Here are more details so people can get an idea of how things work.
A National Emergency for coronavirus is declared, which changes a few things. So here's the Primary Health Care scenario:
- The entire population is suspect, so no more laboratory tests for coronavirus are done.
- A "contaminated" respiratory circuit is developed at the clinic, and which is separated from the rest of the outpatients and health staff. Anybody coming with a cough, or who is sneezing or any respiratory sign is derived there and kept separated from those who say have wound or any non-related respiratory illness. That way, contagion is not propagated to the entire clinic, but is kept isolated in the respiratory circuit who has his own specific doctor.
-The electronic bureaucracy is set in place so that those with a respiratory illness and need to stay at home because they are suspect of carrying something, can get an international code related with the coronavirus label, so they can get their appropriate sick leave paperwork and appropriate days of isolation. Remember, no tests are to be done by now because the entire population is suspect due to the declaration of the national emergency alert. The person can have a common cold, could be coughing from a seasonal allergy, or the regular flu... Since it's a national emergency, it gets labelled as coronavirus related.
- Create a section in the electronic system where all people with doubts regarding the coronavirus or who have respiratory symptoms can make teleconsultations with doctors. Remember, every time a doctor has to write down anything related to a patient's consultation, he or she has to write an electronic note in their file under a diagnosis. In this case, a new diagnosis has to be created just to write down that you talked with someone in the phone. Because of the national emergency, that label falls under the international codes related with the coronavirus.
What I'm trying to say is that that creates a bunch of coronavirus labelled diagnoses when there was no actual laboratory test done and/or when the respiratory illness could have been anything from the common cold to the typical seasonal flu caused by a non-coronavirus. However, these "coronavirus" labels can now be used for statistical purposes.
As far as hospital care, I don't do that any more (I hope!). However, I worked in the past in European hospitals and know their systems.
Exactly, which is what Joe is saying:
Exactly!
This is so obvious to me as a practitioner that I find it hard to realize that it needs explaining. It means people really live in a bubble and have no clue as to what real life really looks like in the health care trenches.
Say a 88 years old patient has a fever. He was coughing the days previously. A doctor might find he's on respiratory failure. In his medical history you find that he has chronic kidney failure (as most elderly do), heart failure, chronic obstructive pulmonary disease (COPD), diabetes, high blood pressure, atrial fibrillation and hypothyroidism. This is not unusual on someone this age and that's why a patient like this could be taking 12 medications, including potent blood thinners. A person such as the above, is likely to be labelled COPD - exacerbation. He or she would be prescribed antibiotics, nebulizations, cortisone, etc. They might test for microbes and find a bacterial infection AND the coronavirus. They will easily find he or she has a urinary tract infection. He or she might have internal bleeding due to the potent blood thinner and its interaction with the antibiotics or any new treatments. If he's not making progress and his organs start to fail all at once, a call to the ICU might be in order. The ICU doctor might not take him into the ICU because he's too old. Nevertheless, the patient might get better. Some don't and die. With so many issues and his age, some will say it was his time to pass away.
European hospitals and clinics are overburdened with patients like this because there are many patients like these. Nevertheless, assistance and a pretty good health care is always provided until the very end. I was often surprised how much Europeans (Italy, Spain) cared about their elderly. Now I got used to it. In other countries, they just don't bother.
As I said before, ICU doctors always run a filter, so they can have beds for those who don't have so many diseases piled in one very old body, which basically signals to them that it's time for this person to pass away. It can happen that health staff get so fixated into treating old patients, that a younger person doesn't have a ICU bed when is needed, i.e. respiratory distress induced by the flu.
In the example above, and for bureaucratic purposes, each disease and infection found will have its own international code for labelling purposes. First cause of death might be cardiopulmonary arrest and/or multiorgan failure. Second diagnosis might be bacterial infection. The coronavirus label will also have its code for statistical purposes. And that's where the numbers are coming from. They come from specific international codes used on doctor's files. It doesn't mean the coronavirus killed the person. As I said in previous posts, some people have so many diseases, that any banal bug could take them out.
As I understand, only patients that are admitted to the hospital (not even patients consulting the ER and who are sent home) are being tested for the coronavirus. That means the mortality will represent this population, not the general population. Only patients that are in a pretty bad shape get admitted.
From the head of the Italian Superior Institute for Health, we gather the following data (note, the video is one of several that contain all the information):
It bears repeating, this season is not very different from the ones before. Actually, I remember 2016 and 2017 as being particularly bad. Many patients that I was called for a home visit back then were already in respiratory failure and all of them had serious underlying health problems and/or where over 85 years old. A guy was just over 40 years old, but he had Down Syndrome and thus, much older than his biological age.
What has happened with this "pandemic"? We went to seeing from 30 to 40 patients per morning (and I have seen over 60 patients in one morning), to seeing 10 stable patients per morning. Those with diabetes, cancer, heart failure, COPD, etc. have to wait out at home, enclosed, until we get the green light that they can continue with their medical visits and follow ups. Too bad if they catch up the cold or anything from the stress this pandemic is engendering. If they end up in the hospital, they will run the coronavirus test, because after all, it's pandemic time. In the time being, they are waiting patiently at home and are very understanding of the system that told them to wait at home because it has to deal with more important issues right now.
The best!
