supply line. With computerized record keeping and modern communications manufacturers anticipate orders by historical patterns and do not keep huge inventories of stock on hand on speculation.

If everyone interested in ventilators were magically suddenly standing in the lobby of the manufacturers with wheelbarrows full of cash it would still be well into the pandemic before every order was filled and waiting for someone well enough to deliver it. This applies to all other expensive equipment as well.

The outcome of this event will not hang on manufacturing such as we saw in the US in WW2. The timeline is too compressed. It appears we will go between phases of a single long wave without breathers in between waves. If so there will be no catching up. The psychological adjustment time for facing a new danger may be more drawn out for professionals, authorities and the public since we are not in the practice from wartime (1918). The general shift from self to government dependance with the expectation that they must do something may lead the government to interfere with the free market manufacturing and allocation as with vaccines. This would add a further layer of complexities.

On the bright side, many doctors will be spared many decisions about who gets scarce resources because there will be fewer resources to decide about.
Liam

 

[tropical]

Re: Medical care, under dire circumstances

...
The outcome of this event will not hang on manufacturing such as we saw in the US in WW2. The timeline is too compressed. It appears we will go between phases of a single long wave without breathers in between waves.
...
The general shift from self to government dependance with the expectation that they must do something may lead the government to interfere with the free market manufacturing and allocation as with vaccines. This would add a further layer of complexities.

On the bright side, many doctors will be spared many decisions about who gets scarce resources because there will be fewer resources to decide about.

Pardon me Liam, but it is not very bright to be leaved at the end of the direction chain to redirect people coming for help, to the dying room.

I remember all, that there were many hysterical estab levels world reactions on private decisions of very hard harmed people, or for other worst, eutanased by doctors.

At the same time there were criminal prosecutions for willingly killing old patients from some nurse elements in some places.

Why inserting double kind of view about?
All the above events could be than equalized to the now sneaking "neccessary" triages.

Such triages at this moment are absolutely unneccessary.

There is plenty of time to make additional vents, and engage or train bunches of people from everywhere, in the next few months.

About the interfere with the free market - what free Market - the one which received megamoney injections for the holes?

The free market will deliver the free vents when the gov/nat budgets will purchase them!

There is no money problem - "Joe the plumber", and the other "Joes", will hapily ticketing their part of few dozen bucks to allow the country estab buy their's needed 16X.xxx vents, or how are needed ...

If the estabs don't want to receive from their citizens an money individual obolus by which they will have more probabilities to be adequately treated, than it must be an "C." reason to not want this, or not ...

 

[the doctor]

Re: Medical care, under dire circumstances

It is important for all of us to understand that during a severe pandemic, the centralized medical model will fail. There will be no ventilators. No hospital beds, not enough nurses or doctors or the legions that back them up and make the miracles they produce day in and day out in the hospital possible.

Below is a chapter on this from The Coming Pandemic Catastrophe.
By Grattan Woodson, MD


Chapter 7: The Collapse of Health Care Services

The vulnerability of the modern hospital-based health care system
Modern health care systems throughout the developed world have adopted a centralized model for providing medical services. The well-equipped set-up and staffed hospital bed plays a key role in this delivery system. A defining characteristic of these systems is the concentration of doctors, nurses, allied health professionals, and an array of specialized high-tech equipment, supplies, and armies of non-medical personnel resulting in modern medical centers. These centers have revolutionized the care of patients in many areas of medicine and surgery. The centralized model on which they are based is highly dependent on advanced technology and has the potential to focus intense services and procedures on a small number of patients at a high cost. In the United States, there are approximately one million set-up and staffed hospital beds and 100,000 respiratory ventilators.

A set-up and staffed hospital bed includes not just an available bed but also sufficient doctors, nurses, medical supplies, pharmacists, drugs, lab and radiology technicians, IT operators, physical plant engineers, janitorial staff, security, and administrators to service the patient in the bed. If any one of these inputs is lost, the centralized model breaks down, ceasing to function. During all three pandemics that occurred in the twentieth century, clinical attack rates in health professionals were as much as twice the rate seen in other groups. This single factor alone will significantly reduce the supply of set-up and staffed hospital beds. The miracle of advanced medical care seen daily in the modern hospital is entirely dependent upon having all the resources necessary available at the same time. The medical outcomes we realize today in these facilities would not be the same in patients treated in other settings, including the inadequately staffed and supplied low-tech temporary hospitals proposed by some public health officials to manage the excess of patients expected during the pandemic.

