Critical care beds: this may be part of what’s wrong in Italy
The number of critical care beds may be – critical.
A while back, while I was trying to figure out why the situation in Italy has gotten so bad, one thing I came across was the idea that Italy doesn’t have that many hospital beds. But when I researched that, I discovered that, although not a star, Italy wasn’t particularly deficient in that regard.
But today I found this, which seems relevant. It’s the number of critical care beds per 100K of population in various countries. When someone is hospitalized with serious respiratory distress related to COVID-19 – or H1N1, or regular pneumonia, or sepsis – ventilation and special care is often needed to save lives. So this may be the more important thing to look at.
The data is a bit old for all the countries, but not so very old. You can see that Italy has 12.5 critical care beds per 100K population. China has 3.6 and South Korea 10.6. The US does rather well on this particular metric: 34.7.
As far as Iran goes, who knows? I doubt the number is at all high.
The death rate for each disease is not some sort of fixed thing. When I wrote about the 1918 flu pandemic, for example, I discussed the wide variation in death rates among countries (India having been especially hard hit). Differences among the health care systems in different countries – even among Western countries, which are not peas in a pod – are relevant today, as well, and this is only one of them. With a severe case of something like COVID-19, time is of the essence and enough respirators and critical care are essential to save threatened lives. Without them, people who might otherwise survive will die.
That’s why all this emphasis is on “flattening the curve” of the growth of a disease in order not to overwhelm the system.
It is not widely reported that a large number of Chinese workers are employed in the textile industries of northern Italy. Whether this is related to the current conditions in Italy cannot be known with certainty, but the possibly of a link is genuine. Meanwhile, in India, Hindus are imbibing the urine of cows in an attempt to protect themselves.
The initial cluster in Italy was the Codogno Hospital. When a hospital is flooded with the virus, it can become extremely lethal, spreading among weakened people (because of age, illness or condition). Even when this virus is not very dangerous, it could kill many people if it runs free in a Hospital. Probably that’s why the situation went so bad, so fast, in Italy.
Something similar happened in the Hospitals in Huabei.
Indeed, I suspect that Trump’s hidden policy can be trying to prevent people from being hospitalized unless they really need to. Healthy people can pass the illness without problems. However, if you take them to the hospitals and the virus starts to run free there, it could kill thousands. And it seems that China has been doing the same out of Huabei: enforcing home quarantines, being admitted in an hospital only when the life is at risk.
j e,
I’ve heard them referred to as slave laborers here in Germany. There are also lots of Sister Cities programs with northern Italian cities and Chinese ones. The Italians want to sell their expensive pocketbooks in China. I doubt that little attention was paid to people coming back and forth from China. And probably no one else in the EU Schengen zone said a word. Now Germany is closing schools, universities etc.
Its been pointed out that another factor making for the hige infection rate and death count in Italy is likely a demographic one; the high percentage of older people who are part of their population.
Next thing ya know there’s a vast spread of TB going on in India.
According to Dr Burks(?) at that press conference earlier between 98-99% of tests are coming back negative which fits with what state of Washington has been reporting.
I watch a lot of British television programs- the one thing I have noticed about hospital scenes in such programs is this- patients share rooms, oftentimes it is wards with 4 or more beds in them, and this is for programs set in the present time, so I imagine that is some of the reality in the UK and likely countries on the continent. My experience with all my relatives in hospitals was 1 patient/room- this goes back to my days as a teen in the 1980s. In fact, the only I had a relative in a room with more than one patient was my youngest sister in a special ICU at Vanderbilt University Hospital following a car accident in 2014- she was in extreme critical care, and the patients were arranged all in circle in a single room- there were about 10 of them as I remember it- with the entire team of doctors and nurses in the room with them.
If this breaks out in a hospital, there are probably lots of countries that have wards with multiple patients, and the WuHan Virus sufferers were probably initially housed with those poor bastards.
Less than 1% of live cases in the US are in critical or serious condition.
I keep thinking back to the ICU doctor I heard on local Seattle radio the other day asking ‘where are all the patients?’ If it’s as wide spread as some say right now statistically there should be quite a few more cases in hospitals you would think.
watch a lot of British television programs- the one thing I have noticed about hospital scenes in such programs is this- patients share rooms, oftentimes it is wards with 4 or more beds in them, and this is for programs set in the present time, so I imagine that is some of the reality in the UK and likely countries on the continent. My experience with all my relatives in hospitals was 1 patient/room- this goes back to my days as a teen in the 1980s.
You’re not from around here, are you? I used to work for a handsome university medical center. The main body of the hospital opened in 1974 and the different components of the physical plant were updated routinely. All of the regular wards mixed private rooms and shared rooms. My last admission there was in 1983. I had a private room for my 12 day sojourn, for which we paid extra. My last inpatient sojourn (in a big-city suburban hospital) featured a roommate – a young man with chronic colitis and quite a mess of chatty Dominican relatives. My nearest and dearest hospitalized in the last 25 years (for the most part, at that university medical center) had a jumble of private and shared accommodations.
