Friday, April 3, 2020

Does Hospitalization Fight Covid-19?

While everybody worries about hospital space and states of emergency are invoked to demand more respirators, I keep wondering: does hospitalization help?

The short answer is that nobody knows yet. The numbers I have seen for the survival of people on respirators are all over the place, from 33 out of 98 surviving in one British study to 3 of 22 in Wuhan. (And that's just in the short term; for ventilator patients in general, many who survive to be discharged from the hospital don't live out the year.) And of course we have no idea how many of them would have survived without intervention. Perhaps we will find out when we run out of ventilators.

Patients not on ventilators seem mostly to be getting IV fluids and supplemental oxygen, and again we have no idea how much either of these things helps.

It was not until years after the SARS epidemic that we had any good data on the benefits of care, which turned out to be unimpressive. Of course this is bigger and more people in more places are getting sick, so results are coming in faster, but on the other hand the panic atmosphere means few people have time to keep good records.

When you consider that hospitals have become loci of infection, spreading it to health care workers, their families, and other patients, you have to wonder how many lives are saved by hospitalization.

Our medical system is just not nearly as wonderful as we like to imagine. Social distancing, hand-washing and so on are much, much more important than hospital space, and it looks to me like medicine won't really help us that much until we have a vaccine.


G. Verloren said...

Our medical system is just not nearly as wonderful as we like to imagine. Social distancing, hand-washing and so on are much, much more important than hospital space, and it looks to me like medicine won't really help us that much until we have a vaccine.

And yet, if you or your loved ones were critically ill, you'd absolutely not want to be denied hospital care because someone decided the difference it made was "unimpressive", and that other measures were having a bigger effect.

"Sorry, we're not going to give you an IV, or supplemental oxygen, or time on a respirator. Why not? Well, because the bean counters didn't like the theoretical percentages they extrapolated from wildly incomplete data sets. In a few years we'll find out for sure how accurate they were, and then if we're proven wrong, you can come back and complain. In the meantime, go see your local clinic for a pain medication prescription, curl up in bed at home, and hope you don't die!"


Maybe you don't realize this, but doctors swear to uphold lofty ideals, including treating those who they may not be able to save. There's more to medicine than the number of corpses to bury at the end of the day - there is the preservation of human dignity; the alleviation of human suffering; the consolation of family members and friends who remain healthy; the protection of the same from possible infection while caring for their loved ones; etc.

Hospitals may be loci of infection, but so are homes with entire families trapped inside. An infected individual who lives in the same house as their immunocompromised children or elderly parents needs to be a in hospital as much for the protection of their family members as for their own sake.


Hospital workers know the risks of their jobs, volunteer to take those risks, know what is necessary to mitigate them, and have the resources necessary to do so.

The public don't.

Which is why it is far preferable for the ill to be placed into hospitals, where their infectiousness has the greatest chance of being managed, rather than being left in their homes where they can infect others of their household, or potentially pass their disease along to public places like grocery stores, et cetera. The sick still have to eat even if they spend all week in bed, and even if someone else does their shopping for them, proximity to the ill puts them at risk for being a carrier.

I don't care if hospital care only makes a difference of 10%. I don't care if it only makes a difference of 2%. I don't give a damn if it only makes a difference of saving half a dozen lives. It's the principle of the matter.

John said...

What if hospitalization actually raises the death rate, so that in the end more people die?

That is not a theoretical question; it has happened many times in the past. It happened most recently with one of the first Ebola outbreaks, when a hospital -- admittedly a poorly equipped hospital in a poor part of Africa -- became one of the main loci of transmission.

There are many, many ways in which our health care makes things worse. If, 20 years ago, you had insisted that your loved one receive coronary bypass surgery after a moderate heart attack, because that was the expensive, medically recommended thing, you would have been hurting him or her.

Without adequate science, you have know way of knowing what interventions will help or hurt. We know next to nothing about Covid-19.

David said...

My dad had a triple (I believe) bypass in 1993 and survived for more than a quarter century after that.

David said...


In other words, when we went along with my dad's desire to have a bypass, we weren't hurting him.

If your point is that science is hard and takes time and we're just at the beginning of the science of Covid-19, fine. I'm sure most doctors and the medical system as a whole would agree with you. But that's not really what your saying, is it? Or at least, can you understand why your readers might think your real attitudes like elsewhere? You've stated before that you have a certain personal animus against the medical system.

It's like Peter Thiel. He may be able to give arguments for why college is valueless, but I think it's pretty clear that at bottom he just doesn't like professors, and thinks it's a good day when he can put five out of work, and a better one if it's ten.

I myself don't like sports, vanity pickup trucks, or the fashion industry. I could make all sorts of arguments and cite all sorts of numbers to show that those things hurt people and cost society; but in reality it's a good thing that I don't have a say in this, and that I just have to accept that millions of other people love those things and find meaning in them.

I realize you don't actually want to abolish modern medicine. Maybe what we all really want is just a little spleen-venting. Let's trade. For every hospital you shrink and ever college Peter Thiel closes, I can close one golf course west of the Mississippi (my biggest beef with sports is that a game designed for the Scottish climate should be abundantly played in Arizona, of all places--and apparently considered an "essential" business by its governor!).

szopeno said...

And masks. Don't foget the masks!

David said...

The NYT today has an article about Germany's approach to the illness that may be related to our discussion. Apparently their policy is that, if a patient has the flu-like symptoms of the illness, they leave the patient at home and send medical personal to check on them repeatedly (the nation's taxis have been drafted into performing the service of driving the medical personnel around). If the patient transitions to the more serious, pulmonary stage, when the disease can be fatal, that's when they are taken to the hospital. The thought seems to be that at that point hospital interventions can really make a difference, if the person is to survive at all.

