Currently, Wisconsin is one of the hottest hot spots in the United States. As of last night, per CovidExitStrategy.org, Wisconsin has a 19.6% test positivity rate. This is indicative out of control community spread. The weather is getting colder and indoor concentrations of people are getting more likely.
Uncontrolled community spread with an increasing case count means hospitals will be seeing patients. There are two notes on hospital capacity that I want to highlight. The first is that the governor has ordered the construction of a 450 bed field hospital to provide surge capacity and overflow beds.
Serious situation in Wisconsin, where a field hospital is being set up to care for a big surge in covid patients. https://t.co/Ju26IRpU5t
— Caitlin Rivers, PhD (@cmyeaton) October 9, 2020
The big constraint on most surge plans is staff. A bed needs skilled nurses, aides, and doctors. Short term surges can run staff into the ground with double and triple shifts. Long term surge capacity needs extra resources from either shutting down other aspects of the local healthcare system, bringing in currently underemployed labor (new trainees, skilled retirees) or bringing in out of state personnel.
The New England Journal of Medicine just published the results of a randomized control trial (RCT) on Remisdivir, an anti-viral medication for COVID. There were significant duration effects and non-significant mortality effects:
Those who received remdesivir had a median recovery time of 10 days (95% confidence interval [CI], 9 to 11), as compared with 15 days (95% CI, 13 to 18) among those who received placebo (rate ratio for recovery, 1.29; 95% CI, 1.12 to 1.49; P<0.001, by a log-rank test)... The KaplanâMeier estimates of mortality were 6.7% with remdesivir and 11.9% with placebo by day 15 and 11.4% with remdesivir and 15.2% with placebo by day 29 (hazard ratio, 0.73; 95% CI, 0.52 to 1.03).
Remisdivir is another way of expanding hospital capacity. A bed and the attached staff can be ~50% more productive by adding a drug to the treatment regimen for some patients.
We saw in the spring that mortality was massively elevated when hospitals were slammed. Expanding capacity by both the construction and staffing of new surge beds and improving the productivity of each current bed will delay if not completely avoid the possibility of local hospital systems getting overwhelmed this fall and winter. Remisdivir should be prioritized for regions that are approaching or over sustainable hospital capacity in order to minimize the total number of deaths. We, as a society, should be willing to pay through the nose for Remisdivir and other drugs that have a good evidence base to reduce mortality and hospital stays when it is used in highly stressed systems and concurrently, we should be willing to pay very little when it is used in regions with thousands of spare hospital beds.
Cheryl Rofer
I look forward to the day when we have a national leadership that wants to control the pandemic. I look forward to watching the numbers go down with a feeling of satisfaction that I’ve contributed to that.
Here’s Biden’s plan. It’s comforting to know it’s there. And I’m sure he has binders of detail and people ready to go on Day 1. I’m also hoping they are thinking of ways to do what they can, starting on November 4.
WereBear
Apparently, “The Heartland” is on fire with COVID-19. Though I can’t find much on Stugis lately, I’m sure that was the matches which lit the dry underbrush there.
dr. bloor
Not to disagree with the larger point, but it’s not at all apparent that this relationship is causal. RI has one of the highest mortality rates in the country, but it’s a function of patient age more than anything. The state recently deconstructed two of three surge sites put into place last spring because none of them saw any business.
Mousebumples
@WereBear: I think it was Strugis, and Labor Day celebrations, and colleges/schools reopening, and people being inside more because it’s been cooler.
But yeah, Sturgis didn’t help, but I don’t think we can reasonably blame that for everything.
Brad
David
50% more productive?
33%, no? 15 to 10 days.
brad
artem1s
so how long before the WI militia decides to storm the state capital? honestly, I hope they have thought about security with assmouth shouting insurrection from his Twitter piehole all day long. We are roughly two weeks out from the Debate Plague here in Cleveland and all on pins and needles. Good news, maybe the Clinic will get to use reconstruct their surge site that was never used because the initial shut down in NEOH worked so well – that very space they converted into a WW Wrestling Ring for Patient Zero to spew COVID all night long. Irony is somewhere out in the universe helping Captain Marvel right now I guess.
Grant Hutchins
@Brad: 50%
From 2 people per 30 days to 3 people per 30 days.
3 is 150% of 2, thus +50%
You get +50% productivity by taking 33% less time.
