Gov. Andrew Cuomo issued an Executive Order on Monday allowing New York to increase hospital surge capacity to prepare for an expected deluge of patients with the novel coronavirus. […]
The state will organize the National Guard and work with building unions and private developers to find existing facilities — such as college dormitories and former nursing homes — that can be converted to backup medical facilities, Cuomo said in a release.
Job 1 right now is the construction of more hospital capacity.
Here’s my question: Who’s going to staff those hospitals? And where is the equipment going to come from?
I’m not trying to be negative or panicky. Patients on ventilators require a large staff of medical professionals to monitor and treat them. Has anyone seen a plan to, say, take half of the dermatologists, orthopedic surgeons and plastic surgeons in a city and give them a refresher on intensive care? How about recruiting large numbers of young people for intensive paramedic training (assessment, starting IVs, etc.) ? If we had a functional President, I imagine that he or she would be talking to all the US-based medical equipment companies and supply companies to make sure they have everything they need to manufacturer mass quantities of a targeted set of equipment and supplies, with the military helping if necessary.
We have the resources to do almost anything, but has anyone seen more than a statement that we need more beds?
Update: Cuomo just announced that Trump will send the USNS Comfort, one of the two Mercy-class hospital ships operated by the Navy, to New York City. That’s 1,000 beds.
Gin & Tonic
Long-time commenter Suzanne is an actual expert in the design and construction of hospitals. Maybe reach out to her for a guest post (I think she offered that recently.)
wmd
Build it and they will come.
Seriously I suspect Medical schools around the country are looking at how to get graduates refreshed on how to provide care. We should be suggesting it to public health officials too.
Van Buren
Pretty sure the invisible hand of the free market is expected to take care of this issue.
download my app in the app store mistermix
@Gin & Tonic: Sounds good – Suzanne if you’re reading this, send me a note and we’ll get it set up.
Wapiti
@wmd: Maybe we could surge our medical staff by contracting with Cuba for a large number of doctors.
Suzanne
@Gin & Tonic: I’ll do a post. It’s on my list for the weekend.
germy
Cuomo has asked nurses and other medical professionals to come out of retirement.
Charluckles
Take all those ICE agents and train them to clean, disinfect and change bedpans.
Renie
Cuomo called on retired medical professionals to sign up to be on call
https://www.newsweek.com/new-york-governor-asks-retired-doctors-nurses-sign-call-amid-coronavirus-crisis-1492825
Betty Cracker
Kind of O/T but not: a reporter just confronted Trump for calling C-19 the “Chinese virus” and pointed out that it’s racist and has caused discrimination/abuse of people of Asian descent. Trump turned into a surly 8-year-old and gave stupid non-answers, but good for that reporter.
download my app in the app store mistermix
@germy: There’s a double-edge sword – it exposes a bunch of older people to the virus.
geg6
I’ve seen reports on MSNBC of several governors who have called up all retired medical providers, such as nurses, doctors and therapists, to come in and give a hand. And Trump is supposed to be making two Navy hospital ships available. At least one, I believe, is slated for NYC.
germy
@download my app in the app store mistermix: Yes, true.
germy
@Betty Cracker:
hells littlest angel
I think these will be more like field hospitals — minimal care, and a fairly comfortable place to die.
Avalune
Very OT: @TaMara (HFG): You can find “Pigging mopping the floor” at @h.l.barnwell or https://flic.kr/p/2iFtvPo for those of you yelling at me about Instagram.
Dorothy A. Winsor
@hells littlest angel:
I thought I heard Cuomo say they’d move less critical patients to the field hospitals. Maybe non-virus patients? Obstetrics and stuff like that.
Baud
Seeing other people struggle with self isolation, I’ve never been happier to be a sociopath.
randy khan
Retired professionals, medical and nursing students, National Guard/Reserve medics, and people in other specialties who can be trained quickly. That’s the pool of people for a surge in need.
Martin
The ‘hospitals’ are just cots in a gym. They staff it with a doctor and a few nurses who can maintain an IV, monitor patients and then send them to the ICU if their condition worsens. But they isolate people to minimize exposure at the proper hospital for people that are there for unrelated things, while providing better care than just sending them home.
That’s what China’s fever clinics did. Anyone with symptoms was directed there first, rather than to the hospital, so they were also triage facilities. They did the testing there, and they generally had a portable CT scanner as they could diagnose from a quick lung scan, rather than deal with the supply chain test kit problem we have. They’d also do a WHO test, but in 10 minutes they’d have a diagnosis they could take action on while they wait for that to come back. There are no ventilators there, as not everyone needed a ventilator – some just needed fluids, and those that would later need a ventilator benefitted from a few days of fluids. And because everyone was in a big open space, you don’t need quite as much staffing because you can glance across 100 patients rather than walking hallways.
The US doesn’t usually do the portable CT scanners, because CT scanners are a whole billable center in the US. China has quite a few of them and they just put them where they need them. Again, China focuses almost everything on speed.
Capri
Lots of folks are circulating on my facebook feed the results of a study where they trained people from a large variety of medical disciplines to operate a ventilator via a 16-hour course. The veterinarians scored the best – better than RNs, MDs, and DDS.
Not surprising since vet.s get much more of a background in basic and applied physiology than most other types of medical workers. Looks like I’ll have something to do when my hospital shuts down.
zhena gogolia
OT, very amusing from Patton Oswalt:
download my app in the app store mistermix
@randy khan: That’s a good point.
@Capri: I always thought the vets our dog saw were really smart and skilled.
Martin
@Betty Cracker: China has been threatening to stop shipping medicine to the US if our officials keep referring to it that way. I thought they had stopped, but I guess scoring points against China with each other is worth the risk of us not getting medicine and medical equipment.
L85NJGT
Pallative care.
A sobering article.
Many of the “facts” about mortality and demographics are being steered by triage choices.
zhena gogolia
@Martin:
Oh, great.
Dorothy A. Winsor
@randy khan:
That’s true. I had a mammogram scheduled for tomorrow and it’s been canceled. The hospital is shifting to meet what’s coming.
Gin & Tonic
The Dow has dropped to below where it was when Trump was inaugurated.
schrodingers_cat
Cuomo and Baker (MA governor) have put out a call to recently retired healthcare workers and students. Also those certified in other states in order to get more personnel.
SiubhanDuinne
@Suzanne: I’m really looking forward to this. Thank you in advance for sharing your expertise with the Jackaltariat, especially now.
download my app in the app store mistermix
@Martin: I’m sure your right about portable cat scans. There used to be a lot of mobile cat scan machines in tractor-trailer trucks in rural areas, before cat scan machines came down in price. There still are mobile MRIs. These trucks are not sophisticated. Hopefully we can do something quickly, even with older machines which are probably good enough for this purpose.
To your other point about China threatening to withold meds and supplies, I don’t take that too seriously. There’s going to be a backlash after this pandemic where we build in-country pharma and med supplies companies. The bigger assholes the Chinese are now, the more likely we are to mandate buying US for a whole host of things they create now.
Martin
@Dorothy A. Winsor: Yeah, it’s not where they put people to die, it’s where patients start. They do intake, start there, and then get moved to the hospital if their condition worsens.
I think in China, they converted most hospital beds to ICU beds, so you didn’t send patients there until they needed the ventilator.
Understand too, that China locked down WAY before we did, so they were able to mobilize doctors and ventilators and send them to Wuhan. I haven’t seen any reports of ventilators being sent from West Virginia to Washington.
Major Major Major Major
One of my friends, a statistician at MSK, has been deputized to help with hospital ops. So they’re definitely… not scraping the bottom of the barrel, but calling up everybody they can.
Calouste
@germy: I said it yesterday as well, but has she ever thought about what they are calling her behind her back?
Martin
@download my app in the app store mistermix: I don’t either. China is really not vindictive in that way, but why the fuck would the Trump folks risk the PR backlash from Americans worried that it’s a serious threat when all they need to do is stop doing racism.
Major Major Major Major
@Betty Cracker: I saw a headline that Conway is defending the use of the terms, saying it’s not racist because her husband is half-Filipino.
MoxieM
Well, to answer your question about docs in various fields, I got a call from the staff of my neurosurgeon yesterday, pushing my appt out till mid June. All the Docs at Yale New Haven are assessing scheduled patient needs, and delaying non-essential (or what they see as non-essential) time allocation to free up the next 6-8 weeks. Seems like their (highly educated) guess is avant moi, le deluge.
Baud
@Martin:
They are nothing if they don’t stoke their racist base.
Martin
@Major Major Major Major: Does she also have a black friend?
Redshift
From the NYT yesterday:
If we didn’t have a wildly incompetent administration, states wouldn’t be having to improvise this; there is actually a system. Trump probably doesn’t know (because he’s refused to learn) that federal response to an emergency isn’t something that other people just do because he puts out a tweet about how we’re “responding very strongly.” He’s spent his whole life as head of an organization where more competent people do stuff while he sits in his gilded office taking credit for it and thinking he’s king of it all and taking credit for it.