Of course, it would probably be harder to institute such a policy in this country, where many patients would probably ignore the plan and insist on hospitalization for themselves even if they just have the flu-like symptoms (which can indeed be pretty brutal, though much less likely to result in death than the pulmonary complications).

Shadow said...


I'm glad to hear about your father, not only because he lived as long as he did after the surgery, but because I just had triple bypass surgery a couple months ago too. I did not have a heart attack. My chest burned when exercising, walking, and after eating. (Eating played a major role in when and how much I felt burning in my chest. One thing I learned is eating puts stress on your heart.)

The difference post-surgery is striking. I used to have to stop riding my bike and rest every mile or so to catch my breath and stop the burning. Not anymore. I can bike my route without stopping now (15 miles). Now I realize this had been coming on for years.

Of course now I'm locked down in the house. Can't win!!

John said...

The medical system has done a lot for me and for millions of others. My experiences in hospitals have all been great. But hospitals kill hundreds of thousands of people. According to some studies, medical errors are the third leading cause of death in the US, after only heart disease and cancer. We have learned that a lot of treatments that used to be common make things worse (like, drug-releasing stents they used to put into coronary arteries).

Yes, I would prefer something like the German system you describe. In America we have a powerful belief that hospitals are safe places where we will be cared for and cured. Often this is not the case. People should not go to hospitals unless 1) they need help and 2) hospitals have an effective treatment to offer them.

I don't object to medical care on the basis of expense; I object because it so often does no good, and given the risk that a hospital will kill you, you just shouldn't go to one for ineffective treatment.

G. Verloren said...


Medical errors kill people, but also not treating people kills people. Are you seriously suggesting that people should not go to the hospital when they need to, out of fear of medical error? Because there's not really any OTHER alternative you could be realistically be suggesting, is there?

It's also worth noting that like so many other aspects of our broken healthcare system, this a case where the US is a weird outlier, and most other modern Western developed nations don't have nearly as much of a problem with medical errors as we do. We could do much more to prevent medical errors, but we prefer a system that exists to profit private shareholders rather than to promote public health, and thus there's far less incentive to prevent medical errors than there is to cut costs.

Also note, the US has a lot more hospitalizations due to preventable diseases than other countries do, because we lack affordable preventative care. It turns out when the average person can't really afford a doctor's visit, they simple don't go, and they naturally don't get proper preventative care. You want less medical errors in hospitals? How about we do more to prevent people having to be hospitalized in the first place?


But all of that's pretty moot anyway in the context of treating COVID victims who need IVs, supplemental oxygen, and rebreathers. There isn't exactly a lot of medical error possible in those treatments, and leaving people untreated is uncontestedly a far greater threat to their health.

And remember, we're talking about a non-preventable pandemic disease: until a vaccine is created or global herd immunity is developed, everyone is going to get exposed at one point or another, and some percentage of people will inevitably require hospitalization in order to survive. Social distancing and other measures don't alter that fact, they just "flatten the curve" and slow the rate at which infections occur, buying us enough time to heal people who are currently infected so that the hospital beds and medical resources they tie up while sick can be freed up for use on people who fall ill later.

There are literally only two options available to us with our extant system - treat infected individuals at hospitals, or don't treat them at all. The idea that you could be at all uncertain as to which of the two is preferable is disturbing.

David said...


I'm delighted to hear your treatment has gone so well, and that you're back to being able to exercise (well, in theory, anyway . . . love that lockdown!). Treatments like bypass really are amazing when they work.

John said...

@G - No, those are not the only two options; read what David posted about what they are doing in Germany.

I am not saying that people who need to be in hospitals should not go to them; I am questioning what "need" means. If hospitalization won't help you, or at best will allow you to trade weeks of medical torture for a few months of life, is that a need?

And it may be cold and heartless but I would say that in a situation where hospitals spread contagious diseases so fast that hospitalization raises the overall death toll, we should not use them. I do not think the lives of nurses are worth less than other lives.

David said...

A problem with what your saying is that 1) you typically don't know what "weeks of medical torture" will result in until after you do it, and 2) even a few months of life may be precious to those who get them.

As for "I do not think the lives of nurses are worth less than other lives," I think it's potentially worse than cold and heartless. Are you really expecting every patient to ask themselves, is it worth my putting the lives of nurses--or how about anyone?--at risk for me to survive? In which case, the honorable answer can only be no. In which case, shouldn't everyone who gets infected simply kill themselves?

At a minimum, you're taking the notion of blaming the victim to a level I never thought of.

David said...

Consider how many folks might take the logic further. How many might ask, am I worthy of putting anyone else to any trouble whatsoever so that I may live? And do we really want to live in a society that encourages people to ask such questions about themselves? I don't.

Consider also that there are radical environmentalists who ask the same of the whole human race, and find the human race wanting.

G. Verloren said...


I said those are the only two options with our extant system.

There are countless ways we could improve our system, but that's not what we're talking about here. You didn't start a discussion about possible reforms to our healthcare, but rather about the value of hospitalizing people with COVID.

The government choosing to copy Germany's "medical taxi service" to bring doctors to patients for house calls to avoid hospitalizing those who don't truly need to be would be fantastic! But that's a discussion about where we draw the line about who requires hospitalization - not an argument against hospitalization itself.

And since it's all but guaranteed to not happen during the course of this pandemic, because of politics and other stupid obstacles, all of that is a moot point anyway.

There is simply no way our current system would allow hospital staff to go around conducting house calls, because the insurance companies would lose their minds over it. Germany can do it because their system works very differently than ours.