U.S. field hospitals stand down, most without treating any Covid-19 patients

> Spain has a “hard lockdown” too. Their excess mortality has returned to a normal level according to momo

That's probably inaccurate. I've been following MOMO's graphs, and the yellow-band portions (most recent weeks) grossly underreport and are subject to upward correction. Data points get larger and larger as they age. For example, "Spain Week 11" was pretty small when first reported (in week 12?), was larger the next week, and larger still a week later.

This isn't true, deaths reported lag, so the numbers continue to go up after the week is over.

I read that data as showing that the USA has had a sharp excess death event for each of the last four weeks reported. I'm seeing a much greater excess death rate than the official Covid19 reports.

Looks at the data by state or city. VA shows a huge spike over normal in early April. NY and NYC show even bigger spikes.

And the data is only through April 1. I suspect the excess death rates will be higher nationwide from April 1-May 1.

Presumably he means they would've happened in the same time period otherwise it's a meaningless statement. On a long enough timescale everyone who died of Covid would've died anyway.

The implication is they would have died soon, like in the next 6 months.

About half of Covid deaths are in nursing homes. The median lifespan after entering a nursing home is 5 months, and the mean is 13 months.

Coronavirus is very infectious, so if it enters a nursing home, it could easily spread and wipe out everyone who was on the brink of dearth, or on a fragile state.

> "I don't want to go to the ER, because I might catch COVID from another patient, or doctor" is a very justifiable fear.

The mortality risk of undetected/unaddressed heart problems, etc, far supercedes the risk from COVID-19. You could find some limited examples where that's not true but it is overwhelmingly the case.

It is becoming increasingly clear that the level of panic associated with COVID-19 is absolutely divorced from the ground truths.

But it doesn't just affect non-COVID-19 mortality. It may be that our response is even making COVID-19 mortality worse in some cases:

From https://www.nejm.org/doi/full/10.1056/NEJMc2009787?query=rec...):

"Social distancing, isolation, and reluctance to present to the hospital may contribute to poor outcomes. Two patients in our series delayed calling an ambulance because they were concerned about going to a hospital during the pandemic." (My note: So the irony here is incredible, these weren't just non-COVID-19 patients afraid to come in but _people who actually had life-threatening COVID-19_.)

And from https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0...:

"Third, the COVID-19 epidemic has caused a parallel epidemic of fear, anxiety, and depression. People with mental health conditions could be more substantially influenced by the emotional responses brought on by the COVID-19 epidemic, resulting in relapses or worsening of an already existing mental health condition because of high susceptibility to stress compared with the general population."

and

"Finally, many people with mental health disorders attend regular outpatient visits for evaluations and prescriptions. However, nationwide regulations on travel and quarantine have resulted in these regular visits becoming more difficult and impractical to attend."

This is an unreasonable response with full information though. Had the media done their job in most parts of the country and reported that hospitals were not actually seeing many covid patients, people would have been more willing to go to the hospital. Instead, every news outlet, including local ones, reported on one or two slightly overloaded hospitals in New York City, which is a thousand or so miles away for most Americans, and completely unimportant when you have a heart attack, stroke, whatever.

Instead, people had to make do with partial information and many people -- believing incorrectly that their local hospitals were overwhelmed and needed them to stay home -- chose to do so.

I hate to say it, but almost all major news outlets have been hysterical about this for the past several months.

All news media is bad at reporting on science and medicine, but they've kicked it into an extra gear for this pandemic. I've seen endless articles pointing out the newest, barely-supported piece of evidence that might mean COVID-19 is even worse than we thought. And you never see the follow up article when that turns our to be pure BS. At one point a couple weeks back someone at the WHO said they don't know exactly how immunity works yet with this virus, which was followed by a flood of articles screaming about how we can't become immune (with a little "maybe" shoved in somewhere way below the headline).

