Item — HN Reader

>This occurred in Italy, New York City, etc., and is now being seen in some cities in Texas and Florida.

Not Florida. An article from yesterday (https://www.news4jax.com/news/local/2020/06/18/florida-has-l...) ominously claims that "less than 25%" of ICU beds are available in the state, but actually read it and see that 90% occupancy rates are normal, and only a few of those in the ICU are COVID19 cases.

Texas? Let's look at Houston, where for a month it's been "we'll be running out of ICU beds in two weeks" every week.

Italian and New York hospitals were overwhelmed because a) both places put sick elderly into old age homes. b) Like elsewhere early on, doctors put everyone serious onto ventilators in a mistaken belief that they should treat patients like they do ARDS cases based on blood oxygen levels. This damaged healthy lung sacs and caused long-term dependence on mechanical respiration that doctors found almost impossible to wean patients from, and other side effects like deep vein thrombosis; Nick Cordero is a recent example. This article from three months ago (https://www.statnews.com/2020/04/08/doctors-say-ventilators-...) was completely vindicated in retrospect.

(And even NYC being overwhelmed was thankfully temporary. That's why the military hospital ship sent there was not used.)

The mean time between symptoms and death is 14 days (https://www.statnews.com/2020/04/08/doctors-say-ventilators-...). 99% of cases where people with COVID19 stay in the hospital for months is because of b), and neither a) nor b) is happening now.

2 comments

56 Florida ICUs are at capacity, with a further 35 are above 90%[0]. Five days ago the largest hospital operator in Houston, TMC announced that they were at 102% [1]. There’s a little bit of flexibility there; TMC can get that down to 72% by converting every possible bed to an ICU space[2], but they are now operating above official capacity.

I agree that there’s a lot to criticize in how NYC handled their hospitals, and that in a pinch hospitals in Texas and Florida can scrounge up extra beds. But those hospitals are filling up.

0: https://www.cnn.com/2020/07/07/health/us-coronavirus-tuesday...

1: https://m.huffpost.com/us/entry/us_5efcd4b7c5b612083c5618d0?...

2: https://www.houstonchronicle.com/news/houston-texas/houston/...

>56 Florida ICUs are at capacity, with a further 35 are above 90%

There are 306 ICUs in Florida (https://bi.ahca.myflorida.com/t/ABICC/views/Public/ICUBedsHo...). As of today, 16.8% of all ICU beds are available.

As I said, a 90% ICU load is normal; hospitals routinely transfer patients elsewhere to maximize utilization across as many facilities as possible. Again, only a small portion of ICU patients are there for COVID19, and a good chunk of the remainder are people who postponed procedures during the lockdown.

Source on 90% capacity being normal? The only study I found [0] said that the ICUs studied averaged 52-87% full with a median usage of 62%.

0: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3840149/

Let me clarify. By "normal" I meant that 90% is not an unusual or undesirable situation. To some extent, an ICU bed is not being used is going to waste; from a hospital administrator's perspective, the ideal situation is 100% utilization at all times with every excess patient smoothly being transferred elsewhere. This of course is unrealistic—you want to leave some surge capacity (thus my 90% figure) if possible—but, generally speaking, a hospital will transfer excess patients elsewhere (either within the same system, or to others in the region), and accept others' excess patients to fill up its own empty beds.

COVID19 patients are not making up a large percentage of ICU patients at the moment; see, for example, the hospital in the aforementioned article with 100 ICU beds. Yes, the 100 beds are full at that moment, but only seven are COVID19 patients; no doubt some other fraction are patients who put off procedures during the lockdown. That hospital is sending new patients it can't handle elsewhere, and will also move some existing patients elsewhere when practical/safe. This is possible because there is no overcapacity on a regional or statewide level.

Thanks for this response, its a good counterpoint with solid evidence, but the main point still stands - societies aren't merely shutting down because of a virus - it's because of a fear of healthcare systems being overwhelmed.