Did Sweden end up taking the best approach?

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I Am A Critic
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In reply to RGV AG • 7:08p, 12/9/20
RGV AG said:
Again, look at Nicaragua as a more representative, to the US, comparison. They are playing at doing stuff against the virus and the country is charging ahead as full speed as their dumbasses can, and the deal is not going off the rails. The age of the population may be factor, but the lack of quality medical care more than negates that.

There were no lockdowns and currently there are not draconian measures taking place and the country is not falling apart with stacks of dead in the street.

The staunchest Covid deal there is that they have very stringent rules for entry into the country, but the reason that they are doing that is to control opposition to the ruling party and to make money on the whole deal.


It'd be nice to be as close to the equator as they are too.
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RGV AG
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In reply to tysker • 7:19p, 12/9/20
AG
They are just working and trying to survive, Covid is easy compared to a lot of the other daily challenges they face.

I lived there a total of 10 years in different stints so I have a lot friends and coworkers that I speak to and I have 2 Nicaraguans working for me in Mex. There has not been the continued fear that is present in other countries. Mexico is similar, they just got called out by the WHO.

I don't know, it just seems things are really nonsensical. In Texas, in the RGV, one county right next to the other reports 380 cases and the other 100, and everyone is interconnected. And across a river a few miles away everyone is living life.

These are crazy ass times.
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Ribbed Paultz
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6:42a, 12/13/20
Looks like Sweden made the completely wrong move to not lock down early. What a complete mess.

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ORAggieFan
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In reply to Ribbed Paultz • 9:03a, 12/13/20
ICU capacity means very little, but CA is in the same boat with some of the strictest policies out there.
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amercer
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In reply to ORAggieFan • 12:30p, 12/13/20
AG
I think ICU capacity is important. But most people probably don't understand that hospitals aren't really designed to have much extra ICU space.

It's the most expensive and highly staffed part of a hospital, you can't have it at 10% capacity in normal times just in case there's some disaster.
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Keegan99
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In reply to Ribbed Paultz • 12:37p, 12/13/20
AG
So setting aside the fact that Ding is a political hack (failed congressional candidate) and a fear-monger looking to promote any negative story and cast it in the worst possible light, suppose Sweden would have locked down early. What would that have achieved?
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ORAggieFan
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In reply to amercer • 1:01p, 12/13/20
amercer said:
I think ICU capacity is important. But most people probably don't understand that hospitals aren't really designed to have much extra ICU space.

It's the most expensive and highly staffed part of a hospital, you can't have it at 10% capacity in normal times just in case there's some disaster.

Yeah, they are designed to be near capacity. It's more important than positive tests, but ICUs usually reach near 100% in flu season. I'm 2018 LA has to setup tents for patients due to the flu. This was barely reported, let alone any restrictions. They were well over 100% capacity. In fact, if Newsom's restrictions based on ICU capacity if 85% resulting in lockdowns, LA would have been locked down each of the last five years.
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cc_ag92
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In reply to ORAggieFan • 1:31p, 12/13/20
AG
At that point, were they able to recruit contract nurses from other parts of the country? Apparently that's a lucrative job. The problem now, as I understand it, is that the the contract nurses are all contracted. We've run out of them.
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bigtruckguy3500
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In reply to ORAggieFan • 2:50p, 12/13/20
ORAggieFan said:
amercer said:
I think ICU capacity is important. But most people probably don't understand that hospitals aren't really designed to have much extra ICU space.

It's the most expensive and highly staffed part of a hospital, you can't have it at 10% capacity in normal times just in case there's some disaster.

Yeah, they are designed to be near capacity. It's more important than positive tests, but ICUs usually reach near 100% in flu season. I'm 2018 LA has to setup tents for patients due to the flu. This was barely reported, let alone any restrictions. They were well over 100% capacity. In fact, if Newsom's restrictions based on ICU capacity if 85% resulting in lockdowns, LA would have been locked down each of the last five years.
The key difference here is that in the past these hospitals were able to surge by bringing in travel nurses (as cc_ag pointed out), hospital networks were able to pull from surrounding hospitals for staff and equipment assistance, they were still acting as tertiary referral centers for rural hospitals, and they were still maintaining their 2:1 nurse to patient ratio. And if hospitals in one county filled up, maybe they could go on divert and send patients to neighboring hospitals.

Right now, there are no extra nurses to hire temporarily. In fact many nurses are quitting their jobs under the pressure, fatigue, and burnout. They are no longer accepting patient transfers from smaller rural hospitals, and this is putting a huge strain on the smaller hospitals that on a good day can barely handle more than a couple critical care patients. And, a lot of places in the country have suspended the 2:1 nurse to patient ratio in order to deal with the nursing shortage.