Ramalama
My brothers live in Madison WI. I am worried about them. But they’re big boys. Capable. They’ve been taking the Rona seriously since day 1… since they’re not in favor of the GOP. Especially the Wisconsin brand of the GOP. If anyone wants to support a small biz in WI (one brother co-owns it) : check out the Burnt Orange Patchouli soap – https://wisconsincandlecompany.com/products/olive-oil-shea-butter-bar-soap or the Fraser fir candle – https://wisconsincandlecompany.com/products/fraiser-fir … I sit surrounded by pines / fir trees up in Quebec province and still I love this candle (same with Sparkle and Lilac and also Peppermint. Peppermint? Yes).
His biz partner is the one with a gifted nose. I have friends up here who are also fans who love the mix of scents.
Everything I’ve gotten from them over the years has been incredible. I’m asthmatic and am somewhat sensitive to certain smells, but everything they’ve sent me has been incredible.
OK I didn’t mean to hype my bro’s business but anyone they could use a sale or two. And they’re not GOP stooges.
Brad
@Grant Hutchins:
got it, Grant. TY
i saw productivity as bed days per 100
David meant heads in beds per 30 days
BruceFromOhio
I also have family in Madison, and they have taken this seriously since March. Fortunately the family farm is out in the sticks away from town. A cousin and his wife are in town with their children, but can escape any time.
An outdoor field hospital at the onset of winter sounds like misery compounded. Gaia help us all.
WereBear
@Mousebumples:
I agree, but it was part of what disseminated it so widely, so the others were worse. I think. :)
Blatant disregard must have some impact.
JCJ
@BruceFromOhio:
The field hospital is in a good sized exhibition building at the state fairgrounds. It is where they have home and garden shows and the like.  It was prepared to be a field hospital several months ago but never used. I don’t know how long it will take them to get it ready now.
Sab
@Ramalama: Satby IS threatening to retire soon.
Nicole
It’s equal parts fascinating and enraging how Covid-19 is playing out exactly like we were told it would, based on our past history with pandemics- since spring they were talking about cases starting to spike once autumn came and people went back indoors. We had months to plan, and did nothing.
Ramalama
@Sab: Are you calling Satby a Stooge ? ;)
JCJ
@Mousebumples: Labor Day gatherings included some Harley-Davidson things in and around Milwaukee. I don’t know how many attended this year, but I saw a good sized tent at the Harley dealership in Oconomowoc. I don’t think there were as many motorbikes around this year as most, but I did see a few.
Sab
@Ramalama: Absolutely not! I like her soap a lot. I am worried about where to get more if and when she stops making it. You brother has scents that sound interesting. Holidays are coming up and I have virtual stockings to stuff.
sherparick
@WereBear: Robin Voss and Scott Fitzgerald, the Wisconsin Republican Majority on the Supreme Court, & the billionaire backers of that party bear complete responsibility for the tragedy and deaths now unfolding in Wisconsin. https://www.jsonline.com/story/news/solutions/2020/10/06/coronavirus-cases-rise-fast-wisconsin-legislature-dithers/5896523002/
Elizabelle
@Nicole: Â THEY had months to plan and did nothing.
I don’t see this as an American failing. Â I see it as a Republican denial of science and epidemiology one. Â They could wear masks and isolate to bring down the disease incidence and cost.
Not taking on their failings.
BellyCat
Attn. David:Â Remisdivir vs Remdesivir?
StringOnAStick
On an individual scale, I find it interesting that my RWNJ father (88) is still wearing his N95 to the grocery store, and posturing that he’s going to verbally assault non mask wearers (big words, guarantee this will never happen).
However, he talked to his sprinkler system repair guy without a mask, and when that guy found out he was exposed my dad had to get a test. It didn’t change his behaviour because he sits outside and has beers with the police chief neighbour, “solving all the world’s problems” , which is RWNJ code for “everything bad is the fault of D’s”. No mask of course because the chief is a authority and white, so if course he can’t have Covid! It feels like a caste system of ‘clean’ and ‘unclean’, and all you need to sort people is their skin colour plus political party.
Nicole
@Elizabelle: I agree the Trump Administration was horrific, but I read a really interesting Smithsonian article at the outset of the pandemic (I have been googling but can’t find it) that looked at the 1918 pandemic and how governments from federal on down to local handled it and how a lot of it was just… not telling the truth. We repeat the same mistakes, over and over.