Over the past two decades, hospitals have reduced capacity, responding to economic pressure from the government and insurance companies to become more cost effective. In doing so, though, they have virtually eliminated their surge capacity, or the spare set-up and staffed hospital beds available for use in an emergency. Capacity utilization in the average hospital today is approximately seventy-five percent, and it is common today for all Intensive Care Unit (ICU) beds to be full.68 This is a regular event in many hospitals during the routine flu season, when all the critical care beds and available ventilators in many U.S. cities are fully occupied with flu patients for many weeks each winter.

U.S. hospitals will remain functional for a while
Most likely, the first victims of a bird flu pandemic in the United States will get excellent treatment within our acute care hospital system. However, given hospital capacity constraints, the assumption of the DHHS PIP that American hospitals will have excess capacity to accommodate an additional ten million seriously ill flu patients lacks credibility. The Congressional Budget Office studied this issue and determined that neither the Veteran?s Administration hospital system nor the U.S. military has the ability to augment the capacity of the private hospital system in any meaningful way.68 An increase in admissions to hospitals of a large magnitude would quickly absorb every available set-up and staffed bed. The DHHS PIP projects a 288% increase in the need for critical care ICU beds and services.11 Under these circumstances, patients in need of ICU services or ventilators would be unlikely to obtain them.

Modeling of this problem suggests that the U.S. hospital system is likely to be able to accommodate approximately one in three of the critically ill influenza patients the DHHS predicts will require hospitalization. This alternative estimate, detailed in the prior chapter on pandemic illness and death, indicates that two in three severely ill patients are going to have to find treatment elsewhere, with their home being the most likely place.

Flu victims will compete for scarce hospital beds with routine patients
One disturbing dilemma likely to evolve during the early days of a pandemic, irrespective of its severity, will be the competition for available hospital beds between critically ill non-influenza and influenza patients. At some point, many hospitals are likely to have a significant number of beds occupied by critically ill patients of both types with little hope for survival. There will be no room for new patients who are equally ill but whose chance of survival is good only if they have access to the benefits of hospitalization in a set-up and staffed bed. This situation will present us with heart-wrenching ethical dilemmas. If the patient with the poor prognosis keeps the bed, then both patients die as a consequence of their illnesses.71 If the patient with the better prognosis displaces the patient with the poor prognosis, then only one person will die but the one who dies will do so because of an act of man, a choice, rather than a result of nature. This is currently not the standard of care in the United States since normally there are an adequate number of set-up and staffed hospital beds to accommodate both patients. Under these circumstances, there is little doubt that professional staff and hospital administrators tasked with managing these challenges during the pandemic are likely to be subjected to both malpractice suits and possibly criminal prosecution.

In an attempt to avoid this nightmare, hospitals are likely to use a much more aggressive triage system during admission than currently in place. This solution is likely to run afoul of malpractice concerns, federal anti-dumping laws, and has the potential for considerable patient and family anger that is likely to result in violence. These issues and the usual criteria for removing patients from life-support treatments will require stringent review in light of the drastically altered circumstances of a severe pandemic. To the extent that these practices and methods have been codified by state legislatures or in the courts, a timely review and amendment of them may be impossible. This legal situation will introduce new levels of complexity to the problem, and these unprecedented predicaments will not have easy or comfortable solutions for anyone involved.

The decentralized health care model of the past
Before 1960, health care was characterized by its decentralized nature. In a decentralized health care system, the doctor or nurse visited patients in their homes where the patients? families provided most of the direct care. Visits to the hospital were rare and only undertaken when surgery was required or the patient was extremely ill. The centralized model is highly dependent on advanced technology, while the decentralized model primarily utilizes low technology practices that are appropriate for the setting. The centralized model has the potential to focus very intense services and procedures on a small number of patients but at a very high cost, while the decentralized model is capable of delivering low intensity care to an almost unlimited number of patients at a relatively low cost.

