The Walls Come Down: No Travel Betwen US and Europe for 30 Days

[Jub]

Jesus christ, and you call my position garbage.

If I could go back in time and shoot the fist few motherfuckers that caught this before they could spread it I'd do that and save lives. As it stands, I'd rather not work our medical professionals to death saving less than twenty percent of people who need ventilators. Especially if those people are old and likely to have a terrible quality of life after 'recovery'.

[The Romulan Republic]

Yeah, Jub, we get it. You're a Hard Man Making Hard Choices While Hard.

Now please, shut the fuck up, and leave triage to the professionals.

[loomer]

Jesus christ, and you call my position garbage.

If I could go back in time and shoot the fist few motherfuckers that caught this before they could spread it I'd do that and save lives. As it stands, I'd rather not work our medical professionals to death saving less than twenty percent of people who need ventilators. Especially if those people are old and likely to have a terrible quality of life after 'recovery'.

Bitch, do you have a single public health expert who's advocating for what you're advocating for? Which is, last time I checked, the fucking involuntary euthanasia of thousands? You want to take the group most in need of aid during this pandemic and literally kill them.

[mr friendly guy]

Not going to get into the fight with Jub but just going to give my personal opinion

It doesn't make much sense to "let things take their course" and overdosing on painkillers. The first part is part of palliation, ie we make sick people comfortable during their last hours and let nature take their course. We use drugs including painkillers during this stage. We ain't speeding up the process, but we aren't trying to stop it either at this point. Overdosing in this case is euthanasia and that has another set of ethical considerations, ie we are actively causing someone to die. Its gone beyond letting things take their course.

My personal opinion is that
a. Have this discussion when the patient is admitted to hospital about resuscitation orders. This is kind of assuming the patient is one who we identify has a higher chance of not doing well. By all means quote the figures. You will be surprise how many people take the view that they have lived a good life and don't want to undergo these measures for a slight chance of survival.

b. If the patient has wants resuscitation it is worthwhile giving a trial of the ventilator if they ever deteriorate if a ventilator is available. If two or more patients at the same time need the only ventilator available, then triaging applies, and unfortunately that will have to go to the patient that will more likely respond well, ie younger, less comorbidities etc.

[madd0ct0r]

That's what happens when the data scientists and mathematicians became the dominant voice amongst the scientists, because they base their assumption on this virus being similar to H1N1 Flu.

There's nothing even remotely true about this statement, speaking as a statistician who works in global health studying infectious diseases.

Yay! I was hoping you'd drop in

[mr friendly guy]

Nothing like a good pandemic to bring people's racism out to the fore. This time against Africans, because Africa is not a continent with people, but a really great testing lab. Good to know.

https://www.dw.com/en/french-doctor-apo ... a-53014811

French doctor apologizes for 'Africa' coronavirus test idea
Suggesting Africans test a "repurposed" tuberculosis vaccine to help find a COVID-19 vaccine has triggered outrage. A French anti-racism group slammed the idea floated by two French doctors, one of whom has apologized.

Paris intensive care doctor Jean-Paul Mira apologized Friday for suggesting the testing in Africa of a "repurposed" tuberculosis vaccine as a COVID-19 beater during an expert chat with a colleague on television.

"Africa isn't a testing lab," replied retired Ivory Coast football star Didier Drogba, and a Moroccan lawyers' collective had said it would sue Mira for racial defamation.

French group SOS Racisme said Africans aren't guinea pigs and France's CSA broadcast ethics watchdog said it had received a complaint.

Paris' clinic network, including Mira as head of intensive care at its Cochin hospital, on Friday quoted him as saying: "I want to present all my apologies to those who were hurt, shocked and felt insulted by the remarks I clumsily expressed."

On Wednesday, in a broadcast on the channel LCI, Mira discussed the rush to find anti-coronavirus vaccines with Camille Locht, research head at France's National Institute of Health and Medical Research (INSERM), based in Lille.

[loomer]

France is setting up 'ethics support units' to assist doctors in managing triage. They seem to think ventilators should be allocated where possible and that doctors will need support to deal with the ethical challenges in deciding who gets one and who doesn't as they become scarcer, as opposed to not bothering and instead actively murdering patients like Jub is advocating for.

[ray245]

That's what happens when the data scientists and mathematicians became the dominant voice amongst the scientists, because they base their assumption on this virus being similar to H1N1 Flu.

There's nothing even remotely true about this statement, speaking as a statistician who works in global health studying infectious diseases.

https://www.theguardian.com/world/2020/ ... unravelled

This is where I got my source from on this issue.

According to Richard Horton, editor-in-chief of the Lancet medical journal, the dominant voices in the Scientific Advisory Group for Emergencies (Sage), the scientific expert group advising the government, were mathematical modellers and behavioural scientists, including Halpern.

On 25 March, Horton told MPs on the science and technology select committee that Sage appeared to have little input from public health experts and doctors, despite being chaired by the chief medical officer, Chris Whitty, and the chief scientific officer, Sir Patrick Vallance.

The clue for Horton was in the main papers it considered in advising the government of the strategy.

“There is evidence on modelling and on behavioural science, but I don’t see the evidence from the public health community or from the clinical community,” he explained.

Testing, isolation and quarantine – basic public health interventions – were barely on the agenda. Warnings from Chinese scientists of the severity of Covid-19 had not been understood.

“We thought we could have a controlled epidemic. We thought we could manage that epidemic over the course of March and April, push the curve to the right, build up herd immunity and that way we could protect people,” said Horton. “The reason why that strategy was wrong is it didn’t recognise that 20% of people infected would end up with severe critical illness. The evidence was there at the end of January.”

