My Bavarian hospital is on there as yellow. I'm currently sitting in the empty urgent care clinic and just had a chat with the nurse from the almost empty emergency room about the fact that both the COVID-19 ward and the ICU are far from capacity. Not really sure why we're yellow, to be honest.
Same here. Yesterday I just had a chat with my brother-in-law who runs the emergency room in a large hospital in Lower Saxony which is depicted yellow. From what he told me yesterday they are far from exceeding their capacity even giving me some numbers.
red/yellow doesn't mean covid-19 full.
clinic close to my birthplace always have had full low care beds and they build and build new stuff every ~5 years to keep up with demand.
Germany has also accepted patients from Italy, France, and The Netherlands. For the latter the university hospital in Münster is coordinating the distribution of Dutch patients who require ICU care across Germany. Great to see neighboring/close by countries cooperate in this way.
Do you have more infos on that ?? I live in france and the general message we keep hearing is that every nation is dealing with the crisis alone and that the european union project may die because of that.
I think this started without "order" from the central government, more as a result of direct action of hospitals in regions close the borders. It doesn't make sense to not help out when a hospital on one side of the border has free capacity, while another hospital a few kilometers away across the border currently has more patients than it can handle.
These 500bn are loans from the ESM. The part of that will go to support public healthcare will be without conditions, but the rest that will go to support the other parts of the economies will be given on conditions of austerity.
This agreement comes on the heels of the rejection of what 9 Eurozone countries including France had asked initially: A Eurobond, or coronabond as it made some headlines. That would have allowed the EU as an entity to borrow money instead of individual counties, but the governments of Germany and Netherlands seems that were against it.
Actually coronabonds would not allow the EU to borrow. It would allow individual countries to borrow with the guarantee given by all countries jointly. Those against it were mainly Netherlands, Austria and Finland, but Germany was not exactly a fan either.
See it this way: everyone knows Italian debt at 140% of GDP is unsustainable. Successive governments have promised again and again to do something about it, but then each finds a reason not to follow this promise. The Italian state is leaking money in all corners with many politically friendly businesses making huge gains at the cost of taxpayers. The default is mostly inevitable if there is not finally a serious attempt to address this issue.
Successive Italian governments have asked for mutualised debt - while increasing the national deficit and debt further each year. It would be crazy for any other government to give Italy a blank check and say "okay take whatever loans you need, wecll guarantee it". It means you are consciously taking up the risk of default for yourself while having no way to stop overspending or fix the underlying systemic issues. This means Italian governments have even less incentive to change the horribly corrupt and broken system.
That other countries say no is not a decision against the Italian citizens. It would be irresponsible towards their own citizens to take this up without some kind of real guarantee that Italy will finally fix the systemic issues, because the past 20 years of promises have been broken.
I consent this argument. Unfortunately there are parts of human nature that imo require checks and balances also with help in these circumstances. Any help money that goes to an actually unneedy person or business or is spent in unresponsible ways takes unnecessarily from others, either now or in the future. It‘s a fine line that shifts depending on the trust the acting parties have in each other.
However, these bad actors are everywhere, even in Germany are apparently cases like public servants sent home with full pay claiming help money or people making up fake lost businesses. So also there checks are increasing
That's not true, Italy's debit was slowly declining till 2009, the big financial crisis that originated in the US and it was mostly because of US bank and funds. after that there was a sharp increase but it then stabilised at least.
In my understanding there is only a blunt no to the coronabond, not a request fro more condition.
It was unfortunate that it started with Italy, and been the first with an outbreak like that in Europe push them to take brave decisions.
To me it feels more like that these countries don't want to help because they feel it's Italy's fault and they need to pay.
But what about all the money that was given for free to Germany to rebuild after the second war war, despite a long history of aggression?
It's not a surprise that people wants to break the EU, it's sad to see this project heading this way.
I agree on your points regarding Italy and the same applies for Greece, Spain, etc.
But the problem is that unless this happens on European level, providing loans to economies that for whatever reason have not yet recovered from the crisis of 2010 is only going to make things worse for them. Putting more austerity on these countries provides the perfect ground for movements in favor of Italexit and Grexit. If that happens won't it affect the Eurozone as a whole and, by extensions, the economies of the surplas countries?
In other words, can we afford not to deal with it at a European level?
Hah. There's much to be said about that fund. Only medical expenses are funded unconditionally, which is a fraction of the cost of this pandemic. As it stands, the countries of the South can look forward to a new wave of IMF/ECB imposed austerity, regardless of the disastrous effects it had last time...
Germany is pretty well equipped with ICU beds and they've increased the capacity even further in preparation for Corona. I'm not worried about Germany really. I'm more worried about other parts of Europe like eastern europe. A Czech friend told me they have barely any respirators in the country.
If it's any comfort, the death rate is so high with ventilators (80%+, which is bad even for ventilators) that some doctors are trying to avoid using them, if possible, because they are concerned the ventilators are actually killing people.
I previously suggested that ventilators were problematic and I wasn't happy with the rush to create more of them instead of promoting less invasive treatments. I'm glad some doctors are looking for alternatives, but we really need to be a lot more aggressive about that angle.
Interesting points, thank you. I previously mostly had the death rate for "ordinary" ICU admissions in mind, which were 50%. Didn't know that once you are you are connected a ventilator, you have a 80% death rate.
To compare the effect of ventilators vs none, one needs good studies with randomized groups where one gets ventilators and the other doesn't. But I guess those aren't available and doing them is probably not possible due to moral issues.
I wonder if there are statistics that are the next best thing, death rate of people who doctors would have wanted to connect to ventilators but there were none available. You shouldn't compare it to the death rate of people with ventilators in places where there is ventilator shortage because then obviously there is some element of choice in who gets the ventilator and who doesn't, e.g. they choose the patients with the worst symptoms, or the patients with the largest chances of survival. Most places probably have/had shortages, so the data we have are all pretty bad to judge whether ventilators help, and if yes how much.
