Quote (Black XistenZ @ Dec 16 2020 09:41am)

I'm closely following the publicly available data and opinions, but I would assume that our decision-makers have access to more up-to-date or detailed data and info. Nonetheless, the absolutely chaotic communication by our political leadership over the past 10 days doesnt project confidence or expertise. They seemed to be in disarray and panicked by the recent and unexpected increase in cases (after the month-long plateau we had previously).

At the start of last week, all the stops were pulled and a concerted PR effort was conducted on all media and TV channels to sell the after-christmas lockdown to the public. For example, our national academy of the sciences came out with a statement calling for a hard lockdown after christmas. The mainstream media suddenly published article after article where various experts, politicians and leaders were calling for the same. It all seemed professional and preplanned. Then, by the middle of the week, panic noticably set in. Local governments were passing minor tightenings of the restrictions, only to call for even more restrictions mere hours later. The news cycles went into a total frenzy, culminating in the Sunday announcement that the country has to go into lockdown starting on Dec 16 (today) instead of Dec 27 like originally planned.

That this development was driven by panic rather than a cool head is not just my personal, potentially biased impression. One of our major newspapers published an article titled "all of a sudden, the politicians are even quicker [with their decision for a lockdown] than scientists had called for".



It's puzzling, but I probably have to accept that my ability to understand the background of this development/decision is limited; I'm just a commoner without insider knowledge after all.

Quote (Bazi @ 16 Dec 2020 18:17)

Yeah in an ideal world this is where transparency helps. When we locked down earlier, we were guessing. What would be the incentive to politicize a pre xmas lockdown?

Quote (Black XistenZ @ Dec 16 2020 11:48am)

Most virologists and public health experts advising our government are "hawks" in the sense that they had, for a long time, been publicly warning of the dangers of a second wave and urging for hard lockdows. One of the most well-covered of them was claiming that the 2nd wave was imminent throughout most of the summer...

I think many of them were very concerned that family visits for christmas would add extra fuel to the pandemic fire, similar to how your experts in the US were super concerned about Thanksgiving. (Here in Germany, christmas is THE family holiday of the year where all generations meet.) To me, it seems that when cases unexpectedly started going up again at the beginning of last week, they were 'finally' able to convince Merkel and the state PMs that going into the holidays without an upfront self-isolating period would result in disaster.

I dont have the expertise to assess how justified this concern is. Secondary infections of household members mean that a 1week buffer is no guarantee that all lingering infections will be noticed or over before the family gatherings take place; and many people are still going to work, sitting in crowded public transport, gotta do their groceries and so on. To me, personally, it doesnt seem plausible that closing schools and stores one week before christmas makes thaaaat much of a difference.

Quote (Bazi @ 16 Dec 2020 19:20)

Do you have information in regards to how full your hospitals are right now? It looks like your guys deaths are still peaking, so you can infer hospital numbers are higher as well. #of cases doesn’t correlate to #of hospitalizations all the time and there is a bit of a lag there. Many cases, at least here, are diagnosed outpatient then after 5-7 days they are worse abs then require hospitalization. I imagine a similar phenomenon exists in Germany where your actual hospitalized cases now are probably considerably higher to that in November given the number of deaths we are seeing. A lot of our hospitals use social media to convey the bed situation and are Uber transparent on what the status is which helps local governments provide guidance

Quote (Black XistenZ @ Dec 16 2020 12:55pm)

We have a central register of intensive care capacities. According to today's situation report, we currently have 4836 covid patients in intensive care. These 4836 patients are the result of two months with daily cases in the region of ~18k. According to the report, we currently have 4546 free ICU beds and 411 free ECMOs, plus a so-called "7-day emergency reserve" of another 11251 (no idea what exactly this means though). So no, our country as a whole is not close to saturation yet.

There are, however, three exacerbating factors:

1.: there is a delay between infections and the moment patients are hospitalized (I think 1-2 weeks?), and our cases are going up again, which isnt reflected in the ICU numbers yet.
2. like you and most experts have been saying, the actually limiting factor are not ICU beds, but ICU staff.
3. there is large regional variation in ICU occupancy. in some of our worst affected counties, hospitals are almost full.

here's a map, showing the number of covid patients per ICU bed on the county level, darker = higher occupancy rate:
https://i.imgur.com/0kECtEz.jpg

You have to keep in mind though that we're a very densely populated country. We have 83m people on the area of Montana. Distances between hospitals are not insurmountable. To some degree, we can transfer patients from saturated hospitals/regions to those with open capacities.

Source (couldnt find an English version of it, sry): https://www.divi.de/joomlatools-files/docman-files/divi-intensivregister-tagesreports/DIVI-Intensivregister_Tagesreport_2020_12_16.pdf

Quote (Bazi @ 16 Dec 2020 20:20)

You guys have a better ecmo ratio than we do wtf

With everything that you are saying and showing, Like I’ve said before, I understand your argument here. At point blank it doesn’t appear you are in immediate danger of hospital saturation.

With that said, You have yourself stated though Xmas is an enormous event and I am sure smarter people than us (at least smarter than I) have come up with predictive algorithms to this effect. Additionally I know zero about your staffing situation. Here in the US we are paying regular RNs ~8k/week in some places, such is the level of demand right now, and this is most definitely our largest hurdle.

I imagine you will also run into this similar problem that we are having: rural hospitals (sounds like they are less common in Germany) are simply not as well trained or have the same resources. Even if there are open beds in rural hospitals, the physicians there (at least in the US) are very quick to press the transfer button to a more academic /resourced hospital. National bed numbers must take into account the unwillingness of hospitals to treat covid patients

Quote (Black XistenZ @ Dec 16 2020 01:34pm)

Yeah, hospital closures in rural regions have been a problem for years. And from personal experience, I also know that the competence of the doctors in small, rural hospitals is lacking. Those who are good at their job (and arent bound to a specific place by family ties) tend to move to the more attractive larger cities, leaving the slouches and underachievers behind. In my rural hometown where I grew up, I know several doctors who unironically botch two-thirds of the surgeries or treatments they're responsible for. :rolleyes:

I guess in Iowa, the most advanced clinics are found in your Des Moines, and that's where patients ultimately end up.