Dorothy A. Winsor
My SIL is VP for nursing at large Catholic hospital chain in upstate Minnesota. She’s been put in charge of their coronavirus response. They couldn’t have picked a smarter, more organized, more hard working person, but she’s working 12-16 hour days. Needless to say, it’s a big responsibility–3 big hospitals and 7 smaller ones.
WaterGirl
@Gin & Tonic: Suzanne wrote to me with the offer, which I gratefully accepted!
Last I heard, she was working on a post. I think she was hoping to know what people would be interested in knowing, so if any of you have thoughts on what you would like to see covered, or questions to contribute, you can share them here.
Or perhaps if that doesn’t take off in this thread, I can do an introductory thread where folks can share those thoughts there.
Le Comte de Monte Cristo, fka Edmund Dantes
Kinda OT – The authority of HUD to halt evictions and foreclosures is limited to Federally backed loans and leases.
I have no idea what happens when utilities get shut down and trash stops hauling due to the inability of landlords to pay.
Gravenstone
@Gin & Tonic: She also commented about the definite hazards of trying to re-purpose existing structures. Primarily related to relatively poor ventilation and the impact on management of potential pathogens. But I’m sure there are many other reasons it’s likely a non-starter or at a minimum require a herculean re-engineering effort.
BBA
OT – Stocks crossed the 7% line, 15 minute trade halt triggered. For the fourth time this month, after the level haven’t been hit in over 20 years…
gwangung
As posted from the other thread, some signs of hope:
https://threadreaderapp.com/thread/1239941983633838080.html
Redshift
@Martin:
Because in the election, the Americans worried it’s a serious threat are probably already lost to them, so they need more than ever to make sure the racists come out to vote. SATSQ
Never forget that even as the federal response is getting less incompetent, Trump’s top priority is always what’s best for him, and he’s not smart enough to realize that doing what’s best for the country may actually be better for him than stroking his supporters and trashing his enemies.
Le Comte de Monte Cristo, fka Edmund Dantes
@Redshift:
If anybody close to him actually cared about him, they’d tell him to ditch Twitter, announce that he won’t be campaigning because he no longer is concerned about the election with so much at stake, and that he can be judged in November based on the actions he’s taking to address the thing now.
Mandalay
From Trump’s coronavirus press conference today:
Thanks for the clarification, Mr. President.
Suzanne
I will address this in a bit more detail when I finally get a chance to sit down and write about this, but most of the reason that we don’t have “surge capacity” of ICU beds is because ICU beds are expensive to build and staff, and hospitals have to remain profitable/financially solvent. Most of America’s hospitals are also (at least in part) in older buildings, built when hospital stays were longer but for less acute/severe illness, so there are a lot of typical acute care beds and they are not easily converted. It is going to be a growing problem outside of this pandemic, as the average hospital inpatient becomes increasingly older and sicker, because people who are well enough to be sent home will do so.
Martin
@Baud: I miss the days when Republicans were smart enough to understand the value of dog whistles.
Suzanne
@WaterGirl: I’ll sit down and write a post this weekend. I am working all week and the kids are all home!
dmsilev
@Martin: Well, it’s because racism is one of the few things that they’re both serious about and good at.
Kelly
My wife’s annual checkup at Kaiser next month is canceled. Kaiser cancelled all dental appts, most medical appts and emphasizing online consultation. The news release listed saving resources for the epidemic.
H.E.Wolf
In my great-great-grandmother’s diary entries for autumn 1918, she recorded that the church vestry – church services were cancelled, because of the influenza epidemic – had been set up as a temporary ward for flu patients.
She also noted that she was making “night dresses” for flu patients, and that the family automobile* was being used to ferry patients over to the church.
*not the “Electric Auto” which they had in 1907, but a newer vehicle.
Suzanne
@Gravenstone: Crappy retail buildings are not going to be converted to permanent, modern hospitals. Buildings like hotels or dormitories would be somewhat easier, but still difficult.
Feathers
@Capri: I’m guessing this is in the same vein as women doing better than men in the learning to shoot a gun for the first time in basic training. But also, vets have to see so many different animals, I imagine they have to be able to improvise. Deeply understanding the basics is so important, as well as being able to put that knowledge into action.
Barbara
@Dorothy A. Winsor:
Right. You aren’t going to run temporary hospitals as ICUs. You will run them as the equivalent of sanatoria where people with less acute needs can get constant medical support without being within the community.
download my app in the app store mistermix
@Martin:
And all a frog needs to do is stop bumping its ass when it jumps.
JPL
@Martin: trump is a racist. He doesn’t just play one on TV.
Barbara
@Betty Cracker: Shades of HIV being called the Haitian Plague or something like that. As if a virus cares about national origin.
SiubhanDuinne
@WaterGirl:
I’ve been trying to figure out how to articulate what I’d like to see Suz address, because it comes down to “I want to know about all the stuff I never would have thought of,” but of course I can’t ask for specifics because I don’t know what I don’t know.
Here’s a kind of example from another specialised field of architecture: After one of the big school shootings, there was some discussion about school corridors that were designed with waves and curves — no dark corners for a shooter to hide in. Don’t remember the specifics, but it was a design that would not have occurred to me yet was presented as making a lot of sense and might provide a student with a few precious extra seconds of safety.
That’s the kind of thing I’d like to know about in a hospital/lab/clinic facility.
Suzanne
@Barbara: Open sanatoria are arguably more dangerous for transmission of illness than nothing at all. What’s worse than being in a room with a sick person? Being in a room with a ton of sick people.
Feathers
@Suzanne: What’s crazy is that forces some people into ICU. My ex had surgery. He also had epilepsy from a car accident head injury and sleep apnea. The doctor knew he wouldn’t be able to get approval for just keeping him overnight to monitor, so he ended up in the ICU.
Jinchi
@Charluckles: Please don’t let my caregiver be a transplanted ICE agent.
Patricia Kayden
Desperately trying to blame President Obama for his failures. Pathetic.
Le Comte de Monte Cristo, fka Edmund Dantes
@Kelly:
Wonder what happens if somebody (like say, a chronic nighttime tooth grinder who seems to have these episodes arise every few months lately, ahem) cracks a tooth and needs a root canal in a hurry?
Feathers
@Suzanne: But if the sanitoria is filled with people all having the exact same illness? I’ve assumed that Harvard emptied its dorms with the intention of being able to fill them up again.
WhatsMyNym
@Gin & Tonic:
Thanks for the tip – Looking at the top 30 components I see a few good buys that haven’t been picked up on yet.
Of course the travel related are being crushed. Boeing is finally being recognized as the mess that has been for the last few years.
WaterGirl
@Suzanne: Everybody is extra busy, and we are all of our game to some extent. Which makes me especially grateful for all the peeps we have at Balloon Juice who are willing to take the time and make the effort to write up guest posts even in the midst of all this.
Truly grateful for everyone here.
WaterGirl
@H.E.Wolf: That made me cry.
But how wonderful to have that diary!!!
Calouste
@Patricia Kayden: You know how we call managers in my line of work who don’t address issues for three years? Unemployed.
geg6
@wmd:
When my university announced the move to online classes, they made clear that nursing and medical school students were to report. They plan to use them at the university’s hospital.
Suzanne
@Feathers: There is no way that all of those people have all of the same illnesses. COVID is top-of-mind right now, but all of those people have other infections and needs simultaneous, which they are sharing with one another while they are all medically vulnerable. Sanatoria/wards are what we’ll do in an absolute crisis, but they’re not good and people will die who could have been kept alive in better circumstances.
Kent
Talked to my wife about this last night. She’s a supervisory physician with Kaiser here in Vancouver WA. They are basically sending all their less experienced staff home to do virtual care as all the routine physical care is transitioned to virtual. The staff physicians with ER and hospital experience and surgical experience (like my wife) are being kept in clinic for triage. Normal life goes on and they are still getting super sick people coming in. Waiting rooms are closed, they leave everyone in their cars and call them in one by one via cell phone. You drive up, check in from your car, then go park and they call you when they can. The staff are in full protective gear head to toe, facemasks, gloves, etc. Yesterday she had a 70 year old man with severe pneumonia needing intensive care. Maybe corona, many not. They sent him off to the hospital. So far as of yesterday they had 4 positive tests but she says it could well be 100x more because they are still only testing those admitted for critical care.
Essentially all the clinics have been converted into critical care and triage centers.
She was on the faculty of a teaching hospital teaching residents in Texas for a decade. She says she would 100x rather have retired doctors and nurses show up than young doctors and nurses fresh out of school, or not quite out of school. Even given that they are at higher risk. They have zero time to train up young staff while they are working.
Redshift
@Barbara: The virus may have been an immigrant from China originally, but what’s infecting Americans now has been in this country for more generations than any human.
Feathers
Very funny. Patton Oswalt homeschooling his daughter. Be sure to watch to the end:
https://twitter.com/pattonoswalt/status/1240098937458970630
* If you don’t want to watch to the end, skip to where he leaves the frame.
Suzanne
@Feathers: Yeah, that happens for sure. Hell, people used to go to hospitals for a week for “exhaustion”. When I was born, SuzMom was hospitalized for five days, and it was an uneventful birth. But that is not the financial environment we are in today.
