Sunday, March 15, 2020

We aren't Talking Enough about Hospital Beds

This weekend has seemed like it might be a critical one for reducing the transmission of the coronavirus and the incidence of full-blown COVID-19. It has been dismaying to read accounts of St. Patrick's Day weekend revelry, of long brunch lines, and of crowded airports.

Locally, the City still likely deferred too much to the State guidelines, which have seemed tentative and behind the best information from Italy, Spain, and France, even Seattle, and did not recommend or even demand stronger measures. People in Europe are the proverbial "travelers from the future," begging and imploring for us to take stronger measures before it's too late. There is increasing evidence of asymptomatic transmission, and so without large-scale testing, we should be assuming that there are many more cases here than we know about.

At this point the problem is really about community capacity and slowing transmission, since it seems likely many, perhaps even most, of us will come to be infected over the next several months.

The Register-Guard has the right focus today:
We will outrun our capacity real fast in a wave of illness
And key to managing that is hospital capacity for the gravely ill. Salem Reporter noted
Salem Hospital has 48 ICU capable beds & 27 negative air flow rooms, per spokesman
There has been too little public acknowledgment of how quickly these will fill in a wave of illness. Some number of them will be needed by people in car crashes, industrial accidents, cancer, heart attack, other illness. If we overwhelm them with patients in very bad respiratory distress, people suffering other illness and misfortune will be harmed with less attention and fewer beds. Doctors and nurses overwhelmed themselves fall ill, and then they are not available to care for new sick patients. There is the prospect for a cascading chain of catastrophe here. We already saw the Keizer Fire Department members have to self-quarantine after an exposure. We are very vulnerable.

"Cancel Everything" and self-isolate as much as possible
(adapted from a USA Today chart on "flattening the curve")
The reason to practice extreme physical distancing right now is not just to protect oneself. It is to preserve capacity for the whole community and those most in need. Physical distancing, social solidarity.

We really missed the window in the first half of March.

This was the City's main advice from March 2nd to the 12th:
"the risk of getting [ill] is very low"
Even with bans on "large gatherings" and with school closures, the tone on the 13th still is like "we've got this" and not enough of "holy crap, this is an emergency, we have to be serious."

The poster for March 13th still
underplays hazard
and potential for catastrophe
Even after Multnomah County Library closed,
Salem stayed open.
But there are reasons to think the OHA guidance is too weak
And focusing on care facilities is important, but may contribute to the idea that younger people don't have to worry.

Today's front page
I hope on Monday, even in the absence of guidance from the OHA or CDC, the City embraces that "abundance of caution" and gets very serious, more serious than they already are.

Addendum, midday

Here's a distinguished voice on the WP simulator and calls to stay home.

via Twitter


Salem Breakfast on Bikes said...

If you are interested in seeing an animation/visualization, the Washington Post has a great simulator that shows a model with different levels of distancing.

Sarah Owens said...

One thing that stands out to me is the assumption apparently shared by a lot of people that the need for delay tactics (banning gatherings, businesses closing, social isolation if you're vulnerable or experiencing symptoms) is going to end mid-April. Everything I read says *we* are going to be dealing with coronavirus for the rest of the year. I'd like to see OHA next week explain what the plan is going forward, realizing any plan is contingent on circumstances at the time of implementation. Because it's not going to work to let people believe they're sacrificing whatever they're sacrificing for x amount of time, only to find out in the end that it's going to be 2x or 3x or there's not an end in sight.

Sarah Owens said...

Forgot to say thanks for the post. Oregon has <2 hospital beds per 1,000 pop.

Salem Breakfast on Bikes said...

Yeah, there's no evidence that things will be in hand and back to normal at the end of March, mid-April, or any time soon. I guess these short deadline actions are just to buy time for bigger, more detailed plans.

(Added note from Barack Obama on the WP simulator, also.)

Salem Breakfast on Bikes said...

Midafternoon update: Governors Pritzker of Illinois, Dewine of Ohio, and Newsome of California have all announced bar and restaurant closure orders. Each state of course has a different set of wrinkles and additional considerations - but this dimension of public association is also ending.

Salem Breakfast on Bikes said...

(Lots of comments nationally suggest the formula "social distancing" strikes the wrong tone. It's physical distance, but we need social bonds and social solidarity. So I've edited some language accordingly. The criticism is persuasive.)

Salem Breakfast on Bikes said...

Governors Inslee of Washington, Baker of Massachusetts, Hogan of Maryland, and Mayor de Blasio of NYC also announced versions of bar and restaurant closure orders.

Governor Brown is this evening apparently deliberating and will announce something tomorrow.

Susann Kaltwasser said...

After listening to Dr Anthony Fauci talk on tv today, it is pretty clear that we are on the same trajectory as Italy...and now Spain is on. We will be shutting down by the end of the week. I predict that this will last for months and very likely schools will not reopen this year. Get ready! And no...many people will not believe this is serious until they know someone who is either very ill or dead.

I agree with you that the City of Salem has been way too lax and too slow on their reactions. Where is the Mayor?

Anonymous said...

On clue, here's Salem Reporter on hospital beds -