Anthony Costello, a UK paediatrician and former director of the WHO, also fiercely criticised the decision to stop tests. “For me and the WHO people I have spoken to, this is absolutely the wrong policy,” he said. “The basic public health approach is playing second fiddle to mathematical modelling.”

[FaxModem1]

Panic buying of beer is happening in Mexico:

NPR

Shoppers In Mexico Are Panic-Buying Beer During The Coronavirus Crisis
April 3, 202011:41 PM ET
CARRIE KAHN


A man stores beer in a shop in Monterrey, Nuevo Leon state on Friday.
Julio Cesar Aguilar/AFP via Getty Images
Mexican authorities ordered the shutdown of all nonessential businesses and industries for the entire month of April in hopes of stemming the spread of the coronavirus. To the shock of many, added to the list of nonessential industries was all alcoholic beverage production. Within days a whole new set of panic buying was taking place. Forget the run on toilet paper, beer hoarding was on in cities and towns throughout Mexico.

In the northern border state of Nuevo Leon, Gov. Jaime Rodríguez Calderón went a step further and recommended banning alcohol sales as well. He worried that with families holed up in their homes and under stress, alcohol consumption could contribute to spikes in domestic violence. To the south in Tabasco state, the governor outright banned sales. Mayors in other cities limited hours of alcohol purchases.

Soon videos of shoppers in long checkout lines with carts full of Mexico's beloved beers were making the rounds of social media.


CHUMIBEBÉ
✔
@ChumelTorres
Oigan, ¿encima de el apocalipsis que se desata nos quieren quitar la chela? #ConLasChelasNO

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9:09 PM - Apr 1, 2020
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As well as a whole new set of memes with the hashtag #ConLasChelasNo, roughly translated, #Don'tMessWithMyBeer.


HoraDeVivir
@Katipop300
#ConLasChelasNo

View image on Twitter
9:23 PM - Apr 1, 2020
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See HoraDeVivir's other Tweets
Mexico has 1,688 confirmed cases of COVID-19, with 60 deaths due to the virus. Among the nonessential businesses ordered shut down on Tuesday were restaurants, bars, and nightclubs, all big purchasers of Mexico's beer and spirits industry.

That reportedly got Mexico's three major beer companies – Constellation Brands, Anheiser-Bush InBev, and Heineken – lobbying Mexico's president to designate their production as essential, as he has for other agribusinesses. Not to be left out, the governor of Jalisco state, home to the city of Tequila where Mexico's most favorite spirit is cultivated, is pushing for an exemption.

Grupo Modelo announced that beginning this Sunday, it would comply with the health emergency decree and suspend its beer production. The company, which sells the Corona label nationally, did stress that it is important to the agricultural industry and that tens of thousands of families depend on its sales.

On a quarterly earnings call Friday, Constellation Brands CEO Bill Newlands didn't say when production of its beers, which include the Corona label for export as well as Pacifico and Victoria brands, might stop, said Benj Steinman, publisher and editor of Beer Marketer's Insights. "It was not clear on the call, it was a little strange and difficult to discern what their plan is," he said.

Constellation Brands is assuring American beer lovers not to worry. The company says it has a 70-day supply of beer already in U.S. warehouses. That's enough to get through the two upcoming big sales days in the U.S. for Mexican beer .... Memorial Day and of course Cinco de Mayo.

[Jub]

Not going to get into the fight with Jub but just going to give my personal opinion

It doesn't make much sense to "let things take their course" and overdosing on painkillers. The first part is part of palliation, ie we make sick people comfortable during their last hours and let nature take their course. We use drugs including painkillers during this stage. We ain't speeding up the process, but we aren't trying to stop it either at this point. Overdosing in this case is euthanasia and that has another set of ethical considerations, ie we are actively causing someone to die. Its gone beyond letting things take their course.

My personal opinion is that
a. Have this discussion when the patient is admitted to hospital about resuscitation orders. This is kind of assuming the patient is one who we identify has a higher chance of not doing well. By all means quote the figures. You will be surprise how many people take the view that they have lived a good life and don't want to undergo these measures for a slight chance of survival.

b. If the patient has wants resuscitation it is worthwhile giving a trial of the ventilator if they ever deteriorate if a ventilator is available. If two or more patients at the same time need the only ventilator available, then triaging applies, and unfortunately that will have to go to the patient that will more likely respond well, ie younger, less comorbidities etc.

What's wrong with euthanasia? Especially in cases where you're spending a great percentage of your effort to care for people with a less than 20% chance of surviving if you do everything perfectly. Is saving 1-in-5 people worth running hospital staff ragged or is it better to try to keep nurses fresh by palliating people more aggressively and taking steps to ensure their passing is an easy one?

Also, I've read that hospitals in the hardest-hit areas have already switched to DNR orders even if a patient may otherwise have other wishes.

https://www.forbes.com/sites/lisettevoy ... 4037983146

https://www.cnn.com/2020/03/26/health/c ... index.html

How far away from euthanasia is enforcing involuntary DNR orders in overwhelmed hospitals? Is traditional palliation actually a better solution than taking a course that ensures each patient deemed unsavable uses up as few resources as possible?

France is setting up 'ethics support units' to assist doctors in managing triage. They seem to think ventilators should be allocated where possible and that doctors will need support to deal with the ethical challenges in deciding who gets one and who doesn't as they become scarcer, as opposed to not bothering and instead actively murdering patients like Jub is advocating for.