Home medical care during the pandemic
Once the pandemic settles in, the hospitals will be full, including waiting rooms, classrooms, and hallways. The medical staff will be sick themselves; some will be dead. The hospital will be running low on critical supplies with shortages of everything from gloves to body bags. At some point, a number of hospitals will simply be forced to close, as their dysfunctional state becomes more of a risk to the lives of the patients than a benefit. So, in my opinion, it would be unwise to depend on the centralized health care system to be there for long during a severe bird flu pandemic.

Under these conditions, many ordinary people will find themselves responsible for providing medical care to critically ill loved ones and friends in the home setting. Under usual circumstances patients this sick would be hospitalized, but what if this were not an option during the pandemic? An alternative to hospital care is good home care. This non-conventional treatment option has the virtue of being low-tech and flexible enough to withstand the same strains and stresses that will topple the conventional centralized health care model.

A decentralized delivery system, by its very nature, is much more resistant to disruption or breakdown under pandemic conditions. It does not use high-tech resources nor is it wholly dependent on the commercial or civil infrastructure to remain functional. The home care model is also able to adapt rapidly to changing conditions, such as a loss of electric and water utility service and continue to operate, while the centralized model is much more rigid and slow to adapt. The enormous capacity of a home-based treatment system can easily encompass the entire population of people expected to become ill with bird flu rather than just the small percentage the centralized model can serve well.

In The Bird Flu Manual I have laid out a detailed strategy for exactly how ordinary people with others that live nearby in their apartment buildings, condominiums or neighborhood can work together to provide good medical care to their sick family members and friends in the home setting. The book also provides advice to health care professionals left adrift by the closure or dysfunction of their conventional workplace on how they can participate in a neighborhood health care network in response to the pandemic.

A modified version of how ordinary people can provide good home care to their families and friends can be downloaded for free from www.BirdFluManual.com. The major difference between material provided in The Bird Flu Manual and the one in the online booklet is the assumption used in the Manual that consumers will have access to a select few prescription drugs as well as a number of over-the-counter non-prescription drugs useful in the management of influenza. The 17-page booklet, Good Home Influenza Care makes use of only over-the-counter non-prescription drugs. The home influenza care sections in the Manual are also somewhat more detailed than those found in the booklet.

While your doctor may deny your request for the prescriptions recommended in the Manual at this time, as the pandemic approaches and becomes increasingly likely, most doctors who were hesitant in the past are likely to see the need for their patients to stockpile both their regular medications and a select few prescription drugs useful for influenza treatment.

I sincerely hope that your hospital remains functional during the pandemic and is able to provide good care for the critically ill in your community. If not, the Manual or the Good Home Influenza Treatment booklet will provide consumers with guidance on how to provide the best possible home care to those with mild, moderate, and severe influenza.

Pharmaceutical and medical supply risks
Pharmaceutical production, inventories, and distribution
Today all pharmaceutical companies, wholesalers, and retail pharmacies have implemented the just-in-time method to control inventory.52,69 This management technique keeps inventories lean, freeing up operating capital for other purposes. A demand spike, especially if prolonged, for any drug will result in a short-term shortage until the manufacturer can scale up production sufficiently. Most drug makers can increase production quantities without the need to add equipment or staff. There is an upper limit that can?t be exceeded without sacrificing quality. To meet demand beyond this level requires the addition of manufacturing facilities and staff as was done in 2005 by Roche to meet the huge increase in demand by countries seeking to add Tamiflu? to their national strategic stockpiles.

During an influenza pandemic, the vast increase in demand for both OTC and prescription drugs useful in the management of flu will lead to prolonged shortages in a large number of these products. This includes OTC drugs for treatment of pain and fever like aspirin, acetaminophen, ibuprofen, and naproxen, cough syrup employing dextromethorphan, antihistamines like diphenhydramine, and decongestants like pseudoephedrine. These products will fly off the drugstore shelves faster than they can be replaced. Manufacturers will be operating at full capacity to meet this demand but at some point, flu-related absenteeism or a lack of raw materials will affect their ability to produce or deliver their products.

These same dynamics apply to prescription drugs, especially those useful in the treatment of influenza, its symptoms and complications. Obviously the antivirals Tamiflu? and Relenza? will remain in continual short supply beginning even before the actual start of the pandemic and extending during the entire pandemic period. Narcotic-containing cough suppressants and pain relievers, antiemetics in the phenothiazine class, prescription antihistamines, and oral and IV antibiotics will all be in continuous short supply or temporarily unavailable.