And have you ever watched local television news? Millions of Americans do every night. It's the worst of the worst, and their over-the-top tactics are a well worn joke. "Is your refrigerator going to kill you and your children? Tune in at eleven to find out, only on FUTV News".

CNN international version or what I get here in Europe has been showing body count 24/7, going as far as making the actual content smaller for the overlay.

In my eyes that define is hysteria.

The news media isn't funded to do that sort of journalism anymore.

It was always a loss-making enterprise, even with centralized distribution.

24 hour news cycles and internet competition isn't a good recipe for in-depth, long-pursuit journalism.

if it helps, I remember your posts.

I also remember the take downs of the various antibody studies all pointing to infection being much more widespread than originally thought. As if it was bad news the IFR was going down.

I lack the intelligence to connect the dots but I sincerely feel there's a large bias, if not outright agenda, here to advise prolonging and deepening the economic destruction.

Considering you said "We need herd immunity sooner than later. Let's get to 80% ASAP!" just yesterday, I'm not surprised there are other posts people weren't taking at face value.

> What "false sense" are you talking about, exactly?

The fact that we were being told to expect Italy/New York levels of hospital overruns ALL OVER the country (hint: field hospitals that hardly got used weren't just deployed in NYC)? And that we're still being told that hospitals ALL OVER the country are in danger of being brought to their knees by re-opening state economies right now? Meanwhile, the nurses that aren't furloughed are making nightly dance videos during their shifts.

> What "false sense" are you talking about, exactly? There was real risk. Are you saying that the media reported overloads that didn't exist?

Um... Cuomo said he needed 40k new ventilators to make sure hospitals had all they needed after he instituted a shelter in place order. He needed nowhere near that amount. That is hysteria. I don't understand why this is controversial.

But aren't people getting money through unemployment and the CARES Act? Won't that help them keep the stress level down a bit?

What missing from this is for large numbers of Americans, losing their jobs, phone being cut off, debt collectors calling is the normal. Difference between now and before is they have an excuse. Sorry landlord, can't pay rent cause I'm not working like all your other tenants. Mortgage holders are kinda bending over backwards not to ruin their paper as well.

Their initial criteria was that a patient had to go get a Covid test at another hospital before they could board the ship.

At least some of the reason it didn't treat many patients is that they made it hard to become a patient.

There's a few factors at play here.

1) Hospitals generally get paid (by someone) for treating patients. So they want to run at 100% capacity, even with covid patients.

2) You can't really just "build an ICU." You can stand up a field hospital that's able to provide similar, degraded services. But it's not going to be the same.

Imagine if someone said "set up a datacenter in a field," and then a customer had a choice to colo their server in a purpose-built DC or your field DC. Which do you think they'd pick?

3) The units that staffed these facilities were heavily augmented by military reserves.

Corpsmen may have non-medical civilian jobs, but what do you think military reserve critical care nurses and doctors do for a living?

If these field hospitals were packed to the brim, all of those people would be locked in place. Possibly while they were needed in their civilian positions, in their home cities (although the military seems to have done a pretty good job about preferentially pulling non-Covid-civilian personnel).

4) Exponential growth with unknown but high R_t. +1 week before we locked down would have looked very different.

... all of that to essentially say that these facilities were designed as surge capacity, in the event they were needed. We intentionally filled up hospitals first.

USD$660M seems like a reasonable price to pay, strictly as insurance, given the very real risk that hospitals would have been overfilled and covid-related mortality would have spiked due to lack of care.

You should bring him to an emergency room now.

I don't know where you are, but in my area (east of NYC) the ERs are non-COVID and strictly separated. Weigh the risk, but know that the ERs are not necessarily warzones. Call the hospital and ask them, but don't delay care just because you don't know the real risks. I've been (physically) to an urgent care clinic, a specialist's office, and a dentist in the past week, because I waited two months for care, and I'm feeling pretty stupid (I'm high risk). The protocols are different, waaaaahhy more strict, but they are treating people.