There is no utilitarian difference between making a choice to withhold care from somebody certain to die without it and actively killing them. I both cases you made a choice that resulted in a death, why do we consider the path of inaction less offensive than the path that requires active participation but which eases suffering while freeing up staff for other duties? What would a purely utilitarian AI do in these hospitals if it's only goal was to ensure that the resources available were maximized to save those most likely to respond well to treatment?

[loomer]

Not going to get into the fight with Jub but just going to give my personal opinion

It doesn't make much sense to "let things take their course" and overdosing on painkillers. The first part is part of palliation, ie we make sick people comfortable during their last hours and let nature take their course. We use drugs including painkillers during this stage. We ain't speeding up the process, but we aren't trying to stop it either at this point. Overdosing in this case is euthanasia and that has another set of ethical considerations, ie we are actively causing someone to die. Its gone beyond letting things take their course.

My personal opinion is that
a. Have this discussion when the patient is admitted to hospital about resuscitation orders. This is kind of assuming the patient is one who we identify has a higher chance of not doing well. By all means quote the figures. You will be surprise how many people take the view that they have lived a good life and don't want to undergo these measures for a slight chance of survival.

b. If the patient has wants resuscitation it is worthwhile giving a trial of the ventilator if they ever deteriorate if a ventilator is available. If two or more patients at the same time need the only ventilator available, then triaging applies, and unfortunately that will have to go to the patient that will more likely respond well, ie younger, less comorbidities etc.

What's wrong with euthanasia? Especially in cases where you're spending a great percentage of your effort to care for people with a less than 20% chance of surviving if you do everything perfectly. Is saving 1-in-5 people worth running hospital staff ragged or is it better to try to keep nurses fresh by palliating people more aggressively and taking steps to ensure their passing is an easy one?

Also, I've read that hospitals in the hardest-hit areas have already switched to DNR orders even if a patient may otherwise have other wishes.

https://www.forbes.com/sites/lisettevoy ... 4037983146

https://www.cnn.com/2020/03/26/health/c ... index.html

How far away from euthanasia is enforcing involuntary DNR orders in overwhelmed hospitals? Is traditional palliation actually a better solution than taking a course that ensures each patient deemed unsavable uses up as few resources as possible?

You're not just proposing euthanasia, fuckhead. You're specifically proposing involuntary euthanasia for thousands of people.

[Jub]

Not going to get into the fight with Jub but just going to give my personal opinion

It doesn't make much sense to "let things take their course" and overdosing on painkillers. The first part is part of palliation, ie we make sick people comfortable during their last hours and let nature take their course. We use drugs including painkillers during this stage. We ain't speeding up the process, but we aren't trying to stop it either at this point. Overdosing in this case is euthanasia and that has another set of ethical considerations, ie we are actively causing someone to die. Its gone beyond letting things take their course.

My personal opinion is that
a. Have this discussion when the patient is admitted to hospital about resuscitation orders. This is kind of assuming the patient is one who we identify has a higher chance of not doing well. By all means quote the figures. You will be surprise how many people take the view that they have lived a good life and don't want to undergo these measures for a slight chance of survival.

b. If the patient has wants resuscitation it is worthwhile giving a trial of the ventilator if they ever deteriorate if a ventilator is available. If two or more patients at the same time need the only ventilator available, then triaging applies, and unfortunately that will have to go to the patient that will more likely respond well, ie younger, less comorbidities etc.

What's wrong with euthanasia? Especially in cases where you're spending a great percentage of your effort to care for people with a less than 20% chance of surviving if you do everything perfectly. Is saving 1-in-5 people worth running hospital staff ragged or is it better to try to keep nurses fresh by palliating people more aggressively and taking steps to ensure their passing is an easy one?

Also, I've read that hospitals in the hardest-hit areas have already switched to DNR orders even if a patient may otherwise have other wishes.

https://www.forbes.com/sites/lisettevoy ... 4037983146

https://www.cnn.com/2020/03/26/health/c ... index.html

How far away from euthanasia is enforcing involuntary DNR orders in overwhelmed hospitals? Is traditional palliation actually a better solution than taking a course that ensures each patient deemed unsavable uses up as few resources as possible?

You're not just proposing euthanasia, fuckhead. You're specifically proposing involuntary euthanasia for thousands of people.

You ninja'd me. Please see my additional thoughts above.

[loomer]

You ninja'd me. Please see my additional thoughts above.

France is setting up 'ethics support units' to assist doctors in managing triage. They seem to think ventilators should be allocated where possible and that doctors will need support to deal with the ethical challenges in deciding who gets one and who doesn't as they become scarcer, as opposed to not bothering and instead actively murdering patients like Jub is advocating for.

There is no utilitarian difference between making a choice to withhold care from somebody certain to die without it and actively killing them. I both cases you made a choice that resulted in a death, why do we consider the path of inaction less offensive than the path that requires active participation but which eases suffering while freeing up staff for other duties? What would a purely utilitarian AI do in these hospitals if it's only goal was to ensure that the resources available were maximized to save those most likely to respond well to treatment?

No, there actually is a utilitarian difference between making no active effort to save those certain to die and advocating for the involuntary euthanasia of seriously ill people with a demonstrably higher chance of recovery if intervention is taken, you fucking maniac. One will result in the same outcome either way (but, incidentally, it's only the same if you don't view the people you're demanding actively kill people as human - there is enormous collateral involved), the other demonstrably won't.

You are, again, advocating for the involuntary euthanasia of thousands of people because a 20% chance of survival isn't good enough for you.

