JAMA: Delay all incoming med students

[Angus Avagadro]

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Would also like to add that the generation of docs that are retiring/at the end of their career are the first of almost any industry to be better off than their predecessors yet leave the field in worse shape for their future successors, and what you outlined in your post sums up why this is happening as well

I would have to say from personal experience that your statement is inaccurate for the following reasons. In the 60s and 70s, practicing physicians could tell the insurance company that they wanted to raise their "Profile", aka, what the insurance company pays you, and the insurance company would agree. So yearly pay increase from the insurer. Secondly, there were no limits on what you could put away in your qualified pension plan. You could put 100k into it if you liked. There have been limits on this now for decades. Its around 40k a year I think. These doctors retired quite well from a financial standpoint. This told to me by family friends and older retiring partners when I was a young attending.

 

[Angus Avagadro]

I get where you're going with this, but you mentioned so yourself: the issue is with an extortive/forceful requirement of servitude under the weight of professional pressure/threat to one's career before one has even started said career all in the name of "this is the field of serving others". I'm sure many if not most medical students (of any level) would volunteer to help out where they can. The issue is suggesting that we will not have the choice or will be looked upon as untouchable black marks if we don't which within itself is manipulative and coercive.

The fear tactics are completely unnecessary and unwarranted. If someone has reservations about serving in environments where they can contract a potentially dangerous illness and suffer physical health consequences to themselves or their loved ones, that shouldn't be a reflection of their dedication to helping others. Yes, medicine is in the business of helping others. But even my basic EMT safety rules list an individual's no 1. priority as assuring safety to oneself. "If the scene isn't safe, do not enter". I'm not sure why this is thrown out the window all of a sudden to other types of health care professionals whom should be allowed to make informed decisions about where they are comfortable or uncomfortable serving. Everyone has their own gauge of risk aversion and using that as metric to one's integrity within the field is toxic, imho.

We don't disagree. You are too young to remember when AIDS came out in the 80s, getting it was a death sentence. At the time a needle stick was a 1 in 200 chance of becoming HIV positive ergo your death sentence. We were told in no uncertain terms that these patients would be cared for. The difference was that PPE was not in short supply. 98% of covid patients, all comers, recover if statistics are to be believed, so your risk is much smaller. If you don't have protective gear and have risk factors, you can't take care of the Covid/suspected patient. If you are disciplined or fired, then you have a lawsuit. You still have a choice, you don't live in China.
And yes, people may judge you on your choices. Get over that. You have to live with your choices and your integrity, Their opinion has little value.

 

[PreachyMusican39]

I'm going to go a bit against the grain here and say that I think whether medical school gets postponed a year will be a separate decision from whether or not to enlist incoming med students. If they do decide to postpone med school by a year, then I would actually be really grateful for the opportunity to work in a hospital provided that I will be paid. I've been funding my undergraduate career and right now all of my jobs are coming to an end in part because I'm graduating and also because of this pandemic. I can't afford to be a volunteer for a year, but I would gladly take a job especially a job that allows me to help, however little, during this pandemic.

 

[IDapplicant]

But why do we keep glossing over the fact that for every accepted medical student there are 1.5 that were not accepted, many of whom would probably love to bolster their application with some experience. We can do things to alleviate the worker shortage without sacrificing 20,000 physicians.

 

[PreachyMusican39]

I'm not glossing over that. That makes sense to me. My point is only that IF they decide to hold off med school for a year, I HOPE they give us the opportunity to have work because that would be invaluable to me as far as being able to support myself during this insane time.

 

[AnatomyGrey12]

If you don't have protective gear and have risk factors, you can't take care of the Covid/suspected patient. If you are disciplined or fired, then you have a lawsuit. You still have a choice, you don't live in China.

I assume you've paying attention to the literal tsunami of resident stories coming out of COVID hot spots?..... Yeah residents have a "choice" alright, do as you're told or you can leave with 400k of debt and no avenue of paying it back. I stand by my statement earlier (not directed at you), if any other industry treated their workers this way it would be shut down for human rights violations.

Healthcare workers die at proportionally higher rates secondary to higher viral loads. I'm not sure the "98% of patients recover so your risk is lower" is correct or reassuring in this context.

 

[PreachyMusican39]

But I absolutely don't agree that it should be mandatory. I honestly have no qualms with working in a hospital right now because I am young and healthy. It would be very unfair to have the same standard for nontrads, people with preexisting conditions, and people who do not feel comfortable due to safety. I'm aware that the deathrate is 0.2% for my demographic and I am comfortable with the risk especially if I can take the place of someone who is older or at higher risk.