Disturbingly, few know that more than eighty percent of the raw materials for drug manufacture and in some cases the finished pharmaceutical used in the United States are imported, mainly from the EU and Asia.69 Disruptions in collection and processing these raw materials in the country of origin, their diversion to regional manufacturers or distributors to meet increased local demand, or interruption in the transportation or distribution of these materials to or within the United States are all easily predicable consequences of a severe pandemic. This can only aggravate shortages of the drugs that will already exist in the United States due to significantly increased demand.

Risky business: Our dependence on disposable medical supplies
Shortages of a wide variety of disposable medical supplies will also plague the delivery of quality health care and affect health care worker safety. The N-95 respirator mask has gotten most attention in this regard but this is just one of many items required for proper infection control within the hospital setting. The supply of everything from latex gloves, paper gowns, shoe covers, syringes, hypodermic needles, sterile saline for IV drug preparation, to the polyethylene IV tubing and intravenous catheters used to administer drugs and fluids will become terribly scarce very quickly after the onset of the pandemic. After initial shortages develop, intermittent re-supply can be expected to occur in the beginning months of the pandemic but the deliveries will never meet the increased demand. There will not be enough time to add manufacturing capacity even if this was warranted from a long-term business prospective, which it is not because manufacturers see that the increased demand will last only as long as the pandemic.

Manufacturers of disposable medical equipment and supplies will be able to ramp up production in the same way as pharmaceutical companies, but only so long as their employees remain healthy and their raw material suppliers can continue to deliver. In the event of a severe pandemic, worldwide influenza-related conditions are likely to reduce or even halt production. These conditions include absenteeism of the plant workforce, inadequate supplies of raw materials, and loss of critical inputs required to operate the plant, such as reliable electric, natural gas or water utility service. Civil disorder or the threat thereof could also result in plant closure.

If these conditions develop it is easy to predict they will be extremely disruptive to the operation of the health care economy, including provision of direct patient care and those responsible for the manufacture of drugs and medical supplies.

Absentee first responders and health care workers
There is growing uncertainty that medical first responders and health care workers will remain at their posts during the pandemic.45

First responders
The lessons learned by first responders to the 9-11 tragedies in New York City remain fresh in the minds of their colleagues everywhere. The collapse of the World Trade Center buildings killed hundreds of first responders, but many more who survived have become disabled due to inhaling the toxic air at the disaster site during the rescue attempt and ensuing weeks spent recovering the deceased?s remains. The U.S. EPA made public statements declaring the air within the vicinity of the disaster was safe. Subsequently we have learned that these declarations were false. The medical first responders and rescue crews believed them and remained at work for weeks within this toxic environment.

Some are now disabled with pulmonary fibrosis and other respiratory disorders and are no longer able to work. Others have been fired, with some being abandoned by the authorities. The front of our health care system in every city across the United States is composed of these same first responders. Given this experience, one wonders what their reaction will be when asked to risk their health during a severe influenza pandemic?

Health care workers
The health care system needs all its workers to operate properly, not just the allied health technicians and medical professionals. In hospitals, this includes the clerical, janitorial, IT staff, facilities maintenance engineers, nursing aids, kitchen, and security staff who do all the heavy lifting and clerical work needed to keep the facility open. Despite the fact that these health care workers are some of the lowest paid in the economy as a whole, no hospital could remain functional without them.

The sacrifice of those who serve
Hospital workers, medical first responders, and the ancillary and professional medical staff will by virtue of their work be repeatedly exposed to the pandemic influenza virus irrespective of the precautions taken. They will carry the virus home with them, exposing their families and friends. As was seen during the 1918 and 1957 pandemics, people in these professions are predicted to have some of the highest clinical attack rates and case fatality rates seen during the pandemic.

Most health care workers are presently unaware of this increased health risk they will be exposed to despite it being well known within the public health community. This fact, and because it is in the public interest that health care workers and first responders live to provide care for others, is why these groups are included in the CDC?s priority list for access to scarce antiviral drugs and vaccines during the pandemic. Unfortunately, the same protection does not extend to the families of health care workers or first responders or to the legions of non-professional hospital staff. No doubt, as the pandemic approaches and certainly once it arrives, these facts will become better known.