Yeah. It's really a shame that there were all these efforts to prevent our health care system from being overwhelmed. Oh well. It looks like enough people would like to run this particular experiment that we just might get to see what it looks like after all. Yay?

The shutdown largely worked. Comparing predictions of what happens without a shutdown is kind of missing the point.

What will happen as we try to return to normal yet another situation.

> the risk of getting Covid19 and not getting access to hospital resources is much lower than expected, so it was true.

Not quite true, NYC was over stressed and there is at least one mass grave and are still corpses in refrigerator trucks.

Luckily, social distancing worked better than expected: peak daily US death was reduced to approximately 2,700 rather than approximately 3,000. And the curve was flatten more than expected with the death rate remaining at peak longer.

One can't extrapolate from the success of social distancing to imply that _not_ doing social distance would be less harmful.

>The results of our original experiment turned out to be different than our expectations

To the contrary, the proposed solution worked as expected. The social distancing combined with state-level quick action reduced the severity of the predicted disaster. In addition, people who would normally go to the ER "just in case" did not for fear of contagion. Or because they lost medical insurance. Or because visiting a GP became difficult and so there were fewer referrals. All reducing strain on hospital resources.

Certainly, The predictions of what would happen without out social distancing still stand as the data behind it is unchanged. And if that isn't enough, there is the 10x fatality rate of Sweden vs its neighbors.

Since Sweden dropped from the narrative when it showed serious differences from its neighbors, it hints that criticism of social distancing is either (justifiably) emotional or (unjustifiably) politically. If it were from an honest appraisal by epidemiologists or economist, there would concrete counter projections and remedies rather than imprecise claims about it's success and ambiguous calls as to what a new policy should be.

It is horrible that the US death total exceeds the Vietnam war and that there is serious economic hardship. That is the terrible truth for natural disasters when no plans are in place (let alone actual preparation) and the response is slow. I hope the lesson from this disaster is that we are prepared next time rather than convincing ourselves nothing serious happened.

> not getting access to hospital resources is much lower than expected

I don't know how you can say 'lower than expected'. Many interventions were non-medical, depending on social behaviour (e.g. adhering to social distancing), effectiveness of governance and enforcement, as well as economic and political (e.g. supply of test kits, ventilators). And even then, we were dealing with a new virus, there was limited data about all kinds of variables. For example, if people are intubated twice as long in the US due to high levels of obesity compared to China, you need twice as much ventilator capacity.

Point being, we always had to deal with a very wide confidence interval.

Now combine that with the fact we're looking to predict an exponential number, rather than something linear, and you can get wildly different outcomes. In New York the doubling time began around 2 days. That meant the difference between hospitalising 50k or 100k was a matter of starting social distancing two days later. The difference between 50k and say 1.6 million, was just 10 days. Hospital resources can't expand that fast, at best you can add 30% extra beds and shift all bed-use to dealing with corona with emergency interventions, but you can't just scale 3000%.

That's where the field hospitals came in. Not because it was guaranteed or fully expected to need them, but because there was a good chance, and there was too little information to conclude they wouldn't be necessary.

OTOH, if I have a really nasty cold which doesn't share symptoms of coronavirus, I am absolutely NOT going to the ER or urgent care even though I normally would. The urgent care center near my house is full hazmat suits and a tent outside to do front line covid screening.

I think the effect you're describing does exist, but its certainly not the whole story. The fact is as well there's PLENTY of actual data available on this so we need not even be extrapolating based on our assumptions. The problem is any data that doesn't line up with our assumptions gets discarded because we don't know which datasets are good and reliable.

As far as I've seen, this is only routine in the USA. Everywhere else, people would go to their GP for this sort of thing.

That's what I did. Vouch didn't work nor was there a reply link.

And yet, a large part of the reason we weren't overrun is because our initial estimates of hospital beds and ventilators needed were far too high on a per-infected-person basis.