Roger Moore
@download my app in the app store mistermix:
Ideally, you’d have them take over non-COVID cases to free up younger providers to deal with the pandemic. After all, we will continue to have ordinary medical problems even as COVID dominates our attention.
Ksmiami
@Suzanne: what about newly built but unoccupied apartment buildings- we have a surplus of those in Dallas
MoxieM
@Le Comte de Monte Cristo, fka Edmund Dantes: Yeah me too. I desperately need a steroid shot in a hip with bursitis. I can barely walk and I’m solo. Hell, I’m pre-self isolated! But seriously, I totally understand that compared to folks who become gravely ill with the virus that seems insignificant. Meanwhile, my life is very hard to manage. Very hard. I’ll just continue to drag the leg like Igor.
Could be worse; could be winter; could be dead. (although at this point that might be an improvement.).
Feathers
@Suzanne: Thanks. My presumption was that there would be full testing before moving to wards, as was done in China, but can see the problems if that isn’t the case.
One of the problems here is we are in a situation where taking edge cases into consideration can make things far worse overall. See the problem of not shutting down NYC schools because children needed lunch.
Another Scott
Yesterday the BBC News on my TV was running an interview with a doc from UPMC (Mayhew’s old stomping grounds). He said he wasn’t worried so much about lack of hospital beds and ventilators, but rather doctors and nursing staff being burned out and/or catching the infection themselves.
The way things are going, it’s going to be a real problem, and people need to be planning for that eventuality.
:-(
Cheers,
Scott.
Kent
On Monday the NYT Daily Podcast interviewed a doctor from a big hospital in northern Italy. He said they had over 450 staff who were home sick, or just home burnt out and unwilling to return. So it is a big problem. They are going to need to pace themselves.
Suzanne
@Ksmiami: Depends on how they’re built. There’s a lot of developer-built four- and five-story wood apartments being thrown up around me, and those are absolutely not going to be hospitals any time soon. Pressurized high-rises could be better.
Nicole
@Feathers: That was great. His daughter clearly inherited his comedic timing.
JaySinWA
Kaiser WA is closing most of its clinics for regular patient care and relocating care personnel to a few large regional centers. A few of the closed centers are being setup for drive through testing.
Kent’s Vancouver branch is still Kaiser OR I believe, it was Kaiser before GHC was bought out in WA so may have somewhat different marching orders.
trollhattan
Johns Hopkins could have accepted my kid, and in a mere [checks watch] 8+ years have issued a fresh doctor to help out, but noooooo.
Sufficiently cynical that I will bet in two years, our medical system will not be changed in a meaningful way as a response to this mess.
opiejeanne
About the shortage of ventilators, this seems relevant :
https://youtu.be/uClq978oohY
Ksmiami
@Another Scott: We’ve e made the decision to avoid the hospital no matter what- my family is healthy and not old so home care is the choice should we get sick. at some point your time is your time and honestly overrun hospitals are risky as well
WhatsMyNym
@Feathers:
Seattle Public Schools closed, but are having grab & go meals for students at schools throughout the city. Students don’t even have to commute to their specific school to get a meal.
Ksmiami
@Suzanne: that’s what I’m talking about – very new high rise apartments with solid design/good materials
chopper
@Martin:
you make it sound like they know how to stop
Another Scott
@Gravenstone: A couple of days ago at the daily dog-and-pony show, I heard Pence say (on the radio) something like “we’re working on having the Army Corps of Engineers renovate old hospitals to add capacity…”!!
In addition to what Suzanne has said here, a little bird told me horror stories about federal renovations taking a literal decade to start because of various issues of any type that you can think of (only some of which are the result of “easy” to remove red-tape)…. Grrr!!!
Donnie and Pence need to stop these stupid, counter-productive, and dangerous daily mis-information sessions. They need to get out of the way and let experts do their jobs.
Cheers,
Scott.
delk
Hmmm… President suffering from dementia and a deadly virus? I already lived through that once and survived. Some ‘80’s nostalgia doesn’t need to make a comeback.
Kent
Yes, my wife’s Kaiser is Kaiser Oregon/SW Washington as we are part of the Portland metro. Part of the original Kaiser that has been here for decades, not the Group Health acquisition in the Seattle area.
They may have closed some small walk-in satellite clinics but the main big clinic locations of which there are 3 in Vancouver are all now running as critical care and triage units I think. Also one in Longview. They operate pretty independently of Kaiser Washington which is mostly just re-branded Group Health.
Suzanne
In general, I see a lot of questions like “Why don’t they turn [Building X] into [Building Y]?”. Broadly speaking, it’s because it’s often financially and operationally infeasible to convert buildings of one occupancy type into another, and so it is cheaper/easier/faster to demolish the existing building and build something new and purpose-built. Reasons it is difficult to convert are usually around building code, emergency egress, insufficient structural or mechanical capacity, site circulation, etc. Things are often incredibly basic, like width of a corridor or size of an elevator. Like an unused apartment building will not have an elevator that can accommodate a hospital bed. It’s incredibly difficult to expand an elevator shaft and put a new (heavier) elevator cab into a finished building. So a whole new elevator would have to be built, which would change up corridor routing. That issue alone right there would sink 98% of conversion projects.
chris
trollhattan
@zhena gogolia:
Hilarious. Nice neighborhood to be stuck in FWIW.
piratedan
and a big deal here is not just the room but the equipment…
sure, they can place you in a bed, but if your presenting with COVID, then chances are they also have to set that up with O2, many of the CCU and ICU beds these days are set up with regulators and the like to help the nursing staff keep you on that O2, or monitor that fluid intake to allow them to take care of (i.e. fill out the voluminous amount of paperwork that is associated with health care) additional patients. Plus there are the reports out there that there’s a company in the US that makes ventilators, but they’ve yet to receive an invoice from the Feds to increase production. Without the infrastructure within the infrastructure, it just becomes a room….
The other huge bottleneck that we’re facing (at least in the Pacific northwest) is the serious lack of PPE (personal protective equipment) gear, which are masks, gowns, containers for storage of samples that are usually disposable. Right now the facility that I work for is shutting down all elective surgery to accommodate this need. Also, we;re running into the bottleneck of now that testing facilities are coming up, the volume of samples submitted greatly outweighs the staffing and reporting capabilities of the testing labs and while there exists an in-house testing capacity, its still needs FDA approval which has yet to be forthcoming (we’ve been in the queue for two weeks on this I believe).
lots of gears that comprise a healthcare delivery system, at least based on the current US model… and they all play a part… doesn’t mean that planning and looking at alternatives and starting to plan for additional beds is a bad thing, just understand that this is just ONE thing and there are multiple pieces of the puzzle, a hospital is many things, not just beds and nurses and docs, but oodles of medical instruments from radiology, to respiratory therapy to clinical lab to pathology and these days molecular testing… as well as a pharmacy and a cafeteria, etc etc etc…
Suzanne
@Ksmiami: Possible. But difficult. There is a behavioral health hospital in Phoenix that was a vacant Class A office building that was built during the recession and never completed. Apparently the conversion was so difficult that Owner said that they would never do it again, and that was a psych hospital, which have a lot less mechanical and plumbing requirements.
trollhattan
@Suzanne:
Having watched quite a few hospitals and medical buildings go up in my burg, I’m always impressed they take at least twice as long as an equal-size office or apartment tower. All the extra plumbing and electrical and air handling etc. must be mindbogglingly complex. I suspect materials and construction tolerances are more rigorous as well.
West of the Rockies
@Feathers:
Thank you so much for that! I love that little family; they’ve dealt with grief and continue to move on with grace and humanity and humor.
catclub
OT:
Am I the only one who thought – unfarted.
Suzanne
@trollhattan: Yeah. Offices and residences are easy. I have spent my career in hospitals and airports, which are…. not.
Sister Golden Bear
Talking with a friend of mine in Seattle. The “good” news is that after consulting her doctor, she only has bronchitis, not coronavirus.
The bad news is that it’s serious enough that normally, her doc would send her straight to the hospital — but advised her that’s too dangerous now.
The ugly is that she still needs to work (albeit in a backroom stocking job where she doesn’t deal with customers) because otherwise she’ll lose her health insurance, her apartment and her ability to buy food.
I sent some money to her GoFundMe, but I’ve got so many, many friends who are also doing GoFundMes — they’re self-employed artists, performers, etc. who have no money coming in, and can’t file for unemployment because they’re self-employed — that I’m hitting my limits of how much I can help.
Kent
Plus, most stuff built in the past 30-40 years that wasn’t built to institutional standards (hospitals, universities etc.) is just cheap crap. ESPECIALLY apartment buildings and strip development like abandoned Wal-Marts and such.
Hospitals, for example, require a LOT of electricity and ethernet cabling for all the equipment. A lot of it is not WiFi so you need wall jacks everywhere to plug in power and internet. Ordinary 20 amp household or apartment circuits are not going to cut it. That means ripping out every single wire and replacing with heavier grade. You can’t just pop in larger circuit breakers, you have to run all new wires. Easier to just bulldoze it and start fresh.