I don't know what data Newsome is looking at, but you have to think about momentum. If we wait till we reach 95% capacity to encourage meaningful steps to curb infections, we could easily blow through 100% capacity. If we start at 85%, by the time those meaninful actions take effect, maybe we're at 95%, maybe we still blow through 100%, or maybe the natural peak was at 85% and we were already on our way down when the restrictions were put in place. And they still need to keep room for the multiple traumas that come in from car accidents, or the industrial accident leading to smoke inhalation and severe burns.
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cone
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In reply to bigtruckguy3500 • 4:04p, 12/13/20
AG
why aren't they canceling elective procedures like they did in April?
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ORAggieFan
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In reply to bigtruckguy3500 • 4:47p, 12/13/20
The problem is thinking government can control this. California was an early state for mask mandates, has had some of the most restrictive measures. LA has not been allowed to have indoor dining at all since this started. Some of the highest mask compliance. None of it works. Now they are taking actions they admit likely won't do anything like closing outdoor dining. This approach causes frustration and more people disobeying with the belief it is unfair. Main whole, FL eases restrictions and is doing much better than CA.
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Bert315
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In reply to cone • 5:16p, 12/13/20
AG
cone said:
why aren't they canceling elective procedures like they did in April?


Because electives are where hospitals make most of their revenue. When hospitals were forced to stop electives in April and May most lost millions. I know of several hospitals in the TMC that saw 8-9 figure decline in reimbursement just from that month and a half timeframe. Most can not afford to cancel electives or they will be forced to lay-off or close their doors.

Government should not be mandating what a hospital can and cannot do. They are not the experts and should not be making those calls.
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bigtruckguy3500
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In reply to cone • 5:17p, 12/13/20
cone said:
why aren't they canceling elective procedures like they did in April?

Well, some hospitals are. But you're right, most aren't. The big reason is that we know a lot more about this virus now than we did in April, and elective procedure process has completely changed at most hospitals I'm familiar with.

There are significantly more pre-procedure checks, including mandatory COVID tests prior to procedures. Patients and all staff are masked, more disinfection procedures are in place, etc. It's a very different environment than April.


ORAggieFan said:
The problem is thinking government can control this. California was an early state for mask mandates, has had some of the most restrictive measures. LA has not been allowed to have indoor dining at all since this started. Some of the highest mask compliance. None of it works. Now they are taking actions they admit likely won't do anything like closing outdoor dining. This approach causes frustration and more people disobeying with the belief it is unfair. Main whole, FL eases restrictions and is doing much better than CA.


Have you compared population density of Florida vs California? Or total population? Would it be a lot worse if these mandates weren't in place? I don't think anyone thinks they can control this. I think government thinks it's their responsibility to control the damage, which I think they can accomplish. I'm in SoCal as well and in my observations compliance with mitigation measures is pretty low. Superficially it looks like there's compliance in low risk situations (grocery stores, public places), but it's the high risk situations (bars, indoor, outdoor dining in makeshift tents and structures, parties, etc) where no one cares.

For what it's worth, Florida has over 50k cases per million population and over 900 deaths per million. California has less than 40k cases per million population and over 500 deaths per million. Very similar number of total deaths despite having an 85% greater population. Is Florida really doing that much better?

What if a place like LA with a very dense population took the same approach as Florida? I don't know. You don't know. Anything is conjecture. There's a reason why we have terms like "hindsight is 20/20" and "monday morning quarterbacking." We won't know the best approach months, or even years from now.


There is no prefect solution here. But a completely hands off solution and just letting things fall as they may is not the way I'd approach this. And Sweden is not America.
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cone
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In reply to bigtruckguy3500 • 6:15p, 12/13/20
AG
but doesn't canceling procedures relieve stress on personnel and/or open up resources?

it doesn't make sense for overwhelmed hospitals to be still running electives, at least temporarily
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cc_ag92
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In reply to cone • 6:44p, 12/13/20
AG
I'm not an expert and defer to those who know more, but I think what we learned in the spring was that cancelling ALL elective procedures was not helpful. Many of the medical professionals who perform those procedures aren't equipped to work in the ICU or Covid wards. They're ophthalmologists, gynecologists, etc., who were unable to work at all when the cancellations were mandated. This, of course, impacted their staff, too.
I'm not sure what the right balance is because this isn't my field of expertise, but I'm guessing there isn't a simple solution.
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bigtruckguy3500
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In reply to cone • 6:49p, 12/13/20
Maybe? It depends though. There's no longer a shortage of testing supplies, in most places, so that's not as big of a concern. PPE is still short in some places, but most places have adapted or secured a stable supply. Or have learned how to reuse what they have.

