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2020-03-20 09:27 by Karl Denninger
in Editorial , 611 references Ignore this thread
My God, Its Full of Stars*
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I'm hearing anecdotal reports that material numbers of hospitals are starting to stockpile and use hydroxychloroquine as part of their Covid-19 response protocols.

Now theoretically it is now available on "compassionate use" and "right to try" sort of situations, but that's a one-off and someone has to request it.  These reports imply that these medical facilities either are now or are preparing to go much further than "one-offs" and start to use this as a front-line response to people coming in long before they get to the serious or critical stage, which is where the "right to try" stuff kicks in.

That is very important, because as I've noted once you get to the point where critical support is necessary in a given case the data we have from other places (e.g. Wuhan) says your survival odds are near zero.

This means that attempting to interdict case loads so as to not "overload" ICU and similar is stupid -- while it will feel good, and look good, it won't change outcomes.  If I'm 95% likely to die if I go on a vent with Covid-19 (and that is the data folks!) then whether I have a vent available or not is exactly the wrong place to give a wet crap.

 

The goal must be to stop that progression.  If you think I've been blowing smoke about this and calling those people arguing for cranking up beds and vent counts criminally insane and nothing more than criminal felons trying to jack up the cost of this thing and make money on people dying that table should shut you up right here and now.

Out of the 61 people who had "assisted breathing" by machine three survived.  That's a 4.9% survival rate.  

In fact free flow oxygen via nasal cannula didn't do well either.  Only one in five persons who had that intervention survived.  The other 80% are dead.

May I remind you that supplemental oxygen via cannula does not require a hospital; we do that all the time for people with COPD and such via either concentrator or bottle at lower levels.  Yet if you get there, 80% of the time you die.

The goal for mitigating death in this disease has to be on preventing compromise of the pulmonary system to the degree that those interventions are necessary.

This is why I've said that all of the focus on "overloads" is simply wrong-headed.  It's not that I don't want "inconvenience" or anything of the sort it is that such interventions do not work.  Nobody can seriously suggest that a path of action that fails 95% of the time is worth screaming about or arguing for irrespective of cost.  Shutting down the economy to accommodate a health system intervention approach that fails 95% of the time is criminally insane.

We must focus on paths of action that have better outcome profiles and the data out of both South Korea and the EU says that there are.

Fortunately it appears that a number of medical facilities have figured this out.  They may not be coming on TV to tell you that, but they have.  They're going after attempting on a front-line basis to attenuate the severity of the attack in individual cases and thus halt the progression to where the hospital itself is necessary.

That, rather than being primarily worried about whether we'll "overload" the hospitals, is the right course of action.

Not because I want people to go back to being able to run their bars and restaurants.

It's because I don't want people to die due to the stupidity of our elected officials.  Simply "accepting" that we must protect the hospital admit rate on the false hope that if there's a bed you'll be fine but if not you die, a premise that countless TV series over the decades have ingrained into the American consciousness (e.g. Marcus Welby, House, etc) is absolutely and completely, in the case of this virus, FALSE.

The only means forward that improves outcomes is to avoid the hospital requirement in the first place.  Dribbling people in to facilities with 95% treatment failure rates just means the same people die of the same thing, but slower.  Avoiding the hospital in the first place means they don't die at all.  We have what appears to be the means to greatly attenuate the need for the hospital in the first place.  While I'm sure that the alternatives are not completely effective almost anything beats that which fails 95% of the time and in terms of all-in costs doing nothing beats 95% failure rates because doing nothing avoids all the collateral damage including all the health care workers who will be sickened or killed by drawing this out for months or years.

Even a 50% failure rate of those alternative paths, which might well happen, radically beats a 95% failure rate.

PS: If you think China has had "zero" new cases and has stopped this in their nation -- that is, if you believe them -- you're nuts.  There is now leaked video coming out of Wuhan showing lines at 6' spacing out the door of their hospitals.  Again folks: China lies and if we allow their lies to dictate our policy and response our people will die too.

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