I have a really serious lung condition. I used to use mechanical intervention to treat my condition. I have found other methods and no longer do that, in part because such interventions are hard to keep adequately sterile and are known to increase risk of antibiotic resistant infections because of that element.
It's really not good to think of this problem space in terms of finding some group without ventilators at all. I get your point about the data, but the problem is that lungs are a critical system. If you have lung issues, you are a priority admit at an ER because that whole not breathing thing can kill within minutes. Inability to breathe is one of the quicker ways to die.
What I was previously suggesting was non invasive airway clearance methods and management techniques like being mindful of better positions to sleep in (which is apparently at least part of what some doctors are now doing according to the article I linked above). I got hounded and attacked as "practicing medicine without a license" for talking about my first-hand experience with managing my very deadly condition using such techniques.
You really can't just not treat patients experiencing lung distress and hope they live. That's a good way to kill people.
But I have looked at a little info on ARDS (the process that actually kills people with Coronavirus) and how ventilators work and I'm quite horrified that the world rushed to create more ventilators rather than rushing to say "We must do everything possible to intervene effectively without ventilators. Ventilators must be an absolute last ditch effort after every other possible intervention has been exhausted."
They aren't doing that. They are too quick to put people on ventilators and the fact that doctors are now coming up with non invasive alternatives tells you they haven't been sufficiently aggressive in exhausting all other treatment modalities first.
I have substantial first-hand experience with staying alive in the face of having routine lung distress that could kill me. I knew from the outset that they were putting people on ventilators too quickly, that ventilators are quite dangerous in their own right and that there are, in fact, other options available.
I'm quite frustrated by the whole thing. This absolutely never needed to be this ugly. I'm certainly not the only person on the planet who knew ahead of time that ventilators are problematic and that there are myriad other options available that can be tried first, especially before it gets that severe in hopes of not letting it get to that point.
The thing is generally for lung treatment doctors follow a path of escalation, start with less invasive methods like oxygen and progress to ventilators. With covid 19 there have been several reports from doctors that skipping this and putting the patient directly on ventilators directly significantly improves survival. Doesn't that contradict what you are suggesting.
I cited my source, above. What you're saying is news to me.
Without a source, I can only reply based on general life experience that most doctors are lazy and quick to prescribe drugs and surgery (or similar intervention -- in this case, ventilators) in place of trying to insist on educating patients and taking more low tech, often labor-intensive approaches instead.
I have seen all the handouts saying if you have allergies and respiratory problems, your first line of defense should be things like having wood floors at home instead of carpeting. Not once has a doctor ever sat me down and had a meaty discussion with me about my decor choices or similar. It's always been, at best, "Which drug is your favorite?"
The Chinese recommendations document ( Handbook of COVID-19 Prevention and Treatment available from https://covid-19.alibabacloud.com/ ) suggests oxygen early on, and not keeping patients on noninvasive ventilation for long before moving on to invasive, or skipping noninvasive altogether (intubating earlier rather than later) gives better outcomes. I suspect this is what the parent post is referencing. However, this applies to hospitalized patients in intensive care. High flow oxygen is the best way to prevent them from reaching that stage. What you're talking about is a much earlier stage of treatment, in order to prevent the need for hospitalization. Once a patient has reached the invasive ventilation stage their chances of recovery have already dropped massively, but at that stage the outcomes with invasive ventilation are significantly better than without. That said, all the emergency hospitals with capacities in the thousands being built are designed to get as many patients as possible on oxygen early on, as this definitely prevents many deaths. Their ventilator patient capacity is significantly lower - the bulk of them (as used in China, Spain, Italy) are just endless rows of beds and oxygen plumbing, to relieve the ICUs and isolation wards from people who just need oxygen and isolation and allow them to be used to only treat critical patients.
I have really serious lung problems and spent years homeless. While homeless, I used to just stand outside my tent and cough up massive amounts of fluid and gunk so I could breathe when I laid down to sleep.
Based on my experiences with my incurable lung disorder, I'm fairly confident we could be doing more with non-invasive techniques even at fairly advanced stages.
FWIW, my anecdata includes a 32 year old son with the same diagnosis who still lives with me and our diagnosis (for a congenital condition) dates to May-June 2001, nearly 19 years ago.
But, yes, first-hand personal experience and anecdata are roughly synonymous, though the first one lacks the generally dismissive implications of the second.
I believe the parent poster's implication was not that your experience is invalid, but that it doesn't reliably transfer to covid patients (where the complication leading to death is fibrosis of the lungs, which incidentally explains the very high death rate of advanced stage disease, ventilator or not).
A former registered nurse once told me that heart problems typically start as lung problems. Heart stress isn't at all unusual with lung distress. The two systems very much work together.
I have serious lung problems and I used to have arhythmia. I don't have arhythmia anymore. I'm generally healthier than I used to be.
I don't know why the death rate on ventilators is so high. I'm not inclined to do a lot of speculating in that regard, but I know they can promote antibiotic resistant infections and one article suggested the high death rate in Italy may have been fueled at least in part by antibiotic resistant secondary infections.
Not having any real medical knowledge, just as a logical speculation, there is always the possibilitly, that at the point, where people get put on the ventilators, the infection has come to a point where the survivability is extremely low.
That's generally true of ventilator usage. It thus fails to account for the abnormally high death rate of people with Coronavirus put on ventilators as compared to statistical norms for ventilator usage generally.
I think we can conclude only one thing from the number: by the time people are put on ventilators, their survival chance is very low. This certainly means: more ventilators won't save many people - but it may well be, that if 80% of the ventilated patients die, they saved 20% of the patients. That would assume, that the patients had died, if they had not been ventilated. Which of course depends, at which point in the development doctors put patients onto ventilation.
