Saturday, July 18, 2020

Not Great News

So, I had the chance to visit the hospital today. I punched a palm-sized hole in the back of my calf and I had to visit the wound clinic. Very painful. Go figure. Anyways, what I found at the hospital was a little worrying. They've laid off about half their staff. Hmm. Let's discuss.

When I got to the hospital, it struck me how empty the parking lot was. I figured it was just early, but it really wasn't. I used the valet, which I always do, but which is the only option right now. I know these people pretty well because I tend to talk to everyone and some of them love to chat. So we caught up on old times.

They told me that about half the nonmedical staff got laid off. Most of the valets got laid off and those who remain work about 20 hours a week instead of 40. Inside, I ran into a couple nurses I know from the wound clinic. They were checking temperatures at the front door. Again, I stopped and we chatted. They told me the hospital has laid off half the nurses as well, with many more having their hours slashed, and they gotten rid of a number of doctors. The one nurse said that this was the first time since February that she'd actually had a 40 hour week. The other went three months without working. I even came across a room where they stored a ton of modern computer gear which the nurses wheel around, suggesting massive cuts.


Why? Well, it turns out that there are several causes. First, the hospital used Covid as an excuse to cut things that were never all that profitable. In the past, I guess, they didn't want to be seen as lacking services and now they don't care, so they slashed away. Similarly, after buying up every practice in town when Obamacare came out, they are now outsourcing everything. Third, a lot of patients stopped coming for anything that isn't really serious, making the problem worse.

What worries me are two things. First, the lesson from Covid was that we were unprepared for the unexpected. We simply did not have enough capacity for anything more than ordinary care. The solution was obvious: build excess capacity into the system. The hospital's response is the opposite. It cut capacity and slashed its facilities to the bone to save money and raise profit. If there is a serious emergency now, having this big pretty hospital will provide pointless because its hollow. That's not good -- and I suspect medicine isn't the only field that is doing this either. Part of this I put on the ownership of the hospital, who are entirely about the bottom line and being as profitable as possible. Law firms act like this. It doesn't matter if you make money for them, you need to make enough money to justify their time. Apparently, hospitals are going to this model.

I also put this on the political class who continue to regulate the hell out of hospitals but have done nothing to require increased capacity and fund it. Unfortunately, I think this shows that the powers-that-be do not have the public's interests at heart... or just aren't that smart.

The other thing that worries me is the depressed activity. If people are skipping medical needs out of fear or finance, then times are much worse than they seem. On the surface, things seem to be running nearly normally again around here, but this suggests that's an illusion. I'm curious what you all are seeing where you are at? Are things quasi-normal or is that an illusion?

Finally, while I'm in the process of giving bad news, something I have long feared is proving true: there will be no vaccine. It's turning out that the antibodies created by having Covid don't last long enough to give meaningful immunity. All you get is a couple months at the most. That means this thing won't be going away, even after most people have had it. Backing this up, follow the money and you'll see that most of the drug companies have gone from working on cures/vaccines to figuring out how to treat the symptoms. That's not good.

Ultimately, I think we will have to accept that this thing will stay with us or we're going to have to do something more drastic. I guess we'll see.



drjim said...

That's depressing news, Andrew.

Here in Northern Colorado, things have been returning to normal. Emperor Polis down in Denvertopia has made mask wearing mandatory this week. Some counties are telling him to go pound sand, as he's already made statements it's unenforceable.

Other than that Big City BS, people are working here, restaurants and other business are doing fine, and people are out and about their business.

Our friends in Wyoming were never really hit hard, regardless of what the Lame Stream Media is saying.

AndrewPrice said...

Hi DrJim!

It was depressing. We've been all over the state in the past few weeks and everything seems pretty normal -- though half the restaurants are still takeout only and the other half are running at half capacity. But the businesses seem busy and people seem employed. But this makes me wonder if that's an accurate view? Is the progress an illusion?

It also worries me that our "leaders" don't get it. When do they ever, right? But this one is simple. When it's clear that you cut to far and left society vulnerable, then it's time to thicken the cords. Instead, it's full speed ahead in the wrong direction.

I'm not sure about Wyoming, but I can say that things never got bad around here. I know some people in Arizona and they are all getting sick. I still don't know anyone in Colorado who got sick.

AndrewPrice said...

BTW, the small towns are much stricter on masks.

Unknown said...

> to save money and raise profit.

Is that your guess or do you have financials from this hospital showing "raised profits" for the period you reference?

How much more do you want to pay for insurance to fund "building excess capacity", also knows as "waste".

AndrewPrice said...

Yes, Unknown, I read the financials. Next.

AndrewPrice said...

Actually, let me explain this to you Unknown, since you obviously don't get it. All businesses have excess capacity, what you so cavalierly call "waste." It is there to cover moments of unexpected demand and seasonal variances. Japanese management concepts have introduced the idea of just-in-time inventory management, which suggests that the closer a company gets to having no excess capacity the better. In fact, they suggest continuing to make cuts right until the point where you are no longer able to meet demand. At that point, your profits are maximized. Yay.