Flea, RN
@Redshift: This is not a panacea – these are largely medical professionals who are attached to this group and redirected at need to a disaster; i.e. Katrina, Houston floods, etc…
COVID is hitting everywhere. If you task one of my ED docs to go work in NY, for example, we will be losing a Dr. at the worst possible time.
Renie
@H.E.Wolf: How lucky you are to have that diary. I’ve done my family history and would have loved to have something like that. Priceless.
Feathers
@chopper: Anti-racism campaigns rarely face the fact that you are dealing with assholes. When confronting racists, I’ve had far better success with calling them out for their assholish behavior. “Fuck, dude. What does that guy have to do with a fucking virus? Can you not be an asshole?” But that is seen as excusing the racism. But the racism is often just an excuse to get the power trip of being a public, raging asshole. A racist is superior, an asshole is not.
Structural racism is another problem, regulation limiting corruption and greed does huge work there.
Kent
Typical apartments build these days are 5 story or lower so they basically make a concrete podium and do traditional wood-frame construction for the 5 stories. Codes don’t allow going higher than that with traditional wood framing. So when you see an apartment go up, it is just ordinary carpenters banging it up with 2×6 construction like they would do a house. It’s what they know and are fast at it. And they can use lots of unskilled immigrant labor.
A hospital or university or tall office tower probably don’t have any wood at all. It’s all concrete and steel so completely different type of construction that requires completely different skilled labor. Everything is more complicated and more expensive. You can’t just rip a wall out and move it because it is 6″ out of place like you can with wood frame construction.
That is also why most apartments and hotels you see scattered around everywhere are limited to 5 stories. It is two to three times cheaper to make them than anything taller. Here is a very interesting blog post from a very interesting blog on the topic if you are curious: https://granolashotgun.com/ scroll down to the January 14 entry. The Russian characters won’t copy and paste here.
Suzanne
@Kent: And emergency power generation, and large amounts of chilled water to run the HVAC, and smoke compartmentation, and, and, and.
lee
@Kent: That makes sense.
I seem to remember reading about a country that ‘graduated’ all of it doctors earlier this week so they could start work.
catclub
@Renie: I was thinking that there will be lots of ‘diaries of a plague year’
blogs.
Whether any gets saved to be accessible in 100 years. Not sure.
trollhattan
@Suzanne:
From my downtown office building we can watch our replacement office building go up a block over, with remarkable speed. They’re
promisedthreatened us we’re getting a super-wonderful happy funtime open office plan in the new space. I looked at the calendar and thought “Eh, not for me.” But the last month has seen the financial markets changing my options bigly. This is making me extremely grumpy.Jinchi
That happened quicker than I expected. Now he has to say Obama has the best record ever.
trollhattan
@catclub:
“Grandpa, what’s a ‘.docx’ file?”
piratedan
@Suzanne: and multiple computer operations centers and networking accommodations…
Feathers
@Suzanne: My dad is a retired civil engineer (highways). The essay question on his civil engineering licensing exam was to design a drainage system for an airport’s runways. I don’t know if it’s PTSD, but he’ll point out how the runways drain to the grandchildren while traveling. I know a great deal of small details of highway design.
JaySinWA
@Kent:
It’s more than just rebranding, but that is a discussion for another time. Kaiser and GHC were very similar in patient care philosophy, but different in other ways.
I am not sure how GHC would be able to weather the storm that is coming. Kaiser brings a stronger financial base.
Barbara
@Suzanne: The idea is, I think, that everyone would have the same disease. This is the model that was used in China is my understanding, once they became convinced that staying at home ended up infecting whole families. Not vouching for the soundness of the idea, just that they won’t be used as ICUs.
1stgengirl
@Suzanne: could the nursees and doctors working in administrative positions for corporations be drafted? So many are employed by insurance companies for reviewing claims to determine medical necessity or for permission for various treatments. All those folks could be put to good use, if they were drafted.
Flea, RN
@Suzanne: and as was well documented in Richard’s thread above, an “ICU bed” is more than a bed – it takes intensivist MD’s, specially trained RN’s and RT’s, special equipment like ventillators, etc…
It’s way more than just building a room.
From the reports I’m seeing from both China and Italy, the average patient is requiring close to 2 weeks in the ICU, so that “bed” is occupied for a long time. About 50% of people who are ventillated will survive (no idea yet about long-term prognoses, but that’s a long time to be artificially ventillated, especially if you have comorbidities before becoming sick)
Some very smart people are even theorizing ways that you could “split” a ventillator to manage up to 8 people at a time, but as far as I can tell, it has never been tried. Dr’s would be taking a huge risk of lawsuits (and for those of you old enough to remember, there were lawsuits against Dr’s and Nurses after Katrina when they were accused of euthanizing ICU patients in a hospital without electricity, medicine, etc… for a period of over a week)
Flea, RN
@Suzanne: and as was well documented in mistermix’s thread above, an “ICU bed” is more than a bed – it takes intensivist MD’s, specially trained RN’s and RT’s, special equipment like ventillators, etc…
It’s way more than just building a room.
From the reports I’m seeing from both China and Italy, the average patient is requiring close to 2 weeks in the ICU, so that “bed” is occupied for a long time. About 50% of people who are ventillated will survive (no idea yet about long-term prognoses, but that’s a long time to be artificially ventillated, especially if you have comorbidities before becoming sick)
Some very smart people are even theorizing ways that you could “split” a ventillator to manage up to 8 people at a time, but as far as I can tell, it has never been tried. Dr’s would be taking a huge risk of lawsuits (and for those of you old enough to remember, there were lawsuits against Dr’s and Nurses after Katrina when they were accused of euthanizing ICU patients in a hospital without electricity, medicine, etc… for a period of over a week)
Kent
As my wife explains it, med school is sort of like law school in that they teach you medicine but not how to actually practice it. That’s what residency is for. Learning all the systems and procedures from electronic medical records, to information flow, to how to do charting to how to consult, to how a hospital operates. Basic stuff like how do you pull up a patient’s medical history on the computer and be able to read it. None of that stuff is taught in med school.
I mean, yes. A 95% trained med student would likely be more useful than someone off the street. But they aren’t ready to just step in and work. They need years of supervision as they learn.
Le Comte de Monte Cristo, fka Edmund Dantes
Best, winningest president ever – he gets on the dais and the market takes a screaming, runny shit.
Suzanne
@1stgengirl: I have no idea of the legality of a draft. But I’ll say this: hospitals are a complex system. You can’t just add on to a part without needing to increase the size of all the other parts, or find a way around it.
JaySinWA
@Jinchi: He has always worked to undo anything that Obama did. So, winning!
Kent
Oh, of course. But from what I understand the transition from GHC to Kaiser is a process that is not yet anywhere near finished.
cckids
@L85NJGT:
I’m haunted by the stories out of China, with family members who have TB being sent home, essentially to die, taken off needed respirators, exposing their families to TB. Cancer patients not getting treated. People with AIDS missing meds. The death toll from this crisis will extend so far beyond those who die from COVID-19.
And yes, people will be discharged from the hospital when they are no longer critical, but when they are in no possible shape to care for themselves. The US hospital system has gone to that method over the past 15 years, and it is incredibly difficult. I’ve got horrifying firsthand experience.
John Harrold
My sister is a nurse in Arkansas. They don’t have enough of the proper PPE and they have been notified they will have to work. No unions. If they refuse they will loose their certification.
chris
The Dow is currently below the November 2016 close. *bitter chuckl
ETA: Nov2016 close-19125
Kelly
@Feathers: My Dad ran heavy equipment building roads, mostly gravel logging roads so I take care of the maintenance of our 1/2 mile of shared gravel road. I’m very opinionated regarding the quality of the gravel from all our local sources. You do not want river sourced gravel on a road. Too many round faces it’ll never pack down.
A Ghost To Most
So off-topic, but I think I just went to war with Denver Water.
The teleconference (down from in-person; thanx covfefe-45) to discuss
the timeline of the Big Dig started well enough. When I tried to nail
down a nebulous timeframe that I understood to be late May to early June,
he said no, they were starting in early April. This involves the closure
of a busy street. I asked if notifications to the neighborhood had gone
out, he said they were underway. I said I hadn’t been notified; he said
you just were.
Then I asked the question that Denver Water has refused to answer, and that
I made clear I wanted an answer to. If my house or foundation is damaged
(66″ pipe laid 15′ from foundation), who will pay for damages? (State Farm
already did their best Pontius Pilate). Crickets. Crickets. Lot of finger
pointing, answering a different question, etc. 7 years of bullshit condensed
into a 45 minute call.
I hung up on them. Next step is a lawyer and Channel 9.
piratedan
@John Harrold: unsure if its possible to make your own washable PPE, granted, you may not get the filtering capability that is available in commercial products, but some protection may be better than none. Unsure if there are specific standards that have to be met regarding the use of something like that. It would be up to the hospital to comply with state guidelines regarding what is acceptable but if they are implying “work without it”, then perhaps that point is moot.