I posted a link in my original comment to a source indicating that's not what doctors are concluding.
It's also not what I'm concluding.
While I'm not a doctor, my life literally depends upon me having a fairly substantial amount of knowledge about things like my lung function. In contrast, you opened with saying you don't have much medical knowledge, this just seems logical to you.
I will suggest you do more reading. Your logic doesn't really hold up in this case.
I found the link you are probably referring to, but the article doesn't give any clear conclusion, other that it is known, that ventilation is a very harmful procedure.
I would assume, for that reason, doctors wouldn't use ventilators until there is no other option to keep people breathing. Do you have a source for ventilators being used much earlier? If so, than this is certainly something which should be reconsidered. Is there any other treatment than ventilation, once the oxygene level in the blood drops beyond a certain level?
I feel I've already covered these points. To recap:
Some doctors are currently making a concerted effort to intentionally delay or avoid use of ventilators because they are concerned about the alarmingly high death rate associated with them. On the face of it, this implicitly admits that doctors haven't heretofore been exhausting all other treatment modalities before ordering use of a ventilator.
I don't know how to answer your last question. I've talked extensively about my firsthand experience with using alternative treatment modalities with my life threatening lung issues, but I'm not a doctor and I don't really have the background to assert anything more than I've already covered, which, as usual, is being dismissed by some commenters as anecdata.
Since I've already qualified it up front as "my firsthand personal experience," it seems entirely pointless to belabor any points about my opinions.
If the opinions of some random internet stranger (aka me) don't satisfy you and the opinions of medical professionals in the source I posted don't either, I think you probably need to do some digging to come up with the sorts of info that interest you.
I've already given the source: it was the opinion of a medical professional I was friends with.
You can readily Google the idea and come up with multiple articles indicating that lung problems can cause heart problems and heart problems can cause lung problems. As I stated above, the heart and lungs work closely together, so it's not uncommon to have problems with both at the same time.
(Please kindly don't try to tell me that's not what I said. It's 3am here and these are comments on a forum, not a PhD thesis. I'm telling you it means the same thing to me. I've given my clarification as best I can and I didn't say "primarily," I said typically, which really doesn't sound the same to me. Given how the heart and lungs work, I think my friend was likely correct that the direction of cause and effect typically starts with the lungs and goes to the heart from there, but not always, of course.)
For me, "typically" does mean a majority of cases.
I'm "only" a Veterinarian, so I'm not quite current in the distribution of how this works in Humans, but from my understanding it's normally the heart that affects the lungs, not the other way around.
That statement might be true inside a specific context, like infections, maybe.
To me, primarily suggests something like "we have hard data showing that 90 percent of cases absolutely start with the lungs" and typically is more like "I have professional experience and years of observation without collecting hard data suggests that this is true at least 51% of the time."
So they don't parse the same for me, though I can see them parsing the same for someone else.
The lungs serve as a filter for everything you breath in. Modern air is generally pretty polluted. I imagine that everyone's lungs get de facto pretty gunked up these days, like the filter on a home AC that never gets changed and then we wonder when other pieces of the system start showing strain.
I imagine it frequently goes unrecognized as starting in the lungs, but I think it probably does. Please note that "starting" there also doesn't preclude other contributing causes, which is another reason I object to the word primarily. Saying "First X happens and then there tends to be a cascade effect from there" absolutely isn't the same as saying "X happens and X is the entire cause of the problem with zero other factors contributing to it."
Edit: I will add that I believe it starts with the lungs in part because reading up on altitude sickness did wonders for my understanding of my condition which has substantial gut involvement. When there is a defect in air quality, it rapidly starts impacting other systems, like the gut, liver and kidneys, and there are huge knock on effects that can be outright deadly.
Before reading up on altitude sickness, I had this hand wavy idea that the gut and lung issues are related, but afterwards I had a clear and definable connection and that connection is how the body processes blood gasses. So, obviously, the connection is the circulatory system, which is powered by the heart.
Outcome of reductionist thinking that is plaguing the world, thanks to its great success by and large, but the downside is wholistic approaches have been contemptuously tossed in the trash.
A downside of oxygen is that it's very flammable. Also, to whatever degree it involves a cannula, masks, etc, it has some of the same issues in terms of sterility challenges.
I've generally relied on things like airway clearance and dietary intervention in recent years.
Nit: oxygen is not flammable. Other things are flammable in its presence. A lump of coal, for example, burns white hot when oxygen is blown on it from a welding torch.
But if you have a personal mask, aren't this then mostly your own microorganism, your body knows how to deal with?
The fire hazard is a real threat, yes, but I imagine, if I ever would have serious trouble breathing, the first thing I would get is a bottle of oxygen to ease it.
I'm a little uncomfortable with the line of questioning here because it is starting to veer into sounding like asking me for medical advice.
I've left comments previously about airway clearance techniques and home remedies I've used. They probably aren't hard to find if you care to read them.
I have an incurable condition and impaired immune system. I personally don't like dealing with anything like masks. I've done it in the past. I know how hard it is to keep them adequately sterile.
I am not a doctor. I am not here to give medical advice in comments.
I know that, I did not really ask for advice, more for your experience. And since you do not have experience with oxygen, I was merely suggesting it, as I heard how it helps people with breathing problems and I do not see the need to have the masks 100% sterile if it is your personal mask. But I am also not a doctor ..
My personal experience is that you do need to diligently sterilize things like masks that only you use. I spent years boiling medical equipment daily.
I had a nebulizer for a time to administer inhaled treatments. It had to be carefully sterilized.
Failure to adequately sterilize your personal medical equipment is sometimes a source of very nasty antibiotic resistant infections.
Your own germs or not, once they leave your body and grow on a surface and come back in contact with you, you had better take it seriously as a threat to your health.
As far as I know mechanical ventilation is the last resort.