So yes, we definitely cut down transmission, but it's not clear that we would have incurred excess deaths due to capacity overrun. The biggest botteleneck is the presence of people on invasive ventilation; other clinical outcomes result in either the individual dying quite quickly (imagine a nursing home patient with multiple comorbidities), or in the patient recovering in 1-2 weeks. But there's that uncanny valley of people healthy enough to not immediately die but in bad enough shape that they need these aggressive interventions.

This is a big part of why I think we could have exposed much more people to the virus with only marginal increase in hospitalizations, by encouraging those who are not at risk to live as normally. It also makes it easier to centralize the resources where you do need it. For example it's much more feasible for government programs to handle food delivery, grocery delivery, and all these other logistical concerns when you only need to provide it for 10-40% of the country as opposed to 80% of it.

Serology in NY has shown us that we have maybe 1/8 of the population with antibodies as of a few weeks ago, which does mean that there was room for another doubling or too before transmission started naturally slowing down to a noticeable extent. So we absolutely could have had a lot more patient volume, but again the # of hospitalizations/invasive ventilation cases is much more related to the # of vulnerable people infected as opposed to the number overall.

(The classic argument here is that by fighting transmission in all members of the population, that the at-risk are better protected. For a number of reasons I think such an approach is misguided but I won't go into the full argument against that here)

The field hospital concept to increase capacity to reduce deaths was based on, in the UK, the Imperial paper which was based on, frankly a non realistic interpretation of the input data from China and Italy.

Meaningless admission/overadmission rates which are clearly vastly wrong/misinterpreted and in turn based on a huge percentage of over 75s being hospitalised and a majority of them in turn needing ventilation.

Except in reality patients of that age are rarely ventilated because they wouldn't survive such an invasive treatment and if they are the recovery is 6-8 months and long and painful and has poor recovery outcomes. That predicate was wrong in the paper.

Secondly the field hospitals built could only receive patients who had no other underlying or exacerbating conditions because the FHs lack the staff and equipment to care for them. Given that practically every person who died from a respiratory covid infection had such issues it rendered them fairly pointless.

The paper also didn't do much to deal with the fact this activity will cause a surge in deaths of non covid related fatalities. Whole other issue

Buffalo to Montauk is 500 miles. Even something like Plattsburgh to NYC is 300 miles.

> No part of NY is further than a few hours drive from any other part of the state, especially during lockdown traffic.

What? Buffalo to NY is 6 hours.

Do you have a reference for those assertions?

Because the metrics for “we don’t need this emergency hospital” and “the epidemic is beginning to burn out” are different.

Well look at Wuhan, Europe, etc. Had people in the US taken the lockdown seriously, we would have ended with an Rt below 1.0 (ideally WAY below 1) so we would be more than ready to reopen now. Instead, people keep doing crap and getting infected, and here we are stuck at home for two months.

Have you seen any attempts to actually put cause and effect together for stay-at-home orders and number of deaths? The only attempt I've seen to quantify it found no statistical connection between the two, but high connection between population density and deaths.

Slow burning respiratory diseases are pretty much the nightmare scenario specifically because they are so good at tricking human risk calculations.

Compare that to diseases like Ebola, which we typically clamp down hard and fast on.

Those would’ve been excellent suggestions in January, yes. But by mid March we’d missed the opportunity to use less intense measures.

> but that doesn't punch the emotional and neurochemical pathways the way politicians and news peddlers want

Every discussion involving advertising or app marketing here inevitably attracts tons of comments adopting a let's-be-real-here, this-is-just-how-it-is tone about the realities of the industry. And yet these same people are also experts on the news industry and know the exact opposite is true there, that "de-politicized" or "balanced" news is somehow a thing that is not only possible but stupidly trivial to produce.

I mean, I get it, I utterly despise crabbed, shoddy, stupid journalism, too. But don't pretend there's some trivial fix. It is the way it is because of a combination of economic and ultimately social pressures. It is as much a symptom as a cause.

What do you think is overhyped? The situation in Italy? Or the thousands of people dying a day?

