People who have health insurance to pay for hospital treatment. In the USA, if you do not have some form of insurance, and you have to go to the hospital, you pay. There is a very complex network of private insurance plans and government run plans for specific groups, but not everyone has full insurance. Hundreds of thousands of Americans a year go bankrupt as a result.
Thanks @Dr.Drake, @RickJay. Follow-up question. Is there a particular reason to assume that one of the following two scenarios is worse for the hospital system than the other?
- High level of insurance - people feel able to go to hospital earlier in the course of the disease
- Lower level of insurance - when smaller numbers of people eventually turn up, lack of early intervention has left them significantly sicker
I had originally wondered if “insured” was a typo (for “uninsured”), but it seems there’s a possibility that the high levels of insurance are actually the cause of the problems (for the hospital system).
j
I’m pretty sure she meant the “un” to carry over.
In the US, poor people, and even middle class people without health insurance, often don’t go to the hospital. Some will get better, and others will die at home. I wondered if there might be something similar in South Africa, where not all the sick people actually sell medical help. Maybe you have national health insurance, and it’s not an issue. I don’t know.
I think @puzzlegal means uninsured. @Morgyn agrees.
I’m not sure why @GreenWyvern is now surprised that the US would be doing poorly since we’ve been saying this from the beginning of this thread. It doesn’t matter if Omicron is more mild. The US has a weak healthcare system and a bunch of anti-vaxx/anti-mask marauders. Right now our ICU patients are approaching our delta surge which was already much larger than any other first world country.
@GreenWyvern, you ask why some parts are experiencing a hospital crisis while others aren’t. Part of that, as explained, is due to differences in strength of the local healthcare system. Another, again, is political differences. Only 24% of our states have a fully-vaccinated rate of 70%. 30% of our states have a fully-vaccinated rate under 55%. We have only 20% of our citizens boosted. Since we have plenty of remote areas, there are probably a lot of unvaccinated people who have not even had covid, including middle-aged and elderly people.
But another aspect is that surges move more slowly in the US. Even with Omicron, some regions are just now starting their surge whereas other places, like NYC, started their surge about the same time as London. Time will tell whether we will see as many deaths as last winter. I will note that our deaths have been higher than the rest of the first world (~ 3X the rate of UK) since July due to delta. They’re already going right back up. Go U.S.A.!
Honestly, I don’t think we’ll know how bad it was until the surge is past, and we can take stock. Doctors at local hospitals are panicking, but there are still some open beds locally. (although maybe there aren’t really, because too many staff are out sick.) If we’ve peaked (and we may have) we will probably do mostly okay. Other parts of the country are still very much on the upswing, and less vaccinated than where I live. But maybe they have a lot of prior infection? Dunno. We’ll find out.
The SA Constitution states that access to healthcare is a basic human right.
Healthcare is divided into public and private sectors – hospitals, clinics, and medical services in general.
Private healthcare is available to those who have private medical insurance or can pay. Public healthcare is available to everyone. It’s mostly free, including all medication and treatment, but there’s a means test, so if you can afford to pay something towards it you have to.
Of course, there’s a big difference in the quality of healthcare between public and private. Public hospitals are often crowded, have long waiting times, fewer facilities, a lower ratio of doctors and nurses to patients, etc. But they won’t turn anyone away.
There’s a certain amount of cooperation between the sectors. The government contracts out certain services to the private sector. e.g. emergency medical services, where the government pays accredited private ambulance services for transporting and treating patients who don’t have medical insurance.
In practice the system works reasonably smoothly.
(Sorry for the slow reply - making marmalade!)
So am I right in thinking that a major stress on the hospital system is people who are insured and unvaccinated?
Also am I wrong in thinking that there are charity hospitals which cater for the uninsured? Although I’m guessing (if I’m correct that they exist) they must run on a shoestring and be the first to be overwhelmed.
j
Yes
I don’t think so. Lots of hospitals are “not for profit”, and they all give a certain amount of free care to the needy, but they also collect medicare, medicaid, insurance payments, and fees from those who can pay.
