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Mortality Rates will Skyrocket once America's medical system is overloaded to WUHAN/IRAN levels
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Original Message
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Greetings - this is regarding Murica
In accordance to GLP stands, I will refer to my sources as my Uncle.
I have several Uncles and my uncles expect that we will be just fine and dandy until the medical system is overloaded. Death rates will be <1% for some time, then once the system is saturated, the death rate will skyrocket depending on what how much the secondary system can handle the overload.
For example in the united states most metropolitan areas will have 3-5 "tertiary level" centers with the ability to do 3-5 ecmo cases each at maximum. Ecmo requires machines and the staff to run them (perfusionists). Most facilities that do coronary artery bypass will have these.
However, once these are saturated which will be 15 - 25 cases in each significant urban center, you loose the ability to do standard bypass operations.
Opportunity cost.
ICU beds, stepdown beds, and telemetry beds. Standard rooms.
The ICU and stepdown beds should be able to handle around 50-150 people depending on size, this would allow oxygenation up to 100% delivery as long as your lungs are working somewhat, this is where the sickest will be. There are different modes of ventilation that can help, namely pressure mode that can increase the pressure pushed into your lungs that increases oxygen delivery, but most people can't be on these for extended periods of time since it causes barotrauma - lung pops like too much pressure in a baloon.
Your regular medicine beds that can give you oxygen to about a non rebreather mask, which gives you "100%" but since your rate of inhaling tends to be faster than the oxygen delivery, you really get between 60-80%. There are things called high flow systems that are better, and some regular wards can have these hook ups.
Now your hospitals at the community should have these beds. Most hospitals are rated for 300-500 beds but are only half full. The issue has generally been staffing.
So depending on our models, it will take some time to hit critical mass where we have opportunity cost involved with taking care of patients.
Wuhan exceeded their capacity and my Uncles believe their death rate to be higher than reported because lack of accurate data.
If our society overloads the hospital system, the next possible locations of treatment will be urgent cares, skilled nursing facilities, acute rehab facilities, some board and cares, oxygen delivery from health health agencies, nursing from home health, hospice access to oxygen / equipment.
We have plenty of resources that can be procured and used to salvage the community patient IF there is access.
Public health officials should be engaging all lines of defense for our patients.
Quarantine efforts will fail over time unless there is strict monitoring with the military. We live in a "free society" - people will move away from the dead and dying. This is only natural.
So as you can see, America has quite a bit of resources if they are accessible and organized in a way that it can be used in this fashion.
it does us no good to have a ton of nebulizers, oxygen concentrators, oxygen tanks in storage rooms of durable medical equipment companies. Then we need a distribution process. Then a way to identify who needs and should get them.
We have reserves. The question is when do the models exceed our ability to handle these cases and spill over to dying on the streets due to lack of resources -> WUHAN / IRAN with a 15 percent or so mortality rate.
The models we have seen (uncles), show that with the first unknown transmission from a specific area has roughtly 2-4 weeks before the hospital systems will be saturated depending on the public health efforts.
So that means northern california will most likely be the first to have issues around the last week of March.
See how that plays out and prepare your local health officials to create contingency plans to be able to access the medical surplus we have as mentioned above.
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