Italian ER Doctor:”Every ventilator becomes like gold”

For those who think this is “just another seasonal flu”. Flu patients aren’t being admitted in droves. Please read


Every ventilator becomes like gold' - doctors give emotional warnings from Italy's Coronavirus outbreak

one doctor who is at the heart of the outbreak in Bergamo, northern Italy, has taken to social media to issue an emotional warning on the reality that could await elsewhere if complacency wins.

The boards with the names of the patients, of different colours depending on the operating unit, are now all red and instead of surgery you see the diagnosis, which is always the damned same: bilateral interstitial pneumonia.

Now, explain to me which flu virus causes such a rapid drama

...... Cases are multiplying, we arrive at a rate of 15-20 admissions per day all for the same reason. The results of the swabs now come one after the other: positive, positive, positive. Suddenly the E.R. is collapsing.

..... Reasons for the access always the same: fever and breathing difficulties, fever and cough, respiratory failure. Radiology reports always the same: bilateral interstitial pneumonia, bilateral interstitial pneumonia, bilateral interstitial pneumonia. All to be hospitalized.

..... "Someone already to be intubated and go to intensive care. For others it's too late... Every ventilator becomes like gold: those in operating theatres that have now suspended their non-urgent activity become intensive care places that did not exist before.

Source

Yeah most people don't realize that there is not some sort of cornucopia for medical supplies and equipment. Ventilators are expensive, have a finite supply and takes years of training to use

a reply to: violet

Yes they are probably now the most valuable thing on the planet.

As I noted in the update thread there are only about 100 of them across Australia. If this thing turns out like the Spanish Flu, about 500,000 people are going to need access to one at some stage, which is obviously not going to happen.

a reply to: FredT

From another doctor I don’t have a source for, it’s that they have to make a quick call on who gets it, it’s being given according to age, the younger are top priority to save first. During an outbreak you might want to think twice about going out driving recklessly or anything else that might land your in the ER. If the person on the stretcher beside you is younger, they get the help. You get pushed into the hallway and left to die.

Even if you don’t need a ventilator, the staff is in short supply
Just remember these stats:

15% are severe infection, requiring oxygen
5% are critical infections, requiring ventilation.

These fractions of severe and critical infection would be higher than what is observed for influenza infection.

originally posted by: myselfaswell
a reply to: violet

Yes they are probably now the most valuable thing on the planet.

As I noted in the update thread there are only about 100 of them across Australia. If this thing turns out like the Spanish Flu, about 500,000 people are going to need access to one at some stage, which is obviously not going to happen.

Wow! Obviously this just isn’t sufficient.

a reply to: violet

You're right it is woefully insufficient. And it's too late to do anything about it.

Sadly that estimate of 500,000 is conservative.

Australia has a population of 26,000,000. 33% infection rate is 8.5 million and 5 percent of that is 429,000. We have a population which has 16% at 65 years and older, China has 9%.

originally posted by: FredT
Yeah most people don't realize that there is not some sort of cornucopia for medical supplies and equipment. Ventilators are expensive, have a finite supply and takes years of training to use

No, it doesn’t take years, maybe 2 weeks during orientation.
Dr Montoya, (505) 842-5105, a Pulmonary Disease specialist in Albuquerque NM, and CRITICAL CARE INTENSIVISTS, instructed ER and ICU nurses in two classes.

Initial ventilator settings:

1. Set the machine to deliver the TV required (10 to 15 mL/kg).
2. Adjust the machine to deliver the lowest concentration of oxygen to maintain normal PaO 2 (80 to 100 mm Hg). ...
3. Record peak inspiratory pressure.
4. Set mode (AC or SIMV) and rate according to the healthcare provider's order.
www.ncbi.nlm.nih.gov...
journals.lww.com...

It's easy peasy.

a reply to: myselfaswell
I looked at Canada

286 hospitals with 3170 ICU beds and 4982 mechanical ventilators for critically ill patients. Twenty-two hospitals had an ICU that routinely cared for children; 15 had dedicated pediatric ICUs.

www.ncbi.nlm.nih.gov...

a reply to: myselfaswell
And I read somewhere today Washington state alone predicts there may be 160,000 cases by May, granted not all will require hospitalization, but still, that is but one state.

Either way you look at it, it’s all looking very gloomy.

a reply to: violet

Don’t believe the hype.

In July, we won’t be talking about this anymore.

This too, shall pass. like all the others.

This virus is different than the flu, it can be very dangerous for those who take meds blocking their immune system. And the elderly who cannot produce all the enzymes they need to fight something like this.