Brachiator
@Suzanne:
This makes perfect sense. Thanks for the clear explanation. I will pass it along to some folks who have asking why we just can’t do everything immediately to fight the virus.
Le Comte de Monte Cristo, fka Edmund Dantes
@chris:
So looking at his idiot tweet of 5 hours ago (“I’m leading Sleepy Joe Biden 48-42 according to The Daily Caller”, or something like that), I’d love to see it revealed that the crosstab is “registered Republican subscribers to The Daily Caller”.
Kelly
@Suzanne:
The debates over tearing down vs restoring the ?80? year old “historic” buildings that were the State Mental Hospital in Salem were something to behold. One of the old buildings was used as the set for “on Flew Over the Cuckoo’s Nest”. It was where the novel was set as well.
germy
germy
artem1s
Dumbass is in charge of the military. WTH. Why aren’t they looking into redirecting funds from the Pentagon’s pet projects. They should also be starting training at military bases on basic care to relief first responders so they are free to attend to critical patients. Cuomo is already deploying National Guard to help out with food delivery in quarantined communities. There are a million things that could be shifted to the military if they only had orders from their Commander in Chief. Epic failure.
Le Comte de Monte Cristo, fka Edmund Dantes
@germy:
“Do you know who I am, goddammit? I can RUIN you by buying your company and firing you.”
Comrade Colette Collaboratrice
I had a phone appointment with my doctor this morning because of high fever and chills and body aches and night sweats since Monday. The good news is my temp is down this morning anyway and I feel considerably better. The medium-bad news is I don’t qualify for Covid testing because I have no history of foreign travel or direct exposure to a known case (although my 16-year-old son goes to school with the first student in our city to test positive, but that’s pretty tenuous).
The really bad news is that the aforementioned son had a total mental health meltdown this morning, punched a hole in the wall, and may have broken his hand. So some of us will likely get to take a trip to the hospital today anyway.
WASF.
Suzanne
@Barbara: At that point, it’s less about getting the sick people well than it is about keeping sick people from well people. Again, it can be done, and it’s better than nothing, but it’s not good healthcare practice.
Honestly, people are crapping their pants about COVID, but nosocomial infections have been recognized as a titanic problem in hospitals for about twenty years. This country loses roughly 747’s worth of people every day to infections acquired within hospitals. Good IP protocol involves separating infectious patients away from one another, not bringing them into shared spaces.
JMG
@germy: I wouldn’t want to be the first rich person known by name to have done this.
Baud
@Le Comte de Monte Cristo, fka Edmund Dantes:
It’s like the market has no object permanence and didn’t realize he was president all this time.
chris
@Le Comte de Monte Cristo, fka Edmund Dantes: “I love the poorly educated!”
Kelly
@germy: A couple weeks ago I thought if I were rich I’d be equipping an ICU room or two in my mansion
ETA:I’d be one of those extremely secretive rich folk…
JustRuss
Asking members of the age group that’s most severely impacted by the virus to deliberately risk exposure seems like a solid plan.
taumaturgo
@Martin: Would you say that China focuses on the needs of the people rather than speed or like we do here, the profits of healthcare insurers?
taumaturgo
This is how the communist leaders in China reacted and are dealing with coronavirus.
https://www.dailymail.co.uk/news/article-7942007/Time-lapse-footage-shows-Wuhan-building-second-coronavirus-hospital-1-600-beds.html
Suzanne
@Comrade Colette Collaboratrice: Ohhhh no, I’m sorry. This quarantine is not good for anyone’s mental health. Spawn the Elder is also not happy about it. I sent him to stay with his dad for a few days.
Le Comte de Monte Cristo, fka Edmund Dantes
Kent
One idea is to deploy retired doctors and nurses to regular hospital wards and floors to take care of non-COVID patients who would be segregated from the floors or wards where they younger staff are concentrating on all the new COVID patients.
People are still figuring this out.
Le Comte de Monte Cristo, fka Edmund Dantes
Mnuchin is a nasty little Gollum. At some point, I can see him hovering and telling the moron “you’re going to take your goddamned Sharpie out and scribble your shit signature on this set of orders. I’m not going to take the fall for this…”
Suzanne
@Brachiator: Not to mention…. where does everyone think all these skilled construction workers and materials are going to come from? When there is one significant hurricane event, supply chain for building materials is impacted for months, at least.
And who do they think is going to operate all these hospitals after this is over?
Feathers
@Kelly: We always were amused by my dad’s old text books. He held on to Concrete I, II, III, & IV, all oversized and filled mostly with tables. I colored in all the dinosaurs in his geology workbook. He only took notes. Boring!
My parents bought a cabin out in the country and the driveway had a little bridge over a small river/stream which needed replacing. He decided to do the designing himself, going back to his roots. He worked at the FHWA and took it over to friends in the bridge department to look over. They teased him that his driveway was built to higher safety standards than the nearby state highway’s bridges. He helped with building it and the contractor wanted to hire him!
JMG
Went for a walk in my neighborhood because it’s sunny and 50, which is springtime in New England. More folks out walking than there ever are when things are normal. Folks more eager to smile and exchange pleasantries, too. On the street one block over a South Asian family group (two kids, mom, dad, one undefined elder man) were playing pickup cricket in their driveway. It was nice to watch.
germy
I just found out Powell’s Books has laid off most of their employees.
piratedan
@Kent: another case in point, in our very litigious society, how does liability figure in for people who have been out of practice for 5-10 years?
JaySinWA
@piratedan: I would hope that good samaritan laws would either be in effect or rapidly passed.
Ksmiami
@Suzanne: like Mrsa etc. When my youngest was born, the pediatrician checked her and then said now get out of here a hospital is no place for a baby- and this was at Hoag in Newport Beach, California
SiubhanDuinne
@Feathers: Kid’s timing is great throughout!
Suzanne
@piratedan: Or the liability when there’s a fire in one of these crappy temporary hospitals and patients die because they can’t be evacuated? Or the wrongful death lawsuits when someone dies because they acquired COVID while at a hospital?
I can’t see many hospital systems wanting to expose themselves to this.
Kent
Hospitals and big clinics like Kaiser have blanket malpractice insurance. In any event, I doubt we are talking about 70 or 80 year old doctors who have been out of practice decades and who’s licenses have expired years go.
There are hundreds of thousands of doctors and nurses around the county who have basically taken early retirement, or who are doing itinerant part-time locum type work. Who have current medical licenses and such. These would be people in their 50s and 60s. My wife’s clinic has a whole cadre of early-retiree doctors who do part-time locum work (covering for other doctors on vacation or leave). There are also thousands of middle-aged nurses who are early-retired because they are married to older spouses. I’m guessing those are the types of people we are talking about. Recent retirees who are still relatively young and properly licensed.
negative 1
@Gin & Tonic: It’s about to drop to below where it was when FDR was inaugurated. I feel like people don’t realize a.) how much of the US is service sector or adjacently employed and b.) how much of the US lives paycheck to paycheck.
One point of frustration is that two $1,000 checks is about the least of what we should do. We should be opening up unemployment benefits to like 75-80% of a person’s salary (rather than 30-50%) for at least as long as this thing is going on. Getting out of the last recession was a matter of un-jamming the credit markets, basically by giving banks money. This one is going to need to put a lot of money in people’s hands, quickly.
Martin
@taumaturgo: Sometimes. I mean, in their quarantine they brought food to residents – all residents. Well, not the Uyghurs.
No, Chinas focus is really on the strategic benefits of China. That has knock on benefits for Chinese citizens because having them not be sick is in China’s best interest, but they’re just as willing to sacrifice Chinese citizens if that’s in China’s best interests.
So, there’s a benevolent and a malevolent side of that approach, but there are lots of things that would be in the strategic interest of the US government and benefit the citizenry but don’t benefit corporations, and we fairly consistently side with the corporations even over the national strength. We’re seeing that consequence now. It’s literally an everyone loses strategy.
Workers are so important to the economy that they’ll just cut us all a check. I don’t need a check, but I guess I’m getting one. But, simultaneous to that, we’re still going to kick nearly a million people off of food stamps, and a month ago giving you sick leave was going to ruin the economy. I mean, they’re just constantly bailing out their own shitty decisions. And when this is over, we still won’t get those things because we can’t afford it because we gave everyone a check, and nothing farther out on the horizon than next week ever exists.
We’re all trapped in a swirlie of derp.
Avalune
I asked my mom how she was doing. We’re very estranged but within the last few years throw a couple sentences at each other via the evil FB. She started griping about liberals. I reminded her I was a liberal. She took the opportunity to yell at me about liberals killing the country and a bunch of other scarcely intelligible garbage. For someone who hated her mother, she sure does act like her, trying to bait me. She’s not religious, so I don’t know why she cares about prayer in school except the talking heads tell her to. Just…yikes lady. It was all I could do to refuse to engage when what I really wanted to do was just shout at her that she is a shitty person and a shittier mother and therefore my opinion being opposite of hers feels rather justified. I didn’t take the bait though. As Leto pointed out, that will teach me for trying to ask her how she was doing.