It's all about the oxygen saturation. If that is too low, patients usually get oxygen first, and of course all the other issues need to be treated, if necessary. If SpO% is still too low, they try the ventilator.
My point is: There is a very good reason patients go on a ventilator. They don't get enough oxygen. When they are on the ventilator, they DO have enough oxygen. And you really need that oxygen to survive and recuperate... So not putting them on a ventilator is sort of contra-indicated.
I think stating it as "ventilators are killing people" is wrong. It's an intervention because these people don't have enough oxygen in their blood, the intervention helps them put oxygen in their blood. It's all well and good to look at alternatives as you put it in your last sentence, but the way you put it at the outset sounds like you think ventilation is worse than nothing on the whole, which is probably not true, even if for some patients it is premature and makes things worse.
That isn't what I said. You misquoted me and I posted my source.
To reiterate: Some doctors are concerned the ventilators are actually killing people. They are concerned because the death rate is shockingly high for ventilator usage, much higher than is typical with ventilators.
The evidence is mounting that use of ventilators should probably be an absolute last ditch treatment option for people with Coronavirus and that other treatment modalities should be used first. Some of these are as simple as recommending different sleep positions to ease lung distress, something I talked about previously.
It's not news at all that some positions are harder on the lungs than others. It's been medical practice for decades to put people on inclined surfaces when they have pneumonia to reduce the amount of lung surface being submerged in fluid. It has a known track record for improving survival and it's non invasive and doesn't require fancy equipment or training, etc etc.
Though it lacks the geegaw "ooh, shiny!" appeal of people cooking up open source ventilator projects, so no one is all excited to talk about such simple and readily available interventions that any idiot can do, even from home, even without a formal diagnosis or doctor's prescription.
Edit: My source doesn't baldly state, as I did, that doctors are concerned that ventilators are killing people. It more delicately states that ventilators may be harming certain patients and then cites the crazy high death rate as evidence of this possibility.
I stand by my more bald framing of the issue. I'm aware it's not PC, but there comes a point past which efforts to be PC do a disservice to the truth.
The speculation is the issue here. You say "evidence is mounting", but I don't see this to be the case.
In the article you quotes, the evidence is that "some doctors think" but even then, the article concludes that ventilators probably save lives.
No inference can be drawn from data points such as death rates with and without ventilators, since ventilators are not randomly assigned. This is just basic statistical inference and the reason why you don't have ANY official sources or guidelines following your directive.
It would still be likely that the people dying with ventilators would die without them, and there is indication that people that survive with ventilation would not have survived otherwise.
Consider, for example, the correlation of death rate for countries without enough ventilators and those (such as Germany) with enough ventilators available. The difference is very large.
Consider also that Chinese doctors recommend the exact opposite to what you say. A lot of people die from heart or organ failure because of the stress oxygen distress induces.
There are a lot of cases where recovery would be possible if it weren't for organ failure. In these cases, ventilation seems to help.
In that sense, there is clear evidence that ventilators are useful and, at least on a population level, outweigh the risks.
We can not (ethically) run experiments in these situations, so it would be wise to refrain from making questionable analyses based on anecdotal data.
My understanding of the term "PC" is that we basically try to be as inoffensive as possible in public. Where this encourages people to not use racist, sexist, etc language, it's generally a good thing.
To the degree that it encourages people to hem and haw about uncomfortable truths, like "this is killing people," it's often counterproductive.
I'm a former military wife. The military is not a culture that tries to politely find ways around talking about death. It's pretty blunt about some things that the civilian world finds uncomfortable.
Nitpick: Lack of PC is not uncomfortable. Quite often it is about telling things the person finds comfortable and that feel good - the ones that imply speaker is superior or that someone was always right about world.
I'm aware that politically incorrect remarks are often about privileged people being unconscionably rude and that such remarks are typically not uncomfortable for the speaker.
I'm trying to make a distinction between being appropriately concerned with respecting the feelings of other people and situations where it's actively problematic in terms of clear communication to try too hard to be delicate about a topic. There are situations where that actively fosters misunderstanding, having nothing at all to do with the fact that privileged people are frequently oblivious to how hurtful their words are for other demographics.
My source delicately frames this problem as "causing harm to some patients." Most people would not frame a dramatically higher death rate as "causing harm to the patient." That framing implies survival.
I think it's appropriate in this case to baldly state that we are talking about people dying, not people suffering moderately more. I've explained why.
I know what you mean. My offtopic remark was claim that it is more. Not just insensitive remark cause you are too privileged.
Instead, itis remark that actively feels good and thus actively makes you more popular among people whose ego is raised by that remark. Remark done so that a group like you more, because you say things that feel good. (Also bonding, but that another topic). Nationalism would be good analogy - it is targeted primary at in-group, to make in-group stick together, feel good and follow you. Like Petersons "women are chaos men are order" is more about making boys feel superior which is pleasant then about any effect on women. It is not random either - it is populist statement actively making a group of people want to.listen to you and worship you. Because it feels good to be order, even if you know deep down it is not true.
You may be underprivileged or unhappy and use that to make yourself feel better about yourself. You may be priviledged and use non PC remark to attract followers, build coalition with both underprivileged and privileged, make common ennemy of whatever group you make fun of.
Not always, but I think fairly often it is used like this - both offline and online. I have seen this play out enought times in both settings to finally conclue the above.
That sounds more like a tangent than a nitpick. Nitpick means "Yes, this is ridiculously minor, but I'm going to argue with you anyway about this tiny insignificant detail about which you are wrong."
I agree with your concerns about Eastern Europe. I have many friends there and their respective countries are not prepared at all in terms of resources.
Turkey has me the most worried at the moment. Turkey is maxing out its testing capacity every day, with cases rising by 4k like clockwork; 47k cases with very few recovered and it's accelerating. Their infrastructure can't handle the existing cases much less another 50k+ in the coming 7-10 days.
