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Here’s the Biggest Thing to Worry About With Coronavirus Here’s the Biggest Thing to Worry About With Coronavirus
(about 11 hours later)
The ability of the American health care system to absorb a shock — what experts call surge capacity — is much weaker than many believe.The ability of the American health care system to absorb a shock — what experts call surge capacity — is much weaker than many believe.
As a medical doctor who analyzes health issues for The Upshot, I strive to place your fears in context and usually tell you that you shouldn’t be nearly as afraid as you are. But when it comes to the nation’s response to the new coronavirus, I cannot be so reassuring.As a medical doctor who analyzes health issues for The Upshot, I strive to place your fears in context and usually tell you that you shouldn’t be nearly as afraid as you are. But when it comes to the nation’s response to the new coronavirus, I cannot be so reassuring.
A crucial thing to understand about the coronavirus threat — and it’s playing out grimly in Italy — is the difference between the total number of people who might get sick and the number who might get sick at the same time. Our country has only 2.8 hospital beds per 1,000 people. That’s fewer than in Italy (3.2), China (4.3) and South Korea (12.3), all of which have had struggles. More important, there are only so many intensive care beds and ventilators.A crucial thing to understand about the coronavirus threat — and it’s playing out grimly in Italy — is the difference between the total number of people who might get sick and the number who might get sick at the same time. Our country has only 2.8 hospital beds per 1,000 people. That’s fewer than in Italy (3.2), China (4.3) and South Korea (12.3), all of which have had struggles. More important, there are only so many intensive care beds and ventilators.
It’s estimated that we have about 45,000 intensive care unit beds in the United States. In a moderate outbreak, about 200,000 Americans would need one.It’s estimated that we have about 45,000 intensive care unit beds in the United States. In a moderate outbreak, about 200,000 Americans would need one.
A recent report from the Center for Health Security at Johns Hopkins estimated that there were about 160,000 ventilators available for patient care. That may seem like a lot, and under normal circumstances, it is. Pandemics, however, change the calculations.A recent report from the Center for Health Security at Johns Hopkins estimated that there were about 160,000 ventilators available for patient care. That may seem like a lot, and under normal circumstances, it is. Pandemics, however, change the calculations.
A few years earlier, the same group modeled how many ventilators would be needed in unusual circumstances. In a pandemic akin to the flu pandemics in 1957 or 1968, about 65,000 people might need ventilation.A few years earlier, the same group modeled how many ventilators would be needed in unusual circumstances. In a pandemic akin to the flu pandemics in 1957 or 1968, about 65,000 people might need ventilation.
Hospitals don’t survive financially in the United States by keeping beds open and equipment idle. They have enough equipment to be cost-effective, but still retain capacity to care for extra people in emergencies. But those emergencies do not account for what we are seeing now. It’s very possible that many of the ventilators are being used right now for patients with other illnesses. They’re also not mobile, and local outbreaks will quickly surpass the numbers of ventilators and respiratory therapists.Hospitals don’t survive financially in the United States by keeping beds open and equipment idle. They have enough equipment to be cost-effective, but still retain capacity to care for extra people in emergencies. But those emergencies do not account for what we are seeing now. It’s very possible that many of the ventilators are being used right now for patients with other illnesses. They’re also not mobile, and local outbreaks will quickly surpass the numbers of ventilators and respiratory therapists.
Moreover, if a pandemic more closely followed the model of the Spanish flu outbreak of 1918, we would need more than 740,000 ventilators.Moreover, if a pandemic more closely followed the model of the Spanish flu outbreak of 1918, we would need more than 740,000 ventilators.
Many people are comparing this virus to the flu. The thing to remember, though, is that the influenza numbers are spread out over eight months or more. They don’t increase exponentially over the course of weeks, as the cases of Covid-19 are doing right now.Many people are comparing this virus to the flu. The thing to remember, though, is that the influenza numbers are spread out over eight months or more. They don’t increase exponentially over the course of weeks, as the cases of Covid-19 are doing right now.
Further, a greater proportion of people who are becoming ill now are seriously sick. According to some estimates, 10 percent to 20 percent of those who are infected may require hospitalization. In a metropolitan setting, if enough people become infected, the numbers who may need significant care will easily overwhelm our capacity to provide it.Further, a greater proportion of people who are becoming ill now are seriously sick. According to some estimates, 10 percent to 20 percent of those who are infected may require hospitalization. In a metropolitan setting, if enough people become infected, the numbers who may need significant care will easily overwhelm our capacity to provide it.
The cautionary tale is Italy. More than 12,000 people have been infected there; more than 800 have died. A little over 1,000 have recovered. Many of the rest are ill. And a significant number of them need to be hospitalized — right now.The cautionary tale is Italy. More than 12,000 people have been infected there; more than 800 have died. A little over 1,000 have recovered. Many of the rest are ill. And a significant number of them need to be hospitalized — right now.
This has exceeded Italy’s capacity for care. It doesn’t matter what physicians’ specialties are — they’re treating coronavirus. As health care providers fall ill, Italy is having trouble replacing them. Elective procedures have been canceled. People who need care for other reasons are having trouble finding space.This has exceeded Italy’s capacity for care. It doesn’t matter what physicians’ specialties are — they’re treating coronavirus. As health care providers fall ill, Italy is having trouble replacing them. Elective procedures have been canceled. People who need care for other reasons are having trouble finding space.