Some choice tidbits:
She deleted the last one but not before I got it. HILLARY! BUTTEREMAILS! You cartoon of a woman. Going to go shower – I feel gross.
Suzanne
@Ksmiami: Hospitals are nasty. I’m in them all the time and am very aware of the hand washing and surface-cleaning issue.
trollhattan
@Suzanne:
It would also be great if we did not have tariffs on steel and aluminum and wood products and fasteners and appliances and….
Somebody needs to club Peter Navarro and Wilbur Ross with a fungo bat.
negative 1
@Feathers: I don’t know that I agree. A lot of racists don’t think of themselves as racist. It’s the old ‘one of the good ones’ trope, or ‘I don’t hate [x] people just ones who act like [y].’ Calling that out in people sometimes gets results.
After all, there are only a small amount of true ‘white supremacists’ relative to the US population. There are, however, a lot of people whose behavior can be described as racist. The difference in those figures is the people who don’t honestly think of their behavior as racist.
Suzanne
@trollhattan: We could also train unemployed Appalachian coal miners how to be nurses in urban hospitals. :::ducks:::
Brought to you by Serious Policy Proposals Corporation, where INNOVATION!!! outweighs competence each and every time.
piratedan
@Kent: may be the case in the Pacific Northwest, very unsure if that model can be extrapolated to healthcare across the country. Not saying if the resources are there to be tapped not to do so, just saying that perhaps there aren’t a ready resources of these types of physicians in places where people don’t go to retire…
Ksmiami
@Suzanne: The creation of resistant superbugs and over prescription of antibiotics is so so dangerous- I know a few ppl who went in for relatively routine procedures and wound up with near life threatening secondary infections. be safe out there.
germy
@Ksmiami:
I had an uncle who went in for a simple hip replacement. He died from an infection after the operation. A few years later I had a neighbor who went in for heart surgery. Nothing extreme, the sort of heart surgery you see celebrities go in for, and then they return to the stage a few months later all peppy and youthful. But my neighbor caught an infection, and eventually died a slow and unpleasant death from it.
I remember thinking “how could this be?” And then I had my own experience in a doctor’s office. The nurse was supposed to draw some blood. She starts coughing in her hand, and then using the same hand to prod around inside my arm for a vein. Then she coughed into her hand again and started prodding again.
At this point, I thought I was on Candid Camera. This is a joke, right? No rubbing alcohol, just this woman coughing into her hand. I made a mild protest, nothing rude, and she said “I’m not sick, it’s just the dry air!” I didn’t say anything else, but apparently I’d pissed her off. She walked out without a word, and a different nurse came in, and drew blood.
A few months later I was back in the waiting room, and saw the nurse with the cough glaring at me from a hallway. I got up and walked out, never returned to that particular doc.
I remember the hospital I used to go to, I’d see nurses standing outside taking smoke breaks.
(Nothing against nurses; I have family members who work in nursing, but the older I get, the more careful I am.)
Dorothy A. Winsor
@JustRuss: I don’t know the stats, so take this as anecdotal, but I know a number of nurses who left nursing because they were underpaid, under respected, and over worked as hospitals understaffed. So they’re not old.
Martin
@Ksmiami: You realize that Hoag maternity hospital in NB is a maternity tourism hospital, right? Fly into John Wayne, spend two weeks at the Ritz Carleton, have your kid with US birth certificate, and fly home.
I have nothing against that, but the fancy shmancy hospital is about turnover, because those folks are paying cash so they don’t even need to deal with the billing bullshit.
Barbara
@Suzanne: I have no idea whether these will even be necessary, but if we truly lack capacity, it will in hindsight look extremely misguided if we make the possible the enemy of the perfect. I suspect that is the kind of category error the CDC made with regard to testing, aiming for the fences and striking out, with enduring negative consequences.
Gravenstone
@Patricia Kayden: So he’s not lying so much as confusing (likely intentionally) the fact the Obama transition team held a mock incident where a global pandemic was one several potential global challenges that might occur. Done as a means to emphasize the importance of federal coordination and intervention. Instead it is reported that a lot of Trump transition teams members downplayed it, failed to see/understand the point or are now simply gone from this administration – given the insane levels of staff turnover they’ve undergone. Of course, it’s a fairly simple twist for him and his sycophants to blame it all on Obama as a result.
germy
@Le Comte de Monte Cristo, fka Edmund Dantes:
Bob Schooley described him as looking like one of those old British comedians who never caught on in the United States.
Renie
@negative 1: Have they said what the maximum income you can have to get these checks?
trollhattan
Somebody alert Betty Cracker, Lindsey Horan’s new puppy has a very familiar look.
Along with COVID babies in nineish months (lord help us) I bet there are a lot of COVID puppy acquisitions occurring.
trollhattan
@germy:
He could certainly rock the bowler and tailcoat.
Suzanne
@germy: A friend of mine died about three years ago from a hospital-acquired infection. She was a paraplegic and so more vulnerable.
Honestly, I don’t think building more hospitals is going to be desirable or feasible. There’s got to be some sort of home-based solution.
lamh36
Bernie Sanders press secretary…and some folks wants the DNC and Biden camp to negotiate with these terrorists?
Here she is along with Ryan Grim, Bernie-Bro journalist, accusing Biden and the DNC of genocide:
https://twitter.com/notcapnamerica/status/1240346349146714115
HIS NATIONAL PRESS SECURITY!!!!
Martin
@Avalune: I have to admit, I didn’t realize how traumatizing the bathroom thing would be to these people until it started showing up in every right wing comment. They must have always been on the edge of freaking the fuck out whenever someone came into the bathroom.
SiubhanDuinne
@germy:
That makes this #bookstorebaby very sad. I adore Powell’s.
A Ghost to Most
@A Ghost To Most: Chapter 2
Hard hat guys show up to install vibration monitors. They heard about the call, and we had a couple laughs at the suits’ expense.
The only people with a spine are outside doing the work.
Ohio Mom
Avalune, I feel for you. I also had a parent, my father, whom I could not have a relationship. You can’t reconcile with someone who won’t or can’t do half the work.
And that’s before you add in the right-wing nuttiness and hate. (Shudder)
SiubhanDuinne
@Avalune: I am so very sorry. It’s awful to have someone like that in your life, and 1000x worse when it’s your mother. I’m very glad you ended up balanced, sane, and rational. Lots of social-distance {{{{{hugs}}}}} to you.
Kelly
@Renie:
The articles I’ve read suggest send a check to everyone because setting up and enforcing any limits would take way too long.
BobS
@germy: Now is the time to go all in on the Trump Flu.
SiubhanDuinne
@germy:
Have you ever seen Stephen Colbert’s impression of Mnuchin? Spot on and hilariously funny.
Suzanne
@Barbara: I think we need to have a mind shift and think of hospitals as a public utility rather than a business that needs to be solvent. We are not prepared for this pandemic because hospitals generally do not make any money on things like ICU, or Level I trauma care, etc., and so they don’t build it if they don’t have to. We need to make more investments in public hospitals and university/research hospitals. And, quite frankly, we need to expect to operate them at a loss.
germy
@BobS: The Mar-A-Lago Virus?
Ksmiami
@Martin: We lived in nb and my pediatrician was just doing rounds his office was the other side of Newport but his advice stuck with me after all these years.
Nora
@germy: My husband cheerfully refers to the market downturn as the Trump Slump.
Suzanne
Y’all will be mindblown when you realize that this entire country has single-digit quantity of full biocontainment beds (considered best practice for infections like Ebola).
Kent
They will probably claw it back in your 2020 tax return that will be due April 15, 2021. So if you are wealthy, you should probably treat it as a no-interest loan.
So, for example, if they set a income cap it will probably be based on your 2020 reported Adjusted Gross Income (AGI). When you go to file your taxes if your 2020 AGI is above the limit (whatever it is) you will owe back these payments, or part of them if there is a phase-out
They have to do it this way because it doesn’t matter what your 2019 income level was if you lost your job now.
Gravenstone
@germy: That’ll work out great for them! If they also have their personal medical staffs to monitor them while they’re on their personal (likely gold plated) ventilators. A missed setting here or there, and old rich bastard is dead and gone forever.
catclub
But that behavior is just another day ending in y.
BobS
@germy: Too cryptic for some people. He needs to have his name attatched, e.g., the Bird Flu, the Swine Flu (I know, makes Trump redundant), the Trump Flu.
Kent
Those are for airborne viruses. where they have to use constant vacuum systems to evacuate all the air. This virus isn’t that. It spreads through droplets from sneezes and contact, but the virus isn’t drifting through the air in viable form. I believe measles is an example of an airborne virus which is why it is so unbelievably contagious. There is some debate about how airborne Ebola is, but since it is so deadly they don’t take chances.
catclub
@Kelly: kevin Drum suggested a website where you could turn it down
if you don’t need it – expecting it to be taxed because of your overall
income.
Or a website where you ask for it and promise to spend it cause you need it. seems to me that would discriminate against those with no internet savvy.