Thanks.
OK, thanks for the clarification. I used to work (pharma industry) with a US based doctor who also did some hours unpaid in a hospital - this would presumably have been in a “not for profit”, then?
j
Probably.
An awful lot of the large, established, urban hospitals are not for profit. For profit hospitals are mostly newer, and mostly targeted suburbs, I think.
Another problem is that the USA already had a shortage of nurses before the pandemic hit, in part because hospitals have been staffing at projected need plus a little bit rather than making sure they’re staffed up to patient requirements with extras on hand just in case.
And of course, quite a few nurses have died and lots of others have gotten out of the business entirely because of burnout and PTSD in the 2+ years since.
They were using student nurses who hadn’t yet graduated during the last surge because they were so short-handed. There just aren’t enough of them in the pipeline, either, plus the sort of care required by COVID patients really requires several years of experience to do well.
Other specialities are facing similar issues, and then there’s the use of specialists inappropriately because of short staffing. I read last night that there’s a hospital in TX that pulled a pathologist into the ER because of how short staffed they are thanks to personnel coming down with, you guess it, COVID. I get the impression that this could be a bad thing for said specialists, too, since they’re not licensed for ER work, but I am not a doctor nor a lawyer with a healthcare background and do not know for certain.
…there are massive systematic problems with the US healthcare system. But that isn’t the cause of the chaos in the US (and much of the rest of the world.)
It’s a failure of strategy.
The US spends twice as much on healthcare than comparable countries. It has 29 ICU beds per 100,000 people, compared to 18 ICU beds per 100,000 in South Africa, and only 4.6 ICU beds here in New Zealand.
What is causing the chaos is the failure to protect the healthcare system.
Here in New Zealand our healthcare system is so fragile, so under resourced, that we have invested heavily in a strategy to protect that system, because if we were to have an outbreak even a fraction of the size that is hitting Australia right now local statisticians predict our health system would collapse in only three weeks. So we start at the borders. And if it gets past the border we have mask and vaccine mandates. We have vaccine passports. We have our testing/tracing/isolation protocols. We have QR codes everywhere.
The same in South Africa. You have comparatively low rates of vaccination, however you have your alert system. You have mandates, curfews, and a range of simple measures that you have in place to mitigate viral spread.
The United States isn’t the same.
More at the link. Some of the stuff there, like Zients and Klain’s plans to “phase out any remaining support for public health measures once all adults were eligible for vaccination”, the " decision to abandon an OSHA regulation that would have protected most workers nationally", and Zients “not encouraging states to adopt covid mitigation policies like mask mandates” in December are a damming indictment on this administrations handling of the pandemic.
The strategy here, is effectively, all in on vaccinations. And what we are seeing, right now, is the results of decisions made by the administration over the last year.
We used to talk about “flattening the curve to protect the healthcare system.” But that thinking has gone out of the window here. It’s too late to worry about flattening the curve when the curve has gone exponential. It doesn’t matter that Omicron is “mild.” The damage has already been baked in.
But everybody who was paying attention three weeks ago knew this was going to happen. It’s why we were yelling “even though this is ‘mild’, we need to take this seriously.” This shouldn’t have been a surprise to anyone.
On the brighter side, that’s good news today in one of the leading indicators in the US:
The sewage authority in the Boston area has been getting regular testing done of covid levels in wastewater. Today there’s a sharp downturn, as compared to the last published data, a few days ago. Those numbers have been a very accurate prediction of Massachusetts infection rates a few days later. (I guess it take time to test and report?) It’s a nice value to watch because it’s highly responsive (not lagged, like deaths) and it’s independent of how much people are choosing to test, whether they can find tests, etc.
I think Boston was a little behind New York in catching omicron, and is a little ahead of more inland parts of the US.
