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Comment by bearjaws | Hacker News Reader

While these numbers might be inaccurate, what is actually going on right now is starting to look very grim.

Every nurse & Dr I know is getting massive bonuses (200-400 a DAY + hazard pay) to pick up 1-2 extra shifts. Recruiters are offering contract jobs at smaller hospitals north of $100 an hour for 12 weeks, with housing. We are weeks away from Doctors & Nurses working 48+ hours a week. (Do you really want to be treated by someone on their last 12 hour shift on overtime?)

There is not much staff left to deploy to help with the rising case load. Florida hospitals will soon be overwhelmed.

I hope we peak here soon and learn a valuable lesson going into winter, where we will have to deal with both corona virus and influenza.

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My 70 year old FIL regularly works 60-70+ hour weeks as a doctor. Nothing to do with Covid, just because that's how the hospital shifts are set up. They regularly put him on 15+ hour shifts. They started thinking he had dementia and it was just chronic sleep deprivation.

It might have something to do with less transitions being safer: https://www.advisory.com/daily-briefing/2017/02/14/transitio...

or hospital control of the labor market:

https://www.theatlantic.com/business/archive/2017/02/doctors...

Personally, I don't see how it's good for anybody, but supposedly it doesn't affect patient safety: https://consumer.healthday.com/general-health-information-16...

> In 2011, new restrictions were put in place to limit residents' shifts to 16 hours or less. > Since then, however, there have been signs that the hoped-for benefits were not being realized.

Well, yeah, because 16 shifts is already way too long.

My wife is a nurse at a large hospital (in the northeast) and as of the other day they were down to 1 covid patient. She's seeing nurses actually get laid off because the hospitals initially planned for a large influx of covid patients that never came.

Hospitals initially cancelled most elective procedures (which is what pays the hospital's bills), which helps explain why hospitals are more likely to flag a death as "covid-related", so they can collect federal covid money to make up lost revenue.

Also, picking up extra shifts isn't the same thing as a "massive bonus"....and "travel nursing" (where they pay for housing) has always paid a lot of money, even before the pandemic.

The northeast had to plan for a wide range of outcomes because of the uncontrolled covid outbreak that killed tens of thousands. The excess death rate tells the story and lots more people died than the baseline rate from prior years (on top of major decreases across other categories of mortality). The same is happening in Florida: many more people are dying than expected right now for _some reason_. It's reasonable to think it's covid, and all of the reports of ICUs nearing or hitting capacity due to covid cases is pretty hard to square with any other explanation. At a policy level, the NY/NJ/CT area stopped its outbreak with a strong regionally coordinated response that Florida has notably not done.

> the reports of ICUs nearing or hitting capacity due to covid cases

This is the key takeaway here. You're taking the "reports" fed to you at face-value when you don't have all the relevant information. If 10% of beds in a given hospital are listed as "available for use", and all 10% are accounted for, a hospital can claim they are at 100% capacity.

This statistic-manipulation is not only being done with hospital capacity numbers, but also with covid test numbers, and covid death numbers. Statistics have been messed with like this throughout history. Wake up people.

If you have any good sources on excess deaths, can you share them. My understanding is that it is difficult to separate Covid deaths from mass deaths caused by hospitals shutdowns and fear of hospitals.

https://www.economist.com/graphic-detail/2020/07/15/tracking...

Here's the CDC's data on this. You can download as a CSV for more details. (This is only for the US.)

https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm

It's looking grim for plenty of reasons, but nurses and doctors working 50+ hours is not new. Some docs do that their entire career.

Also, if you've ever been treated by a resident, they were almost certainly over worked, they move to cap their hours at 80 per week received pushback from docs saying that residents needed 80-100hrs/wk for training.

To further build off this point, shift changes are incredibly dangerous at hospitals because there is usually specific patient knowledge that isn't sufficiently passed from the outgoing workers to the incoming workers. So if we are optimizing for patient health, it isn't as simple as just having them work less hours.

That actually is, because the doctors and nurses make more mistakes when they are tired.

It that were the case, you would expect the danger to come towards the end of shifts and not from the changeover itself or beginning of new shifts. The problem is the passing of information. Some places operate on a 12 hour schedule and some on an 8 hour schedule. It isn't clear that the 8 hour schedule is actually safer because while workers are less tired, you increasing the number of daily handovers by 50%.

And meanwhile both 12 ams 8 hour schedule places involve people who were at work more then 24 hours or had massive overtimes last weeks.

Yes I'm so sick of the "need to work long hours" bullshit. It's an incoherent argument.

Higher more people, overlap shifts, problem solved.

>Higher more people, overlap shifts, problem solved.

Sure, sometimes the solution is to just throw more money at the problem. However that doesn't mean the money is available to dedicate to that solution.

If the problem is money, they should just say so. The "but the outcomes" talk is still a lie.

Also US healthcare is so grossly inefficient it doesn't make sense to look at one cost center in isolation from a policy perspective, only from a the perspective of private sector actors I think shouldn't exist.

Hiring clinicians is expensive. Healthcare is already 18% of GDP. Where would you propose to get the additional funding?

Are you claiming the work hours of doctors are the expensive thing in all that?

I feel like this is an excuse more than anything. If there are higher complication or medical error rates as a result of patient handoffs, the solution isn't to make the medical team work longer hours, it's to fix miscommunications wrt the handoff process.