I am older, I know I may have a problem with this, but the wife and I are not that worried. We will try to avoid going out to social functions and stores when it gets around here. we are going to get more of the things we need to have tomorrow, so we only need to go out occasionally when the disease gets here. I am learning about this and how to effectively reduce the risk of it hurting us and we are trying to lower our risk of getting it too. Not quarantine, just common sense since it does effect older people worse.

Got to go get a pile of peanut butter cups and at least five cartons of good ice cream and ice cream bars tomorrow. Along with some other comfort foods so we don't go nuts out here when it gets sunny.

I am not afraid of this virus, you cannot let fear dominate your life. Just lessen the risk, do not go to places where sick people are if you are in the risk group. This virus will probably not be around in the summer. our core temp goes up when we are active and out in the sun, that kills this virus. Your heat goes to the skin to warm you in the winter when it is cold, the virus can get worse when you are wet and out in the cold.

originally posted by: FredT
Yeah most people don't realize that there is not some sort of cornucopia for medical supplies and equipment. Ventilators are expensive, have a finite supply and takes years of training to use

What happens when you only have 10 on hand? I think it is very easy to overwhelm a system with little effort. Take toilet paper...

originally posted by: KKLOCO
a reply to: violet

Don’t believe the hype.

In July, we won’t be talking about this anymore.

This too, shall pass. like all the others.

The hype, currently, is about what’s coming, so you’re right, that won’t be getting discussed in July.
Also the OP was about what’s going on in Italy right now, if you think it’s made up hype. That's ok.

originally posted by: KKLOCO
a reply to: violet

Don’t believe the hype.

In July, we won’t be talking about this anymore.

This too, shall pass. like all the others.

Are you a religious person ?

a reply to: rickymouse

It should be on its way out by summer. I’m not planning to socialize much either. I’m pretty much in isolation anyways so I won’t suffer having to do that. It’s wise to plan for a forced isolation or quarantine.it only takes one person you know to test positive and you’re on the call list. Wondering what my “case number” might be lol

originally posted by: hopenotfeariswhatweneed

originally posted by: KKLOCO
a reply to: violet

Don’t believe the hype.

In July, we won’t be talking about this anymore.

This too, shall pass. like all the others.

Are you a religious person ?

Who are you asking?

a reply to: violet

So the other thing that people forget is that while we have this outbreak life is still going on and ICU's typically run 75-85 percent full and Peds ICU's higher. So alot of that gear is already in use.

originally posted by: Xtrozero

originally posted by: FredT
Yeah most people don't realize that there is not some sort of cornucopia for medical supplies and equipment. Ventilators are expensive, have a finite supply and takes years of training to use

What happens when you only have 10 on hand? I think it is very easy to overwhelm a system with little effort. Take toilet paper...

Well you make a paper mache Ventilator with all of that TP

Thats why I have been concerned. Most modern healthcare systems have about 5%-30% extra capacity in terms of beds. Thats not gear or staff mind you. Dedicated Pediatric facilities are even tighter. Mine typically runs 85-95% full. There is no surge capacity

According to this 2018 report, the US has 160,000 ventilators in use.

• Based on these numbers, the maximum number that can be potentially ventilated is around 160,000.
• US: 20.5 ICU beds with mechanical ventilation capability per 100,000 population
• Canada: 8.7 ICU beds with mechanical ventilation capability per 100,000 population
• Australia & New Zealand: 5.4 ICU beds with mechanical ventilation capability per 100,000
population

In addition, the CDC Strategic National Stockpile has an estimated 8,900 ventilators as of 2010.3 Ventilators are stored and kept as managed inventory. Malatino et al report that shipments from managed inventory “could arrive within 24-36 hours of the federal decision to deploy them.”

It goes on to say the number of Respiratory Therapists would be the limiting factor.

Various other factors constrain the capacity of the US healthcare system from providing ventilation therapy. Using mathematical models, one study found that the limiting factor during a pandemic-level crisis would be the number of respiratory therapists—maxing our ventilator therapy capacity at around 135,000— significantly lower than the estimated 742,500 needed.
www.centerforhealthsecurity.org...

originally posted by: myselfaswell
a reply to: violet

Yes they are probably now the most valuable thing on the planet.

As I noted in the update thread there are only about 100 of them across Australia. .

Begging to disagree a bit. I have visited Royal Children's Hospital in Melbourne and they probably had at least 60-70 in the CV and Peds Icu's and more in the NICU

I cannot figure how to add a PDF link, but this article from 2010 "A Unique Snapshot of Intensive Care Resources in Australia" says that there are 1300 ventilator beds in the country