And then Russia. I wish there was a clearer picture of what was going on there. For example:
"Suifenhe in China’s far northeastern Heilongjiang province has seen an influx of Chinese people returning home, many infected with the virus, travelling by road from the Russian far eastern city of Vladivostok after flying there from Moscow."
I would say the respirator situation here in Czech Republic stabilized since the - the awrial bridge is still running and medical personel shoukd be stocked now by PPE & some buffer is being built. As for normal people - everyone uses hand made cloth masks & that seems to work fine. You can even buy the cloth masks easily online now if you don't have sewing skills and don't know someone who does.
From that list, Germany has more ICU beds per 100k inhabitants than any other country in that list except for the US, so it confirms that at least. Italy, France, Belgium, etc all have > 11, while Poland, Slovakia, Slovenia, Russia etc. have less than 10 each. Hungary and Czech republic have really good numbers, opposite to the trend and Netherlands, Portugal, Sweden, Denmark have really low numbers, also opposite to the trend.
So it's pretty mixed actually. Only gives me more countries to be worried about :(
Part of it is cultural. For hospital beds, do you keep patients one extra night ‘just in case’, or do you send them home as soon as possible?
For IC beds, do you give patients the choice between going home to die a week later and a bed in IC that will make them live a bit longer, but with a less comfort and less contact with their loved ones, or do you always go for “all life is sacred”?
Some countries discus this with patients, even if the IC option has a chance of survival. That may sound unethical, but survival, for many patients, will be with much lower quality of life. They may have to move to a care home, stay on medication with severe side effects, may have to train hard for months to even be able to walk again.
Patients that already have a low life expectancy may choose to stay out of IC.
I wonder why they have such extreme numbers of ICU beds. Are they reporting them differently, e.g. disaster wards that are normally not operating unless there is a disaster are counted?
Or do they really run with a tiny fraction of beds occupied, in the years between wars and pandemics? It seems a bit wasteful to have that low usage, instead of having the capability stored for a rainy day.
I read somewhere that they have difficulties getting medication and might running out of sedatives in the next weeks to take out people who have to be ventilated.
This may make more sense if it's normalised by the size of each hospital? Small hospitals are immediately at limit and make a red dot for obvious reasons.
For example, there's a red circle next to Bremen, Alle-Weser-Klinik Verden, they have 131 beds [1]. Verden has about 27k inhabitants. There's a large blue circle in Baden-Wuerttenberg, Klinikum am Gesundbrunnen, they have 970 beds [2]. It's in Heilbronn which has 120k inhabitants.
People from other countries are always hating "just wait, we laughed too, but then things got worse!"
But I have the feeling, in Germany we are doing pretty good for ourselves.
I don't think this will be over soon, but when I look at our numbers, I just can't see it getting much worse, let alone as bad as our neighbors or the US has it...
Death rates will rise and things will get worse, but if we are lucky not dramatically so.
In contrast to literally every other large European country, we did a lot of testing (compare for example CDR for France against Germany, we did ten times more tests especially early on). If you run the numbers on tests vs. infections, assuming that death rates are more accurate, you have to conclude that Italy, Spain and France likely have a magnitude more cases than tests would suggest.
Initial infections were mostly young people at the carnival events. This helps with the death rate.
Furthermore, Germany is more decentralized than any other country in the EU, and has "decent" capabilities spread.
We had a good start. Call it luck. However, it'll get worse, especially since people are itching for it to be over.
Here in Germany, we have the "weekend reporting" lull, where cases go down. Each time, people in big cities somehow take this as "peak reached" and go out. All actions have a two-week lag, so we don't really know anything about what works and what doesn't. Yet.
We NEED to be vigilant now, and you need to urge everyone you know to keep distancing and quarantining. Do your part.
Yes, it's 27C and sunny outside, but we are not over the bump yet.
IF we keep going like this, we may be able to get over this crisis without ever having a health care catastrophe like France, Spain and Italy.
But if we let our guard down too early, then we can get in trouble.
Yes, we were lucky with initial cases and our testing capability. But if we get to infection rates like other countries (10x more than current numbers suggest, at least), then our hospital system will also collapse.
It's best to ignore daily infection numbers, especially here where few cases are sent to RKI over week-ends and holidays.
Let's celebrate when the death rate goes toward zero.
The peak of the last weekly cycle was April 2nd, and was the highest peak yet.
The current cycle is still in progress. Cases get added to previous days of the week retroactively. For example, there were days when it looked like case would go down, and then the next day several thousand cases were added to prior days and we went back to the weekly cycle.
We need to wait until next week to make any judgement about what is going on right now.
Up until now, there seems to be a linear increase if we ignore the cyclic component. At least for two weeks, people have been fantasizing about a decline that did not occur.
I agree that it looks like as if we'll have less cases this week. However, since it's holiday, this may be deceptive.
We will not know for certain until next week, perhaps week after next week.
It's too early to celebrate.
Obviously I share the hope.
Wait few days after Eastern celebration, parks in Munich are full, people around houses are celebrating in packs. Even deep in woods 30 miles away isn’t that empty as it was few days ago. 4000+ new cases alone yesterday. So another 200 intensive care beds needed. I am really worried about all this careless “we are doing well”.
The ones say “we’re doing great”, covidiots believe that and don’t follow rules, because “we’re doing great”. I would say “we’re doing great” when daily infection rate drops from current 4000+ to 500.
We reacted late, but not as late as for example Italy. And at least where I live, many people tried to reduce social contacts. Not all obviously, but streets got emptier. But probably the most relevant thing to do was closing schools and especially kindergartens.
It may just work out fine, I think it also depends on whether people get their shit together during the Easter weekend regarding family visits. Good weather also helps making things look less grim.
We acted later than Italy, in temporal terms. Maybe earlier in terms of the infection curve.