I don’t think the huge increase in the recent peak over previous peaks reflects that many more people with covid, because i think a person who catches one of the recent strains sheds more viral particles than a person just as sick with an older strain. (And what’s being measured is concentration of viral particles in sewage.) That is, i think the numbers can be misleading if you try to compare strains. But within a single wave i think the data is very good.
I think this is the logical outcome of the speedy omicron spread.
Various sources suggest that the true number of infections on any given day may be 5-10 time higher than the official amount.
Taking a mid point of that number and looking at the official infection numbers (for the UK at least) from the beginning of Dec to now, we could be looking at 30+ million actual infections over that period.
Even allowing for errors in the data, uncertainties in estimates and reinfections it is clear that omicron cannot continue at its fastest rate for very long without running out of people to infect. There is already probably 30% of the population that are unlikely to be infected anyway due to natural immunity, vaccination and boosters so not surprising that the figures are now on the way down even without any additional restrictions or measures.
Following up on the last 7 days’ positive test numbers from the UK, which I posted yesterday, here’s a nice summary from the BBC:
TLDR:
…the biggest clue Omicron may be peaking, and arguably a more important measure of Covid [than positive test results], is how many cases are ending up in hospital. From this data we can see the number of admissions appears to have plateaued at just above 2,200 a day in the UK, about half last winter’s peak.
j
That is quite an outdated article. They are still moving forward with the Emergency Temporary Standard, which was held up by the courts. My employer is preparing to be in compliance.
…that was a copy-and-paste-pull-quote from the Justin Feldman article, Discourse automatically parsed the citation. Here is the full quote, for context.
It appears from your cite that Feldman is correct, that it protects healthcare or healthcare support services workers, but doesn’t cover all workers.
Dec 3: 306
Dec 11: 485
Dec 12: 586
Dec 13: 804
Dec 14: 1360
Dec 15: 1742 (Exceeded the previous highest amount of cases)
Dec 16: 2213 (192 cases admitted to hospital, 26 in ICU)
Dec 17: 2482 (215 cases admitted to hospital, 24 in ICU)
Dec 18: 2566 (206 cases admitted to hospital, 26 in ICU)
Dec 19: 2501 (227 cases admitted to hospital, 28 in ICU)
Dec 20: 2482 (261 cases admitted to hospital, 33 in ICU)
Dec 21: 3033 (284 cases admitted to hospital, 39 in ICU)
Dec 22: 3763 (302 cases admitted to hospital, 40 in ICU)
Dec 23: 5715 (347 cases admitted to hospital, 45 in ICU)
Jan 4th: 23,131 cases, 2 deaths (1,344 cases admitted to hospital, 105 in ICU)
Jan 5th: 35,054 cases, 8 deaths (1491 cases admitted to hospital, 119 in ICU)
Jan 6th: 34,994 cases, 6 deaths (1609 in hospital, 131 in ICU)
Jan 7th: 38,625 cases, 11 deaths (1738 in hospital, 134 in ICU)
Jan 8th: 45,098 cases, 9 deaths (1795 in hospital, 145 in iCU)
Jan 9th: 30,062 cases, 16 deaths (1927 in hospital, 151 in ICU)
Latest updates:
Jan 10th: 20,293 cases, 18 deaths (2,030 in hospital, 159 in ICU)
Jan 11th: 25,870 cases, 11 deaths (2,186 in hospital, 170 in ICU)
Jan 12th: 34,759 cases, 21 deaths (2242 in hospital, 175 in ICU)
Jan 13th: 92,264 cases, 22 deaths (2383 in hospital, 182 in ICU)
So today NSW finally got their rapid antigen test reporting system operating, which explains the massive jump in numbers. Included in today’s total are 61,387 positive rapid test results from the 1st of January.
From the Citizens Dashboard:
4941 healthcare workers in isolation
13,784 people in “Hospital at Home.”
156 people have died in the latest outbreak.
So looking at hospitalizations, people in ICU, and deaths instead of just “cases”, we can see that in NSW hospitalizations are up on a month ago. People in ICU is up on a month ago. And more people are dying.