In an unthinkable fashion, physicians are having to ration care. They’re having to choose whom to treat, and whom to ignore.In an unthinkable fashion, physicians are having to ration care. They’re having to choose whom to treat, and whom to ignore.
They’re having to choose who will die.They’re having to choose who will die.
Italy, especially Northern Italy, has a solid health care system. It might not be the best in the world, but it’s certainly not lacking in ability. It’s just not ready for the sudden influx of cases. There aren’t enough physicians. There’s not enough equipment.Italy, especially Northern Italy, has a solid health care system. It might not be the best in the world, but it’s certainly not lacking in ability. It’s just not ready for the sudden influx of cases. There aren’t enough physicians. There’s not enough equipment.
The United States isn’t better prepared.The United States isn’t better prepared.
Many health experts expect that a majority of people will eventually be exposed to, if not infected with, this virus. The total number of infected people isn’t what scares many epidemiologists. It’s how many are infected at the same time.Many health experts expect that a majority of people will eventually be exposed to, if not infected with, this virus. The total number of infected people isn’t what scares many epidemiologists. It’s how many are infected at the same time.
An unchecked pandemic will lead to an ever-quickening rate of infection. If, however, we engage in social distancing, proper quarantining and proper hygiene, we can slow the rate of spread, and make sure there are enough resources to properly care for everyone. This can also buy us time for a vaccine to be developed.An unchecked pandemic will lead to an ever-quickening rate of infection. If, however, we engage in social distancing, proper quarantining and proper hygiene, we can slow the rate of spread, and make sure there are enough resources to properly care for everyone. This can also buy us time for a vaccine to be developed.
South Korea has flattened its curve by engaging in extreme testing and social distancing. It has set up drive-through screening stations so people can check if they’re infected without putting others at risk. As of Sunday, almost 190,000 people there had been tested for the virus. That allowed a more targeted quarantine of infected people.South Korea has flattened its curve by engaging in extreme testing and social distancing. It has set up drive-through screening stations so people can check if they’re infected without putting others at risk. As of Sunday, almost 190,000 people there had been tested for the virus. That allowed a more targeted quarantine of infected people.
We have no real idea how many people in the United States are infected. We’re still woefully behind in testing.We have no real idea how many people in the United States are infected. We’re still woefully behind in testing.
Colleges are closing campuses left and right because they’re worried — correctly — about spring break, and the potential for students to travel, become infected and then spread the disease among other students and faculty in the next few weeks. But the rest of us have much harder decisions to make.Colleges are closing campuses left and right because they’re worried — correctly — about spring break, and the potential for students to travel, become infected and then spread the disease among other students and faculty in the next few weeks. But the rest of us have much harder decisions to make.
Updated June 12, 2020 Updated June 16, 2020
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
Studies show that when children are prevented from being a high-transmitter group, deaths among older people are significantly reduced. But closing elementary, middle and high schools could do more harm than good if parents are still working. This could mean children are left in the care of older people (i.e., grandparents), and of course that places those most vulnerable at higher risk.Studies show that when children are prevented from being a high-transmitter group, deaths among older people are significantly reduced. But closing elementary, middle and high schools could do more harm than good if parents are still working. This could mean children are left in the care of older people (i.e., grandparents), and of course that places those most vulnerable at higher risk.
Further, many children rely on schools for food. Without planning on how to get them meals if school is canceled, this could result in many going hungry.Further, many children rely on schools for food. Without planning on how to get them meals if school is canceled, this could result in many going hungry.
What might help the most is comprehensive paid sick leave from work. The people who are ill — or who need to care for children who are ill — need to be able to stay home and not expose others to illness. If that doesn’t happen, everyone is at higher risk.What might help the most is comprehensive paid sick leave from work. The people who are ill — or who need to care for children who are ill — need to be able to stay home and not expose others to illness. If that doesn’t happen, everyone is at higher risk.
Of course, general advice still applies. Wash your hands (that can’t be stressed enough), don’t touch your face, cough and sneeze into your elbow, stay away from sick people, and stay away from people when you’re sick yourself.Of course, general advice still applies. Wash your hands (that can’t be stressed enough), don’t touch your face, cough and sneeze into your elbow, stay away from sick people, and stay away from people when you’re sick yourself.
We have a window to get hold of this, but it’s closing rapidly. The initial travel restrictions to China probably made a big difference, but we failed to follow up appropriately, The decisions made in the last week to increase social distancing — including canceling many large gatherings across the country — are necessary but not sufficient.We have a window to get hold of this, but it’s closing rapidly. The initial travel restrictions to China probably made a big difference, but we failed to follow up appropriately, The decisions made in the last week to increase social distancing — including canceling many large gatherings across the country — are necessary but not sufficient.
We need data, meaning the ability to test more people to understand where community transmission might be occurring. We need to protect those who are most vulnerable, supporting their ability to self-quarantine. We need to convince people who might be sick, even mildly so, to stay home. And we need to make it economically possible for them to do so.We need data, meaning the ability to test more people to understand where community transmission might be occurring. We need to protect those who are most vulnerable, supporting their ability to self-quarantine. We need to convince people who might be sick, even mildly so, to stay home. And we need to make it economically possible for them to do so.
Without quick action, what we’re seeing in other countries may happen here, with terrible consequences.Without quick action, what we’re seeing in other countries may happen here, with terrible consequences.