I completely agree, but this isn't a new problem in medicine. If we couldn't fix it during normal times, I doubt we are going to fix it during a pandemic when staff are already overworked.

How specifically would you propose to fix miscommunications? Communication itself takes time, whether it's entering data in an EHR or talking 1:1 with your shift replacement. Time spent on communication is time not spent on delivering direct patient care.

Can humans even effectively learn/train @ 80-100 hrs/week? 90 hrs/week + 8 hours sleeping(all-in) leaves 3 hours/day for "personal" non-(work|sleep). Or, alternatively, it leaves 1 full day free per week, with 6 days where there is only 1 hour/day for personal activities.

It depends on what you mean by effectively. Slaves routinely worked sun up to sun down 6 days a week. Long work weeks are common in some developing countries now.

Two of my family members are nurses. Both have covid19. They can't work. We will run out of nurses first. We need open air hospitals yesterday. We need to allow volunteers yesterday.

A friend of mine works at a large hospital in the New England area in the ICU. Having COVID19 is no longer enough of a reason to stay home. It's assumed you're going to get it, and have to really be suffering from it before you're allowed to stay home. Similarly, this friend says that they've seen people they KNOW has it walking around without a mask.

We are so screwed.

The 7 day moving average of percent positive tests in Florida peaked five days ago at 19.6% and looks to be on the descent. Let's hope it stays that way.

https://coronavirus.jhu.edu/testing/individual-states/florid...

Looking at that graph, the percentage of positive tests peaked just before testing increased. I'm not sure that indicates the spread of the virus peaked rather than increased testing capacity resulted in less stringent requirements for tests and a lower positive rate.

It is by no means only just now starting to look grim.

The media is trying to make it seem much grimmer than it actually is since it's an election year. I don't really know why, but they push the virus dialogue every election season. This election year it's the coronavirus, last election (2016) was the Zika virus, the 2012 election was the Ebola virus.

I'm aware it sounds crazy, but food for thought.

https://trends.google.com/trends/explore?date=all&geo=US&q=e... https://en.wikipedia.org/wiki/Ebola_virus_cases_in_the_Unite...

2014

The Zika and Ebola outbreaks were not pandemics.

The media in the U.S. was doing their absolute best to make them seem like they were. Truth isn't really relevant when spreading fear.

> they push the pandemic dialogue every election season. This election year it's the coronavirus, last election (2016) was the Zika virus, the 2012 election was the Ebola virus.

Neither Zika not Ebola outbreaks were, nor were pushed by the media as, pandemics (also, the 2012 Ebola outbreaks, depsite being in a Presidential election year, received minor news coverage consistent with their magnitude; the major media coverage of a recent set of Ebola outbreaks was of the 2014 set, which were not in a Presidential election year.)

The media is reporting a pandemic in 2020 because one exists, just as they did with the flu pandemic in 2009, which you will note was not an (US federal, even midterm) election year.

....from the "American conspiracy theory which falls apart as soon as you realize other countries exist" department.

Is there any indication that all these locations have stopped all elective surgeries and procedures? Most early states did that, which hurt the bottom line tremendously, but enabled all hospitals to stay below capacity. From what you are writing, this doesn't seem to be the case. Covid19 doesn't cause a shortage in medical staff. It causes a shortage in capacity and beds.

And when influenza hits (starting usually September 1st) it is going to get even worse - that will place a lot of load on the system as well.

We will be lucky to end up with less than 750k dead and/or end up locked in our houses for 8-12 weeks straight.

If influenza hits. Most anti-Covid measures are universal - we should have the lightest influenza season in history.

Yup. In fact, when I saw one of those conspiracy "Covid is a lie" memes that used "flu cases are down!" as a talking point, I quite literally didn't get it for a minute. I thought to myself, "Of course flu cases are down when everyone's sheltering at home in March and April, what's their point?" It took me a very long time to realize that they were pushing the conspiracy theory that flu infections were being intentionally miscategorized as covid infections.

Good points! Fortunately, we can prevent influenza and corona with the same measures of mask, social distance, remote work, etc.

I am concerned for the US economy long term. The pandemic will kill 100k more at least, current projected deaths in just a couple months is up to 150k, which doesn't count the winter ahead.

But considering how damaged our collective productivity is going to be from 3/20 to 3/21, we are in for unemployment above 10% for a very long time as shutdowns and closures continue.

Will all the musicians, music venues, sports venues, museums, bars, restaurants, parades, weddings, etc still be the same after mass vaccination? I think they will all be hollowed out industries, we will not achieve that level of culture for a few years...sigh.

Anyone else feel depressed to be American?

And on 3/21 hundreds of thousands will be dead that likely would have otherwise been alive. We’re already at 1/3 the number of Americans who died in WWII, in less than half a year. They won’t come back in “a few years.”

What’s insane is how much more under control this could be with federal leadership, and a more compliant public.

> Anyone else feel depressed to be American?

Yes, especially since getting the virus load down to a level that can be effectively managed with testing and contact tracing isn't rocket science. We were doing okay through April then just gave up (at least that's what it seems like in Texas).

Yes; it's become beyond obvious that there will be no leadership whatsoever on this issue until at least January.

There was a period where some states were working together, but I don't know what happened to that -- maybe we just stopped hearing about it, maybe the relative success in New England caused that to fall off my radar?

Of course, the federal government is also actively working against state-level leadership on Coronavirus, which is worse than doing nothing.

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