At some point there wasn't anything to act on. Cases where far and few between and have been individually isolated for a time. There was no way to find community spread because there was no way to identify other cases without testing millions. And the official incidence rate is still about one in a thousand people.
According to the district office there are 778 cases in the district of Ortenau right now [1]. Curiously the map colors indicate shortages in several places but checking the individual clinics yield 0 cases.
Germany (like a few other countries) is in the situation "too much lockdown, too few sick".
So it has to remove those lockdowns. This creates a fun political dynamic where the authorities who just spend a month scaring the population in doors now has to explain and justify why it is ok to go out and get a little sick.
I strongly disagree with the statement, that we have "too few sick" here in Germany. With the lockdown, we managed to just keep the health system from being completely overloaded in the most infected regions. But that already at the price of postponing non-urgent medical procedures. So yes, there are a few free beds in hospitals still, but we might still need them.
What is not accounted for is, that supplies (masks...) are still scarce and more importandly, most medical personal is working at an unsustainable intensity. There is plenty of reason of desiring even less sick people.
The reasons for reducing the lockdown are practical, social and economic. The lockdown is hard on many people, depending on their social and living situation. Especially in dense cities, most people don't have housing which was designed to be confined to it for many weeks. And apart from that, people want to go out, want to meet other people again. Need to do shopping for clothing, get a haircut. Also, we should try to keep the economy from collapsing.
The trick will be to reduce the lockdown while keeping the minimum safety in place and without too many people acting reckless and endangering the population again.
It is the same "problem" here in Denmark; massive lockdown and overcapacity for COVID19 treatment.
The current level of lockdown is unmaintainable as this virus is probably going to be here for a year or two. However it is very hard for our politicians to say: It is too expensive to save these lives - other lives are cheaper to save.
In a way the media coverage has been so effective that people actually do not want the restrictions lifted.
If enough people stay careful, it is easier to lift the restrictions. As the grocery stores stayed open during the lockdown, we can see that it is reasonable safe to interact with other people, if the minimum distances are obeyed and proper hygene is used. After this model, most other shops should be allowed to open again as long as people keep their distances. Not sure what to do about the previously crowded shopping streets in the city centers. Perhaps there, only half of the shops should be allowed to open on alternating days.
You clearly live in a different Denmark than I do. Maybe you read too much Ekstra Bladet.
We are following the curve just as planned - not over and not under. There are no "overcapacity" and the lockdown isn't "massive" at all. Only a tiny percentage of shops are closed down and the rest isn't close to what a lot of other countries are doing.
Stop spreading FUD and try to appreciate we have a system that is working great in this crisis.
> I strongly disagree with the statement, that we have "too few sick" here in Germany.
We want to be close to maximum capacity (but just under) though, and we're not. If "the curve" is too flat, it gets drawn out much more than necessary, and nobody should fool themselves into thinking that this can be a permanent setup. You'll need martial law if you want to confine everyone to their homes for 12+ months.
That is why we have to find a way out of the lockdown: because, as I wrote, you can't confine people to their home for too long. But not because we have "too few sick". If you are playing towards herd immunity: it doesn't look like we are getting there with "acceptable" infection rates. The disease is too nasty for that. So we have to reduce the lockdown in a way so that the infection rate does not increase significantly.
I disagree. If we can push the R0 low enough such that active case numbers decline to be less than a thousand, we can implement aggressive test/trace measures that would allow us to lift restrictions altogether, hopefully forever. We need an infrastructure to test people rapidly and often, we need an infrastructure to develop rapid containment and quarantines and so forth.
We need to act, as if we'd never get rid of this virus. As if this virus were now a fact of life.
This is the way to go, because developing this capability will be useful for the future as well. If, instead, our hospitals are at the limits and everyone is on full lock down, no such capabilities will be developed. The health care system will just struggle to keep people from dying and we may have the same situation when this or another virus returns.
There are other considerations for this, of course.
First, fewer people will die. Second, it's not clear how immune a population can be to this virus. And even if herd immunity turns out to be viable, having a low R0 puts us into a waiting position where we can let the virus infect young and healthy people if that's a wise decision.
Fully agree. Just one comment: there is a middle ground, where we lift most, but not all restrictions. While we keep a lot of anti-infection measures. For example, most businesses can open, with the distance rules still paid attention too. But we would avoild to have the most critical events, like big parties, trade shows, concerts, football games. And of course, still try to maintain proper hygene, like hand washing and possibly mask wearing.
By this we could reduce the risk of infections by a huge amount compared to the pre-lockdown behavior but still have a pretty normal life. If we managed to get the number of infectios people small enough during the lock down, together with active measures like testing, tracking, etc. it might be good enough to keep the infection rate at or below 1.
As far as I'm aware, contact tracing has never really stopped in Germany, despite the lockdown. Since both tracing (via local Gesundheitsämter) and testing (via lots of local labs) is distributed and not centralized, you can still effectively implement contact tracing in places where you're not overwhelmed. And there's lots of such places, despite the growing numbers. Unlike Italy, Spain, or the US, Germany wasn't hit that hard in a single area (except Heinsberg, but that happened to be right in the middle of a gigantic metropolitan area, so there's plenty of infrastructure to deal with that). Cases are spread out all over the country and so is testing and tracing capacity.
Germany is NOT at a place where the lockdown is too strong. The spread is still growing exponentially and they will run into issues a few weeks from now if it continues at this rate.
You can’t keep everything open and then shut everything down once you’re at capacity, as it takes three weeks for lockdown measures to show up in the hospitalization rates.
Currently the R0 in Germany has gone below 1, according to some models.
I don't think the measures will be softened before May, but according to the authorities, the ICU capacity will not be overburdened. Stressed to the maximum, yes, but not (or not much) over capacity.
Another issue is that with an R0 this low there will be a much lower rate of immunity. Which in turn means the restrictions can't be lifted because then the whole mess starts up again.