Health care workers and medical first responders are among some of the most dedicated people in our society, and many will remain at their posts irrespective of the risk, but not all. It is easy to see that health care workers in every category will be significantly reduced due to the combined effects of illness and death due to influenza and to those who resign their positions or simply fail to return to work due to concern about becoming ill themselves and/or infecting their family members.71 While volunteers can help keep the hospital clean, prepare food, and bath patients, when it comes to highly technical roles in the laboratory, respiratory, radiology, or ICU there will be no relief.

As soon as physicians, nurses, and health care administrators come to a more realistic appraisal of the conditions that could emerge during a severe pandemic, the sooner they can begin planning appropriately for it.

Preparing for this pandemic makes a lot of sense despite the fact that most hospitals and few doctors have done very little so far. Those that plan now will be in a much better position to weather the storm when it comes and recover more quickly once it is over.


This chapter was written with the coming H5N1 pandemic in mind where I project a CAR of 50% and a CFR of 8% in the developed nations and 12.5% in the underdeveloped ones.

What we will see as this long wave progresses across the world is not currently known. What is clear though is how vulnerable our centralized model is to a spike in demand, especially a prolonged one. It is simply unable to accommodate it.

The only answer for individuals interested in their families surviving a severe influenza pandemic under these circumstances is to prepare to provide good home care to their family and friends. You must not count on your doctor being available nor the hospital. While one or both might be, this is not something that the prudent should bet their life on.

GW

 

[tropical]

Re: Medical care, under dire circumstances

#31:"The only answer for individuals interested in their families surviving a severe influenza pandemic under these circumstances is to prepare to provide good home care to their family and friends. You must not count on your doctor being available nor the hospital. While one or both might be, this is not something that the prudent should bet their life on."


Very probable that we entered a black tunnel as societies, GW.

But until this not realized itself, we must push the very well payed public estabs officials, to squeeze additional needs and organisations, not give up before the event, this is a point.

All the health structure are so much permisive from the begining, instead to skip out from the over-grip.

Apart the rich, or the already equiped, the 99% have not any chances to allested an home vent equipment, etc., to not mention other specialistic care at emergency wards which try to keep the people alive.

That's why it is especialy bw or handwashing from the estab to not try to endorse at least an health prepared structure for the 2%CFR.

An speculated reason of that is that probably the main decisors have already aranged private facilities to cary for their lives in case of severe illness, early hammered vacc., and they will not follow the masses dumped from the public facilities, so they have little fear about the chaos and their health; or they are missleaded.

 

[the doctor]

Re: Medical care, under dire circumstances

#31:"The only answer for individuals interested in their families surviving a severe influenza pandemic under these circumstances is to prepare to provide good home care to their family and friends. You must not count on your doctor being available nor the hospital. While one or both might be, this is not something that the prudent should bet their life on."


Very probable that we entered a black tunnel as societies, GW.

But until this not realized itself, we must push the very well payed public estabs officials, to squeeze additional needs and organisations, not give up before the event, this is a point.

All the health structure are so much permisive from the begining, instead to skip out from the over-grip.

Apart the very rich, or the already equiped, the 99% have not any chances to allested an home vent equipment, etc., to not mention other specialistic care at emergency wards which try to keep the people alive.

That's why it is especial bw to not try to endorse at least an health prepared structure for the 2%CFR.

The main reason of that is that the main decisors have already aranged private facilities to cary for their lives in case of severe illness and they will not follow the masses dumping from the public facilities, so they have not any fear about the chaos.

What I am advocating is that regular people like you and me make simple preparations to care for our loved ones and friends in our homes. The second point I am making is that we should not depend on the fragile medical care delivery system for care. We need to take this responsibility for ourselves.

TPTB has implied that this will be needed but has not been very directive in this regard. Clearly, they know this is what will be needed as well but are constrained by the need to avoid panic within the public if they were to tell them that in the event that the pandemic becomes moderate or severe that home care will be the only option for most people.

We though know this to be true and can make simple preparations to provide good home care. The cost is very low to do so. What is required is the vision to understand the need and the initiative to do so.

