This isn't a ramble. I have a number of lines of thought I've been stewing over at work all weekend, and I'll be going down each one until I'm done. Let's begin.
4000
8000
16000
32000
64000
128000
256000
512000
1000000
2000000
4000000
8000000
16000000
32000000
64000000
128000000
256000000
512000000
4000 is the number of confirmed cases of coronavirus in the U.S. now. (That we know about. Reality could be 100,000 or more.)
If that original number doubles seventeen more times, the product is a number larger than the populations of the U.S. (330M), Mexico(137M), and Canada(37M), combined. IOW, it's virtually everywhere in North America at that point. (No, I'm not particularly concerned about the banana republics between Mexico and South America in this regard. They can lump it.)
What I've read is that the outbreak is doubling every 4-6 days. So somewhere between 68 and 102 days from today, the shit sandwich on this continent reaches full maturity.
If the spread of the disease is moving at that rate. If the current voluntary measures don't halt that growth, or even slow that pace. If it doesn't run out of people stupid enough to keep doing things to spread it.
With the above caveats: May 22nd, to June 26th, give or take. It crests 100M cases a week to two earlier.
Long before then, we'll have a great view of how lethal it is, and how many cases are serious. So by somewhere between mid-May and Mid-June, we'll either have metric f**ktons of people requiring hospitalization, and dead, or not. How much better or worse it is then will be a foolproof look at whether this is a nothingburger, or Spanish Flu. Oh, and if there are really 100,000 cases now, we get there a full month earlier.
Now maybe you can figure out why POTUS said this will last through July or August, at minimum.
And remember, the 85% (or more, or less) of all infected people who have symptoms ranging from none, to moderate flu, aren't the problem. They never were. They'll be just fine.
It's the hordes dying in droves, and crashing the entire U.S. medical system that could put a kink in this country that'll last for decades. And crashing the stock market. And everyone going broke. And crashing the economy even after this passes. And so on. And so on. And so on.
That's 5 1/2 months from now. How much food do you have?
How much cash on hand do you have?
How much of each of those does Gilligan's family have, and how far are they from you?
So, how much ammo do you have??
That little thought exercise should concentrate your minds wonderfully.
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Now, a reminder about some other numbers. 900,000 staffed hospital beds.
93,000 staffed ICU beds.
60,000 ventilators.
1,000,000 medical doctors.
2,800,000 registered nurses.
106,000 respiratory therapists.
That is the army you're going to war with, in this pandemic.
And when I say staffed beds, I don't just mean doctors, nurses, and RTs. I also mean D.Os, PAs, EMTs, CNAs, pharmacists, radiology techs, facilities engineers, clean-up crew, supply workers, registration clerks, administration people, IT geeks, and hundreds of other clerks and jerks, without whose constant efforts and hard work, plus medical supplies in small mountains every single day, Dr. Hero and Nurse Awesome are just a couple of people in funny pajamas, and with about as much lifesaving ability on their own as there is actual magical ability in Rupert Grint and Matthew Lewis.
If it was just beds we needed, we could take all the surplus army cots from the 2M guys RIFFed from Uncle Sam in the 1990s, unfold them, and Presto!, have another 2M spots to dump patients. It doesn't work like that.
I bring this up because if "only" 10% of Kung Flu victims require a hospital bed, because they're really that sick, then long about the time we hit 16,000,000 victims, in (44 to 66 days, so let's average it to) 55 days, we have more patients than we have beds for them. At that point, we're Italy. Say about May the 12th or so. (We may also have up to 480,000 dead, which if it happens would have crushed every ICU in the country 5 times over long before that point.)
We've covered this before, but it bears keeping in mind. Keep your thumb in this spot, as we move along.
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This weekend, all considered, from purely a Kung Flu cases standpoint, was just ducky.
We had maybe half a dozen to ten "rule-outs" (meaning "maybe it is, maybe it isn't; look for other things that rule out Kung Flu. Like actual influenza flu.) Given the abysmally slow return time, I believe at least one was positive for Kung Flu.
"Ten patients? Is that all?!? Aesop is fulla sh*t! This is a big conjob nothingburger!" - every two-digit IQ soopergenius who ever read a word I wrote on this topic.
And herewith, we digress for a bit.
Scenario One: You're in the military. In a combat zone. The enemy is known to have chemical weapons. One day, a shell whistles over from the enemy side of things, and goes off with a less than enthusiastic bang. Then another, and another. You see a hazy white cloud forming at each impact site, coalescing into a large white cloud, now drifting lazily towards your position.
Do you
a) send the company dumbass Gilligan over there to have a sniff for you, and report back
b) send the whole company of men over, and see what happens
c) put Gilligan in temporary command, and have him lead the whole company over there
d) Yell "GAS! GAS! GAS!", while clanging metal-on-metal, and then rapidly don your MOPP gear and gas mask, before the cloud blows into your position, and prepare to treat anyone nearby who was slower on the uptake.
Scenario Two: You're working in a hospital. An ambulance arrives, and unloads a patient spurting blood everywhere, who tells you he just arrived from the Congo, where he runs an HIV and Ebola Survivors Clinic, and tripped on the jetway and cut his leg open.
Do you
a) run over and apply direct pressure with your bare hands, while fountaining blood cascades into your eyes, nose, and mouth, and lick yourself clean afterwards
b) yell at all your other co-workers to join you in performing "a"
c) Both "a" and "b"
d) put on appropriate gown, gloves, and mask with splatter shield, and apply an emergency tourniquet
In case you were wondering, the correct answer to both scenarios is "d". You always assume the worst, from common sense, and institutional policy, and over-prepare, so you can deal with it easily if it turns out to be less-than. You don't grab your .22 to go take on that African Cape Buffalo, and then find out you needed a bit more to get it done. Unless you're a farking moron. I told you that story so I could tell you this one:
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Some days back, I stated that I didn't think we'd bring Kung Flu patients into the hospital, but instead, triage them in tents outside, then send the ones meeting criteria to some FEMA-set-up Kung Flu Treatment Center, staffed as possible, and serviced by dedicated Hazmat 9-1-1 ambulances, whisking members of the community there as appropriate, in full protective gear, 24/7/365.
