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Bracing for The Surge

Covid-19 peak in Massachusetts could be April 15, researchers think

Potential MA Covid-19 peak demands, by Institute for Health Metrics and Evaluation.

The feds have agreed to ship at least 1,000 ventilators to Massachusetts and state officials begin to clear out some nursing homes for recovering Covid-19 patients who still need nursing care but not intensive hospital attention, Gov. Charlie Baker said today.

At his daily press briefing, Baker said that current state projections show the peak demand on hospital resources from coronavirus patients could hit Massachusetts between April 7 and April 17. The University of Washington's Institute for Health Metrics and Evaluation, which has been monitoring Covid-19 and hospital resources nationwide, is currently pegging April 14 as the anticipated Massachusetts peak.

Baker said he was heartened when federal officials told him that the state would be getting at least 1,000 ventilators from a national stockpile by next week, which he said would make a big difference in caring for the state's sickest Covid-19 patients.

But Baker cautioned that he'll believe it when he sees them, because these days, "you don't have a confirmed order until it actually shows up."

Baker said a contract with the Beaumont Rehabilitation and Skilled Nursing Center in Worcester, with 300 some beds, marks the first of several such deals with skilled nursing facilities to move out current patients so they can be transformed into Covid-19-specific facilities and that he's looking to create space for at least 1,000 patients statewide. He said it's unfortunate current patients have to be moved, but said that dedicated Covid-19 recovery buildings will help to minimize the risks of vulnerable seniors getting infected. The alternative, he said, would be requiring current nursing homes to set aside beds for Covid-19 patients, which would be far riskier.

Baker added the state is looking to sign contracts with existing nursing homes, rather than trying to equip unused buildings, because the nursing homes already have staff, equipment and contracts for food and other necessities in place.

Baker added that although he has yet to rule out sterner measures, such as shutting parks or hunting down people from states with high infection rates, he says that social distancing and people staying at home so far seems to be helping. He pointed to all the photos everybody's now seen of deserted streets and downtowns and said that even in parks where people are going, people seem to be mostly staying at least six feet away from other people.

"I think people need to go outside," for mental-health reasons alone, he said.

The governor had a request for people who will be eligible for federal unemployment benefits who are not currently eligible for state benefits: Stay off the state unemployment Web site, because it's not currently enabled to handle their signups. He said state officials are still awaiting specific technical instructions from the federal government on how to enroll people and vowed that the instant the state has that information and can reprogram its application site, it will alert residents.

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Comments

Note - that interactive site has a drop down for each state. The graphic which displays above in the post is for the country as a whole, not MA. Choose Massachusetts in the drop down to see our specific data.

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Great job UniversalHub!

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Yeah, I grabbed the Mass. map last night, then went back today to see if it had changed (I'm hearing they've been doing some realtime updating) and, well, got the wrong map ...

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On Patriots day Paul Revere will be warning everyone that 'The Virus is Coming'

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You really need to act this joke out:

Paul Revere is riding hell-bent-for-leather to warn the colonists.

He gallops up to Farmer Smith's place, jumps down, hammers on the door, and shouts "Farmer Smith! Farmer Smith! The British are coming!"

He gallops up to Farmer Browns's place, jumps down, hammers on the door, and shouts "Farmer Brown! Farmer Brown! The British are coming!"

He gallops up to the Widow Jones's place, jumps down, hammers on the door, and shouts "Widow Jones! Widow Jones! The British are - naked...."

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You think we have it bad?

The chart for Maine estimates that they will need 9,613 beds and they only have 1,061 beds available.

Stay the fuck home and flatten the curve.

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Unfortunately a lot of people from Maine will be attempting to come to Boston hospitals.

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Oh wait, no she isn't. She'll move out of Maine like Lepage the second she's not an elected official from there. Guaranteed.

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I mean, other than your personal political biases.

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The woman works for one person only - herself. That is abundantly clear to anyone with a working nervous system. She probably isn't in the state or is holed up away from all her "dirty" constituents.

You don't ask cops to arrest a waiting room full of people when they are exercising their right to talk to their senator in a peaceful way.

She made it more difficult for Maine to respond to this: https://www.commondreams.org/news/2020/03/13/coronavirus-grips-us-critic...

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Flat out untrue. I'd go so far as calling it a deliberate lie, knowing your penchant for precision and citations.

So, your citing the 'commondreams' link is flat out untrue and wrong.