Here in NYC, Hizzoner declared early on in the summer that schools would reopen for in-person instruction in the fall, and then I guess forgot that you need to do a lot of work in the meantime to make that happen, and so the reopening was a bit of a cluster fuck because no one did anything practical about it until August and then there wasn’t enough time.
Here’s the really interesting bit from the article (link to full article, which is a great read, here). This took place in Los Angeles, which is not exactly a hotspot of Republican rule.
dmsilev
@WereBear: As bad as Wisconsin is right now, North and South Dakota are arguably worse. So much for the “it’s a disease of the filthy leftist cities” theory.
bluefoot
My sister and her family are in Madison. She’s a doctor, and she’s seen how insufficient the staffing is for the number of cases. She’s been taking care of non-urgent cases at the hospital to free up doctors with more COVID-relevant experience to take care of COVID patients. (Like your allergist taking care of routine respiratory visits so that pulmonologists can take care of COVID cases with respiratory issues.)
She thinks the positive rate is higher than what is being reported. And that the positive rate on campus is a lot higher than reported. Apparently there’s a lot denial about the severity of the situation, even amongst health care workers. It’s making her angry because so much of it is driven by the misinformation and lack of information from the federal government.
Enhanced Voting Techniques
It’s not we, it’s 20% of the population who refuse to do anything to prepare for the Fall and that 20% Lazy Fuckswits just happened to be in control.
Going threw California and virus county by county is good model to see what a Biden admin might be like with the virus. The counties willing to follow the instructions are doing ok, the other had to learn the hard way and then there is Imperial County, the charnel house of California, that no amount of death and misery will change things.
BruceFromOhio
@JCJ: Thanks for the detail. I read ‘field’ and think M*A*S*H. Here’s hoping they don’t need it, or only need it in a limited capacity.
StringOnAStick
@Nicole: A few years ago Smithsonian magazine had an article by the author of “The Great Influenza”, a very informed and interesting book I had read several years before that. The author said the same thing, that telling the truth was what hadn’t happened in 1918 (WWI greatly figured in that choice), and that current pandemic planning was inadequate and war gaming it resulted in exactly the response by officials that you describe. I like to think that the original Smithsonian article had something to do the Obama administration deciding it needed to create a plan for a pandemic response that the desiccated orange tossed out because it has Obama cooties. It was good to feel like we recently had officials in charge who actually looked at last events and, you know, learned something from them. Â
Enhanced Voting Techniques
Worth keeping in mind that the Spanish Flue killed Trump’s granddad and Fred Trump got his start off the money he inherited from his father. Very likely the Trump’s think disease and death is awesome because it’s legal way to murder your relatives for their money.
BruceFromOhio
@Enhanced Voting Techniques:
Some credit to the xx% Lazy Fuckwit Cultists.
“Ah ain’t wearin’ a may-ask, Ah gaht rahts!”
Almost Retired
Anyone have any insight on why Wisconsin seems to be the current epicenter? The New York Times infection map (or whatever it’s called) has shown most of Wisconsin in Covid-soaked Black for weeks. There’s the fuckwit factor, of course, but Wisconsin has hardly cornered the market on fuckwits. Motorcycle rallies can’t explain it all.
BruceFromOhio
@Nicole:
Was there any evaluation of why this decision?
We were very fortunate my employer learned right away that sometimes the answer is, “we don’t know what is going to happen.” That was often followed by “here’s what we think you should do to prepare.” The leadership retained credibility, and continued to be a source of useful information. And us rank & file rubes knew to hunker down, and right quick. It made a huge difference in what followed.
Nicole
@StringOnAStick: I linked to that very article in a comment upthread! Yeah, it’s a great read. The ending was super frustrating (the workshop anecdote) to read, because it reminded me that an unwillingness to say unpopular things permeates government at all levels.
Which I don’t take as a “both sides are the same”; they very much are not; I take it as a reminder I have an obligation to my fellow citizens to follow the science and lean on my elected representatives to do their jobs and tell the truth.
I’ve quoted Kay’s post from some months back often to people who start up the “governors seizing this as an opportunity to control us” with her wise point that governors don’t want to seize control; they want 4% unemployment and no crises. I think most in government want that, and so they’ll downplay things in the hopes they’ll go away, and often end up making things worse.