> I don't think the measures will be softened before May, but according to the authorities, the ICU capacity will not be overburdened. Stressed to the maximum, yes, but not (or not much) over capacity.
Yes, sounds like Germany nailed it
> Another issue is that with an R0 this low there will be a much lower rate of immunity. Which in turn means the restrictions can't be lifted because then the whole mess starts up again.
Literally no way to avoid this if you want to avoid overrunning the hospitals
There will be a question of whether or not a slightly higher R0 would be beneficial.
It's clear that we can't hold this up until the vaccines are ready. The antibody studies will be crucial to determine how much immunity is there.
Ideally we would take back the restrictions when immunity has broadened enough. But that might take too long. I don't think this kind of shut down is sustainable for another two months.
Would be cool to have this for NY as well. I have this nagging suspicion that the press is only showing the small number of hospitals that are overflowing, and not showing the ones that are under capacity, to stoke panic and drive clicks. Similar to the "mass graves" bullshit they wheeled out the other day.
To see why it's bullshit, one has to do some basic arithmetic. Consider that if life expectancy in NY metro area is 75 years and 21 million people live there, 1/75th of the population, or 280K people die per year in NY metro area alone. That's 7671 person per day on average. At the time of this writing 7844 people have died of corona in the entire state, total. I'd bet good money a good chunk (if not most) of these people would die of something else if it wasn't corona, so that's not a "net" increase. If you want to tell me these deaths require mass graves, I have some fine swamp land in Florida that you might want to check out.
The New York Times put out an article just yesterday[1] that directly addresses most of your doubts.
In summary:
* Substantially more people have died in both NYC and NY state than is demographically expected, suggesting a significant effect from the virus.
* Virus deaths are probably still under-counted, as bodies retrieved from homes aren't being tested. Patients with significant comorbidities may also be being mis- or under-counted.
I live in NYC, and all of my local hospitals are at the limits of their normal capacities (many have been able to expand their capacities, thankfully). The city has been asking for volunteers to come out of retirement.
To my knowledge, none of my friends or family have been able to get non-urgent treatment or tests for coronavirus symptoms; the system is completely focused on (and occupied with) treating those most at need.
Edit: I also forgot to mention: I don't know exactly what you're referring to w/r/t "mass graves," but I'm guessing it has something to do with Hart's Island. The city buries its unclaimed dead there; any uptick in activity probably tracks roughly with death's among the city's general demographics. It wouldn't be surprising for them to need a few more trenches.
Yes, Hart Island is being sold as "mass graves". Plus this right here clown (of "come to celebrate the Chinese new year, in spite of coronavirus" fame) said the other day there'd be _temporary burials_ in city parks: https://twitter.com/MarkLevineNYC?ref_src=twsrc%5Egoogle%7Ct...
My point is, as bad as the situation on the ground is in NY, the single digit percentage uptick in the overall number of deaths would most definitely not overwhelm anything at all, and given the dis-use of the emergency hospital capacity and reduced hospital and ICU admissions over the past few days, crowding in the hospitals seems like a load balancing problem to me.
And if anything, I would not be surprised if the official figures _overstate_ the death toll. Dr. Birx mentioned in the presser the other day that everyone who died _with_ C19 is counted as a C19 fatality, even if they did not die _of_ C19. Died of cancer but also have C19? You'll be counted as a C19 fatality.
> crowding in the hospitals seems like a load balancing problem to me
The problem is that once a patient is so far gone that they are on a ventilator in the ICU, even the regular movements of going over speed bumps and potholes become potentially life threatening.
That's in the best of times. Given that hospitals are running out of PPE, what are the chances that they can even move an infected patient without collateral damage that would further serve to overwhelm the hospitals they are moving the patient to?
They aren't. You're being fed fake news. Hospital admissions and ICU admissions in NY are _way_ down. Nobody is running out of PPE. If you're going to dispute this, please provide a credible source familiar with the situation on the ground. My source is governor Cuomo: https://www.washingtonexaminer.com/news/were-ok-andrew-cuomo.... Don't bother pasting that teary eyed nurse who was "forced to work without PPE". That's fake news. Look it up. She's not a nurse, she's an Instagram "influencer".
> regular movements of going over speed bumps and potholes become potentially life threatening
Yes. Move them ahead of time, before they need intubation. Seems like people are in some kind of a stupor there. These are pretty obvious things.
> Hospital admissions and ICU admissions in NY are _way_ down.
They aren't. You're being fed fake news. If you're going to dispute this, please provide a credible source familiar with the situation on the ground.
> Nobody is running out of PPE. If you're going to dispute this, please provide a credible source familiar with the situation on the ground.
From a New York City Department of Health advisory to NYC doctors, dated March 20, 2020 [1]:
Like other jurisdictions with general community transmission of COVID-19, New York City (NYC) is facing a critical shortage of PPE
Your source's factuality is rated as "mixed" on MBFC [2]. Given their low bar, that's basically propaganda and a quick perusal confirms that this is a media organization most fond of rhetorical tactics like emotionally loaded language and one sided coverage than they are of facts, a defining features of manipulative "fake news,".
Anyway, let's focus on the actual content of that article: the tiny video clip of the New York state governor's press conference at the bottom, shot less than 24 hours ago. When a reporter asks Cuomo about the PPE situation he says: "If you ask any hospital 'do you have enough PPE?' they will say no. It's like asking a budget director 'do you have enough revenue?' They will say no. And these hospitals are accustomed to having one month or two months stockpile. They're now looking at several days of stockpile. So they are all uncomfortable. But, we only have several days for any hospital and we do have several days for every hospital and we do have a supply that is coming in so compared to how we have been operating on this new dire circumstances, we are relatively comfortable with ventilators and PPE if, big IF, big I, big F, if the hospitalization rate stays down, which will only happen if we continue to do what we need to do." I wasn't born yesterday so you'll have to excuse me for interpreting that as press conference bullshit. Any politician worth his salt with an adequate PPE supply would have used that golden opportunity for a display of confidence, not hem and haw about budget directors. Especially if that politician is overseeing the country's financial center.