Ortho has a lot of elective cases, but orthopedic surgeons are useless in the ER and ICU unless there's a broken bone (as are many specialsts that do elective stuff). Surgical scrub techs aren't much use outside the OR. OR circulating nurses sometimes have experience with critical care, but most that do have moved to the OR long ago for a more relaxed environment and are probably rusty. In a pinch they could do some stuff I suppose. Now anesthesiologists would be useful in the ICU, to a certain extent. CRNAs know physiology and vents, but don't know medicine. Would you want an ENT or plastic surgeon managing a ventilator for a loved one in the ICU? I know I wouldn't.

The big question is what elective procedures require an overnight stay, and thus take a room and bed away? A lot of hospitals have cancelled those, or are beginning to cancel them. In some of the worst hit areas some are cancelling all elective procedures. But each hospital should look at what resources are needed for each procedure, and what risks are required, and make a judgement call individually.
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ORAggieFan
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In reply to bigtruckguy3500 • 7:19p, 12/13/20
But according to LA's own stats, way more spread has come in grocery stores (number one business for spread) and "warehouse" stores. You have to go way down to find outdoor dining.


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cone
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In reply to bigtruckguy3500 • 7:27p, 12/13/20
AG
have a lot of hospitals canceled those?

I haven't heard about any in the greater Houston area
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amercer
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In reply to ORAggieFan • 7:28p, 12/13/20
AG
Is that employees or shoppers? Do they break down non-residential spread vs spread at home.

We are told where I am that small gatherings at home are the main driver, but the county never actually shares the numbers.
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cone
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In reply to amercer • 7:36p, 12/13/20
AG
small gatherings in the home or picking up the virus at the store and then getting four other people in your house or apartment infected?

I can see where cases get multiplied easily in the home, but there's got to be a significant seeding outside of the home... I can't imagine your typical person's interpersonal bubble is that large, especially the type of bubble that would be invited into your home.
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amercer
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In reply to cone • 7:49p, 12/13/20
AG
My assumption is that it's hard to pickup at the store but easy to spread at home. Still, I'd like to see the numbers.
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cone
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In reply to amercer • 7:51p, 12/13/20
AG
so how do you bring it home?

the way the cases are skyrocketing now it's got to be easy/easier to pick up somewhere outside of the home

the math doesn't seem to work if this is just in-home spread
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cone
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7:54p, 12/13/20
AG
just a personal deal, but I don't go in any enclosed public space without a n95 now

I'm not sure the masking we've deemed acceptable actually works, especially in the winter
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bigtruckguy3500
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8:09p, 12/13/20

ORAggieFan said:
But according to LA's own stats, way more spread has come in grocery stores (number one business for spread) and "warehouse" stores. You have to go way down to find outdoor dining.


I'd be interested to see how they figured that out. I'm involved in contact tracing and attempting to find sources of the infection, and over the past month at least 75% of the time we cannot identify a source. I don't even know how you'd prove you got it in a grocery store unless that was the only contact you had with other people.

For example, I know one person who flew while symptomatic and long story short didn't admit to flying and wouldn't provide his seat or airline to notify the people he was next to that they were close contacts with a positive. That would definitely skew stats if someone on that airline got sick.

Also, do you know what that graph is actually depicting? I don't think it's depicting what you think it's depicting. If you don't know, I'll let you know what I believe it's depicting based off a search, but I wasn't able to find the original source.
cone said:
have a lot of hospitals canceled those?

I haven't heard about any in the greater Houston area
I don't know, the US is pretty big and I'm not plugged into all regions.
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cone
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In reply to bigtruckguy3500 • 8:16p, 12/13/20
AG
I'm just curious where they have canceled overnight stays as a result of elective procedures
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ORAggieFan
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In reply to bigtruckguy3500 • 8:17p, 12/13/20
The source is LA Countey public data on community spread. But, as mentioned, it's limited to community they can trace and at home spread is way bigger. Which is my whole point, public limits on things like dining aren't helping anything and will cause more harm.
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bigtruckguy3500
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9:29p, 12/13/20
cone said:
I'm just curious where they have canceled overnight stays as a result of elective procedures
I said the opposite. They're not doing (cancelling) elective procedures that would require overnight stays (joint replacements, for example). Out patient procedures are proceeding - cystoscopy, PFTs, stress tests, EGDs, colonoscopies, vasectomies, etc. That's what's happening at my hospital in SoCal, and a few other hospitals that are around here that I'm aware of.


ORAggieFan said:
The source is LA Countey public data on community spread. But, as mentioned, it's limited to community they can trace and at home spread is way bigger. Which is my whole point, public limits on things like dining aren't helping anything and will cause more harm.

