| | | There are two other "math and logic" related issues people seem to have had a hard time with...
Both relate to the idea that the hospitals doing their best in treating sick people... is good for the sick people being cared for... but it isn't actually helping solve the public health problem...
Instead, the hospitals have tended to make the problem worse...
That's not saying we shouldn't treat sick people... its only saying that by doing that at a hospital... the way we tend to do it... all you are doing is amplifying the risks as you're making the hospital into a new spreading center... And otherwise, what you need to do to stop the spread is not care for people who are sick, and risk spreading it more by doing so... but instead isolate everyone... so they stop spreading it. The two things have very different goals... and they're in direct conflict.
The rigor of using the PPE properly to avoid becoming infected yourself... but also to avoid spreading it to others from your PPE... is always a challenge at first. Every new outbreak, like the Ebola thing in west Africa... you will see overly confident doctors and nurses getting infected ? That's assuming they have the best PPE and do know how to use it. That's not often going to be the case.
Wuhan was the worst of all of that... as their hospitals became overwhelmed. Patients would go to a hospital for treatment... wait to be seen... be turned away... and end up going to 6 more hospitals before finding someone who could see them. Then, I dubbed their approach to triage as "catch and release"... they treated the sickest only... told the rest to go home and incubate some more... when what needed to happen, early on, was to put each patient who presented with this new thing, no matter how ill... into isolation. That really didn't begin to happen until the day after the Army took over from the local officials... and by then, it was pretty late... and they were pretty brutal in the way some of it was enforced.
Sending the cops out to wrestle people off the streets to get then to self isolate ? All that did was infect all the cops and turn them into spreaders...
Otherwise, enabling all the comings and goings at hospital are also only making the problem worse... The new hospitals they built, crammed "less ill" patients in there in giant open wards... like military barracks... without adequate medical staff to care for them. So, everyone who went in there... soon had it.. if they didn't before... It's like at every step where there was a chance to disrupt transmission... they did the opposite.
And then, of course... the doctors and nurses do get sick... giving it to every patient they see, to each other, and friends and family... until they too succumb...
The other issue is another I had forecast was likely to occur... and sure enough it did...
Taking "heroic measures" to try to save someone who isn't making it... is no problem at all when there isn't an epidemic. When there is an epidemic, there is a risk as with this virus... that you might overwhelm the ICU facilities and see the mortality rate ramp up from 2% to 14% without enough beds in ICU. But, as you struggle to save these patients, and get BETTER at saving them with practice ? They will tend to spend a longer time in the ICU... since they live longer... and the longer the time they spend in the ICU... the fewer available beds there are. If they hang on in ICU for ten days instead of five... that halves the number of beds... so there's a risk the mortality statistics will go UP the more people you save that way... and could even cascade into the ramp up to 14% in result. You don't want to run out of ICU beds.
So, the most desperate public health need for this bug... was to prevent cases developing so fast that the demand for ICU facilities became over-subscribed... ensuring you could keep mortality down around 2% or less... not risk having it exploding up to 14% or more...
China didn't do that in Wuhan, but I think they did most everywhere else... once they got straight on what the LOGIC was, with the features of the bug necessarily driving change in the requirements as the virus dictated. Adapting to the bug... rather than just "doing what we always do"... was critical.
Italy... also failed. New York... some of the stories are about "ICU care" from untrained staff... using unfamiliar equipment... and not being successful. And, a lot of stories about "having to make hard choices" about who gets a ventilator and who doesn't... So, the ample time that was created for preparation... was mostly pissed away... and New York got very close to going full Wuhanic Plague on us in result... but in the end they "just" squeaked by and avoided that.
So the social distancing, masks, hand-washing, #staythefuckhome in self isolation... and all that... slows the doubling rate... spreading it out from every two days, to three, then four... then five... seven. If you can get it slowed down to the point that it is not doubling at all, but begins to just barely reproduce itself in even numbers... then in theory you can whack it into shrinking and make it go away. In theory.
This virus... seems more persistent than others. Re-activating... and re-infecting people who survived it once, killing them the second time around. So I'm not sure that our getting past it will be as simple as "developing herd immunity". Coronaviruses also pretty well known already for being "tricksey"... A vaccination for one bug... potentially setting you up and making you only more susceptible to another...
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