The Arizona modeling team has been running models to predict hospital demand from both COVID and non-COVID demand drivers. On November 27th, they wrote to the Arizona state government about their most recent model runs. The results are dire:
No matter what actions are taken, Arizona will experience a hospital crisis in the coming weeks. However, if action is not immediately taken, then it risks a catastrophe on the scale of the worst natural disaster the state has ever experienced. It would be akin to facing a major forest fire without evacuation orders….”
This is a dire half paragraph from academics.
And it is based on modeling that has a key assumption that is probably optimistic:
The models that are projecting a baked in crisis and a catastrophic outcome under a no-change scenario are assuming that there is no change in transmission dynamics from the Thanksgiving holiday. That is a shaky assumption. We know that Thanksgiving has lots of people traveling, even if travel was down significantly this year compared to 2019. We know that Thanksgiving tends to have a lot of talking and loud voices in confined, interior spaces. We know that Thanksgiving tends to have a good amount of drinking. I think that making the assumption that Thanksgiving will not change infection trends is a key assumption that requires significant sensitivity analysis.
However, I also think that the modeling exercise with data that probably was fresh on Tuesday or Wednesday of the week for a Friday release is useful. The model is putting out a floor. Thanksgiving could be a nothingburger but business as usual is still a catastrophe by Christmas. Thanksgiving could produce a significant bump in transmission which moves up the no-intervention hospital overload by days or weeks. The model and its results gives a meaningful floor from which action can be taken to divert from the projected outcomes.
But right now, this is what “optimistic” modeling looks like in some states.
Excellent and sobering piece. Thanks for sharing. This reflects what I am seeing in Colorado, as well. Our hospital is shutting down much of the high dollar end of year “I used my deductible so let’s get this knee replacement done” money making procedures in order to be able to convert pre-op and post-op beds to icu beds. Gearing up for a bumpy ride into the New Year.
Are they going to start building field hospitals, send a hospital ship, etc, or is everyone just going to standby and watch?
And a big part of this insanity is solely due to president agent orange (a toxic substance) making masks a polictical issues rather than the essential safety issue it actually is. Another gift from the grifter-in-chief
They’ll fill an arena (or several) with beds and call it a hospital.
In my rural County the hospital is bragging that they are completely prepared for anything and the Sheriff has announced in a long and self-congratulatory facebook post that he will not enforce the Governor’s covid mandates. So bars are open and people jam the coffee shops every morning, fogging up the windows. We just had our first two deaths, a week apart. I feel like I’m trapped on the Titanic.
@Searcher: the treatment constraints are Space, Stuff and Staff.
Right now the hard constraint is Staff. In April and July there were large implicit reserved of skilled, trained and mobile clinical caregivers. Tennessee could back up NYC with a flight of incoming nurses and docs in April to supplement and relieve NYC scrubbed staff. NYC and Boston had flights heading south in July.
Those reserved do not exist right now
I don’t think it’s mentioned enough how Republicans sacrificed the health and well being of its voters by holding massive rallies and endless indoor campaign events just to win.
Republican leadership was silent.
Blood on their hands.
And to think they’d strip healthcare from those same people and sit there with their solemn straight faces.
I’ve read airlines no longer keep the middle seats open to aid with distancing. This alone would indicate pending infection rate increases.
HP’s wife here (OB/GYN):
I feel like fucking Cassandra – we’re a rural hospital. The tertiary centers we usually ship to are now not accepting patients (except for maternity. WHEW!) The closest children’s hospital is accepting a few adult transports. Our med-surg floor is full, mostly COVID. Nurses and aides are in tears running from room to room caring for sicker patients than they should but the REALLY sick ones are in the 6 bed ICU.
We’re still doing elective surgeries! I’ve argued at least stop the ones who are planned admissions post-op. Keep the small outpatient ones for cash flow. Have PACU become both pre- and -post op (open bays) while converting what we use as pre-op (individual rooms) into hospital beds. Evidently I’m the only surgeon in the hospital warning patients that their case may be delayed. WTF?