Did you find the primary source of that image and read it? I couldn't find the primary source, but I found another source and as far as I can tell it it's not depicting the percentages of community spread. It's depicting where particular subset of outbreaks have occured. In other words, it's not saying that 20% of people got COVID from a grocery store. It's saying that out of the 200+ outbreaks that are being tracked, and can be traced back to a single source, 20% occured at grocery stores, or whatever the numbers are. At least that's what I gathered from reading the secondary source. And we know food processing and distribution sites like meat processing plants have been sites of large outbreaks. 10 unrelated people get COVID from a grocery store is different than 10 coworkers at a grocery store that work the same shift get COVID.

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nortex97
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In reply to ORAggieFan • 8:01a, 12/16/20
AG
Well maybe the distancing guidelines just started miraculously getting ignored simultaneously in multiple states? Or, maybe, like all other ILI, it's a seasonal illness, and the county tracing as to where it is being contracted is...as scientific as unicorn behavioral studies?

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amercer
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9:54a, 12/16/20
AG
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nortex97
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In reply to amercer • 10:10a, 12/16/20
AG
amercer said:
Tracking 'cases per million' without taking into account AT LEAST (a) climate, (b) population density, (c) demographics, and (d) testing per capita is utterly meaningless.

Additional details would really be needed to suggest that chart...has any meaning but I'll let others look up why that might be the case. The present casedemic in the US is anything but a pandemic.
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amercer
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In reply to nortex97 • 10:14a, 12/16/20
AG
Yes, yes any data you disagree with is "utterly meaningless"

Europe has outbreaks, shuts things down and the numbers go down. The US does what we do and we get the numbers we get.
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nortex97
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In reply to amercer • 10:17a, 12/16/20
AG
amercer said:
Yes, yes any data you disagree with is "utterly meaningless"

Europe has outbreaks, shuts things down and the numbers go down. The US does what we do and we get the numbers we get.
Please share the metrics showing shut down dates, by country, and decreases in cases. Thanks in advance.

Your chart lacked any meaning related to the conclusion you tried to draw, sorry.
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Gordo14
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In reply to nortex97 • 10:33a, 12/16/20
That doesn't mean interventions and actions are useless. Yes the virus will spread quicker and more effectively in the winter, but there's still a difference between what the spread would look like everyone was acting like it's 2019 vs what we are doing today vs what we could be doing. Actions aren't useless just because it's spreading...

Also, it is interesting how you ignore the data from Europe, given the sudden sharp reversal they've seen. They have similar climate to the US, they are more population dense, generally speaking, and they are equally as concerned about identifying this "casdemic". This "casedmic" just happens to cause well over 500,000 excess deaths in the US in 2020 - a majority of which just happened to have respiratory symptoms that indicated viral infection, yet wasn't the flu - and a massive increase in hospital patients that just happen to be cases I guess.
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gougler08
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In reply to Gordo14 • 10:34a, 12/16/20
AG
Gordo14 said:
That doesn't mean interventions and actions are useless. Yes the virus will spread quicker and more effectively in the winter, but there's still a difference between what the spread would look like everyone was acting like it's 2019 vs what we are doing today vs what we could be doing. Actions aren't useless just because it's spreading...

Also, it is interesting how you ignore the data from Europe, given the sudden sharp reversal they've seen. They have similar climate to the US, they are more population dense, generally speaking, and they are equally as concerned about identifying this "casdemic". This "casedmic" just happens to cause well over 500,000 excess deaths in the US in 2020 - a majority of which just happened to have respiratory symptoms that indicated viral infection, yet wasn't the flu - and a massive increase in hospital patients that just happen to be cases I guess.


We are at 500k now? And I generally thought total deaths were in line with past years in the US (of course some of that is because of the lockdowns and people doing less)
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Gordo14
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In reply to gougler08 • 10:36a, 12/16/20
gougler08 said:
Gordo14 said:
That doesn't mean interventions and actions are useless. Yes the virus will spread quicker and more effectively in the winter, but there's still a difference between what the spread would look like everyone was acting like it's 2019 vs what we are doing today vs what we could be doing. Actions aren't useless just because it's spreading...

Also, it is interesting how you ignore the data from Europe, given the sudden sharp reversal they've seen. They have similar climate to the US, they are more population dense, generally speaking, and they are equally as concerned about identifying this "casdemic". This "casedmic" just happens to cause well over 500,000 excess deaths in the US in 2020 - a majority of which just happened to have respiratory symptoms that indicated viral infection, yet wasn't the flu - and a massive increase in hospital patients that just happen to be cases I guess.


We are at 500k now?


Excess deaths. Yes. Official COVID deaths, no.
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