Here is, as Paul Harvey would say...the rest of the story...
https://www.newsweek.com/gop-senator-susan-collins-argued-against-870-mi...
OK, the lede, "Politico senior writer Michael Grunwald posted a tweet Friday that explained Maine Senator Susan Collins successfully argued for the removal of pandemic flu preparation funds from the stimulus package 11 years ago: "I had forgotten my own reporting that Senator Collins stripped $870M for pandemic preparations out of the 2009 stimulus."

Hardly a bastion of right wing lunacy, Newsweek had this to say about Senator Collins and Senator Schumer, "Collins wasn't the only supporter of removing the pandemic funding from the bill, according to a 2009 article from The Hill. That article quotes both Collins and New York Senator Chuck Schumer as being advocates for the funding not to be included in the stimulus package meant to infuse a sluggish U.S. economy in the midst of a recession."
"In a separate interview, Schumer celebrated the eventual removal of the funding from the bill. "All those little porky things that the House put in, the money for the [National] Mall or the sexually transmitted diseases or the flu pandemic, they're all out," he said in 2009."
https://thehill.com/blogs/blog-briefing-room/news/36372-collins-schumer-...
https://www.rollcall.com/2009/04/27/sen-collins-defends-role-in-axing-pa...
"Collins’ spokesman Kevin Kelley took aim at her critics. “Claims that she is opposed to increased funding for pandemic flu research are blatantly false and politically motivated,— he said.
Kelley noted that Collins sought a $905 million increase for the Public Health and Social Services Emergency Fund in a December 2008 letter to Senate leaders."

I can cite many more articles, but I think I made my point. The whole Senator Collins thing is just a leftie smear, untrue in its entirety.

You're better than that Swirl...or not. I dunno.

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your argument is “chuck schumer did it too”?

foh

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Susan Collins has shown she is nothing but two faced trash in recent years.

I want to wish she regrets her vote a few months ago now, but some how i don't. Its just a pattern for her. She says one thing, and magically she does the exact opposite.

I am sure I can play "follow the money" with her, I'd love to look at her "donations" and match them up to times of key votes. I am sure we could find some 'large donation' or some 'favor' that gets granted just before a vote so she changes her mind. Its always tied to money & greed.. always. Romney proved you can have a ton of money, and still put the greed aside for a split second and do the right thing. But not Collins.

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My sister on the other side of the country, who avoids the news as much as possible, had a positive opinion about Collins, because she votes against the Rightwing Republicans some. I had to tell her that Collins only does that after confirming that her vote won't matter, by checking in with McConnell. If they need her vote, they always get it. The oppo votes are just a shell game to fool her constituents. It's worked, at least until recently.

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...it's based on Susan Collins' well-known habit of pearl-clutching as her exclusive response to any crisis.

And your response is based on your personal political voices. Once again, Waquoit, thou hast railed on thyself.

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...she is a graceful woman that has courage in the face of shrieking lefties...like the ones that promised to go after her Senate seat a while back.

No, the left is not covering itself in glory with this untruthful smear.

Too bad Senator Schumer stood by her side at the time.

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she is a graceful woman

Yeah, uh-huh. I call that the "Phyllis Schlafley effect".

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No proof that she would leave the state.

And I will remind the chorus of blue staters here that Trump won the Congressional district where Sen. Collins was born, raised, and currently lives.

Bitter, bitter people. And she's not even your Senator.

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Where are you seeing that? It's saying 1,175 beds right now.
Also, how the F does Arkansas, pop 3mil, has more hospital/ICU beds (5005, 394) than Mass, pop 7mil (4848, 277)

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Just a guess, but larger states have more-distributed services. In Massachusetts, we might think we're fine with regional hospitals and just about every place is ~90 minutes away (or less) from the clusters of hospitals in Boston.
Other states are larger areas, need several of those clusters.
...like I said, just a guess

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Well, thanks for the link.
Looks like California might be, preparedness-wise, in fairly good shape. They seem to have what they need to put up a fight.
Maine looks a bit rough.

But, take a look at the shape New York is in...President Trump was right to send them the Navy hospital ship.

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In his amazing abounding wisdom, President Trump wisely sent a Navy ship to the most populated city in the United States during a deadly pandemic!

(of course, he sent it a week after he said he would, but who’s counting?)