The problem is that this style of management has zero ability to handle any problem in the supply chain. It also has zero ability to manage fluctuations in demand. Nor is it realistic for businesses with fixed facilities like restaurants that can't shrink their floor space or number of booths.

When it comes to services that are of a critical nature, like replacement parts for airplanes, medicines or public services, the idea of using these types of inventory practices is ludicrous and generally are not allowed by law or contract. Indeed, car makers, plane makers, etc. all require their suppliers to hold large stores of inventory to avoid production shutdowns because those cost of the shutdown far outweighs the little saved by having smaller inventories.

When it comes to public services, cuts are deeply problematic because demand is nearly random and ramp-up times are immense. Hence, there are way more police than there is crime at any one time to avoid the chaos that will happen if there are not sufficient police if a massive surge in crime occurs. They are even backed up by a National Guard who serve no purpose whatsoever except on rare occasions of war or disaster -- something you apparently would see as waste. There are far more fire stations than are needed at any one time for the same reasons. The local power plant too has excess capacity to avoid the system breaking on that one ultra hot day or in case of unexpected growth.

Hospitals are ostensibly private institutions, but they fall into this category of public service where they are expected to have excess capacity to cover unexpected surges. Only a lunatic would run a hospital on a just-in-time principal. You simply can't predict the number of patients or their potential needs with sufficient accuracy.

By trying to run something like any of the above on a just-in-time basis, you create very public failures. The public responds as humans always do by clamoring for the government to step in and regulate. Thus, the failure of libertarianism breeds a call for socialism... after it kills some people.

Terry said...

Here in Riverside county, in southern California,we have every Licensed ICU bed filled. However Riverside Community Hospital has half of their Nursing staff laid off because the census is so low with normal cases. Nurses have been picketing the hospital for a couple of weeks. We have plenty of excess beds that can be used as ICU beds, they are just not the normally licensed ones they are considered emergency ones.

As for a vaccine, I never thought there would be one, if you look at the history of these types of outbreaks there has never been one for any of them. They appear make people sick, kill sometimes a few and sometimes many and then just go away. During the Hong Kong flu pandemic of 1968/69, I was in 5th and 6th grade, we landed on the moon, and the Mets even won the World Series. I remember all of this, but do not remember ever hearing about a flu pandemic that may have killed from 50,000 to 100,000 Americans.

As for this pandemic, the CDC has said they call the death reporting,"P,I & c, Pneumonia,Influenza and Civid-19. We will have to wait at least a few years for the numbers to be straightened out to know the real death toll just from Covid.

AndrewPrice said...

Hi Terry,

The numbers are definitely entirely unreliable. For one thing, we don't know who has died of what. We just don't. Nor do we know how many people had it. So any sort of attempt to determine infection rates and the such is doomed.

I also think this one likely was more fatal than it will be in the future because this was its first time out and it hit all the people who are most vulnerable. Next time, I think the death rate will be closer to a slightly worse flu. But, as you say, I don't see a vaccine. So we need to learn to live with it, which we still haven't really figured out.

In terms of bed use, I don't think Colorado has nearly the infection rate of other states. The bigger problem strikes me as the number of professionals who got laid off. As so many industries have learned, once you lose that labor force, it's hard to replace -- which is why so many industries end up hiring foreigners. Welders is a good example of this. It strikes me as a very short sighted choice.

Between this and Obamacare, I hear a lot of doctors now telling people to avoid the profession. That's not good in the longer term.

Rustbelt said...

It looked like things were going to return to normal here in Penn's Woods, but Tom Wolfe- who, along with Cuomo, is challenging Whitmer's title of top gubernatorial fuhrer- was looking for any excuse to 'F' everybody else.
In May, he openly called business owners petitioning to re-open "selfish" and "cowards," then ordered the police- who complied to quite a degree- to arrest anyone not wearing a mask or protesting the restrictions and be treated lie mass murderers.
Of course, these these mandates didn't seem to matter when he marched with the BLM brownshirts in Harrisburg. (Yeah, I went there.)

Okay, I don't really have a point. I'm just venting. Been working at home for a few months. And though I don't miss the bus rides to downtown (or the many jerks you frequently have to endure while patronizing PAT Transit), I do miss the camaraderie of my coworkers.
As for covid, who's really anti-science here? I saw an article (which I can't find right now), in which one of the top doctors at Pitt's School of Medicine advocated paying less attention to numbers and more attention to severity. The basic thesis was that although numbers were going up, it was healthy people testing positive with minor symptoms- i.e. people who can better cope and don't need much treatment. Still, that didn't stop Wolf from grabbing the opportunity to issue new decrees shutting everything down again. I went through one of our local malls and it's just gut-wrenching to see how may businesses have folded.