[Jub]

No, there actually is a utilitarian difference between making no active effort to save those certain to die and advocating for the involuntary euthanasia of seriously ill people with a demonstrably higher chance of recovery if intervention is taken, you fucking maniac. One will result in the same outcome either way (but, incidentally, it's only the same if you don't view the people you're demanding actively kill people as human - there is enormous collateral involved), the other demonstrably won't.

You are, again, advocating for the involuntary euthanasia of thousands of people because a 20% chance of survival isn't good enough for you.

20% is the best-case scenario, but I doubt you'd change your mind if we were strictly talking worst case and assume a 3% survival rate. Even then survival doesn't mean they're going to recover in any meaningful way. "[A] study of 18 ventilated patients in Washington state found that nine were still alive when the study ended, but only six had recovered enough to breathe on their own." That was posted 2 days ago now, how many of those six do you think are still alive?

Regardless, with the risk of lung damage, "Unfortunately, Osborn says, "the ventilator itself can do damage to the lung tissue based on how much pressure is required to help oxygen get processed by the lungs." And coronavirus patients often need dangerously high levels of both pressure and oxygen because their lungs have so much inflammation." Given that "survivors of such treatment often fare poorly over the long term." what are the odds that long term survivors who were ventilated for more than a day or two ever come off mechanically assisted breathing?

The prospects are so grim that "As the number of Canadians made critically ill by the virus ticks up, some patients or their families are actually foregoing entirely the often-harrowing treatment afforded by ICUs and breathing machines. A number of elderly patients have died in long-term care homes rather than submit to intensive therapy that might have only made their passing more painful and uncomfortable."

On the other side, "Some doctors are even considering whether to raise a more touchy issue, asking patients or families to consider giving up their chance at a ventilator for someone more likely to survive." and “Early establishment of goals of care may also reduce unnecessary utilization of limited critical care,” they say." So doctors aren't yet willing to make the call but they are considering and in some cases more than simply considering, denying certain patients any care at all. This drives that 11% average survival rate down even more, so where is the floor at which we just throw up our hands and start doing something else?

In one case in Ontario we get the following scenario:

"When the first cases of the coronarvirus emerged at Pinecrest Nursing Home in Bobcaygeon, Ont., last month, its medical director, Dr. Michelle Snarr, emailed families to warn they may have to decide whether to send their loved ones to hospital. That would involve going on a ventilator, she said, and a frail nursing-home resident would likely “suffer a great deal” and might not survive the ordeal.

Snarr could not be reached for comment, but it appears none went the ICU route.

“Under normal times, we would send people to the hospital if that was the family’s wishes, but we knew that was not going to be possible knowing that so many people were going to all get sick at once and also knowing the only way to save a life from COVID is with a ventilator and to put a frail, elderly person on a ventilator, that’s cruel,” she told CTV News."

How about the fact that, many patients simply don't understand what intubation means?

"“It’s not like you’re awake and alert and writing notes to loved ones.” Getty Images
With a tube down their throat and often under sedation, they cannot communicate, while the process of inserting the tube and suctioning airways is uncomfortable and painful. Patients are also unable to take care of their own bodily functions or cleaning. Some say they would let staff know when they’ve had enough, but are shocked to learn they’d have no way to indicate that, said Rubenfeld."

But if this isn't bad enough let's look at outcomes for disease with easier treatment paths than Covid-19:

"And the research, a lot of it carried out by Canada’s critical-care doctors, indicates that those who make it out of the ICU and a long stint on a ventilator face an unsure future.

Experts call the possible negative effects “post intensive-care syndrome” — a combination of cognitive decline, psychiatric problems like depression and post-traumatic stress and muscular-skeletal weakness.

A striking 2017 paper by Detsky and colleagues looked at about 300 patients in Pennsylvania who had spent at least three days in the ICU and more than 48 hours on ventilation or being infused with a drug for dangerously low blood pressure.

With a median age of 62, half were dead within six months, and just a third were back to their previous health levels, the researchers found."

So half of less than 11% are being treated only to survive another six months with diminished function, and even fewer properly recover. This is for the shit we know how to treat!

It's not just one source saying these things either:

"[M]edical experts told FRANCE 24 that COVID-19 can cause severe long-term damage to the lungs, heart, brain and other organs – and that for some patients, these complications may be permanent."

"“Because of how serious the ARDS is, the damage that you can have for that is for a lifetime.”

“Large numbers of ARDS survivors are not able to go back to work,” added Onjen Gajic, a critical care specialist at the Pulmonary Medical Department of the Mayo Clinic in Rochester, Minnesota."

"‘Survival is just the beginning’

In serious cases of COVID-19, “the associated viral pneumonia progresses to ARDS more often than in influenza”, Gajic observed.

Over the medium- and long-terms “the decline in lung function itself is less pronounced than other consequences” for ARDS sufferers, Gajic continued. The most serious of these ramifications are a “decline in physical and functional status, changes in cognitive function and psychological effects”, he said.

"“Kidneys for instance, begin to self-destruct, so it’s common that patients on medical ventilators for ARDS require dialysis – and flooding the brain with medications to provoke a medically induced coma will cause some level of delirium that’s going to be hard to undo,” he continued."

So really, which is crueller a swift death or what amounts to debilitating torture so that, at best assuming a full 19% survival rate, 6.3% of people might recover to their previous level of health?

