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Translation of the German captions:

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)

Just a note: This includes hospitals that do not have intensive care units or that does not take Covid patients at all.

For example, I found a "clinic" for neurodiagnostic that has zero patients and is "fully utilized".

Thank you.

The translation I saw described yellow as something like "emerging bottlenecks." There seem to be a lot of them in Bavaria, where I have relatives.

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.
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.
That's absolutely not what we're hearing in France... Here's a news article from three weeks ago talking about 31 cases transferred to Germany: https://www.franceinfo.fr/sante/maladie/coronavirus/grand-es...
For instance: https://www.dw.com/en/coronavirus-treating-european-patients...

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.

Alone? Like with the 500 billion euro EU emergency fund that was agreed yesterday?
In the University Hospital where I work in Germany we have two patients from Italy on ICU
Germany is for example taking the new cases in Alsace.
There is a more detailed interactive map of critical care bed capacity created by researchers at Konstantz University.

Visualization: https://coronavis.dbvis.de/en/

Press release (English): https://www.campus.uni-konstanz.de/en/science/university-of-...

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.

https://news.ycombinator.com/item?id=22819580

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.

Yes that's likely correct based on what physicians are seeing in the field. Check out the latest care protocol from Eastern Virginia Medical School.

https://www.evms.edu/covid-19/medical_information_resources/...

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.
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."

https://www.reuters.com/article/us-health-coronavirus-china-...

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.
I think western countries have it worse: https://en.m.wikipedia.org/wiki/List_of_countries_by_hospita...
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.

Edit: found the Article: https://www.spiegel.de/wirtschaft/corona-krise-lieferengpass...

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.

So in a way, this is a population density map https://xkcd.com/1138/

[1] https://de.wikipedia.org/wiki/Aller-Weser-Klinik

[2] https://www.slk-kliniken.de/ueber-uns/daten-fakten/die-slk-k...

Looks like the peak ICU occupation in Germany has clearly passed:

11/04: 2088, 76% on ventilators 10/04(?): 2453, 76% -"-

04/04: 2680, 83% -"- 03/04: 2421, 83% -"- 02/04: 2139, 83% -"- 01/04: 1876, 82% -"-

Can't find data for in between 04/04 and 10/04, since DIVI stopped publishing daily reports apparently, but must have peaked in between.

https://www.intensivregister.de/#/intensivregister https://www.divi.de/images/Dokumente/DIVI-IntensivRegister_T...

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.

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”.
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.
This is very cool, though not quite complete.

https://www.klinikum-fuerth.de/ is missing from the map, which is the biggest hospital in Fürth, Bavaria.

Also interesting: some hospital report some contention, but no COVID-19 cases.

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.

[1] https://www.ortenaukreis.de/Politik-Verwaltung/Verwaltung/Si...

Shortages may also be due to non-Covid-19 patients. It's not that hospitals suddenly stopped caring for all other ailments.
... I am aware cases != clinic beds. But 0 clinical cases at 778 total cases is unlikely (right?).
Probably from the same data source(DIVI Intensivregister/RKI): https://diviexchange.z6.web.core.windows.net/report.html
It includes Fürth, so I guess it is a scraping problem. Maybe all cities with umlauts are missing :)
Why can’t we see data like this here?
New Jersey has started to publish this yesterday, see 'Hospital Census'

https://covid19.nj.gov/#live-updates

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.

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.

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.

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.

[1]: https://www.nytimes.com/2020/04/10/nyregion/new-york-coronav...

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.

Edit: The actual numbers for NY show a more than 2x increase so far, see here https://www.nytimes.com/interactive/2020/04/10/upshot/corona...

Yes, you really need to follow death rates.

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.

https://www.euromomo.eu/ shows long term death rates in selected European countries.