Oh, boy. Honestly, I'm avoiding news as much as possible because it's just soul-crushing these days. Seriously. During work, in the background, I've been playing documentaries on Youtube on true crime, serial killers, Hitler, Stalin, WW1, and the Khmer Rouge. And guess what? I actually find them slightly less depressing than current news!

Yeah, yeah...i'm still venting. But I'd like to end this post, if possible, on a positive note:

-I went for a three-hour walk this evening. And the neighborhoods could not look better around here. Many flags, walkers, bicyclists, well-kept yards, and people having fun. Only the 90-degree temperatures are getting in the way.
-Exhibition baseball started this evening. Hey, I'll take anything for a distraction right now! Chuckled when I saw that, in lieu of fans, cardboard cutouts were placed behind home plate at Citified for the Mets and Yanks. Though, the Buccos clearly beat this by going full pro wrestling-level carny and piped in crowd sounds to an empty PNC Park. (Lex Luger and Goldberg, anyone?)
-Well, the Big Ten and Pac-12 cancelled their non-conference games. (So long, Bucks vs. Ducks.) But we have ten years to get things right and still have the long-awaited Daniel v. Rustbelt (a.k.a. Bulldogs vs. Buckeyes) Challenge!
-And we're only 9 days away from the NHL's pre-playoff Exhibition Games. But did they have to make the Pens play the f****** Flyers? Really?

Okay, I really just wanted to get a few things off my chest.

Andrew, buddy, I hope your latest medical condition clears up, quickly and fully.

Critch said...

I think everyone down here in the Ozarks has just had enough and started venturing out again...some of the food places are carryout only, some aren't...WE have still barely topped 110 cases total in our county, there are only 28 active cases at this time, and two deaths, however, both people were in their 80s and sick already.

tryanmax said...

Other than more and more places deciding it’s time to make customers wear masks, I’ve experienced little disruption in Omaha. The big bugger is that Walmart closes earlier than anyplace, now.

Last week, had to take my oldest to the ER. She swallowed a house key. First, we went to urgent care. It was pretty late, so it wasn’t odd to get right in. They found the key on x-ray, phoned ahead to the hospital. There, we spent the normal amount of time in the waiting room. Ended up staying the night for the GI specialist to come do the scope in the morning. No idea if that’s normal or not. He did the extraction in the morning on time and we were set.

No one in the hospital seemed stressed. Nothing seemed out of the ordinary. (We’ve had more than our share of ER visits.) When the strap on my paper mask broke, no one was even in a hurry to get me a new one.


Gov. Ricketts has set a pretty hands off policy. Maximum venue numbers is about it. Everything people are doing is on their own.

Two weeks ago, went out to a restaurant for the first time. Instead of menus, we scanned QR code’s with our phones. The codes went to the wrong page of the website.

I think my sister’s salon is booked back to normal. I’m still working from home but I hear most of R&D is back in the office, in addition to the production staff, who never left. But in general, it’s just hard to get a picture of how close to normal are things.

Some good news: I came upon a study showing that T-cells seem to be an immunity factor maybe more so than antibodies, and T-cells produced in response to earlier coronaviruses appear to confer resistance covid. In one part of the study, they looked at blood drawn as far back as 2015 and observed T-cells reacting to covid. So part of the reason some people seem ineffected may be because they gained immunity from the common cold.

I must confess, I didn’t realize antibodies were separate from T-cells. I thought antibodies came from T-cells. (They don’t, they come from plasma cells.) So now I want to know why T-cells are just coming to the fore now.

Tennessee Jed said...


Tennessee Jed said...

Tennessee has been a bit cavalier about masks in smaller towns or rural areas

AndrewPrice said...

Hi Rustbelt! Thanks!

I think it's going to take some time to sort all of this out. First, people will have to accept that Covid won't ever really just go away. This isn't polio, its the flu and it will be with us always.

In terms of sports, I'm really not sure how much is actually going to happen this year. The first athlete that dies anywhere will probably stop everything is my guess.

AndrewPrice said...

Jed, Our smaller towns seem to be strictest. I think for one thing it's easier to police those and, for another, they are awash in tourists who tend to be plague carriers and aren't particularly concerned about the damage they cause.

Our bigger towns are much more loosey goosey.

AndrewPrice said...

Critch, We've had around a 1,000 deaths in Colorado, which is tiny compared to our 7 million population. This is still largely centered in a handful of big cities.

AndrewPrice said...

tryanmax, I didn't know that either. Hopefully, it leads to something, but I remain skeptical. We seem to be good at curing specific types of diseases which take certain routes to attack and terrible at curing things like viruses and colds and more general attack diseases. I see Covid as one of these general attack things that we've never really been able to cure. We'll see I guess.

Stacy said...

I live in Rustbelt's corner of the world (neighboring county) and he's described it pretty well. I will add that I think it's going to take a while for the economy here to bounce back. My husband is a project superintendent for a commercial construction company that works mostly in a tri-county area around Pittsburgh. The project he is currently on should last until about February, but the company has nothing else lined up. They did have several projects waiting in the wings, but either companies are folding or banks are pulling funding.

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