You're exactly right Curt, Italians are much more affectionate, and their idea of personal space is much closer than ours.
Max Dillon Charleston SC Mar 15, 2020 8:22:51 PM Curt Raymond via Mercedes <mercedes@okiebenz.com>: > Italy is a very different country from the USA and I find it difficult to > draw any conclusions on how things will be here based on there. They have > very little "country" or at least the way we think of it. Even out in the > hinterlands people are packed into villages and interact with each other much > more closely than we do here. > > They also touch each other WAAAAAY more than we do. When we were there last > spring people we'd just met were hugging us and kissing our cheeks in a way > we'd only do for close family or friends here. > > Interesting times anyway... > -Curt > > On Sunday, March 15, 2020, 6:56:07 PM EDT, Karl Wittnebel via Mercedes > <mercedes@okiebenz.com> wrote: > > I should say that I/we will be very happy to be proven incorrect, but Italy > is up to 1800 deaths from 25000 cases, which is much higher than China's > reported figures. > > This guy is pretty close to the coal face: > > https://youtu.be/9mrPHO-nkVE > > On Sun, Mar 15, 2020, 10:12 AM Dan Penoff via Mercedes < > mercedes@okiebenz.com> wrote: > > > > Thanks, Karl. We appreciate your candor. > > > > Dan > > > > > > > On Mar 15, 2020, at 1:07 PM, Karl Wittnebel via Mercedes < > > > > > mercedes@okiebenz.com> wrote: > > > > > > > > Dan asked me a couple of days ago to comment. This is the draft I had > > > sitting in the outbox. It tracks pretty well with what your son is > > > > > saying. > > > > > My hospital is preparing for an overload of infectious patients in > > > respiratory failure. We have tents up outside the ER to triage patients > > > without exposing other patients. We have a few cases in house but the > > > tsunami has not really hit here yet. ER docs in Houston and Seattle are > > > reporting heavy volume. The feeling it is only a matter of time. > > > > > > The CDC bungle on diagnostic testing put us really far behind in putting > > > appropriate measures in place to control transmission. One of the biggest > > > failures was not immediately adopting the diagnostic tests already being > > > used in other countries, in favor of developing our own, which then was > > > flawed, and now has reagent shortages. > > > > > > The key in South Korea was immediate free testing available on demand. It > > > enabled them to rapidly quantify the scale of the problem and implement > > > appropriate isolation policies. Here we have had several weeks where each > > > public health dept lab could process perhaps 20 samples only. So there > > > > > has > > > > > been virtually no community level testing. Docs have patients in ICU > > > intubated with CT scans consistent with COVID and even this week it is > > > taking 4 days to get a test result from quest after quest started > > > processing tests Monday. If hospital docs cannot get patients tested, you > > > know no one in the community is getting tested. Meanwhile the virus is > > > spreading exponentially because social distancing is not being > > > > > implemented > > > > > in a timely manner. We will have more testing available each day and the > > > suspicion is we will uncover a large number of cases eventually. The > > > severely ill have not hit the hospital in numbers yet because it is early > > > and the numbers of infected people are building rapidly but not all of > > > > > the > > > > > infected people who will get sick are sick yet. Basically there is no > > > reason to suspect this will be any better than Italy, and there are good > > > reasons to suspect the disease will spread further before appropriate > > > containment measures are taken. > > > > > > If it runs its course without intervention, or even with intervention, > > > there could be a considerable amount of time during which hospitals may > > > > > be > > > > > unable to care for all patients with respiratory failure, no matter the > > > cause of the respiratory failure (trauma, heart attacks, strokes etc > > > > > would > > > > > all be competing with covid 19 patients for hospital resources). Italy is > > > in that situation now and the problem is still getting worse daily. We > > > > > are > > > > > not accustomed to having to make tough , resource constrained decisions > > > about which patient to save. Of course 80% of patients will be able to > > > > > ride > > > > > it out without hospitalization, but that isnt setting a very high bar by > > > any modern healthcare standard. > > > > > > Comparing annualized incidence numbers of influenza fatalities to a novel > > > disease with an epidemic in its infancy is obviously not meaningful due > > > > > to > > > > > the fact that this is only weeks old and good prevalence/incidence data > > > > > for > > > > > covid 19 is simply lacking in the general population. We do know that it > > > can put enough people into respiratory failure rapidly enough to overload > > > the hospital system of a fairly advanced industrial democracy. How big a > > > problem that is depends upon whether you or your loved one are a patient > > > > > or > > > > > not, and how many people have friends or family members who end up being > > > hospitalized or dying during this epidemic, for any reason. Your > > > > > likelihood > > > > > of