-----

Quotes sourced from:

https://www.npr.org/sections/health-sho ... 9-patients

https://nationalpost.com/health/some-cr ... tor-in-icu

https://www.france24.com/en/20200402-fo ... a-lifetime

[Jub]

Addendum:

How much strain will it place on families, especially in the United States, when their loved one comes home alive and costs hundreds of thousands to keep in that state due to complications from the treatment and incomplete recovery? How about in native communities where these individuals will be sucking up already limited health resources? How many suicides, will be caused by bankruptcy due to medical expenses alone? Or due to lack of care because the one ventilator in a clinic is in use by a patient who will never emerge from their coma?

Is saving a life, in this case, a win given the second-order effects that saving them is almost certain to have?

[loomer]

No, there actually is a utilitarian difference between making no active effort to save those certain to die and advocating for the involuntary euthanasia of seriously ill people with a demonstrably higher chance of recovery if intervention is taken, you fucking maniac. One will result in the same outcome either way (but, incidentally, it's only the same if you don't view the people you're demanding actively kill people as human - there is enormous collateral involved), the other demonstrably won't.

You are, again, advocating for the involuntary euthanasia of thousands of people because a 20% chance of survival isn't good enough for you.

20% is the best-case scenario, but I doubt you'd change your mind if we were strictly talking worst case and assume a 3% survival rate. Even then survival doesn't mean they're going to recover in any meaningful way. "[A] study of 18 ventilated patients in Washington state found that nine were still alive when the study ended, but only six had recovered enough to breathe on their own." That was posted 2 days ago now, how many of those six do you think are still alive?

I don't know, probably all six given that once they're breathing on their own the worst danger has passed? Go find out if you want to argue that they shouldn't be alive, fuckhead.

Regardless, with the risk of lung damage, "Unfortunately, Osborn says, "the ventilator itself can do damage to the lung tissue based on how much pressure is required to help oxygen get processed by the lungs." And coronavirus patients often need dangerously high levels of both pressure and oxygen because their lungs have so much inflammation." Given that "survivors of such treatment often fare poorly over the long term." what are the odds that long term survivors who were ventilated for more than a day or two ever come off mechanically assisted breathing?

The prospects are so grim that "As the number of Canadians made critically ill by the virus ticks up, some patients or their families are actually foregoing entirely the often-harrowing treatment afforded by ICUs and breathing machines. A number of elderly patients have died in long-term care homes rather than submit to intensive therapy that might have only made their passing more painful and uncomfortable."

On the other side, "Some doctors are even considering whether to raise a more touchy issue, asking patients or families to consider giving up their chance at a ventilator for someone more likely to survive." and “Early establishment of goals of care may also reduce unnecessary utilization of limited critical care,” they say." So doctors aren't yet willing to make the call but they are considering and in some cases more than simply considering, denying certain patients any care at all. This drives that 11% average survival rate down even more, so where is the floor at which we just throw up our hands and start doing something else?

Patients are free to refuse treatment. You aren't talking about that - you're talking about looking at every patient who needs a ventilator and then actively killing them. Let's look at your prior example, eh? 18 patients. 9 survived, 6 recovered the ability to breathe on their own. That's a 33% recovery rate. You would reduce that rate to, quite literally, 0%.

In one case in Ontario we get the following scenario:

"When the first cases of the coronarvirus emerged at Pinecrest Nursing Home in Bobcaygeon, Ont., last month, its medical director, Dr. Michelle Snarr, emailed families to warn they may have to decide whether to send their loved ones to hospital. That would involve going on a ventilator, she said, and a frail nursing-home resident would likely “suffer a great deal” and might not survive the ordeal.

Snarr could not be reached for comment, but it appears none went the ICU route.

“Under normal times, we would send people to the hospital if that was the family’s wishes, but we knew that was not going to be possible knowing that so many people were going to all get sick at once and also knowing the only way to save a life from COVID is with a ventilator and to put a frail, elderly person on a ventilator, that’s cruel,” she told CTV News."

How about the fact that, many patients simply don't understand what intubation means?

"“It’s not like you’re awake and alert and writing notes to loved ones.” Getty Images
With a tube down their throat and often under sedation, they cannot communicate, while the process of inserting the tube and suctioning airways is uncomfortable and painful. Patients are also unable to take care of their own bodily functions or cleaning. Some say they would let staff know when they’ve had enough, but are shocked to learn they’d have no way to indicate that, said Rubenfeld."

Again, you are advocating for looking at every patient who might need a ventilator - and they aren't just the elderly and the frail - and saying 'no, you have to die instead'. Every single one. To justify that by arguing that hey, ventilation sucks and maybe patients don't understand is fucked. You explain it better, if you're concerned they don't understand - you have an informed discussion, or as much of one as circumstances dictate. If they no longer wish to - that's their decision and it should be respected.

You do not decide to actively kill them regardless of their wishes.

But if this isn't bad enough let's look at outcomes for disease with easier treatment paths than Covid-19:

"And the research, a lot of it carried out by Canada’s critical-care doctors, indicates that those who make it out of the ICU and a long stint on a ventilator face an unsure future.

Experts call the possible negative effects “post intensive-care syndrome” — a combination of cognitive decline, psychiatric problems like depression and post-traumatic stress and muscular-skeletal weakness.

A striking 2017 paper by Detsky and colleagues looked at about 300 patients in Pennsylvania who had spent at least three days in the ICU and more than 48 hours on ventilation or being infused with a drug for dangerously low blood pressure.

With a median age of 62, half were dead within six months, and just a third were back to their previous health levels, the researchers found."

So half of less than 11% are being treated only to survive another six months with diminished function, and even fewer properly recover. This is for the shit we know how to treat!

The odds of recovery are higher than 11% for the shit people are familiar with, fuckhead. Are you even following your own examples?