 

[PreachyMusican39]

Honestly if they do decide to postpone med school a year I'm terrified because my backup job back home has always been being a lifeguard and right now that isn't exactly something i can rely on. I'm not trying to virtue signal or anything, just honestly don't know how else I would be able to support myself for a year.


I'm also a psychology major if that helps clarify... Definitely went all in on getting into medical school a bust

 

[AmaranthMoor]

But it war in more than one way. While the medical battle is being fought in the hospitals, the "home front" of the civilians are being ordered to behave in a different manner on a societal scale. In World War II, there was rationing and people taking jobs then had never done because they simply

needed the "manpower." In that sense, that attitude, it will be the same here

“Hup-two! Hup-two!” Old gonnif cries
With dreamy glory in his eyes
“All of you premeds, fall in line
And MARCH—don’t let me hear a whine!

“You whippersnappers ought to know
What WAR was like, so long ago!
When sammy drafts you for the FIGHT
I want salutes—stand straight—FULL might!

“For MY wet dream, you all should know:
Premeds, with nowhere else to go
Should waste an extra year of life
Delay the fruits of 8 years’ strife
While drowning all the while in debt
Many who live like paupers yet—

Should be herded and promptly sent
To jobs that barely pay the rent
And possibly may risk their health
If not long-term concerns on wealth—“

“And—WHAT? You think it’s EXPLOITATION?”
(He swells with righteous indignation)
“You miserable, weak premed lot
Should be THANKFUL for what you’ve got!
The chance to train for NINE years straight
Is actually BETTER than eight!”

Now listen, gonnif, my good man
I’m just as much an ardent stan
Of action by community
I volunteer, glad as can be,

But this weird armageddon spiel
Is just too much for me to deal
Delete it, sir, before it leaks
It smacks of privilege—nay, it reeks

All that this war-like language nets
Is that the country all forgets
That docs AREN’T soldiers, and deserve
To question admins that they serve

So I’ll repeat, before I go
What you told me five years ago
A little rudely, on a post
Advice that will now help YOU most—
(Maybe that’s why I’m salty, still)—
Remember when you told me, “Chill?”

 

[Matthew9Thirtyfive]

The difference was that PPE was not in short supply.

Just being in the same room or even touching an HIV patient won't give you HIV. Viral burden in COVID is a thing, and being around lots of COVID patients can make your prognosis worse, apparently. So not only just being in the same room greatly increases your risk of getting it, but being around multiple patients with it can make your disease course worse.

So not quite the same.

 

[ComebackKid345]

The “salary” offered will amount to peanuts if this plan is ever implemented. The part about “graduating some students a year early” sounds like a preemptive measure for those incoming students wondering how they will make up for the missed year of attending salary to the tune of ~$200K. And let’s be honest, after this pandemic is over, does anyone really believe admins would allow students to graduate a full year early?

You know what would get incoming students to buy in? Reducing our debt load by the amount that is the difference between the volunteer salary and an average first year attending salary. I would sign up for that in a second. But what I wouldn’t sign up for is paying full priced tuition in addition to delaying my graduation by a year.

Anyone making arguments about altruism here and how incoming students should do this out of the kindness of their hearts should put their money where their mouth is. First and foremost the author of this article. I call on him/her to donate their salary for this year, after all, we are in a pandemic and they signed up to help people when they went to medical school.

 

[IDapplicant]

Honestly if they do decide to postpone med school a year I'm terrified because my backup job back home has always been being a lifeguard and right now that isn't exactly something i can rely on. I'm not trying to virtue signal or anything, just honestly don't know how else I would be able to support myself for a year.

That totally makes sense, and my comment wasn’t directed at you. I agree that if it is postponed, I would probably take them up on that opportunity to work in healthcare. I just think that this is a poor solution and is utilizing the wrong resources.

 

[Angus Avagadro]

I assume you've paying attention to the literal tsunami of resident stories coming out of COVID hot spots?..... Yeah residents have a "choice" alright, do as you're told or you can leave with 400k of debt and no avenue of paying it back. I stand by my statement earlier (not directed at you), if any other industry treated their workers this way it would be shut down for human rights violations.

Healthcare workers die at proportionally higher rates secondary to higher viral loads. I'm not sure the "98% of patients recover so your risk is lower" is correct or reassuring in this context.

I think you give too much credit to resident employers. There will be lawsuits. Violating OSHA and CDC guidelines will have consequences. I agree with you that they think they have you over a financial barrel for the short term. I would document any abusive behavior and save it for later, like the Blue Dress. You just might win enough to eliminate that debt. I have no love for administrators, who usually are not your intellectual peer, but live behind a desk and dictate clear violations of OSHA and the CDC. Their time will come.

 

[HopeP]

sounds more like healthcare draft version of army.