Who would question our great head of state’s incredible wisdom and mercy?!

the almighty leader in his unquestionable prescience deserves a cookie

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Baker said a contract with the Beaumont Rehabilitation and Skilled Nursing Center in Worcester, with 300 some beds, marks the first of several such deals...

This doesn't pass the smell test. I see that the family who own this nursing home has given the maximum allowable campaign contributions to Governor Charlie Baker (R-Swampscott) and Lt. Governor Karyn "Pay to Play" Polito (R-Shrewsbury). With plenty of vacant dormitory and medical facilities already identified, is it really necessary to uproot elderly patients resting comfortably at their nursing home? How much more does the state/feds pay for "Corona beds" compared to current earnings? Has anyone considered the potential non-virus health problems sure to be infllicted on existing patients by such traumatic relocations? Follow the money.

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Sorry, Fish, you're the fish who cried wolf one too many times. Because of your incessant need to always imagine the worst of anyone who's not a radical right wing lunatic, no one with any sense will credit anything you say. Bring receipts or stfu.

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I mean ... I thought "Karyn "Pay to Play" Polito" was a right wing lunatic.

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The intelligence of this plan is that, as the story reported, the nursing homes already have everything they need in place; namely hospital beds, a food supply chain and staff. An empty dorm is simply not as easily converted to patient-care. And besides, there are sick people all over the state. It's OK to have additional capacity in Worcester.

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And I think most of his comments are harmful to any reasonable dialog. However the questions he raises here are reasonable. Baker is as corrupt as they come. I dont know if Tea Party Polito is corrupt but this should be looked at.

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But "corrupt as they come"? If you really believe he is that corrupt, how about some actual evidence?

The guy is busting his ass out there for our safety.

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I am absolutely no baker fan but when push comes to shove, he will do the right thing.

After the conf call with Trump and him getting directly quoted and calling that jackass out on his sh*t, I had to hat tip and raise a glass to old Charlie. He wasn't going to snap in line with the rest of the GOP governors.

Unfortunately now, it's going to work against him, even as a republican. Very soon it will get worse for us, and Trump will play his games again against Baker and the blue states. And Baker will have enough... I honestly think he has already considering his comments above (paraphrased) "I'll believe it when I see it" to getting the ventilators from the fed.

Charlie is sick of his sh*t.

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if Baker doesn't go independent when this is all over.

(I still won't vote for him.)

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because other people may see this.

Re-purposing dorms is not ideal, except possibly the ones that are CONNECTED to the hospitals/have medical supplies in them, like BU/Tufts/ UMass Medical. Of course, those dorms are mostly full, because they still have med students in them.
In fact, most schools still have students in their dorms. A lot fewer, but they aren't completely closed, because some students aren't able to go home.

But there are certainly some empty dorms in MA, so why don't we use them?

The obvious issue of course is that dorms don't have the medical supplies/surgery centers etc that you need in a hospital or clinic, but there are other things people don't consider:

  1. Most dorms have only one freight elevator that can hold a hospital bed and all of the people needed to move a coding patient, while hospital/nursing homes all have the large freight style elevators.
  2. Most dorm rooms don't have bathrooms attached, so patients would need to use a communal bathroom, most of which are not handicapped accessible. This would require a sick patient to shuffle down the hall, coughing, and/or have a person to go with them.

While some dorms have industrial kitchens for dining services, most do not, and the ones that do still have students in them. They also don't have a way to serve those meals, because the students go to them. There's no process for taking the food to the individual rooms.

A better option would be housing medical personnel in the dorms, but then you need to transport them across the city somehow. You can't just shuffle out of Warren Towers on Comm Ave and catch an Uber to MGH, there would need to be a shuttle of some sort. Not a terrible idea, and one I'm sure the Governor is thinking of, should he need it.

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or I am reading it incorrectly. But it states that MA has a total of 277 ICU beds. Mass General alone reports they have 150,
https://www.wbur.org/commonhealth/2020/03/27/massachusetts-general-icu-e...

Plus, again for MA, the model says we would need 937 ventilators. so with the 1000 from the feds, then we are good?

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Their model estimates a range of 1900-2400 beds needed today, while the actual number from DPH as of 4pm is 453. That's a pretty dramatic difference in this context.

I'd need more time than I have to pick through their paper to understand why it could be so far off, and whether it means we're just a few days slow getting there, if their model is too aggressive, or if we've bent the curve that much.