It's not just one source saying these things either:

"[M]edical experts told FRANCE 24 that COVID-19 can cause severe long-term damage to the lungs, heart, brain and other organs – and that for some patients, these complications may be permanent."

"“Because of how serious the ARDS is, the damage that you can have for that is for a lifetime.”

“Large numbers of ARDS survivors are not able to go back to work,” added Onjen Gajic, a critical care specialist at the Pulmonary Medical Department of the Mayo Clinic in Rochester, Minnesota."

"‘Survival is just the beginning’

In serious cases of COVID-19, “the associated viral pneumonia progresses to ARDS more often than in influenza”, Gajic observed.

Over the medium- and long-terms “the decline in lung function itself is less pronounced than other consequences” for ARDS sufferers, Gajic continued. The most serious of these ramifications are a “decline in physical and functional status, changes in cognitive function and psychological effects”, he said.

"“Kidneys for instance, begin to self-destruct, so it’s common that patients on medical ventilators for ARDS require dialysis – and flooding the brain with medications to provoke a medically induced coma will cause some level of delirium that’s going to be hard to undo,” he continued."

So really, which is crueller a swift death or what amounts to debilitating torture so that, at best assuming a full 19% survival rate, 6.3% of people might recover to their previous level of health?

You give them the choice, dickhead. You don't go 'well, you might suffer needlessly, so we're going to automatically terminate you'. That's your proposal: Death. Automatic death for anyone who needs a ventilator. Not a choice, not a chance, but just an automatic 'now you die' policy.

Addendum:

How much strain will it place on families, especially in the United States, when their loved one comes home alive and costs hundreds of thousands to keep in that state due to complications from the treatment and incomplete recovery? How about in native communities where these individuals will be sucking up already limited health resources? How many suicides, will be caused by bankruptcy due to medical expenses alone? Or due to lack of care because the one ventilator in a clinic is in use by a patient who will never emerge from their coma?

Is saving a life, in this case, a win given the second-order effects that saving them is almost certain to have?

Jub. You are advocating instead for telling these people and their families that they must die to spare their families a cost their families may be willing and able to face. You are advocating for involuntary euthanasia. You are advocating, quite literally, for murdering thousands of people.

You literally want to take the 5-10% of hospitalized COVID-19 patients who will require ventilation and turn that into a guaranteed death sentence. Let me ask you: Do you have a single medical expert who is actually advocating for what you are, and not just your attempt at quote mining people pointing out that it isn't a magic bullet? No one thinks it is.

You are not an ethicist, Jub. Don't try and act like one.

Also, fuck you - you don't get to characterize Indigenous peoples who need ventilators as 'sucking up already limited health resources' when you're against increasing access to those resources.

[loomer]

It bears re-emphasizing that you aren't talking about making euthanasia a choice for patients facing these odds. You're talking about making it mandatory. You're talking about taking even patients with the best odds of recovery on a ventilator and giving them an overdose whether they want one or not, not just those whose odds are grim either way. You're talking about taking the healthy who were unlucky and overdosing them without their consent, not taking those who are being passed over to treat those with better odds and offering them a dignified exit.

You are talking about murder, Jub. Not palliative care, not euthanasia, not withholding unnecessary or futile care, but active murder. You are talking about ending people's lives without their consent to ease the burden on the healthcare system, regardless of their individual odds of recovery. This is not merely a garbage position to take - it is actively monstrous.

[Jub]

Patients are free to refuse treatment. You aren't talking about that - you're talking about looking at every patient who needs a ventilator and then actively killing them. Let's look at your prior example, eh? 18 patients. 9 survived, 6 recovered the ability to breathe on their own. That's a 33% recovery rate. You would reduce that rate to, quite literally, 0%.

What about forced DNR orders, do you support those?

Again, you are advocating for looking at every patient who might need a ventilator - and they aren't just the elderly and the frail - and saying 'no, you have to die instead'. Every single one. To justify that by arguing that hey, ventilation sucks and maybe patients don't understand is fucked. You explain it better, if you're concerned they don't understand - you have an informed discussion, or as much of one as circumstances dictate. If they no longer wish to - that's their decision and it should be respected.

You do not decide to actively kill them regardless of their wishes.

Do you honestly think that a simple explanation done while the patient is under severe stress will properly convey the experience of being intubated?

The odds of recovery are higher than 11% for the shit people are familiar with, fuckhead. Are you even following your own examples?

No shit, the 11% rate is the average between the best case recovery rate for Covid-19 (19%) and the worst case (3%) and given that these numbers come from real-world studies will include everybody who required a ventilator not just the old or frail. Try reading what I'm actually writing...

You give them the choice, dickhead. You don't go 'well, you might suffer needlessly, so we're going to automatically terminate you'. That's your proposal: Death. Automatic death for anyone who needs a ventilator. Not a choice, not a chance, but just an automatic 'now you die' policy.

How is it any worse than refusing them care because your equipment and trained staff are already at capacity? Isn't refusing to ventilate a person who needs it equally a death sentence only slower?

Jub. You are advocating instead for telling these people and their families that they must die to spare their families a cost their families may be willing and able to face. You are advocating for involuntary euthanasia. You are advocating, quite literally, for murdering thousands of people.

I'm bringing up the reality of the situation and saying that we shouldn't allow stressed scared and confused people make a choice that could ruin them.

You literally want to take the 5-10% of hospitalized COVID-19 patients who will require ventilation and turn that into a guaranteed death sentence. Let me ask you: Do you have a single medical expert who is actually advocating for what you are, and not just your attempt at quote mining people pointing out that it isn't a magic bullet? No one thinks it is.

