Read this, Gittins

A glimpse inside northen Italy hospitals:

Jason Van Schoor @jasonvanschoor Registrar in Anaesthesia & ICM | NIHR UCL Academic Clinical Fellow

From a well respected friend and intensivist/A&E consultant who is currently in northern Italy:

1/ ‘I feel the pressure to give you a quick personal update about what is happening in Italy, and also give some quick direct advice about what you should do.

2/ First, Lumbardy is the most developed region in Italy and it has a extraordinary good healthcare, I have worked in Italy, UK and Aus and don’t make the mistake to think that what is happening is happening in a 3rd world country.

3/ The current situation is difficult to imagine and numbers do not explain things at all. Our hospitals are overwhelmed by Covid-19, they are running 200% capacity

4/ We’ve stopped all routine, all ORs have been converted to ITUs and they are now diverting or not treating all other emergencies like trauma or strokes. There are hundreds of pts with severe resp failure and many of them do not have access to anything above a reservoir mask.

5/ Patients above 65 or younger with comorbidities are not even assessed by ITU, I am not saying not tubed, I’m saying not assessed and no ITU staff attends when they arrest. Staff are working as much as they can but they are starting to get sick and are emotionally overwhelmed.

6/ My friends call me in tears because they see people dying in front of them and they con only offer some oxygen. Ortho and pathologists are being given a leaflet and sent to see patients on NIV. PLEASE STOP, READ THIS AGAIN AND THINK.

7/ We have seen the same pattern in different areas a week apart, and there is no reason that in a few weeks it won’t be the same everywhere, this is the pattern:

8/ 1)A few positive cases, first mild measures, people are told to avoid ED but still hang out in groups, everyone says not to panic
2)Some moderate resp failures and a few severe ones that need tube, but regular access to ED is significantly reduced so everything looks great

9/ 3)Tons of patients with moderate resp failure, that overtime deteriorate to saturate ICUs first, then NIVs, then CPAP hoods, then even O2.
4)Staff gets sick so it gets difficult to cover for shifts, mortality spikes also from all other causes that can’t be treated properly.

10/ Everything about how to treat them is online but the only things that will make a difference are: do not be afraid of massively strict measures to keep people safe,

11/ if governments won’t do this at least keep your family safe, your loved ones with history of cancer or diabetes or any transplant will not be tubed if they need it even if they are young. By safe I mean YOU do not attend them and YOU decide who does and YOU teach them how to.

12/ Another typical attitude is read and listen to people saying things like this and think “that’s bad dude” and then go out for dinner because you think you’ll be safe.

13/ We have seen it, you won’t be if you don’t take it seriously. I really hope it won’t be as bad as here but prepare.

Basically, that is a description of battlefield triage.

If anyone can, please forward this to Ross Gittins who keeps encouraging this outcome for Australia by demanding everyone get out and spend.

David Llewellyn-Smith
Latest posts by David Llewellyn-Smith (see all)

Comments

  1. I’ve still got family claiming it’ll all be ok

    I work in health and I’ve got colleagues looking at me strangely when I gently call out some of the cries of “Pollyanna “ on this or explain our quiet prepping. Plenty still think this is just a flu

    Lots still are totally complacent

    Meanwhile – we’re about to relist our hobby farm and was speaking to the agent and talking about MB and other predictions of property off by 50% (didn’t mention the solar minimum) as a result and to my surprise he agreed. Caveats on location etc – we’re in a water-secure regional bolt hole so who know

    Here’s hoping WA goes into lockdown for round 1 AFL so the demons don’t have to put up with the extraordinary crowd at domain and the undeniable effect it has on home team umpire bias

    • You should mention the solar minimum also to your RE agent. My guess is that he will chuckle, agree also and say “well, that’s a good reason and now’s the time to list”. Just a wild guess.

    • I suspect it will be worse than #justtheflu, but will also be a largely non-event for the under 50s. The over 50s though (like Gittins), ooh boy, not looking great.

    • My MIL is a microbiologist and is dismissing it as “just a flu.”

      I mean, I dismiss most of what she says socially (evangelical Christian who thinks the world is only 6000 years old and that my 4-year old son will turn [email protected] because he likes dancing) but I never expected her professional opinion to be completely at odds with reality.

      • Why? Think Abbott, Taylor, shit…nearly anyone in the LNP, Malcolm Roberts (MS ENG), Joanne Nova etc, etc, etc.

        Political / religious bias and also, imo, reverse Dunning-Kruger effect! Sometimes people are too smart for their own good.

  2. People focus on the 3% mortality rate and think that’s a low number….maybe, fair enough. But it’s 10-15% who need will need serious medical help that’s the show-stopper. Who really fancies waiting around for a bed in a too-crowded ICU, with depleted staff and supplies, watching those around you die ugly deaths? The narrow-minded, dumb-ass thinking of some of our so-called economic intellectuals makes me think they may not really have a grasp of how the real world actually operates…

      • 3%?
        Is the data set big enough, and can be trusted enough, to say this is the number?
        Does it incluide all those who have it but don’t show the nasty side effects that show on some?