Renie
@Kent: But if you file jointly and if one spouse works & hits the maximum but the other spouse is below the maximum? Think they will allow the lower paid person to get it?
trollhattan
@lamh36:
WT absolute F?!? How does anything that has occurred in the last four years support this moron’s proposition? Name one thing, crazy lady. One would be a great start. When did “bend the knee” become “bend facts until they cry uncle”?
Barbara
@Suzanne: Yes, all true, but probably not feasible in the near term.
BobS
@Suzanne: I work in one of the biggest and busiest emergency centers in the United States. We have 8 reverse isolation rooms. This is effectively a biological attack (not the kind the Alex Jones crowd would like us to believe, but we have been attacked by a biological agent). The response as orchestrated by the federal government shows that all the drills and testing that has been required of hospitals, first responders, etc since 9/11 has just been fucking theater.
Suzanne
@Kent: Understood. I was just trying to emphasize how little capacity there is in the American healthcare system for rare-but-potentially-devastating events.
Another one: the entire state of Nevada has two Level I trauma bays. Two. For the whole state.
Another Scott
@catclub: (Not picking on you. :-)
Figuring out ways to claw it back and so forth is such a waste of time while the economy is falling off a cliff.
They need to send the checks out now, and demand that people spend them within 60 days. Anyone who puts them in a savings account or similar should get a very stern talking to…
The whole point is to get money moving again.
(sigh)
Cheers,
Scott.
A Ghost to Most
@germy: So many lampposts, so little time. I want to live to see the Great Comeuppance.
Barbara
@trollhattan: Even more despicable when you consider what you have to blot out to consider Trump to the left of Biden, as in everything related to immigration, civil rights, voting rights — the things she doesn’t worry about and therefore apparently don’t matter to her.
Gravenstone
@germy: The Trump plague.
Well Trump is a plague in his own right, regardless.
germy
@Another Scott:
So my son uses it to pay his rent, and his landlord puts it into his savings account. Does the landlord get a stern talking to?
BobS
@Suzanne: I can’t even imagine. Those people are superheros for the way they dealt with the mass shooting.
Mrs. D. Ranged in AZ
@Comrade Colette Collaboratrice: I know exactly what you’re going through. My 16 yo son living here with me and my 55 yo sister in PA both have Corona symptoms but they won’t test them because no travel and no contact (that they know of). Of course, my sister works with patients in a hospital that has no masks and isn’t engaging in proper cleaning procedures. It’s a nightmare.
Ruckus
@Charluckles:
I like this idea.
Kent
I don’t have any idea what they are actually going to do. But these things generally have separate income limits for single, married filing separately, and married filing jointly. If you are filing jointly then your incomes are co-mingled on your tax return.
So, hypothetically the could sit an income limit of $75,000 if you are filing single, and $125,000 if you are married and filing jointly (I’m just making those numbers up). If they do that I would hope they announce it early enough so that those over the limit know they will be having to return the money later.
cckids
@Renie: Also, will it be like Bush’s checks – if you owe money to the IRS, will they just keep the check? We were on a payment plan at the time, and that sucked.
Jeffro
This is odd…I thought my TCNJ dad was an only child? But it appears he and your mom were separated at birth.
/sympathy x10
Le Comte de Monte Cristo, fka Edmund Dantes
Maybe Navarro can deliver this news to Trump.
JaySinWA
@Suzanne: King county is trying to ramp up a number of field hospitals to handle hospital overflow and/or isolation of people testing positive but probably not requiring ICU level care. The details I have are fairly sparse as yet They are proposing taking over a soccer field a few blocks from me, proposing 200 beds. With several other sites under consideration looking to house around 3000.
Looking to start construction as early as a mid March. I have no clue how feasible this is.
Early info on the one close to me: https://www.shorelineareanews.com/2020/03/site-in-shoreline-identified-for.html
ETA I haven’t seen any mention of how to staff them.
Renie
@Mrs. D. Ranged in AZ: it is ridiculous that someone working in a hospital and showing symptoms can’t get tested. at the presser this AM trump was asked about asymptomatic wealthy people and athletes getting tested. his response was “that’s been the story of life”, as if that makes it ok. smh
Chyron HR
@lamh36:
I’m sorry, the “How dare you suggest that Bernie’s revolution is a bunch of mentally diseased assholes” thread was this morning.
chris
@germy: The Two Ronnies
Another Scott
@germy: Yes.
The landlord should spend it, too.
The whole point is to get money moving again. :-)
Cheers,
Scott.
Brachiator
@Another Scott:
No it’s not.
This is not a recession, where the government is trying to stimulate the economy. People may need the income for any manner of maintenance purpose, even a future bill or debt.
One of the things that I hate about Trump is that he is too focused on how a falling Dow may make him look bad. He is thinking about this deliberate contraction of the economy in the wrong way. And even his advisors who have a clue are too afraid to confront him with ideas that may be more appropriate to what is happening.
And hell, even if having an extra $1,000 makes a person feel more secure, this is a good thing.
wenchacha
@Charluckles: Hey, they like to be thorough. Good idea.
Jeffro
It was what sent my formerly fairly liberal mother-in-law over the edge. Once Fox manages to get people trolled and riled up with their particular outrage-generator, the whole rest of the package starts to set in. MIL actually tried to tell me a few months ago that trumpov turned around the “lousy” Obama economy, but what got her started down the slippery Fox-slope was LGBTQ issues and trans/bathroom issues in particular.
Gin & Tonic
@Suzanne:
I may have mentioned this, but my dear wife worked third shift in the ER closest to the Station nightclub fire. “Overwhelmed” doesn’t begin to describe it. Among (many) other things, the hospital ran out of morphine.
trollhattan
@Barbara:
Exactly right and further, how does this person’s boss look in comparison to Biden, never mind Trump.
I’m concerned these Wilmer folks are planning to poison the well, and all he will do is murmur what a shame that had to happen.
Yutsano
@Kent: If that law doesn’t get written now and those rules don’t go through the IRS filtering process, that won’t get done in time for the 2020 filing. It’s not just saying there will be a clawback mechanism, it’s determining what level of authority the IRS has in enforcing that mechanism either on that current year or in a future year. Plus then the rules require training so the front line folks *waves* can explain what’s happening in a coherent fashion. I don’t see President Toadface or anyone in the administration having the wherewithal to pull something like that off in short notice. It’s easier to just say it’s non-taxable.
NotMax
@Suzanne
Trivia:
Up the road a piece is a facility originally built as a TB sanatorium in 1909 and used for that purpose for decades (TB services listed as discontinued in 1975) , now operating as a critical care hospital – in the original five story building.
BobS
@Jeffro: now you can tell her he really has turned around the Obama economy. Start sending graphs every day.
Suzanne
@NotMax: I did a number of projects in a hospital building that was also an old TB sanatorium. There’s actually a lot of them in Arizona. ANYWAY, that building was disgusting. The exterior facade of the building was in such bad shape that water had been blowing in for decades. The fiberglass batt insulation had been so wet for so long that it was rotten. It’s a trick to rot inorganic things, so imagine what had been growing on it for how long. Fun fact: that hospital remained open until about four months ago. In that condition.
Ruckus
@Martin:
If they stopped doing racism they wouldn’t be republicans…….
And they’d lose all the support they might have.
Ella in New Mexico
@Suzanne:
I’d say even many existing non-ICU/IMC hospital rooms would be too difficult and expensive to refit right now.
Thinking of all the electronic monitoring of vitals, temps, pressures, etc. we do with our specialized computer systems in ICU and how we only have enough for that unit. ED/post-OP rooms also limited to those patients there. We even find ourselves running out of portable tele monitors for the ambulatory floors at times. Add in all the air, suction and other specialty devices we use, as well as the fact that all our “floor” rooms have wooden doors that make it impossible to monitor patients from outside the room if they’re on precautions I’m betting we’d spend less setting up a tent in the parking lot to accommodate people.
And don’t get me started on our TERRIBLE in-house WiFi which already makes it hard to use our encrypted apps or portable phones to talk to the docs.
Kent
I don’t understand this. King county is filled with empty public schools right now. Seems like it would be much easier to just start using those sorts of buildings rather than building tent hospitals in soccer fields. Yes, I know a public school isn’t a hospital. But they have wide hallways, and endless rows of rooms that have heat, power, water, WiFi etc. They also have parking and are generally separated from the rest of the community by green space. They also have commercial kitchens.
Brachiator
@Renie:
If they based this on filing status, they would look at total income on a married filing joint return.
trollhattan
@NotMax:
Friend’s Sierra Foothill home is a short walk from the extensive grounds and facilities of a former TB sanitarium. It has a few miles of trails and Actual Mountain Lions. Among the manzanita is the graveyard, a spookily large array of simple wood posts bearing small brass numbers. Hundreds.
A peaceful and poignant spot. The buildings are now the home of some kind of institute. “Ommmmm”
We (Calif) used to have a network of state hospitals that housed mentally ill and developmentally disabled. Most were closed by Reagan and now are torn down. I worked on the grounds of one in and right after college. It was large, had extensive housing and medical facilities, and was separated from the surrounding city.
germy
trollhattan
@Kent:
One Nice Thing: Ciara and Mr. Ciara are donating 1 million meals to Seattle area food banks.