Aside from the ones who are already discussing criteria for who even gets treated and the ones pushing DNRs on Covid-19 patients who, for obvious reasons, can't consent to such an order being enforced? This is taking that a step forward and saying that, logically, the juice very likely isn't worth the squeeze until we figure out better treatment options.

Also, fuck you - you don't get to characterize Indigenous peoples who need ventilators as 'sucking up already limited health resources' when you're against increasing access to those resources.

I advocated against sending them anything more than their population size would warrant, especially while places like NYC are currently overcapacity. Is the life of a New Yorker worth less than the life of a native now?

It bears re-emphasizing that you aren't talking about making euthanasia a choice for patients facing these odds. You're talking about making it mandatory. You're talking about taking even patients with the best odds of recovery on a ventilator and giving them an overdose whether they want one or not, not just those whose odds are grim either way. You're talking about taking the healthy who were unlucky and overdosing them without their consent, not taking those who are being passed over to treat those with better odds and offering them a dignified exit.

You are talking about murder, Jub. Not palliative care, not euthanasia, not withholding unnecessary or futile care, but active murder. You are talking about ending people's lives without their consent to ease the burden on the healthcare system, regardless of their individual odds of recovery. This is not merely a garbage position to take - it is actively monstrous.

Would it be more palatable if instead we simply refused to intubate anybody with Covid-19 until we have a better treatment option? The alternative is asking NYC hospitals and their staff members to maintain current workloads for potentially the next 18 months or more. Do you honestly think that's sustainable? What do you think this will do to the staff of these hospitals, and he more that will surely follow, if this does drag on for more than a year?

[mr friendly guy]

What's wrong with euthanasia? Especially in cases where you're spending a great percentage of your effort to care for people with a less than 20% chance of surviving if you do everything perfectly. Is saving 1-in-5 people worth running hospital staff ragged or is it better to try to keep nurses fresh by palliating people more aggressively and taking steps to ensure their passing is an easy one?

I don't have a problem with voluntary euthanasia, although that is a separate topic. But before we go on, I just want to make sure you understand the distinction between euthanasia and palliation. Because even in your passage, it seems to me you use the terms interchangeably. There is a difference medically and ethically between them. With euthanasia you are violating the "do no harm" rule and actively doing harm, as opposed to palliation where you aren't actively moving to harm thm per se. This difference is why some doctors argue for palliation rather than voluntary euthanasia.

Also, I've read that hospitals in the hardest-hit areas have already switched to DNR orders even if a patient may otherwise have other wishes.

https://www.forbes.com/sites/lisettevoy ... 4037983146

https://www.cnn.com/2020/03/26/health/c ... index.html

How far away from euthanasia is enforcing involuntary DNR orders in overwhelmed hospitals? Is traditional palliation actually a better solution than taking a course that ensures each patient deemed unsavable uses up as few resources as possible?

1. I wouldn't be surprise if they are doing involuntary DNR orders. If things are futile even without taking into account limited resources, I would argue its prolonging suffering. But it is a grey area.

2. I would consider euthanasia (whether voluntary or involuntary) and enforcing involuntary DNR orders quite different actually, both in practical terms and ethical terms. Doctors who oppose euthanasia don't necessarily opposing involuntary DNR if they consider resuscitation futile.

3. I would argue traditional palliation wouldn't take that much resource up vs your proposal of involuntary euthanasia. Once you realise what palliation involves. For one, we don't need the ICU bed. We can use a normal bed + the standard COVID precautions we use. Syringe driver, the usual cocktail of drugs, some form of opiods, benzodiazepine, hyoscine which aren't expensive. If they need ventilators to keep on breathing, they most probably aren't going to live more than a day or two anyway. So the bed isn't taken up for very long even if you're arguing from the resource allocation perspective.

[madd0ct0r]

I think. Given the mix of people in this thread, and how most are tracking this out of personal fear, that a seperate triage and palliation thread might be better for everyone's mental health

[Jub]

I don't have a problem with voluntary euthanasia, although that is a separate topic. But before we go on, I just want to make sure you understand the distinction between euthanasia and palliation. Because even in your passage, it seems to me you use the terms interchangeably. There is a difference medically and ethically between them. With euthanasia you are violating the "do no harm" rule and actively doing harm, as opposed to palliation where you aren't actively moving to harm thm per se. This difference is why some doctors argue for palliation rather than voluntary euthanasia.

The dead are dead either way. Death via neglect has exactly the same outcome as murder. When the situation is approached from a purely logical standpoint it's as clear as day that palliation is equivalent to euthanasia.

1. I wouldn't be surprise if they are doing involuntary DNR orders. If things are futile even without taking into account limited resources, I would argue its prolonging suffering. But it is a grey area.

Currently were prolonging the suffering of greater than 80% of all patients that require ventilation. Likely greater than 90% when you look at places such as NYC and account for the condition of dome survivors.

2. I would consider euthanasia (whether voluntary or involuntary) and enforcing involuntary DNR orders quite different actually, both in practical terms and ethical terms. Doctors who oppose euthanasia don't necessarily opposing involuntary DNR if they consider resuscitation futile.

Don't forget the third and forth categories, patients that are sent straight to palliation without receiving any treatment and patients who are given the medical advice to simply die where they are to not burden the medical system. How do you feel about those options?