        • Not saying the data set is large enough – but that’s the WHO number for now.

          Source is from here, for example: https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

          At the time of writing, infections = 118,582 and deaths = 4,262. Therefore, death rate = 4262 / 118582 * 100 = ~3.6%.

          I’ve heard pros saying they think the number will eventually wash out to ~1% (if contained very well, and health systems are not overwheled). Maybe they are right, maybe they are not.

          Either way, still an order of magnitude worse than common flu, and is at least as virulent / easily spread.

          Therefore, if flu kills ~400,000 each year globally (when health systems are not overwhelmed), and this is even just 10 times worse, we could be looking at millions dead over the next year (allow for a southern hemisphere winter and a full northern hemisphere winter).

          Hence, it’s worth acting to slow this thing down.

          My 2c

          • Michael Osterholm is an internationally recognized expert in infectious disease epidemiology. He was saying early stages but best guess is “This is going to be 10 to 15 times worse than the worst seasonal flu”

            The problem we are facing is that last flu season, hospitals were stretched to the absolute max. Heading into winter and adding corona to the mix we are going to see a broken system. Make no mistake, Australian healthcare will be as bad as what the doctor is talking about in the original post.

            There’s no stopping it now, no putting it back in the box… That ship has sailed. The best we can hope for is to slow the spread down so that our hospitals, GP’s and healthcare workers can cope. But so far our government has been reactive every step of the way and I hold little hope they will be able to manage.

            People thinking this is just the flu or that it will go away tomorrow are mistaken. This is going to drag on for months and will ultimately affect people’s older family and friends.

        • Seasonal flu said to be 0.1, low end of Covid-19 (outside Wuhan, allegedly) 0.7, so still 7 times!

  3. thanks for sharing this valuable update as it really is a stern warning of whats to come – not good at all

  4. I’m a huge bear – and I’m worried about the effects of this, but how could the percentage of deaths be so low if what’s happening here was actually the case?

    • Yeah 3% is definitely not small. During the war, the world lost 3% of its population. Doesn’t sound like much but is actually pretty bloody bad. Just like the war, it will affect everyone, those who survive (hopefully 97% or better), will know someone who didn’t. Italy’s death rate is currently 6.2%, not good.

  5. “11/ if governments won’t do this at least keep your family safe, your loved ones with history of cancer or diabetes or any transplant will not be tubed if they need it even if they are young.”
    What does any transplant will not be tubed mean?

    • Any person that has had an organ transplant will not be intubated (and put on a ventilator)

    • Transplant patients are immunosuppressed to reduce the rejection rate of the transplanted organ.
      It leaves them susceptible to infection.
      It is a brutal form of triage is what it sounds like.

    • What it means is there isn’t enough equipment to treat everyone, and the easiest first option to choose who gets treatment is simply not treat anyone with existing problems that lower their survival probabilities.

  6. I must admit I just don’t get your logic on this topic.
    In eastern cultures there’s a deep seated belief that you will rewarded for whatever good or bad deeds you do, it’s called karma. In western cultures we have a similar sentiment expressed in biblical verses like “You reap what you sow “.
    Yet when the grim reaper comes and comes with the intent of carting away only the elderly you’re wanting to stop him at the door. Why do you want to stop him? why aren’t the young welcoming this virus and spreading it as widely as possible?
    Karma is a biatch, but sometimes karma is the only justice that we have.

    • I can’t speak for everyone. I want change, but not at the cost of people’s very lives…

      I carry some deep anger at the Boomers and their general recalcitrance, as well as toxic stoics of similar inclinations – but I don’t want them to die.

      It’s a core part of my worldview.

        • You goin’ soft Stewie?! At the same time as Stu has?!

          Colour me suspicious…. you’ve never been seen in the same room together, either….

          • Stewie GriffinMEMBER

            We’ll all die in due course – the Boomers are less the culpable villains I use to believe and more the generation of naive low IQ patsies, who were collectively persuaded or brown beaten by a culture of scam artists and hustlers into handing over the most valuable thing they had… control over our own social destiny.

            Hearing the rest of DAD’s story I would roundly support the Boomer in question having the fuel tank of his Audi being filled with sugar, and would probably even turn a blind eye into them receiving a good beating.

      • Yeah I used to think the same way that you do but after our last landlord decided to toss us (family of six) out on the street a month before Xmas with only one months notice well lets just say Fvk’em.
        He treated my family like dog dirt that he needed to scrape off his shoes, so in my opinion death can’t come soon enough for boomer chunts like him. If a virus does the hard work then that’s ok by me.