being in that group depends in part upon how long the system remains > > > > > in > > > > > a resource constrained mode of operation, and upon how large the mismatch > > > is. The mismatch between available resources and sick patients on any > > > > > given > > > > > day depends in large part upon the incidence (new cases per day), which > > > > > is > > > > > most effectively limited through early control of transmission. People > > > > > in > > > > > respiratory failure die fairly quickly, and it would be particularly > > > > > tragic > > > > > to lose a large number of people due to critical care bed shortages when > > > many patients seem to be able to recover from it given proper supportive > > > measures. Social distancing is going to be a key part of limiting the > > > spread, because there are many cases with mild symptoms who still shed > > > > > the > > > > > virus. Isolating very sick people is not enough. > > > > > > Karl > > > > > > On Sat, Mar 14, 2020, 7:07 PM Buggered Benzmail via Mercedes < > > > mercedes@okiebenz.com> wrote: > > > > > > > > > > I am not one to get too exercised about this Covid thing but that might > > > > have changed. > > > > > > > > Dr. Boy (Villanova, Georgetown University School of Medicine, Brown U > > > > resident Internal Medicine, currently Stanford U Fellow in Pulmonary > > > > Critical Care) called me a little while ago to check in on my > > > > > > > > > situation. He > > > > > > > > > is pretty low key but no bullsh*t. Tells it straight. And he’s pretty > > > > > > > > > smart > > > > > > > > > if I do say so... > > > > > > > > They have several covid patients at the hospital now. They are preparing > > > > for an onslaught of more patients the next week or two. Turning ORs and > > > > other spaces into ICUs right now. The expectation is that his > > > > > > > > > hospital, as > > > > > > > > > well as every other hospital, will be completely overwhelmed before > > > > > > > > > long. > > > > > > > > > > > > > Apparently this is now happening in Italy and is rolling into other EU > > > > countries though that has not been widely reported. It’s bad. No one > > > > believes what China are reporting though their draconian measures to > > > > contain the contagion *might* have helped lower the fatalities. The > > > > > > > > > view is > > > > > > > > > that it is really bad there and will likely be so in other places. > > > > > > > > The limiting factor will be ventilators to deal with respiratory failure > > > > or compromise. If (and this could be a big if) you get to the hospital, > > > > > > > > > and > > > > > > > > > if they have room, and there are no ventilators and you need one you > > > > > > > > > will > > > > > > > > > be SOL. Reality as there is a limited supply of these things and it is > > > > > > > > > not > > > > > > > > > large. > > > > > > > > He strongly suggested, even though I am quite healthy, that I severely > > > > limit my interaction with the world. Even being healthy the chances of > > > > catching this and having adverse effects are not trivial given the > > > > > > > > > expected > > > > > > > > > infection rate and effects. I am situated as to where that would not be > > > > too difficult to do, save some occasional trips to the grocery and > > > > > > > > > Lowe’s > > > > > > > > > and such. I’m working on my house, getting it ready to sell, so can just > > > > focus on that rather than social intercourse. > > > > > > > > I am digesting this but strongly considering revising my view on all > > > > > > > > > this > > > > > > > > > given I absolutely trust the boy, and this is the first time he has been > > > > this serious about something. > > > > > > > > As always, YMMV... > > > > > > > > --FT > > > > Sent from iPhone > > > > _______________________________________ > > > > http://www.okiebenz.com > > > > > > > > To search list archives http://www.okiebenz.com/archive/ > > > > > > > > To Unsubscribe or change delivery options go to: > > > > http://mail.okiebenz.com/mailman/listinfo/mercedes_okiebenz.com > > > > > > > > > > > > > > > _______________________________________ > > > http://www.okiebenz.com > > > > > > To search list archives http://www.okiebenz.com/archive/ > > > > > > To Unsubscribe or change delivery options go to: > > > http://mail.okiebenz.com/mailman/listinfo/mercedes_okiebenz.com > > > > > > > > > > > > _______________________________________ > > http://www.okiebenz.com > > > > To search list archives http://www.okiebenz.com/archive/ > > > > To Unsubscribe or change delivery options go to: > > http://mail.okiebenz.com/mailman/listinfo/mercedes_okiebenz.com > > > > > > > _______________________________________ > http://www.okiebenz.com > > To search list archives http://www.okiebenz.com/archive/ > > To Unsubscribe or change delivery options go to: > http://mail.okiebenz.com/mailman/listinfo/mercedes_okiebenz.com > > > _______________________________________ > http://www.okiebenz.com > > To search list archives http://www.okiebenz.com/archive/ > > To Unsubscribe or change delivery options go to: > http://mail.okiebenz.com/mailman/listinfo/mercedes_okiebenz.com > > _______________________________________ http://www.okiebenz.com To search list archives http://www.okiebenz.com/archive/ To Unsubscribe or change delivery options go to: http://mail.okiebenz.com/mailman/listinfo/mercedes_okiebenz.com