But why stop there? Before someone could even ask the next question, Melissa DeRosa (Secretary to the Governor) interrupts to add: "If I could just make one caveat, there are certain hospitals that we get anecdotal reports on that are continuing to operate under the crisis conservation guidelines on PPE, where they ask people to wear PPE for days at a time versus what the ordinary protocol is and as we're hearing those reports we are reaching out to the hospitals and making sure they have the supply so that they don't have to operate that way." Note that she doesn't say that those hospitals are operating incorrectly because there is no shortage, but that they are still in the process of supplying those hospitals. They wouldn't have to do any of this if there wasn't a shortage, although maybe that's just a little more obvious to someone with actual clinical experience.
I think you've been focusing too much on "Instagram influencers," "teary eyed nurses", and ideological conflicts. I strongly recommend limiting your information intake to official (on Google: "site:gov") or academic ("site:edu" or Google Scholar) sources.
Facepalm. Your PDF is from March 20th. Watch recent Cuomo's pressers from the past few days: https://www.youtube.com/watch?v=Prq-RZfDO8Y. Skip to 13:23 or so to see the chart, followed by ICU admissions chart.
Didn't read the rest of your message, sorry. You're being gaslit.
You mean the charts labelled change in total hospital/ICU
admissions? Based on your folkloric grasp of the English language, you have clearly misinterpreted those graphs.
"Change" here means "hospitalizations per day", which is exactly what I meant. Seems like it's your grasp of the English language that's "folkloric", not mine. NY no longer projects that they will need anywhere near the capacity they already have.
Cuomo, BTW, then proceeds to talk about how models were total horseshit. He doesn't quite characterize them as such, choosing instead to give credit to his own response, but nearly all of the models he quotes assumed the current levels of mitigation.
Why might admissions to hospital be dropping? Because the hospitals are full?
From your video, 14:00
"This is a little deceptive, because at one time hospitals had discrete ICU wards or ICU beds. Effectively now in a hospital all the beds are ICU beds".
But ICU admissions are also dropping and going negative. That is, fewer people are admitted than discharged. And according to frontline medics, everyone who needs an ICU bed gets an ICU bed.
> the single digit percentage uptick in the overall number of deaths would most definitely not overwhelm anything at all, and given the dis-use of the emergency hospital capacity and reduced hospital and ICU admissions over the past few days, crowding in the hospitals seems like a load balancing problem to me.
Deaths lag admissions by about 15 days.
Deaths are not the only outcome, some people will be in ITU for a few weeks but not dying. They'll then be transferred to ordinary wards, and then back home or to a care home.
Reduced hospital admissions is a bad thing -- we know if someone's having a stroke they need care as soon as possible. If people are having stroke but staying away from hospital we're going to find a bunch of people dying away from hospital, or a bunch of people with long term preventable disability.
> And if anything, I would not be surprised if the official figures _overstate_ the death toll. Dr. Birx mentioned in the presser the other day that everyone who died _with_ C19 is counted as a C19 fatality, even if they did not die _of_ C19. Died of cancer but also have C19? You'll be counted as a C19 fatality.
This is such a frustrating misunderstanding of what's actually happening.
We count flu deaths the same way. But here you're not saying that we overcount flu deaths, you're looking for anything so you can say "covid-19 isn't that bad".
Because of the way covid-19 deaths are counted it's likely they're being undercounted at the moment. A certifier has to say to the best of their knowledge and experience that covid-19 was a contributory factor in the death. That's hard to do when so few people are being tested.
> Died of cancer but also have C19? You'll be counted as a C19 fatality.
Aside from the arguments others have already replied to, your numbers are wrong by an order of magnitude. 280K/year comes out to 767/day on average. Yesterday 777 people died of Covid, so, roughly, it seems to be doubling the death rate at the moment (not quite true, since we shouldn't compare to average, and maybe some of these people would have died now anyway, but +100% is a closer estimate than an increase by a single digit percentage). Note that the number of deaths/day are still on an increase, and without lockdown it'd have been expected to increase exponentially for a while longer.
Of course, things get even worse when the disease is left unchecked or hospitals become overwhelmed; some tows in the Bergamo province in Italy reached daily death rates that where 6 times as high as the ones from last year in the same time period.
According to some claims up to 70% of corona infections could not result in observable symptoms.
However, if you take just dying people, it would not come as a surprise that they are so weak that the additional infection can produce visible symptoms and their death is attributed to COVID.
In some places in Lombardy (Italy) the death rate is clearly higher. You didn't need the army to transport coffins before. No statistical anlysis required here.
The analysis is further complicated that death rates vary a lot over the year even under normal circumstances. I don't doubt that in some countries a corona peak will be seen, but it will still take months to be sure how big it is.
Not ridiculous. After the first town in north east Italy was put in quarantine (Vo Euganeo) the local governor decided to test the whole town for Coronavirus (a few thousand people). More than half of the infected people where without symptoms.
It should be obvious, when you have a virus with an infection rate doubling X number of days and it takes X or more days to start showing symptoms, if you do a random sample, 50% will be asymptomatic. That does NOT mean that they will continue to be asymptomatic
This is exactly what I want to see at at least county-level resolution for the US, and at a borough level in NY. This is something that's immediately usable. "X people died" is not usable on its own, because it contains no information on how X compares with what's "normal" in a geographic region.
The number of hospitals that report that their ICU capacities as:
Blue: Has Free Capacities (639 currently)
Yellow: Some Contention (326 currently)
Red: Fully Utilized (41 currently)
Covid 19 patients in ICUs: 2453 (76% of which are on ventilators)
ICU beds reported by hospitals: 19,663 (58% in use currently)