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C & C: Coronavirus #4

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***Moderator Note*** Split from Correspondence and Coherence Blog

On 3/24/2020 at 1:40 PM, merjet said:

So bottom line what I am seeing is that Switzerland has almost 10 times better healthcare than Italy. 

Switzerland 0.0133815948228584‬ death rate
Italy has   0.0985891060483405 death rate
 

But did I get that right, Italy has almost a 10 percent death rate? I thought the Coronavirus had a 2 percent mortality rate.

Edited by dream_weaver

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8 hours ago, Easy Truth said:

But did I get that right, Italy has almost a 10 percent death rate? I thought the Coronavirus had a 2 percent mortality rate

Yes, tentatively. I say "tentatively" since the Worldometer numbers change often and ceteris paribus. Based on the following numbers captured only minutes ago, the mortality rate for Italy is about 7.4 times that for Switzerland. I added Spain and the USA this time.

Date Country Total
Cases
Total
Deaths
Tot Cases/
1M pop
Tot Deaths/
1M pop
Deaths / Cases
3/25/2020 Italy 69,176 6,820 1,144 113 9.86%
3/25/2020 Spain 47,610 3434 1,018 73 7.21%
3/25/2020 Switzerland 10,171 135 1,175 16 1.33%
3/25/2020 USA 54,963 784 166 2 1.43%

Also, the age distribution of the countries' infected populations may differ and mortality rates vary significantly by age regardless. For example the following are mortality rates from the 2016 US Life Table.

 
Death probability
 
Age Male Female
65 0.015808 0.009761
70 0.023122 0.015413
75 0.035963 0.025035
80 0.057712 0.042539
85 0.096603 0.073763
90 0.163689 0.129706

Recognizing the caveats, I believe it is still safe to say that Switzerland's health care system is handling the pandemic much better than Italy's or Spain's. Based on this page, it seems that Spain's health care system is very much under government control with patients paying very little. There is some private health insurance.

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2 hours ago, dream_weaver said:

Try: Covid-9 + a healthcare variable = 0.013%—0.098% (truncated) mortality.

Tell me if I am correct, I think you mean:

covid-19_mortality_with_no_healthcare  -   a_country-s_healthcare_variable   =   country-s_death_rate

(since healthcare decreases mortality)

(Italian health variable) is 1.3% therefore

9.8% - 1.3% =  8.5% Italian Mortality

Is this correct?

Other than that more questions:

"As a result, South Korean healthcare did what Italy’s already undersupplied system could not do—cope effectively with the pandemic and manage to get it under control without shutting down the entire country in the process. "

There is a mention that the market encouraged an increase in hospital beds (Yaron Brook made a reference to US preventing market forces from providing more hospital beds) but why is it profitable to have more hospital beds (when there is no pandemic)? What is the incentive?

The other technique that has been mentioned is the test and track method. Is that also less effective in a socialised medical system?

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3 hours ago, merjet said:

I believe it is still safe to say that Switzerland's health care system is handling the pandemic much better than Italy's or Spain's.

But what about the system? I'm not even sure that quality of healthcare would make much of a difference, at least as far as the people who end up dying. This might be true for treatments, but there is no treatment for coronavirus. There would have been no better healthcare to get for the people who died.

My point isn't that their healthcare systems are good or worthwhile, just that I doubt that the healthcare system is what makes it different in this case. Something about Italy compared to everywhere else seems different besides healthcare. It could be the climate; it could have to do with significant social differences.

 

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Eiuol,

It seems more accurate to say there is no good cure for coronavirus.  This article is about treatment. Some patients have been given drugs experimentally, which has helped some, and many are recovering from the virus. Aren't ventilators, which are often in news stories such as this one, a treatment? If a patient with COVID-19 has great difficulty breathing, can be put in a hospital on a ventilator, and survives, that strikes me as better than no hospital and no ventilator.  It sounds plausible to me that the patient is better off in Switzerland than Italy or Spain.

One thing I read about recently that is attributed to the high prevalence of coronavirus in Italy (and Iran) is the “One Belt and One Road” (OBOR) initiative. See here and here.

Hope that helps.

Edited by merjet

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One element that is not being talked about is temperature in the country. The northern hemisphere had its winter. Now the Southern Hemisphere is going to start theirs. This seems to have an effect but there does not seem to be any declaration of the "temperature" factor anywhere. So in theory, their winter is starting so their cases should go up and ours should go down "naturally caused".

covid.thumb.png.5350bba489a1fae4ccd09156a7915108.png

https://www.ft.com/coronavirus-latest

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On 3/25/2020 at 12:11 PM, merjet said:

If a patient with COVID-19 has great difficulty breathing, can be put in a hospital on a ventilator, and survives, that strikes me as better than no hospital and no ventilator.