3. I would argue traditional palliation wouldn't take that much resource up vs your proposal of involuntary euthanasia. Once you realise what palliation involves. For one, we don't need the ICU bed. We can use a normal bed + the standard COVID precautions we use. Syringe driver, the usual cocktail of drugs, some form of opiods, benzodiazepine, hyoscine which aren't expensive. If they need ventilators to keep on breathing, they most probably aren't going to live more than a day or two anyway. So the bed isn't taken up for very long even if you're arguing from the resource allocation perspective.

I was just in the hospital for a procedure to remove a kidney stone. It was noninvasive and outpatient. This still required no fewer than 4 nurses to run just the outpatient recovery beds. This doesn't account for the cleaning staff, medical supplies used, etc. required just for that one small minimally equipped unit.

When your already above capacity every single bed and staff member counts and all have better things to do than care for the soon to be dead. It's more efficient to speed things along and keep those resources free.

[mr friendly guy]

I think. Given the mix of people in this thread, and how most are tracking this out of personal fear, that a seperate triage and palliation thread might be better for everyone's mental health

Sounds reasonable. I will hold off further posting on that particular side topic.

[MKSheppard]

Jesus christ, and you call my position garbage.

I dunno. I think he's been reading Herman Kahn:

How much would we have to drop our standards in a realistic attack situation? I suggest that something like the following rather dangerous-looking standards might be both adequate and acceptable in some postwar worlds. The common contaminated foods which would be the major source of Sr-90 might be classified into five grades—A, B, C, D, and E. Food in each of these five grades, if eaten with no other alleviatory measures ( such as supplementary calcium in the diet), might result in the levels of contamination in new bone that are shown in Table 13.

The A food would be restricted to children and to pregnant women. The B food would be a high-priced food available to everybody. The C food would be a low-priced food also available to everybody. Finally, the D food would be restricted to people over age forty or fifty. Even though this food would be unacceptable for children, it probably would be acceptable for those past middle age, partly because their bones are already formed so that they do not pick up anywhere near as much strontium as the young, and partly because at these low levels of contamination it generally takes some decades for cancer to develop. Most of these people would die of other causes before they got cancer. Finally, there would be an E food restricted to the feeding of animals whose resulting use (meat, draft animals, leather, wool, and so on) would not cause an increase in the human burden of Sr-90.

[MKSheppard]

Cuomo has made his demands clear for Upstate:

https://www.syracuse.com/coronavirus/20 ... ewide.html

Albany, NY -- Gov. Andrew Cuomo said Saturday that he only plans to take 20 percent of unused ventilators from statewide hospitals, suggesting that could bring a total of 500 more to the Downstate coronavirus fight.

Cuomo’s comments came a day after he signed a provocative order allowing the National Guard to take control of unused ventilators statewide. He believes that Downstate’s greatest need could come within seven days, leaving the state drastically short of the life-saving device with no time to manufacture more.

The governor toned down his language, too, couching it as an “ask” and not as a demand. He also had a conference call with the state’s hospitals, to coordinate deployment of resources.

More ventilators are needed in the short-term: A record number of New Yorkers died overnight from the coronavirus. Cuomo has indicated the ventilators would be returned after the pandemic is over Downstate.

Onondaga County Executive Ryan McMahon said on Friday that Central New York doesn’t have any ventilators to spare, and suggested that the governor was talking about seizing excess supplies elsewhere.

Cuomo made it clear Saturday that he wasn’t proposing taking all unused ventilators from hospitals outside the Downstate hot zone.

“If you ask hospitals today what ventilators do you have that were unused -- and available -- that they don’t need in the short-term, and take 20 percent of that number of available ventilators, that’s 500 ventilators,” Cuomo said Saturday. “500 ventilators is a significant number now.”

The governor would not guess how many ventilators would be needed at the disease’s high point in the state, but said that the state is still trying to fill the gap left after a contract to by 17,000 ventilators mostly fell through. He announced that China had donated 1,000 ventilators and the state of Oregon was sending 140.

In addition, the federal government is taking over staffing and equipping of the makeshift COVID-19 hospital at New York’s main convention center, providing significant relief for the state’s resources, Cuomo said. (That hospital had previously been assigned to non-coronavirus patients, but will be converted.)

Days ago, Cuomo guessed the state might need up to 40,000 ventilators. It’s unclear how many the state has now. But we’ll still be short, even after help from the federal government, the donations from out-of-state and collections of unused ventilators statewide, Cuomo said.

The only choices left will be to convert other types of respiratory equipment into ventilators and to split ventilators so one device that provide oxygen to two patients.

[Ziggy Stardust]

This is where I got my source from on this issue.

<snipping article>

I can't find a list online of the members of Sage, but the two leaders of the group (Whitty and Vallance) are both physicians, the former with a wealth of expertise in public health. I don't know who the other members of the group are so impossible to validate how many of them are "mathematical modellers and behavioural scientists". And the article doesn't actually provide any evidence of what Horton is saying, Horton is just claiming that this is true. I won't go on a tangent about why I distrust Horton himself, but even setting that aside the article should be taken with a huge grain of salt until any evidence is actually presented.

The fact is that public health experts were (and continue to be, to some extent) divided on the best way for governments to respond to this pandemic. The information we have had on Covid-19 has changed over time as it spreads, and there is still a good deal of heterogeneity in the way it attacks different populations that we don't understand. There are plenty of different paradigms for public health policy even in the best of times, and this isn't the best of times. Differences of opinion and approach across a broad field of science isn't new or unprecedented, even in times of crisis. The idea that there is one camp of "public health experts" that is a separate camp from "mathematical modellers and behavioural scientists" is absurd. Mathematical modeling has been an integral part of epidemiology and public health since the 1950s.