Maybe it’s just human nature. How many of us put off going to the doctor because it’s not “that bad”? It takes a very gifted and brave politician to be smart enough to head things off ahead of time.
namekarB
I’m in Placer County just north of Sacramento. For the very first time since the pandemic started, our hospitals (3) are reporting zero cases in ICU. Our hospitals serve both Placer County and a large metropolitan area that includes Sacramento County. So yeah, hurray for us
Nicole
@BruceFromOhio:
I think he reacted from fear of the consequences of telling people something bad was coming, and used a healthy dose of magical thinking “maybe it won’t happen after all.” Politicians don’t want to tell people bad news because bad news affects their job security.
Even Cuomo was downplaying things the first week or two here in NY. He got on the right side of telling the truth pretty quickly after that, but he was pretty firmly against any shutdowns at the start. That said, it was when he started being honest with us that his popularity went up. Funny how politicians can’t grasp that.
On the other hand, Jimmy Carter is generally considered the most honest President of recent history and that didn’t work out so well for his reelection, so there you go.  I guess some Americans really can’t handle the truth.
narya
@Almost Retired: My guess? Parts of the UW system. And lots of RWNJs scattered around. I compare the WI map to the IL map every day–and continue to be impressed by the (relatively) good job that’s been done in IL. I don’t fully understand it–I can speak to what’s being done in Chicago, and I see a TON of effort from multiple directions–but the downstate outbreaks seem to be under control, and my understanding is that U of I has done a lot of testing.
Seanly
Speaking of hospitals, I just got a negative result for CoVID. I had to travel for work last week and had a cough and runny nose early this week. Timing had me thinking that I got exposed during my trip so I qualified to get tested on Tuesday. She works the phones for one of our local health systems and they use a quicker test for employees (even office/remote like her). She didn’t feel too good yesterday so she got tested & got another negative result this morning.
My wife & I would be ravaged by CoVID so very glad we got negative results.
Back to the topic at hand, I know numbers have been going up in Idaho. Even with our demand for more doctors in Idaho, our system hasn’t been overwhelmed yet.
Enhanced Voting Techniques
Yes, as Killer Angels up it “We’re fighting for our rats”Â
Nicole
@Seanly: Glad to hear your result was negative.
My poor neighbor was just informed by a coworker that he’s not feeling well and is still waiting on the results of his Covid test. She was sick in March with what we’re sure was Covid (although back then she couldn’t get a test for it, but we’re sure it was Covid because she’d had a friend staying over who got sick and could get a test, due to working for a medical facility, and my neighbor got sick right after the friend did). So it’s not likely she will be infectious, or get sick again, but she’s still stuck quarantining while he waits for results, and if he does have it, she’s gotta go through the whole 14 days.
And, of course, it’s the start of cold and flu season, so even the usual cough and sniffles will start a person panicking.
SFBayAreaGal
@StringOnAStick: Even though I can’t stand Bush Jr. he deseves the credit for responding to a potential pandemic hitting the U.S. He led and gathered experts to create a response to a potential pandemic.
Almost Retired
@narya: That explanation makes sense. Thanks.
piratedan
I get the very real sense that this pandemic is not going to be brought under heel until you bring Fox under heel. I don’t mean to change their political leanings but to have them behave and take the virus seriously as a public health threat rather than some fucking political “gotcha!” as a conduit for additional political propaganda. I’m sorry, if they can’t comply then pull them off the fucking airwaves so they will stop killing people.
WereBear
@sherparick: Oh, absolutely. There is plenty of Republican blame to go around the world a few times.
David Anderson
@Brad: 1 bed in a month can support either 2 people or 3 people.
That to me is a 50% improvement in productivity.
Brachiator
Sounds eminently reasonable. But I fear the decisions of the current administration will base allocation of resources on ego and political considerations.
Also, it seems apparent that Trump had very warm and close relationships with drug company executives. It is a damn shame that he couldn’t use those relationships to better advantage in crafting good national policy.
dr. luba
A friend tells me that the ICUs are at capacity in Michiganâs Keweenaw peninsula, and there is talk of opening a field hospital. They are a popular summer travel destination for not just Michiganders, but also Wisconsinites, so…..
Kayla Rudbek
@Almost Retired: the Wisconsin Catholic dioceses also lifted the dispensation from going to Sunday Mass from what Iâve seen on Twitter, so add that into the mix…