This is hindsight bias. That those steps alone would be sufficient was not established in March (and could be argued even now).

in the US we still aren't even following these simple rules consistently (even in NYC where I live). I agree with your point, I blame the guy in charge of everything who's repeatedly tried to downplay the severity, causing the rest of the system to seemingly overreact to compensate for people refusing to follow the rules.

TBH, even if it was an overreaction, the effects were by and large positive, regardless of the pandemic. Work from home, less traffic, more family time, slowdown of economy, pausing of a lot of wasteful, useless activity. I really enjoyed walking around with almost no cars on the roads and listening to birds.

You claim that we should listen to the economists but you don't seem to have any clue what the economists are actually saying and are just putting words into their mouths.

Basically every economist is acknowledging that you can't get the economy back to normal until the health crisis is under control. You can lift the ban on people going to movie theaters and restaurants if you want, but no one is actually going to do it if they don't feel safe doing so. Example: air travel is down 95+% even though there are no laws against flying places.

This is an event where the need for hospital capacity grows exponentially, and we can't scale up medical resources that quickly.

So off by an inch now potentially means being off by miles later on. If the doubling period wasn't lengthened enough, a hospital at 50% capacity will be in serious trouble very soon.

> when we should also be listening to economists

Maybe we can listen to economists coming out of this too then; On things like

- Healthcare attached to employment

- UBI

- Sick Leave

- Servers wages

- Gig Economy

- Taxation and Austerity

We would have been better off economically if we had listened to much of the general consensus before.

>> It could be (is likely) that the problem never was as bad to begin with

As of today the USA has 75,000+ dead and counting. That is pretty fucking bad.

And we're not even close to the end of this. If the IFR holds up at what we're seeing, we already have another 50K deaths that will happen in the next few weeks.

Then the math gets really ugly. If herd immunity requires north of 60% to have been infected, that means 197M Americans. Of those 197M, roughly 5% will require hospitalization, and 1% will die. That equates to 10M hospitalizations and 1.9M deaths. Even being generous and lowering the IFR to .1%, means 190K deaths. Now this make be spread out over the next 7 months, but the butcher's bill will be paid. Hopefully we'll get a vaccine by then, or some therapeutic drugs, but I'm not optimistic.

"Which models" the ones projecting 2.2 million deaths... the ones based on 4% fatality rates.

"do you think it would be safe" With the data thats coming out? Yes. Absolutely. COVID is turning out to only be a little more dangerous than the Flu and "lockdowns" are not slowing or stopping the spread of the virus.

"How can someone get to this position"

Honestly... January WHO was saying COVID didn't pass person to person and models were predicting 2.2 million dead in the US alone.

I'm not making a prediction... I'm casting aspersions on the "predictions" that have been used to feed opinions like "do you think it would be safe?" as if we are all going to die - 99.5% of those who get it survive. Worse than the flu but not worth shutting everything down (which hasn't stopped it at all - look at New York).

Personally I know we can protect those who need extra protections (Old, ill, etc) without unproven shutdowns based on faulty models fed with bad data.

Why do I feel this way? Because I know that hurricane predictions are "Scientific models" and are wrong just like "market predictions" and all other forms of prediction based models based on past data.

The priorities all major surgeries and try to work with patients to push off the ones in terms of severity. That way hospital could at least keep taking people. If they have to cancel everyone in a week; that's still better than not taking anything at all right now (and being overloaded this/next months as everyone comes in needing things)

Depends on the way you look at this, and what your politics are.

Underemployed hospitals means a lot of procedures are not happening right now. Lots of chemo and similar things. Those will be facing long waiting lists once the state opens back up. If you even get those patients to come back in the next months. I think the risks are somewhat distorted. If you are skipping chemo because you are scared of Covid19, you may be missing something. And yes, chemo was deemed not essential as far as I can tell. I think they call those excess deaths, and it's very hard to say how those will shape up.