Good people.
JaySinWA
Email from Medicare:
Medicare and telehealth benefits
Jay,
Medicare has temporarily expanded its coverage of telehealth services to respond to COVID-19.
Medicare beneficiaries can temporarily use telehealth services for common office visits, mental health counseling and preventive health screenings. This will help ensure Medicare beneficiaries are able to visit with their doctor from their home, without having to go to a doctor’s office or hospital, which puts themselves and others at risk.
If you have an existing healthcare appointment, or think you need to see your doctor, please call them first to see if your appointment can be conducted over a smartphone with video capability or any device using video technology, like a tablet or a laptop. For some appointments, a simple check-in over the phone without video capabilities may suffice.
Important: If you think you have been exposed to COVID-19 and develop a fever and symptoms, such as a cough or difficulty breathing, call your healthcare provider immediately.
Get More Info
Remember: Medicare covers the lab tests for COVID-19. You pay no out-of-pocket costs.
For the latest information on the coronavirus, visit the Centers for Disease Control and Prevention.
Sincerely,
The Medicare Team
germy
Mom Loving Extra Time To Pick Up Sticks In The Yard
BobS
@Ella in New Mexico: It’s going to depend on the hospital. The one I work in has pretty sophisticated monitoring equipment for a lot of non-ICU beds. Virtually all of our ICU-stepdown beds are pretty spacious single patient rooms and could (and will) be readily adapted, the only major difference being the design of the floor outside the door- visibility and access is quite a bit poorer. The biggest difference is the training required to manage an ICU bed.
Every hospital bed in the US (including emergency, pre-op, recovery, etc) has suction and O2. I’m anticipating us using those pre-op and recovery beds for inpatient as more and more elective procedures are canceled.
Suzanne
@BobS: I think what you just described is what is likely to happen: every licensed patient space in EDs, preop and PACU, maybe even outpatient clinic exam rooms will end up being used.
Sab
@Kelly: Thanks for that. Our park service uses square gravel on the paths that hurts my dogs’ feet. Now I understand why so I will stop complaining about it.
Ruckus
@Another Scott:
In their minds, especially trump’s tiny deranged mind, they are experts, they know more and exactly what to do than any “experts.”
Especially if trump doesn’t hear what he wants to hear – he thinks he just knows more and whatever he says will be done because he said it.
NotMax
@trollhattan
Inside an abandoned TB hospital on Staten Island.
Fascinating web site overall.
BobS
@Suzanne: Our hospital has already had some practice doing just that. Hospital census (> 1000 bed hospital, 5 adult ICUs, almost 100 ICU beds) is frequently > 100%. PACU and cardiac cath lab beds have been used for inpatient holds, i.e. admitted patients without a room, in exigent circumstances. It’s pretty normal that we have ICU patients being held in the EC at least once or twice a week, sometimes > 24 hours (we commonly have patients in the EC long enough to downgrade to ICU-stepdown, and occasionally even extubate). Of course, this means the EC beds fill up, and people end up having to wait 10 hours or more for treatment.
This is without COVID-19.
What a lot of people don’t realize is that rural hospitals all over the US rely on hospitals like mine to accept their sickest (not to mention traumas, which should theoretically decrease as people start staying home- at least until they get sick of each other and gun happy Americans start shooting each other).
Another Scott
@Brachiator:
https://www.calculatedriskblog.com/2020/03/comments-on-february-housing-starts.html
Housing starts are a leading indicator.
This isn’t about the DJIA.
People need to be spending money now, and that means people who will soon have no money need to get money from Uncle Sam.
Quickly.
Cheers,
Scott.
Ruckus
Just a note.
I have an appointment on Monday at the VA hospital. I called and asked if it was still on and they said yes. Once again driving, not ridding the train/bus.
I’m also taking 2-3 weeks off work, staying away from humans as much as possible
Oh and making bread this afternoon. First time in a long while, and there was only one loaf of crappy bread in the store this morning.
Suzanne
@BobS: Many of my clients deal with similar circumstances. It’s rough.
Mrs. D. Ranged in AZ
@Renie: I know. Every time I see an athlete or celebrity getting tested, I get so angry. My sister said that the doctor’s office where she was treated was doing everything correctly. Everyone had masks and goggles, they were wiping down surfaces between patients, etc. But the hospital she works at isn’t doing any of that. She said they have one box of masks under lock and key in the managers office and he is only giving them to the lab techs. On top of that, no one is cleaning surfaces, people are crowded together in the waiting room, etc. She’s been given antibiotics and will go back to work in a day or so. She has no choice. She is trying to find a mask on her own and if all else fails is considering buying a face shield. I almost wish she has corona because then she’d have some immunity.
Oh and another little fun story from her perspective. She ran out of basic stuff and there is no one near her who can shop for her or help her. She is completely alone just like me. Well she went to Walmart and the greeter there noticed she was sick and got angry at her. Scolding her for coming to the store. My sister understood her concern but was polite in response saying, ‘I don’t have anybody to help me and I was out of TP and food’. The woman sneered at her. I would have told her to go eff herself. A lot of people are in my sister’s position and it’s because of how our stupid economic system treats hourly workers and the Trump admin delaying their reaction to this disaster.
Jeffro
@BobS: Yeeeup. You read my mind. =)
Jeffro
@NotMax: that reminds me of those photos of North Brother Island, in the East River near the Bronx.
Brachiator
@Another Scott:
Again, you are fundamentally thinking about it wrong.
In Los Angeles County, things are shutting down. People cannot go out and spend money.
Because they are told to stay home.
They cannot go out to eat. They cannot go to the movies. They cannot go to bars. They cannot go to concerts.
One guy who has a home remodel/construction business says that some clients don’t want him to come into their homes because of fear of the virus.
Nationally, the travel and leisure industry is dying. Hotel occupancy is down to 20 percent. In LA it is 10 percent. Convention business is down.
No sports teams playing. No parking and concessions.
No tips to be earned in bars and restaurants or by parking attendants.
In this deliberate contraction, there are fewer places where anyone can spend money. Even if they have it.
You cannot go out and spend money if you are told not to go out.
But this is a new reality that we are adjusting to. The old rules for stimulating the economy do not apply. The fundamental ability of people to circulate money through the economy has been severely slowed because every place where economic activity takes place has been slowed or closed down.
In LA county and elsewhere there are temporary ordinances to prevent commercial and residential evictions. Still, one estimate is that 18 percent of the working population has been laid off or had their wages reduced.
ETA: One of the many reasons that Trump is bugging me is that he doesn’t quite get it either. And so his policy is stupid and ineffective.
Another Scott
@Brachiator: I understand that it’s a deliberate contraction (different from the deliberate contractions caused by the fed tightening the money supply). The reason for the contraction doesn’t matter anywhere near as much as the fact that a large fraction of the economy has simply stopped.
People who can no longer work still need money to pay their rent, buy food, pay all their other bills, and support their local businesses.
They still need money.
And they still need to spend that money.
Money needs to circulate in the economy even if lots of people are isolating at home.
The US government needs to quickly get money to people who need it and need to spend it. Worrying that someone with an AGI of $149,501 might also get it, or worrying that the IRS rules aren’t in place to figure out how to tax it or not, or worrying that it will just go into some slumlord’s TD Ameritrade account, is delaying the fact that people need the money NOW.
My $0.02.
Cheers,
Scott.
Brachiator
@Another Scott:
You keep saying this and you are fundamentally wrong.
Under the present circumstances, people cannot possibly spend money at anything like the pre-virus conditions.
The government may have to do more to prop up individuals and businesses until we get through this.
In Norway, for example, the country is taking steps to guarantee income and support:
Other countries need to consider similar measures. Essentially this substitutes for money that would be flowing through the economy.
Another Scott
@Brachiator: We’re talking past each other.
We don’t have the safety net that Norway does. But Norway is shoveling money at real people (“full pay for 20 days”, etc.).
We (the US government) needs to shovel money at real people using the mechanisms we have as quickly as possible. That means checks (physical or virtual).
People who are living paycheck to paycheck need money. They will spend that money (at groceries, drug stores, on-line deliveries, and even at carry-out restaurants that are trying to keep money coming in when they can’t seat people at tables).
That is all. EOT.
Cheers,
Scott.
Feathers
@negative 1: Which is why calling them out as assholes and pointing out why their behavior is assholish without specifically labeling it as racist can often work. It certainly doesn’t work for all types of racism, but for where “asshole” fits, it does. Lots of times people seeing themselves as speaking “hard truths” or “joking.” But they are really just racist assholes. The racism part can come later, right then or in a follow up.
Brachiator
@Another Scott:
I understand exactly what you are saying.
I am just asking you to think about the issue from a new perspective.
Sally
@germy: No not true. Why wouldn’t they put the retirees in the general, non covid19 wards and utilise the still working, younger ones on covid19 duty. Let’s not forget that younger people can still die or become seriously ill.