Next week, classes are being held for administrative RNs to return to the bedside (those working in IT or the education departments for example). It’s going to teach charting in the EMR as well as things like how to run the IV pumps.
I’m happy to say we at least have PPE. But the public is going about acting like it’s 2019.
Here, they converted a convention center to a treatment center back in the early days. They’ve since dismantled it, but kept everything there in case things get bad again (which they are). They say it will take 7 to 10 days to reinstall the beds, etc. FWIW.
@Mikeindublin: Iowa’s numbers have held steady or are slightly declining the past few days. Mostly holiday breaks in testing and reporting, I’m assuming. I was thinking the huge rise in early and mid-November was from Halloween, but my son reminded me of the big Frump and Pence rallies just before the election. And our governor quit governing at all as she ran from rally to rally, cheerleading and throwing maga hats to the crowds. She’s back in her office now but we can’t see that that makes any difference
That’s the damnable thing about this wave: there may be a few places that are doing OK, but by and large, it’s everywhere. There aren’t any big places with lots of slack.
Because of that, we absolutely NEED a unified national response this time. And we’re absolutely not going to get one for another 52 days, because Trumpublicans.
In the meantime, probably ~100,000 more Americans will die of Covid, and who knows how many others will die because the hospitals are full. And doctors and nurses will die of Covid, or break down due to sheer exhaustion, because of all those people insisting on their freedumbs.
Arizona is a warm climate. People can still stay outside. That should help a little, David. We had an outdoors Thanksgiving, distanced too. It was pleasant shorts weather. I’ll also add that the interstate didn’t look busy anytime I passed it this weekend, and for Florida, that is amazing. I can’t help noticing how the current infection rates have been really bad up north.
Half a million dead by the inauguration.
As realistic as I know that number is, it is still unbelievable.
My brother reported that on his recent trip to Las Vegas (via American) the flights were full, including the middle seats. The passengers were good about masking, though.
His HMO’s medical group (he is a doctor) has a coronavirus wiki that they all contribute to and keep up to date with research as it comes out, and the consensus seems to be that the airlines are doing a good job with in-flight air filtering and circulation. So there’s that.
I still wouldn’t recommend hopping on a plane. My brother did only because of a family (pseudo-)emergency.
I’ve heard reports that maskless people are allowed in the terminals and on the planes. No amount of sanitization is going to work against that.
The AZ modeling team made a no change assumption for thanksgiving because the conclusion is already bad enough and any theoretical transmission increase added in, no matter how small and well justified, would be seized upon to haggle over and used unfairly to discredit the entire study. It’s because the “other side” to this argument is exceedingly dishonest (which is the only thing they can be to even have an other side in the face of objective reality).
@debbie: It’s horrifying.
@Nelle: The way that cases absolutely exploded here in SoCal makes me think Halloween was indeed a really big deal. Case numbers took off like a rocket just a few days afterwards. We didn’t have rallies and our distancing restrictions have been constant or strengthening for 2 months
@Benw: This is also a common issue with climate change science. The denialists are so aggressive disputing anything even slightly in doubt that the predictions have been trimmed back to be quite conservative, with the very rare exception. Predictably, the actual changes are now consistently beating the median prediction and actions based on those rosy predictions are turning out to be inadequate.
@Barry: Movie reference “Contagion”. “Is this coming out of our budget or yours? ” says the local health person to the CDC rep.
@debbie: Some airlines (American and United, I believe) are actively removing mask resistors from planes, and then blacklisting the offenders, preventing them from buying tickets or flying for 6 months.
Snarki, child of Loki
@Searcher: I hear Trump has ordered the Navy to send a hospital ship to Arizona.
@Benw: I would add that what has happened over Thanksgiving will be obvious soon enough. It’s a waste of energy to argue over something that you will know for sure within the week, drowning out your larger point that changes are needed no matter what.
Of all the things I have to be thankful for, a sane family committed to distancing without even debating the issue is high on the list. One of the younger members (nephew) did fly home but he was adamant about not coming into contact with more than three other people in his immediate family.