From a resident perspective, I see a flat curve with plenty of capacity, even of ventilators, and still a closed up state. But that's getting us into politics. The governor is following a timeline of opening up to normal maybe within 4-6 month. As long as sections are closed up, you need to sustain comfortable unemployment benefits to keep people even halfway in line to play along. Soon the money for that will run dry. It seems like she can extend stay-at-home orders without democratic agreement, but once the money runs dry, she cannot make a budget by herself. So things will get ugly eventually.

> Underemployed seems like... a good position to be in right now, no?

Not for the 10s of millions of families currently in hardship because the parent(s) lost their job.

Seems a bit hyperbolic to me. All signs point to greater spread than previously known in places like NYC, meaning majority of people who had it either had no symptoms or extremely mild symptoms and didn’t even notice.

Do you mean where the virus is going to go, or where this situation will go?

Yes, most likely it will not get burnt out in the US until we have vaccine, herd immunity or the 3rd option, which is coalition/state/county level containment.

My comment reflected on the subject of these emergency field hospitals. Its A) not efficient to keep these up for the time being B) its unlikely we will be caught underestimating the virus the 2nd/3rd/xth time around.

And something else to just reiterate. There are multiple steps between "keeping the field hospitals operational" and "shutting them down". Just like there are multiple steps between "social distancing" and "opening back up". :)

I think that until we get everyone tested we aren't going to know the real fatality rate. Some portion of people, perhaps larger than we expect, experience this virus as a cold that passes normally. Some people never even realize they have it. Until we have tested everyone and know for sure how many people have it asymptomatically that fatality rate is likely an overestimate and we can't really know by how much.

There's still areas all over the world which have not been hit too badly solely by luck - for instance, here in Alberta Calgary has been hit with an order of magnitude more cases than Edmonton without a great reason why. Regardless of the potential of immunity, these lightly hit areas are still open for initial infection and community outbreaks. I can't see why they wouldn't occur - on a long enough timeline luck just runs out.

> likelihood to evolve

We also don't know how lockdowns caused it to evolve.

Those model predictions are not for the first 3 months, but for the whole epidemic. We could very likely breach some of those predictions in the next 1-2 years.

Also, the Imperial College paper was one of the more extreme models. It is the one that supposedly scared the White House and lots of states into action. In this way, it was not a best case estimate, but was self-selected to be an outlier.

How so? Both political parties fucked this up, but one party more than another stands to gain from pretending like they didn't.

Edit: also my statements are factual as far as I can tell. We had since January to prepare, and instead our leaders -- political party aside -- decided to fuck around and play misinformation games with the public instead.

The expert in question was about 4 feet away from him and confirmed what he said immediately, and repeatedly.

I agree with your sentiment and I would go one level deeper down the rabbit hole. A lot of what we've been led to believe were blatant lies. Just look at the way people are talking about reopening. There's all this talk of vaccines and testing. Those aren't going to be real solutions. A vaccine is a year away. Closing everything for a year+ would be the end of civilization. As far as testing... think about the scale of testing we would need. You'd have to basically isolate everyone, test them, and then keep the infected isolated. And you'd have to do that over a very short period of time, like a few days. We're not delivering 300+ million tests in a few days. It's not happening. Testing is useful. It's not going to be some panacea of perfection, or even particularly "good." The hard truth is we're going to eat a lot of deaths from this. And none of the experts can possibly know what is the exact right recipe to minimize deaths, either from covid or economic disaster. Any state/country/whatever that gets better results will have done so totally by luck and their solution might not have worked elsewhere for a myriad of reasons. It's all false confidence.

Just look at Remdesivir, or however it's spelled. The news corps are pushing that as a possible treatment. Except guess what? It doesn't seem to reduce your chances of dying. Worth noting, pharma companies are major advertisers for news networks. It's all been bullshit.

TBH given the failures of the last months, I wouldn't be surprised if we are completely unable to execute, even if we get a couple of years. A pity.