What I'm wondering is if lacking a ventilator is why anyone died, or if the ventilator actually changes the eventual outcome. People died despite the ventilator. Basically, if there isn't a known cure, you are only treating symptoms, in which case you are prolonging things, not changing the death rate. That means it would still be unusual why Italy has a higher death rate.

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@Eiuol A ventilator helps to add oxygen to a lung where the capacity to absorb oxygen is impaired by this virus. Without a known medically applicable cure, keeping the patient alive long enough for the body to heal/recover itself, i.e., oxygenated, hydrated, nourished, does not ensure that every patient will make it, but aides those that may not have otherwise done so.

@Easy Truth Many virus' spread more so during colder temperatures. And yes, the seasons are inversed between the northern and southern hemispheres. What is known so far about Covid-19 does not conclusively address your inquiry. Here's a BBC article I selected from this google search.

Edited by dream_weaver

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@merjet Your Elon Musk reference reminded me of the James Dyson article by WRBCtv.

I don't think one need be in the medical profession to learn bits and pieces here and there. Ventilators assist with the inhale/exhale process. The air moved via the process can be infused with oxygen raising it from the natural content of 21%, making more of it available for respiration.

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The implication is that healthcare in this case means helping the person's own immune system deal with the problem, i.e. "supporting" the immune system.

-Warm clothing in winter ends up being an element of healthcare

-Having a place to live that has ease of accessibility to water to hydrate may also help

But in South Korea, healthcare went beyond all this as in putting mandatory location monitoring of an infected person. Kind of a big brother approach that in this case worked. What I fear is we may be surprised that some fascist or socialist systems may do better than us in this crisis.

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2 hours ago, dream_weaver said:

Without a known medically applicable cure, keeping the patient alive long enough for the body to heal/recover itself, i.e., oxygenated, hydrated, nourished, does not ensure that every patient will make it, but aides those that may not have otherwise done so.

I understand what you mean, so I am wondering the rate of recovery of people on ventilators compared to those not on ventilators. It makes perfect sense when you can treat the disease itself rather than just the symptoms. Of the people who die, was it inevitable no matter what you did at this stage? Sure, I would rather be sick in the US, but that doesn't mean in this case the healthcare systems are different in a way that matters.

1 hour ago, Easy Truth said:

What I fear is we may be surprised that some fascist or socialist systems may do better than us in this crisis.

Authoritarianism works great. There is no question about that. You could declare martial law, kill anybody in the street, then it would all go away pretty quickly. This means that respecting rights requires great creativity in a crisis, apparently something most people in the government and business lack. Elon Musk probably deserves more attention.

Edited by Eiuol

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7 hours ago, Eiuol said:

I understand what you mean, so I am wondering the rate of recovery of people on ventilators compared to those not on ventilators.

I, personally, am unaware of data to draw upon for such an inquiry at this time.

 

7 hours ago, Eiuol said:

Of the people who die, was it inevitable no matter what you did at this stage?

Perhaps it's the order of your statements. If equipment and resources to treat the patient are not available, that results in the inevitability as well. The patient may have lived had the equipment and resources been available, but they were not, ergo.

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9 hours ago, Eiuol said:

I am wondering [about] the rate of recovery of people on ventilators compared to those not on ventilators.

That's worth wondering about. For the comparison to be informative, the two different sets of test cases need to be otherwise as similar as possible. It the set of patients on ventilators are older and their health conditions much worse than the set of patients not on ventilators, then the comparison would not be very informative.

By a similar standard, I admit that my comparing Switzerland to Italy and Spain may not be highly informative. The perspective is without doubt a "bird's eye view." Yet the differences between the countries are big enough to urge me to believe they are worth considering.

Edited by merjet

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Regarding the immune system, in recent news there is talk about trying to use antibodies from people who have recovered from the coronavirus to treat patients suffering from the coronavirus.