Because, as I argued with flawless logic, to do otherwise would be to a) risk our entire healthcare system being overwhelmed and destroyed, a la Italy, and b) make every other medical emergency impossible to deal with, thus doubling casualties from every other treatable and preventable cause of death, from heart attacks and strokes to appendicitis, because the entirety of any and every hospital would be filled with Kung Flu-infected plague petri dishes, in every nook and cranny.
Turns out, TPTB, top to bottom, make the Italians look like Leonardo da Vinci.
1) We're not putting tents up everywhere.
2) We're not segregating people out of the hospital.
3) We'll do a half-assed triage assessment outside the building somewhere (fill in the blank where___________)
4) Using screening criteria overtaken by reality a month ago, because the CDC, no matter how asinine, is always the CDC
4a) to wit, asking about foreign travel, even though homegrown community-acquired cases outstrip foreign travel candidates, and have for two weeks
4b) ask about exposure to known Kung Flu patients, even though the CDC and local public health departments refused to test for Kung Flu until four days ago, in most cases, (due to jackassery, fuckwittery, and a dearth of functional kits for two months) thus insuring via Catch-22, that if you never test for King Flu, nobody anyone was in contact with ever officially has Kung Flu
5) then bring the infected into an appropriate sealed negative airflow room
5a) which cleverly has no patient monitoring equipment
5b) will not allow you to get portable chest x-ray equipment into the room with the patient with respiratory problems (which, cleverly, no one thought about prior to then)
5c) which would contaminate said portable x-ray equipment every time you got it into the quarantine room
5d) which would require an extensive, nigh impossible decontamination of said X-ray equipment for each and every subsequent patient
5e) thus leading to shooting x-rays outside the building, or in other places that probably violate 27 hospital safety policies, local health and safety codes, and probably eleventy Nuclear Regulatory Commission regulations regarding radiological safety of patients, staff, and bystanders, in a slow-rolling Chernobyl sort of way
5f) and taking them to CT scanners which are then contaminated, and failing to do a full terminal clean of said rooms and equipment each and every time, which would take them offline for hours each shift, and necessitate closing the hospital to ambulance traffic, so why bother cleaning?
6)unless you're fresh out of negative airflow rooms, in which case you
7) put them into open rooms with no protection or containment
8) thus insuring that all staff members and other patients are exposed over and over again
9) to cases which will not be tested for Kung Flu unless they're first proven negative for the flu
10) Or not
11) All such "policies" being rather more like the Pirates Code ("just guidelines, really"), purely at the whimsy and caprice of whatever doctor(s), charge nurses, or cranky old bat nurse has phone duty that day at the Public Health office, and their personal and capricious interpretation of the current (of four or five or six, so far) CDC guidelines
12) which apparently are changed every hour, if not more frequently
13) while the managers, and senior management, who should be living in the same shoes and underpants 24/7/365 until they sort this shit out, weekend or no, but whom are instead nowhere to be seen, heard from, or in any wise directly involved, until the total colossal clusterfuck falls over from its own weight seven or eight times over, between Friday afternoon and the middle of the following week.
14) while staff and patients having to deal with the results of people with Acute-on-Chronic Head-Up-The-Ass-Syndrome are repeatedly subjected to potential pandemic exposure, leading to sickness, preventative quarantine, lawsuits, and death
15) as the Low IQ staff members, who still think this is no big deal, continue to half-ass every bit of their response, 24/7/365, because half of them were below the upper/lower cut in their graduating classes as well.
THAT'S WHAT YOU'RE GETTING.
The CDC (as per usual, going back years decades) has no f**king idea that it doesn't even know what it doesn't even know, including how to find its own ass with both hands, a map, a compass, and a rearview mirror.
ManageManglement has no idea the CDC can't find its own ass either, and is looking for their own as well.
Supervisory staff puts on its Lemming Suicide Squad Crash Helmet and blinders, and announces that the Light Brigade will smartly charge right over the cliff.
Grunt-level staff, doctors, nurses, ancillary members, etc. will continue to work until
a) they can't take the bullshit
b) they get sick
c) they realize their own family's safety trumps a paycheck.
Instead of learning from Italy's mistakes, and trying to save people and the overall healthcare system, we're going to keep on half-assing this until we're in it over our heads, and then drown. Instead of making the hard call early, and working the kinks out now, when it would have been easy, when it's five patients a week, we'll wait until it's 500 patients an hour, and then crash and burn in a glorious orgy of stupidity.
I expect people to hit the wall.
This is all new to everyone.
There hasn't been a pandemic like this in 100 years.
BUT I ALSO EXPECTED THEM NOT TO BE SO GODDAMN STUPID AFTER THEY HIT THE WALL AS TO NOT RUN HEADFIRST INTO IT TEN OR TWENTY MORE TIMES, IN RAPID SUCCESSION, SIMPLY BECAUSE THEY CAN.
That last expectation was misguided, being most clearly irrational hubris overcoming a solid and well-founded pessimism about people in general, the universality of the Peter Principle, and the inevitability of people, left to their own devices, shooting themselves in the feet until they run out of feet, or ammunition. And then, reloading.
Take care of yourselves.
Take care of your families.
Take care of your friends.
Take care of Your People.
No one is coming to save you.
Not me.
Not the government.
Not. Any. One.
Poster Comment:
Author works in an ER on the West Coast