          • The C#nt wouldn’t even man up and meet me when I wanted to discuss delaying the move for two weeks because we couldn’t find alternative rental accommodation for a large family. He wouldn’t even call me to discuss the move (matter of fact he threatened me with an injunction for stalking because I had the audacity to call his father and relay a message that the we needed to talk)
            He sent his little RE biatch demanding that we vacate the house at the time he wanted, not one day later(and threatening to turn off the power and change the locks if we weren’t gone on that day) . He wasn’t man enough to meet me, so yeah as far as I’m concerned he can vacate this world and the sooner he does there the better.
            I’m not going to lift a finger to cause him harm, but I’m certainly not going to alter my life again just so that we minimize the chances of him getting what’s justly coming his way.
            So yeah that’s my modern day Xmas spirit showing.

    • blindjusticeMEMBER

      coz my parents were not part of the 1% who ruined the socio-economic structures that they benefited from. Im all for the virus annihilating the guilty but not at any cost

      • You say this like it’s only the “guilty” young families that are being punished by Australia’s absurdly over priced houses. What are they guilty of?
        What?
        rising above their station and expecting to be able to afford a house
        Not respecting the property ladder
        not engaging in financial stupidity and bidding stupid amounts so that Boomers retire rich
        What crime have these families committed?
        At least my “virus justice” has some logical basis, it might punish a few innocents but that’s ok with me.

    • “In eastern cultures there’s a deep seated belief that you will rewarded for whatever good or bad deeds you do, it’s called karma.”

      That’s isn’t what karma means at all.

  7. To all of you who think there is some massive capacity in Australia’s health system to deal with this – have you not been listening when the stories of bed block, ambulance ramping and swamped EDs were in the news before we had even heard of COVID?

    Emergency department doctors spoke out yesterday about the dangerous conditions they confront, with overcrowding reaching chronic levels at peak times and critically ill people still forced to wait for crucial tests.

    “The sickest, most unknown, most high-risk patients are subjected to the highest risk environment – we frequently do not have resuscitation beds, we have people sitting on chairs when they should not be.”

    https://www.smh.com.au/national/emergency-wards-so-crowded-theyre-dangerous-doctors-20051112-gdmfic.html

    That was published 14 years, i.e 3 million migrants, ago …

    What is happening in Italy will happen here.

    And another thing:
    In 1980 Australia had 12 acute hospital beds per 1000 population
    In 2014 Australia had 3.8 acute hospital beds per 1000 population
    Now it has something less than 3
    (the Government goes out of its way to no longer report this statistic, for reasons which will be obvious)

    Is now a good time to ask how this has happened?

  8. Dont pick on Gittins, he is just continuing the long tradition of economists (including the one on this site) wandering in to areas where they have little knowledge or expertise and pontificating about what ought to be done.

  9. Wuhan / Hubei was a humanitarian disaster
    The rest of China did better – but only with draconian measures that likely won’t be possible elsewhere.
    North Italy is rapidly approaching a humanitarian disaster.
    Iran is likely a humanitarian disaster.
    Korea looks better – but the average age of those infected was low (religious cult)

    The rest of the world is too early / too small numbers to know.

    So I would not be complacent.

  10. PolarBearMEMBER

    Well he does have git in his name. And wow northern Italy is looking like the third Wuhan after Iran. Based on Australia’s behavior so far, I doubt we will avoid our own.

  11. https://www.theaustralian.com.au/business/hardline-advice-to-bosses-over-coronavirus-dont-pay-workers-until-sick/news-story/5b68e997849dfb971675b7e66bf5b225

    Employers have been told they do not have to provide paid leave to permanent workers forced into isolation after being in China or in contact with a person with coronavirus if the employees are “not yet sick themselves”.

    This should work out well when workers simply ignore advice to isolate in favour of paying bills.

  12. As a critical care doctor, that is simply terrifying. I’m mentally preparing myself for hell when this hits.

    • Agreed.

      We are looking at using the relatively high end vents found in OT these days for the resp failures, and using basic vents for surgery in young patients with normal lungs.
      Heard a rumour that a large hospital in Sydney just went out and bought a lot of ECMO circuits. At a large centre in Italy, they were down to a handful of ECMO circuits with their next delivery (from China) due in “maybe May”

      Those of us that can best predict where this is likely going are very concerned and wanting greater public health measures immediately. Those that are blasé will become concerned at some stage – by then the time for these measures will have gone.

      People concerned about the financial cost of greater public health initiatives should start working about the cost of not implementing measures. A friend is a pilot. His manager often rolls eyes at the cost of various safety matters. My friend tells him “If you think safety is expensive, try having an accident”

      • China built a hospital in 10 days. With all this lead time why are we not converting any of those useless new stadiums into temporary hospitals in advance? People may ask this kind of thing in hindsight but others will be dead by then. Why not do this now?!

  13. Has to be said there is a lot more close quarters kissing, touching (and for reusa – rooting) in Italy so that might explain some of the spread …