And yet the Denver Convention Center laid off the vast majority of their staff shortly after converting to one of these field hospitals.

Nothing personal, but I found it a bit ironic that your own criticism of the parent amounted to simply asserting "Not really" without addressing any specific points. You didn't say which experts you would have chosen, and why, and how you know that the author of the article has purposefully attempted to cherry pick specific people. Its one thing to simply dismiss someones work, its quite another to provide constructive criticism with actionable material.

I prefer outlets that do their very best to attempt to remain impartial and present a "just the facts and all the facts please" view, even if we all know it's not 100% achievable.

I agree with you, this article is not that. If you listen to any economist, healthcare provider, or logistics expert, they will all tell you that this was the prudent choice given the worst-case tail scenario, and that this resource is one that has continuing value for some time.

But this article takes all that information and manages to paint that information in a negative light. It is "an opinion of the author" piece that even manages to express the opposite opinion FROM the expert opinions it reports.

It's also a bit cynical to say "nearly four months into the pandemic", as if there have been four months where the hospitals could have been seeing patients in the US but didn't.

Also, in the big picture this cost is trivial. 660m is less than $2 per person. Compare that to the 3T bailout or so (numbers change so quickly I can't keep up), which is around $10,000 per person.

That is a reasonable objection. But now that we have this data, there doesn't seem to be any appetite to bump up the curve, i.e. it's not about flattening the curve anymore, it is targetting zero infection until an hypothetical vaccine. Very different objective, no debate about it. And no herd immunity.

I fear particularly for a subset of countries for whom this could easily be an opportunity for highly punative destruction of rights that has been forming in the background already. South Africa for example.

No, I’m not saying that it wasn’t necessary. Simply that a more intelligent analysis would have factored in various costs and benefits, as well as the likelihood of actual events vs. perceived ones. Every action has unintended consequences, but this simple fact seems to have been total forgotten with the response to the coronavirus.

Seems like it should be fairly trivial to test.

Different countries went into lockdown at different times. When did each one's curve start to flatten in relation to their lockdowns?

What data do you think will exist by next year that we don't have now? Doctors have recorded those who died with respiratory distress and other Covid19 symptoms, and that tested positive, as being victims -- that data is here now and shows increased deaths haven't been just to co-morbidities not being treated.

Test results are available to those in power.

The data is around, it's just not public because - I warrant - politicians can't manipulate the story if the public has the full data.

> That SARS-CoV-2 was in our environment for months longer than thought, that 20% or more of Americans may already have antibodies

It's generally a good habit to do a little bit of simple arithmetic to see if the claims you are making pass a basic sanity check. If 20% of Americans already have antibodies, then how come NYC has 10x as many deaths per capita as the rest of the country? Did 200% of New Yorkers get infected?

> That SARS-CoV-2 was in our environment for months longer than thought, that 20% or more of Americans may already have antibodies

That would be a reasonable conclusion, perhaps, if the curve was flattening somewhat informally, and not specifically in places that have stronger lockdowns.

> That there's no evidence social distancing did anything at all

There’s reams of evidence in data across the world, and comparing locations in the US, that distancing has a substantial effect. Even most of the nutballs clamoring for radical reopening, like the President and his Republican allies, acknowledge that there is a trade-off in reopening, but argue that the lives to be lost from COVID-19 are a price worth paying for the near-term economic gains.

This is what (reliable, and I repeat reliable) serological testing might tell us.

Where did I, or anyone else say 'any amount of money' or anything interpretable in that way?

There were credible scenarios, which could not have been discounted at the time, in which that capacity would have been needed. Spain set up emergency hospitals in convention centres, and a morgue in an ice rink. Those were exactly the model we prepared to follow in the UK.

As for the costs structure of the US model, frankly I have no idea. The NHS here works completely differently, suppliers do price gouge we're not immune to it, but that sort of thing can't really happen at the bed-provision level as that's an administrative rather than commercial issue.