And among the most dispiriting things, knowing that we are so close to an effective vaccine campaign with so many people still willing to risk the lives of others because they are bored and feel cheated ranks highest. I understand people who are willing to risk going back to work because they truly need the money. I don’t understand people willing to go to bars or travel.
@Searcher: Stand by and watch.
Problem is that there are no surplus staff for those ideas. Nobody that can airlift in to staff them, unless we want to hire doctors from China, Taiwan, South Korea, Vietnam – you know, the countries that haven’t fucked themselves.
It appears that not all airlines in the US are enforcing masks and social distancing. I can understand the economic pressure on the aviation business, but in a better world the FAA would surely issue a directive requiring they did that.
Good. I don’t know what I’d do if I boarded and saw an unmasked passenger.
@Martin: New York Magazine published an essay from a doctor in Montana who came out of retirement in the spring to help relieve the crisis in NYC. She is an intensivist, and she figured that her services would be especially required, and she might as well learn what she could about the disease if it ever got bad enough in Montana, which she said she honestly didn’t think it would. She is incredulous that things have gotten as bad as they have in the upper Midwest. And she realizes that no one will be coming from anywhere else to help them out, because there is no one now who isn’t needed where they are. The Dakotas and Montana don’t have enough doctors and nurses even during normal times.
@Snarki, child of Loki:
I expect you’re kidding, but Trump is stupid enough that I fear you might not be.
BTW, be prepared for epic labor action by healthcare workers once this pandemic is over.
It is all completely horrifying. In my family, my mother cooked dinner on Thursday, which my brother then picked up and took back to his house, and I am SO glad of that. Brother, SIL, and both nephews are sorta-deniers, all taking WAY more risks than I think is wise and underestimating the risks to themselves (and, therefore, each other), but at least they’re mostly staying away from my parents and wearing masks when they do show up (and my mother had to insist on that). Cannot. Even.
When the history of this is written, the ability of hospitals to use HIPPA to ban reporters and news coverage of what was going on will be seen as one of the contributing factors to the outrageous and tragic denialism.
In Italy, people were angry about the lockdown (and there were scofflaws) but it was largely accepted as a necessary sacrifice because the news led every night with footage of the overrun hospital wards and patients in chairs and on gurneys in the hallways. Invasion of privacy? Probably. Did it save many, many lives? Undoubtedly.
As we were getting the early news from China, I watched a documentary (Netflix?) on the coming outbreak. One of the hardest memories was the highly competent doctor in charge of NYC’s infectious disease running training exercises and the doctors and nurses basically refusing to follow instructions to mask up and take care of themselves first, to protect themselves so that they would be able to keep treating patients beyond the first wave. Once something becomes a moral good, people fight hard to maintain it, even when it is causing harm. It was like the Pentagon making sure no uncensored combat footage makes it to American airwaves. Yes, it can be traumatizing to watch, but also necessary.
This is a good article on why it’s so hard for us to respond to this.
The american experiment in extreme individualism is going to be crushed by Covid and climate change.
About damn time.
And rightly so!
@Martin: I have been hoping for that. Nurses are paid far, far too little, and their staff-to-patient ratios have been climbing. And all the laypeople wondering why we don’t have more hospital beds, more doctors, more equipment…. it’s because all of that costs money, both at the startup as well as to maintain when we are not in a crisis posture. I hope the healthcare sector does some incredibly hardcore pushing for all of it.
Very good article, especially on the difference between “feeling” safe and actually being safe.
J R in WV
Typo alert — pretty sure that when you say:
You meant to say:
Nice think piece, otherwise. I don’t have the expertise to make an analysis, but I can predict the continuation of a swiftly rising curve as well as the next person who isn’t blind… We Are So Fuqed by Trump, and so deliberately, also, too.
He should be facing 200,000 indictments for manslaughter, or negligent homicide, or plain old Second Degree Homicide, for the people who died at his hand.
What a monster — why did he do that? Was it on orders from Putin? Will we ever know? Prob not…
@Feathers: But I don’t think HIPAA can be blamed for that. From a technical standpoint, HIPAA specifically exempts a lot of this for public health situations.