GW

 

[tropical]

Re: Medical care, under dire circumstances

I agree with you about the situation, as was many months/years by net docs suspect that the estabs will prepare almost nothing, as it could be seen in many countries now.

Stil, for an life care suport of severe cytokine patients, seems that this is beyond the cheap, or feaseable option for many.

Sorry for the pesimism, but if this emerge to be a moloch, it will be mostly untreatable probably.

I know, we must always fight to the last possibility open ...

What I am advocating is that regular people like you and me make simple preparations to care for our loved ones and friends in our homes. The second point I am making is that we should not depend on the fragile medical care delivery system for care. We need to take this responsibility for ourselves.

TPTB has implied that this will be needed but has not been very directive in this regard. Clearly, they know this is what will be needed as well but are constrained by the need to avoid panic within the public if they were to tell them that in the event that the pandemic becomes moderate or severe that home care will be the only option for most people.

We though know this to be true and can make simple preparations to provide good home care. The cost is very low to do so. What is required is the vision to understand the need and the initiative to do so.

GW

 

[Rocky]

Re: Medical care, under dire circumstances

Did anyone notice suddenly on every news station today Swine Flu is back in the spot light... :magnify:

Keep ringing the bells and sounding alarms...

The clock is ticking down and with two months left there is still time to put things in place but people need to act now!!!

 

[liam]

Re: Medical care, under dire circumstances

With respect tropical, my intent was to convey the extent to which we have come, not too late to a party, but to a party happening with such speed that unlimited money would have little effect at this time.

A lessening of the infection rate or mortality rate as the virus changes is the only thing that may spare us much.

My sarcastic remark about the doctors spared the necessity of choosing among human life may have been in poor taste. It was not meant to incite so much as to convey sympathy to the doctors in such a position.

I can think of nothing so frustrating as to be a doctor who has a grasp of the present situation.
Liam

 

[the doctor]

Re: Medical care, under dire circumstances

I agree with you about the situation, as was many months/years by net docs suspect that the estabs will prepare almost nothing, as it could be seen in many countries now.

Stil, for an life care suport of severe cytokine patients, seems that this is beyond the cheap, or feaseable option for many.

Sorry for the pesimism, but if this emerge to be a moloch, it will be mostly untreatable probably.

I know, we must always fight to the last possibility open ...

The best way for those between age 13 and 45 to avoid cytokine storm is to have optimal 25 OH vitamin D3 levels. This means between 50ng/ml and 80ngml or in international units 125 nmol/l and 200nmol/l.

This can be obtained by taking a daily vitamin D3 supplement of at least 2500iu or getting in the full sun for 10 to 15 minutes each day without sunscreen.

GW

 

[the doctor]

Re: Medical care, under dire circumstances

With respect tropical, my intent was to convey the extent to which we have come, not too late to a party, but to a party happening with such speed that unlimited money would have little effect at this time.

A lessening of the infection rate or mortality rate as the virus changes is the only thing that may spare us much.

My sarcastic remark about the doctors spared the necessity of choosing among human life may have been in poor taste. It was not meant to incite so much as to convey sympathy to the doctors in such a position.

I can think of nothing so frustrating as to be a doctor who has a grasp of the present situation.
Liam

Dear Liam,

Regrettably, most of my colleagues are clueless even now. I can not defend their ignorance. The proof has been around for several years that we were ripe for pandemic but very few paid attention.

Even today the majority remain ignorant. They prattle along in their daily practice day in and day out and will, when the tsunami of pandemic patients break against their clinic door will be as surprised as John Doe is about severity and extent of the disease.

I guess that doctors are simply human and despite our expectations of their being informed are as susceptible to denial as most everyone else.

GW

 

[AlaskaDenise]

Re: Medical care, under dire circumstances

Did anyone notice suddenly on every news station today Swine Flu is back in the spot light... :magnify:.....

Yes, given the fall flu timeline small doses of information are just what the public needs. Even GMA said Probiotics could help fight flu. Now they need to do a show on Vitamin D.

.

 

[peter m]

Re: Medical care, under dire circumstances

Thanks Doctor for that excellent penetrating article on modern day hospital equipment/beds/ ICU's supply issues and likely shortages in event of a deluge of SW FLU cases this fall and winter. I respect your articles and your expertize and will save that article on my disk and read it through.