I am looking at the daily updates of Covid19 cases, hospitalizations, and deaths by country and in the case of the US by state. One thing that became apparent early on is that different countries had different responses to the disease. In particular, there was a lot of variation in terms of when patients were tested. Some countries proactively tested even asymptomatic people. Other countries tested only when symptoms suggested high likelihood of this particular infection. Other countries tested only when patient was admitted to hospital, at that point being already severely ill. Other countries tested even later. The pattern that emerges is that the later into the infection that the overall policy tested patients, the higher the estimated fatality rate.
The often cited example is the large difference in fatality rates in Germany and Italy. Germany had extensive tested early one before there were a lot of cases and as a result detected a lot of Covid19 cases that later would recover without need for any medical assistance. In contrast, Italy tested those who were already sick enough to be in hospitals and this overwhelmed them to the point where there was no capability to test anyone else.
Long before this epidemic, I wrote about the need for distinct medical systems: one for high contagious diseases and another for everything else. Our existing medical system is best suited for handling the normal and nearly predictable influx of new cases even if those cases varied widely in their individual needs. We need a separate system for handling contagious diseases.
It is intuitive that hospitalization is best option when people suffer conditions such as stroke, heart attack, or some form of cancer or organ deterioration/failure.
It is also intuitive that people sick from cold or flu symptoms are best treated by their staying home, taking care of themselves, or having others in same house help out. In fact, this is the current advice even with Covid19 for early symptoms.
I assume our CDC also knows this is a good approach. Contagious people should be kept out of the hospital until conditions get bad enough and even then they should be isolated in a different wing or section sufficiently isolated from rest of hospital operations (and the associated staff and patients).
In my recent post, I raised the question of whether the CDC had seriously considered the stay at home care may be extended further into the progression of the disease. That home care may be assisted with neighborhood volunteers who take quick training on the essentials for using more advanced techniques such as providing oxygen or managing ventilators. Clearly patients are getting to the point of needing these more specialized treatment options.
It is not clear why those in the past who were planning how to deal with pandemics would exclusively focus on hospitals (or temporary versions) staffed with generally trained doctors and nurses. There was the other option of permitting a consumer market of life support appliances such as ventilators, health measurements, and so on.
When I look at images of how hospital beds for ventilator patients are equipped, I can’t see what all of that cannot have consumer variants. Such variants could be more affordable by not requiring so may displays and knobs (these can be accessed remotely). The can also be miniaturized and consolidated perhaps into a single microwave-oven sized appliance that can be installed near the bed. Trained neighbors may come to set it up and adjust things as needed.
Such consumer appliances may come with more limited manufacturer liability or certification of reliability compared to the standards needed in the hospitals to keep costs down. Perhaps the devices are designed to be returned to be recycled after the patient no longer needs it instead of reused for many patients in sequence.
Such consumer life-support appliances are definitely need to be more reliable than simple consumer appliances such as ovens or washing machines. But there are many other consumer products that do have similar standards for protecting lives. Examples include parachutes, mountain-climbing gear, wing suits, scuba gear, hazardous conditions respirators, cold-weather survival gear, off-road vehicles for long excursions far from anyone, etc. The consumer’s life is likely lost if any of these consumer products fail during use. Yet they remain available to consumers and are used widely.
Why are there no such appliances to prolong the self-treatment at home for contagious diseases? In particular, why are there no off-the-shelf consumer devices for pneumonia treatment?
Going back to the examples of different Covid19 statistics from different countries, it appears to me that once a patient becomes sick enough to go to the hospital, his chances of dying are fairly high, particularly when the hospital resources are overwhelmed. Some of those hospitalized may have survived if they had just stayed at home. In fact, I suspect that some of those who died in hospitalization might have survived if they had stayed at home, due to complications of the stress and discomfort of being in a hospital setting.
Certainly, many of the hospitalized survivors would have died had they not gone to the hospital. The question I want answered is what is the overall effectiveness of hospitalization for Covid19 compared to the effectiveness of home care even through the worst of the disease. In both settings some will die and some will survive. I imagine that hospitalization would save more lives than home self care. What is the marginal benefit of one versus the other?
Can the margin be narrowed by simply making available consumer appliances for at home pneumonia care with remote monitoring capabilities and neighborhood volunteers who are trained specifically and only to manage this equipment?
Based on casual look at the data from different countries and their approaches for testing and their differences in reported fatality rates, it appears that there is not a large gap between going to the hospital and staying home. I think CDC should have recognized this long ago, and instead of focusing on rapid expansion of hospitalization, they could have focused on affordable and quickly available consumer appliances specific to certain complications such as pneumonia treatment.
We are not yet at the point where hospitalization is an obsolete approach for treating epidemics. The reason is that we haven’t tried.