I think the bigger cause is our cultural tendency to seek out uplifting stories, which is a real problem with journalism in the US. We don’t like to show people dying, even when the public needs to see people dying. It’s a downer, and we reject the notion that we could be failing at something. If American Exceptionalism means anything, it means denying our failures.
@Martin: I’ve always been amazed at that “evolutionary psychology” (AKA the science that proves that professors should sleep with their youngest and most attractive graduate students) takes the view that all of these “natural” instincts should not be denied. What they should be is warning bells. These notions may have been in handy on the savannah, but they are counterproductive in a modern, multicultural society. In the modern world, feeling safe and actually being safe are two very different things.
One thing I keep pushing for is to bring back civil defense classes. They ended when the Soviet Union collapsed, but there is a place for them. Now the big bad is school shooters, but school shooter lessons (not the experiential garbage that exists to thrill the cops), along with what to do in case of floods, hurricanes, fires, pandemics, etc. would be very good and important classes for the government to offer again. People say, but I don’t remember any of that. The real lesson is that there is a right thing to do in those situations and it can save your life.
J R in WV
We’ve been seeing the same family practice doc for about 40 years now. He knows our bodies and what is wrong with them, and how to treat those issues, what works for our ailments.
I sure hope he doesn’t die of this, I really want to predecease him if at all possible. Breaking a new doctor would be terrible, not least because so few are solo practitioners, as he is. I gently encouraged him to recruit a youngster a couple of years ago, he just laughed at me.
“Arizona is a warm climate. People can still stay outside. That should help a little, David. ”
Presumably the ASU modeling team was assuming that warm weather.
We are not going to get one even after Jan 20th – the Republican governors will put on a show of defiance – and then fundraise off of that. Basically, the grift machine will use the pandemic and efforts to quell the virus as a way to make more money. This is where we are right now.
The GOP sees the virus as a way to get rid of folks who are on the govt teat – the old people using social security, poor people on food stamps – etc etc. They see it as a win – they don’t give a shit about our humanity.
@Amir Khalid: Are you saying there’s something the United States can’t do? Something involving giant, expensive military operations, I mean, not something truly impossible like universal healthcare or gun control.
Good – and every business should do that – and that hsould also include taking the vaccine – if you haven’t taken the vaccine you don’t get to fly, go to a restaurant, or what not. If you’re not interested in being part of the solution, you’re part of the problem.
Interesting thread, cautionary. If long-term morbidity for COVID-19 is similar to the 1918 flu, there will be downstream societal effects, that could get ugly. America is/may be setting itself up for some ugliness above and beyond long term damage to millions of peoples’ bodies.
@cain: Yep that would deal with the loudmouthed schnooks who are boldly announcing that they will refuse any and all vaccines.
ETA: I think a boot to the ear would deal with them even better.
I have a friend who is in the ICU right now with a severe case of Covid.
He is on a ventilator plus a dialysis machine. Keeping him alive is a two to three week process.
That is one reason I am sure why hospitals are under such stress. They were built to have ICU patients in and out in about five days.
@Gvg: The major population centers are in areas with relatively mild winter climates. On the other hand, over half the physical area of the state, including a number of towns and most of the indigenous population, is higher elevation and gets pretty cold in winter.
Mai Naem mobile
Ofcourse i comment on a dying thread. I kind of stopped watching the AZ COVID stats during the heat of the election but started watching them again after the election. Positivity is definitely going up. I drive around in the Phoenix area and in general I see people masking(granted i don’t go to the super red shit kicker outer burbs areas.) What bothers me is the number of cars I see in strip centers with multiple food establishments. The parking lots are packed. Phoenix has quite a few hospitals. I am wondering if the real problem is the rest of the state including Tucson which I think has 4 hospitals. There are quite a few smallish towns with 10K to 50K populations with either no hospitals or small community hospitals. Off the top of my head I can think of 17 such towns. That’s scary.
@Cheryl Rofer: I remember when someone on this site, I think a from-pager, estimated 200,000 to 500,000 American dead. That was back in the beginning, like March I think. And I don’t remember who it was or what post. I’ve had those numbers in my mind ever since.