"[T]he mortality rate among patients over age 65 exceeded 26 percent, and almost all patients over 65 who needed mechanical ventilation during that period died."

According to a new JAMA article (which studied coronavirus patients in Northwell Health hospitals "in and around New York City"), reported in "Do You Want to Die in an I.C.U.? Pandemic Makes Question All Too Real/Sobering statistics for older patients sharpen the need to draw up advanced directives for treatment and share them with their families" (NYT).

A new study in JAMA Internal Medicine questioned 180 patients over age 60 with serious illnesses; most said they would trade a year of life if that meant they could avoid dying in an I.C.U. on life support.... “Many older patients we’ve encountered with Covid-19 have opted not to undergo ventilation and an I.C.U.,” Dr. White said. “No one should impose that on a patient, though if there’s true scarcity, that may arise. But patients might choose it for themselves.”...

While you're thinking about that, here's the ad the NYT served up for me in the middle of the article:



"More than 20% of Americans think vampires are real/More than 25% think climate change is not"... therefore you might want to donate $1,000 to the World Health Organization. We're supposed to worry that a fifth to a quarter of Americans are so science-ignorant that we should give money to an organization that may or may not represent good science. How would I know? Well, one thing is: I'm wondering if it is really true that 20% of Americans think vampires are real, because if they don't, then the organization is passing on fake statistics and that's evidence against its dedication to good science!

Here's a study from last year (at YouGov) that says 13% of Americans believe in vampires — 14% of Republicans and 8% of Democrats. And here's an IPSOS survey from last year that said "Almost half of Americans believe that ghosts are real (46%), and a third believe that aliens visit earth (32%), while only a small amount believe in vampires (7%) and zombies (6%)."

For $1,000, you need to do better with the statistics. And now I'm wondering about the value of the statistics about how likely you are to die if you're over 65 and end up on a ventilator. Just as the World Health Organization wants its donations, the health care system would benefit if you decline its services and accept home-based death.

"The United States has roughly 2.8 hospital beds per 1,000 people. South Korea, which has seen success mitigating its large outbreak..."

"...has more than 12 hospital beds per 1,000 people. China, where hospitals in Hubei were quickly overrun, has 4.3 beds per 1,000 people. Italy, a developed country with a reasonably decent health system, has seen its hospitals overwhelmed and has 3.2 beds per 1,000 people."

From "This is the coronavirus math that has experts so worried: Running out of ventilators, hospital beds" (WaPo).

As for the ventilators:

In a report last month, the Center for Health Security at Johns Hopkins estimated the United States has a total of 160,000 ventilators available for patient care (with at least an additional 8,900 in the national stockpile). A planning study run by the federal government in 2005 estimated that if the United States were struck with a moderate pandemic like the 1957 influenza, the country would need more than 64,000 ventilators. If we were struck with a severe pandemic like the 1918 Spanish flu, we would need more than 740,000 ventilators — many times more than are available.

That's some background on "Healthcare system capacity" means in this now-familiar graph:

Important to remember that #Covid-19 epidemic control measures may only delay cases, not prevent. However, this helps limit surge and gives hospitals time to prepare and manage. It's the difference between finding an ICU bed & ventilator or being treated in the parking lot tent. pic.twitter.com/VOyfBcLMus

— Drew A. Harris, DPM, MPH (@drewaharris) February 28, 2020

"For months, as part of a research project into the flu, [Dr. Helen Y. Chu] and a team of researchers had been collecting nasal swabs from residents experiencing symptoms throughout the Puget Sound region."

"To repurpose the tests for monitoring the coronavirus, they would need the support of state and federal officials. But nearly everywhere Dr. Chu turned, officials repeatedly rejected the idea, interviews and emails show, even as weeks crawled by and outbreaks emerged in countries outside of China, where the infection began. By Feb. 25, Dr. Chu and her colleagues could not bear to wait any longer. They began performing coronavirus tests, without government approval. What came back confirmed their worst fear. They quickly had a positive test from a local teenager with no recent travel history. The coronavirus had already established itself on American soil without anybody realizing it. 'It must have been here this entire time,' Dr. Chu recalled thinking with dread. 'It’s just everywhere already.'... Federal and state officials said the flu study could not be repurposed because it did not have explicit permission from research subjects; the labs were also not certified for clinical work. While acknowledging the ethical questions, Dr. Chu and others argued there should be more flexibility in an emergency during which so many lives could be lost. On Monday night, state regulators told them to stop testing altogether...."

From "'It’s Just Everywhere Already': How Delays in Testing Set Back the U.S. Coronavirus Response/A series of missed chances by the federal government to ensure more widespread testing came during the early days of the outbreak, when containment would have been easier" (NYT).

Coronavirus makes medical ethics look like red tape.

I found that article as I was looking for something about the true number of coronavirus cases in the U.S. I see that, right now, there have been 1,039 cases confirmed in the United States, but, as the linked article makes clear, the testing for the virus has been quite limited.

"This is a unique position to be in, a unique and very humbling position. I want to be an ambassador of hope."

Said Adam Castillejo, quoted in "The ‘London Patient,’ Cured of H.I.V., Reveals His Identity" (DNYUZ).

Last March, scientists announced that Mr. Castillejo, then identified only as the “London Patient,” had been cured of H.I.V. after receiving a bone-marrow transplant for his lymphoma. The donor carried a mutation that impeded the ability of H.I.V. to enter cells, so the transplant essentially replaced Mr. Castillejo’s immune system with one resistant to the virus. The approach, though effective in his case, was intended to cure his cancer and is not a practical option for the widespread curing of H.I.V. because of the risks involved.