One of the regulars on a place I visit has insisted that the disaster in Lombardy and adjacent parts of Italy was because the hospitals themselves were the vector. Patients infect staff who infect other patients. (He noted this is why SARS was such a wretched problem in Toronto but not elsewhere in North America). I’m not sure where he learned this and haven’t seen reports of this nature from any other source. (He’s some sort of engineering manager still working past 70, not a public health maven). Perhaps Michael K could enlighten us.
Hospitals increase the R—the numbers who get the disease from each patient—yet decrease the mortality of the individual patient, a paradoxical effect. Also, because everyone makes mistakes, workers get exposed and have to be quarantined so that eventually labor supply in hospitals is going to severely diminish.
Folks who are really sick should ideally be isolated at home with ventilators and IVs and good staff there, an impossibility at this time.
Social distancing will stop the pandemic but hospitals stop the dying yet keep the pandemic going by increasing the R.
Hospitals increase the R—the numbers who get the disease from each patient—yet decrease the mortality of the individual patient, a paradoxical effect.
Is that what’s been happening, or is that what’s happening in disaster zones like Lombardy?
“That’s why all this emphasis is on “flattening the curve” of the growth of a disease in order not to overwhelm the system.” – Neo
Excellent post by the WaPo (never thought I would write that sentence), because they aren’t pushing any politics.
This link wasn’t behind the paywall when I tried it.
https://www.washingtonpost.com/graphics/2020/world/corona-simulator/
Canadian healty care is much better than in the US, the left always tells us.
BUT Canada has only 12.9 critical care beds per 100,000, comparable to Italy.
Even without an epidemic there are long waits for treatment in Canada.
The US has more than twice the critical care capacity.
Government medicine loved by socialists kills.
Really interesting article at the WaPo, and thanks for posting it, AesopFan. that’s what we’re hoping for with these school closures and quarantine and social distancing — that it will slow down enough to allow treatments and vaccines to come online. If it works, we won’t run out of ICU beds.
@Art Deco
– on Toronto and SARS, simply google the term:
toronto sars outbreak hospitals
and you’ll get a pile of backup for what that elsewhere-regular wrote
(e.g. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3323242/ )
As a population fraction, Italy has more old people than any other country except Japan. That’s not the only explanation for their troubles with the Wuhan virus, but no one denies its importance.
So why does the virus kill old people? I very, very, very rarely find anything worth reading at “Vox,” but maybe here’s the exception that proves the rule. If nothing else, for us old-timers, we should remember the phrase “cytokime storm.”
Read it or die. (Just kidding)
Here’s a link:
https://www.vox.com/2020/3/12/21173783/coronavirus-death-age-covid-19-elderly-seniors
Just saw someone point out another Italian practice which may have played a small role in higher incidence there than in some other places: 67% of 18 to 34 yr old Italians live with their parents, rather than alone or with others their age — these younger people go out, get exposure and bring the virus home where their more sedentary oldfolks catch it. Dunno, but could be a thing to look into.
sdferr — I always knew those Pajama Boys were going to cause trouble.
sdferr,
I thought about that with China also. Don’t know if it’s as common a practice as Italy but I imagine way more than here. Iran, too, maybe but they have many other issues of course.
So much of the US population is spread out and even many big cities are nowhere near as dense as big cities in other countries it would seem the rate of spread of the virus would be less for that reason alone.
I’ve been wondering what impact Obamacare has had on the number of critical care beds. That number is from 2009, which was pre-Obamacare. I’ve also been wondering what the comparison is between the US and countries with socialized medicine. (UK, Canada, etc…)
Nice work, and it is a good example of what I have told others recently: a) Facts without Compares = Fear the Risk, or b) Facts with Compares = Understand the Risk. That is why I pulled the data noted below together – and why I appreciate your work.
***
1) Influenza Virus Deaths: USA
• 2019-2020: 22K (season not over)
• 2018-2019: 60K
• 2017-2018: 80K
• 2016-2017: 38K
• 2015-2016: 23K
• 2014-2015: 51K
• 2013-2014:
• 2012-2013: 56K
• 2011-2012: 12K
• 2010-2011:
• 2009: 12K [H1N1-Swine Flu Pandemic]
• 1968: 34-100K [H3N2-Hong Kong Flu Pandemic]
• 1957: 70-116K [H2N2-Asian Flu Pandemic]
• 1918: 675K [H1N1-Spanish Flu Pandemic]
2) Coronavirus – SARS-CoV2 (Severe Acute Respiratory Syndrome) – Deaths: USA
• 2019-2020: 69 (6,705 deaths worldwide) **as of March 16, 2020
3) Coronavirus – MERS-CoV (Middle East Respiratory Syndrome) – Deaths: USA
• 2012-2020: 2 cases, 0 deaths (862 deaths worldwide)
4) Coronavirus – SARS-CoV (Severe Acute Respiratory Syndrome) – Deaths: USA
• 2003-2005: 8 cases, 0 deaths (774 deaths worldwide)
5) Coronavirus – “Common Cold” – Deaths: USA
• No data