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At the very beginning of the outbreak in the US, the death rate in Washington was very high, I believe around 20%. It is now substantially lower. The explanation is that the disease spread first through a specific elder care facility. There was a very strong correlation between “might be tested” and “was a patient at that facility”. This is a reminder that there are lots of unreported variables – facts about being tested, testing positive, and dying are not randomly distributed in the population. If you believe the statistics (my message is, don’t!), Italians recover better than Americans – US recovery rate is 2.5% and Italy’s is 12%. I suspect that it’s not that around 90,000 Americans still have the disease, instead there is a difference in reporting. The highest rates of infection are in Andorra, San Marino, Iceland and Luxembourg: basically, cities elevated to the status of country. The really low incidence of the disease in Africa is explained by the fact that people don’t move around much there. The one case where I think we can reasonably attribute something political to the number of cases is Iran, compared with Afghanistan and Turkey. I think they see this as an opportunity to get sanctions lifted.

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On 3/26/2020 at 7:35 PM, dream_weaver said:

keeping the patient alive long enough for the body to heal/recover itself, i.e., oxygenated, hydrated, nourished, does not ensure that every patient will make it, but aides those that may not have otherwise done so.

This isn't quite true for ventilators. It's okay to be on a ventilator for a few days. But the longer you are on a ventilator past that time, you are simply extending their time until death. It is possible that Italian hospitals are mismanaging the use of ventilators, not an issue of socialized medicine or not. That is, the proper action might be to limit ventilator use to a week at most. If they don't recover, let them die, since at that point it probably would not make a difference. 

 

 

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@Eiuol I'm seeing 14-21 days, if the quibble is over "a few days" compared to "long enough". Currently many community hospitals in America have reached their limit, bed-wise. The factors that led to this are going to be debated for years to come, contrasting it with the causes of WW1, WW2, or the "Great Depression".

The medical field has had government intruding into it since the 1950's. The FDA and other regulatory agencies serve as gatekeepers of varying degrees of objectivity in their approval processes. Medicare and government regulation requiring treatment complicate where finite resources are to be allocated.

How would this play out in a capitalist society? . . . why am I reading: "The proper action might be to limit ventilator use to a week at most.  If they don't recover, let them die, since at that point it probably would not make a difference."?

History reports what is, while fiction portrays what should and ought be. — Aristotle, paraphrased.

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1 hour ago, dream_weaver said:

How would this play out in a capitalist society? . . . why am I reading:

Because I didn't mention anything about the government making that determination. That would just be hospital policy.

1 hour ago, dream_weaver said:

I'm seeing 14-21 days, if the quibble is over "a few days" compared to "long enough".

Any studies are probably for people not sick with a viral infection that has no known cure. So hospital administrators should make the determination of how long people should use a ventilator if they have covid. Besides, there are people on ventilators longer than 21 days anyway. In a crisis, I think it would be better to err on the side of preserving as many resources as possible. 

 

Edited by Eiuol

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I am not finding a lot of info about the quality of ventilators and using them. But here goes. Several news stories report doctors saying there is a great shortage of ventilators in Italy. Do they have old ventilators or new cutting edge ones? No answer. I don’t see similar stories about shortages in Switzerland. Maybe in Switzerland there are more ventilators available, doctors know better how to use them, and/or they have better ventilators. Maybe hospitals in Switzerland are freer and more adaptive to getting supplies than they are in Italy.

Coronavirus' ventilator demand: Who makes them and what will it take to get them? lists several ventilator makers. One of them is Hamilton Medical in Switzerland, which has raised its production in response to demand (link). Interestingly, the CEO says about his company’s devices:

“The new generation of these devices has a so-called closed-loop ventilation. This means that you almost only have to put the mask on the patient or intubate him. And then the device does everything necessary fully automatically based on pressure, volume, lung mechanics and other parameters that measure heart and lung functions, for example.

This relieves the physician from having to check again and again whether the device is set correctly or whether it needs readjustment.

And it provides additional safety, especially in countries where the expertise of medical personnel does not match the level in this country."

This article gives the impression that the ventilator must be used, or be designed, in the right way in order to give optimal controlled assistance to the patient.

This article shows a picture of one of these devices.

Edited by merjet

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One thing that has struck me about the social impact of this outbreak is how much the character of the social response is altered by the advance in communications technology. In 1957-58 there was the pandemic of the H2N2 virus. I was only nine and didn’t retain much memory of it. According to the CDC note linked below, it killed about 116,000 people in the USA. That is twice the number of Americans killed in Vietnam. The population of the US in 1957 was about 172 million, whereas today it’s about 330 million. So percentage-wise, it would today be as if about 200,000 Americans were killed. I attach also a study I found on the US response to that pandemic.

https://www.cdc.gov/flu/pandemic-resources/1957-1958-pandemic.html

https://www.liebertpub.com/doi/pdfplus/10.1089/bsp.2009.0729

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