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Isn't it projected need by 4/14?

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Looking into the underlying methodology at the link and all its talk about excess demand and average occupancy, I think 277 is the average available ICU beds statewide, after subtracting out however many other ICU beds are usually occupied by heart attack, trauma, etc patients.

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Assuming they are in working order (which was not the case in California) and nothing else goes pear shaped.

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If you hover over the icon next to "Hospital resource use" it provides more information about the numbers.
"ICU beds available is the total number of ICU beds available for COVID patients minus the average historical ICU bed use."

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Please note:
The numbers for All beds needed and All beds available include ICU beds.
All beds available is the total number of hospital beds available for COVID patients minus the average historical bed use.
ICU beds available is the total number of ICU beds available for COVID patients minus the average historical ICU bed use.

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Would current non-COVID ICU bed use tend to be lower than average historical ICU bed use? Elective procedures generate some ICU bed use, correct? Postponing elective procedures would have started to lessen that load (I hope).

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n/t

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Wouldn't MA have quite a few to begin with? (At least, one would hope that it's the case, especially given all the specialized operations that Boston-area hospitals are globally known for.)

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Depends how many patients are sent down from Maine, NH, VT and cross over to invade us from RI (maybe we need a wall to keep those from RI out or require state police to harass people with RI plates?).

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It's based off average hospital/ICU occupancy. Most hospitals keep their hospital and ICU beds relatively full during normal times. The hospitals that I'm personally aware of have basically emptied their inpatient units for this surge. However, even starting with a completely empty hospital there will always be beds required for non-covid patients. Even using up non-traditional ICU spaces (step down, PACU, OR, etc.) for non-covid patients we might run out of places to put patients.

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The 4,848 beds available isn't a very accurate number.

All beds available is the total number of hospital beds available for COVID patients minus the average historical bed use.

But our current use is well below average historical, for two different reasons:
1. With the non-essential businesses closed, ER visits are down ~25% across the board. Not just traumas, but all visits.
2. Elective surgeries were cancelled two weeks ago, and still are verboten. All of those folks would be recovering in hospital beds for zero or more days, and they're not because they're stuck at home with a still-bum-knee or bunion or whatever.

There are other *possible* reasons, though I'm not aware of the data supporting these just yet:
3. Doctors are figuring out how to get patients home a bit earlier. Send 'em home instead of one more night for observation. Not every patient, not every case, but sometimes.
4. We're building more beds! Old nursing homes, hospitals, and other well-wired buildings are being converted.

I don't know if 1-2 (or even 1-4) are enough, but they are effectively adding to the total number of available beds.

--

There is something that will take away beds though. Out-of-state patients. As it is, Southwest Connecticut is pushing any patient it can toward Hartford to make room for NYC overflow. Hartford will push too -- north to MA, east to RI. If RI has trouble, they'll push north into MA. And, when Maine struggles, and when New Hampshire struggles, they'll end up in MA too.

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The last time I looked at that site the prediction was for about 2,000 more with a peak of April 12. That means that we may be bringing that peak down and attenuating it.

If so, that means that we need to hold our ground on the social distancing because it may be working.

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It would be interesting to see a plot of the prediction cone as the prediction changed over time. I wonder if that information is accessible on that site... maybe in archived page views.

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...if you right click on the page, it gives you a screenshot option, page or just screen. It'll be interesting to see how the predictions pan out.

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Looking at the total beds available / projected need and ICU beds available / projected ICU bed needs, we should be at or above ICU bed capacity since Sunday 3/29 through April 26th and we will be at total bed need at or above capacity between 4/8 and 4/22.

Those are bad periods to be in. Once demand for resources exceeds capacity, it's bad news for everyone under that curve.

Production and acquisition of equipment and supplies will increase, temporary facilities and additional bed capacity will increase as time goes on. But what happens when our already fully taxed healthcare workers have to continue working beyond capacity? Even when we get to the down slope, they will be spent. And it's not easy to replace an entire workforce that spends years in school to be even minimally qualified to do those jobs.

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Today's forecast has shifted the peak to April 15, with yet another reduction in peak intensity (6,072 peak total beds, 929 ICU beds).

A projected 1500 or so deaths total for the first six months of the year. That's more than 4x our yearly deathtoll for motor vehicle crashes.

Still overwhelming the system, but improving due to our behavior.

Hold your ground and keep flattening that curve!!

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