 

[HopeP]

"Greetings"

This is the way the letters from the draft board would announce that you just have been selected for service into the military and I would suggest any entering medical student needs to assume that they will be drafted into service this coming year, though likely as aides or nonclinical work such as housekeeping, food service, etc. If you get a choice not to volunteer, it will likely be remembered and reflected 4 years later when you start looking for residency letter. And of course, in the end, you all can be "drafted" or rather all the medical schools in the country can be essentially compelled to do so assist in this. Let me explain

This is the reality when the "war" we are fighting is with a pandemic and the public health is the force we have to fight it with. BTW, the US Public Health Service is one of the eight uniformed service branches in the US. Legally, as individuals you cant be directly drafted into service. However, with a declaration of a national emergency as well as declaration at the state and local levels does give power to the PHS to press doctors, nurses, and non-medical personnel into work for the emergency. There is no doubt that they could do so for medical students as well as non medical staff at the schools. In NYS they have started to "draft" non-medical staff from medical insurance companies into jobs such as security at a hospital.

Ultimately, with millions sick and out of work, millions of others not working to take care of those at home sick, they will be looking for warm bodies to do many of the nonclinical jobs at the hospitals. And I will tell you, whether you want it or not, assume that your medical school orientation maybe "here is a pair gloves, here is a mask, dont lose it, now follow me." Your only option may likely be to withdrawal your acceptance. And this will go on for 6 to 24 months depending on when we have both a widespread vaccination program and antibody testing

This is what happens in war, it changes plans and changes lives. Scream all you want, but I promise, you all will be working on the front lines or close to it, the from almost the moment you show up on campus. Your first year may not actually start until next year and there not be an application cycle at many schools this cycle.

Why does it sound more like reading alternative facts?

 

[HopeP]

Sorry, but this line was legit funny.

Isn't it funny, same lawyers adviced their clients to admit to hospitals to avoid whatever..

 

[dr_kateb]

Is anyone legitimately shocked? Especially considering all the meaningless meaningful volunteering everyone had to do? Then these admins act like it's a cardinal sin to want to go into medicine for the money. It's truly extraordinary.

 

[deleted621740]

Just to put things in rough perspective:

There are about 180 allopathic and osteopathic medical schools. Let's assume that the average class size is 100 students (this is a conservative estimate) and average tuition is 50K/year.

100 students * 50K = ~$5,000,000 * 180 schools = ~$900,000,000

So this strategy would call for over 1 billion dollars in taxpayer money solely given to medical schools to essentially place their class on retainer. I can think of SO many better ways that this money could be used as opposed ensuring that unskilled incoming M1s are singled out to assist with the pandemic response effort. I know people who literally can't pay rent and can't get unemployment because the system is overwhelmed, all the while waiting for a measly $1200 that won't even cover 1 month's worth of expenses. Surely this money would be better spent employing them or aiding small businesses so that they can continue to pay their employees.

I get that it might seem reasonable to suggest that medical students be offered up for this given their intentions of practicing medicine, but if you are ACTUALLY taking the coronavirus seriously and ACTUALLY want to help, then you would not make a recommendation, in JAMA nonetheless, that would be so high cost with such unextraordinary yield.

 

[deleted972488]

April Fools?

 

[Angus Avagadro]

Just being in the same room or even touching an HIV patient won't give you HIV. Viral burden in COVID is a thing, and being around lots of COVID patients can make your prognosis worse, apparently. So not only just being in the same room greatly increases your risk of getting it, but being around multiple patients with it can make your disease course worse.

So not quite the same.

First, thank you for your service. Agreed , not quite the same. What is the same is that Doctors, Nurses, and all healthcare workers put themselves at risk, taking care of patients who could infect them for centuries. Plague, Spanish flu, Hepatitis, Tuberculosis, HIV, etc., we recognize these as a known risk we all took when entering the profession. We should all do our best to protect ourselves and our loved ones. Problem is, data is evolving on a weekly basis. What we may be doing now may not be very effective, but its the best evidence we have. We were behind when this started and have been playing catch up. Make no mistake, these are less than ideal circumstances and all we can do right now is our best. The 100 yr old injecting of serum from recovering patients seems to be showing promise. Maybe we can inoculate healthcare workers for round 2 this fall? My great thanks go out to all on the front lines who are putting themselves at risk by caring for these patients. I have said before, medicine is like football, its not for everybody. Lots of big, strong, fast people cant make it. I pray for these brave workers and their families every day.

 

[Matthew9Thirtyfive]

First, thank you for your service. Agreed , not quite the same. What is the same is that Doctors, Nurses, and all healthcare workers put themselves at risk, taking care of patients who could infect them for centuries. Plague, Spanish flu, Hepatitis, Tuberculosis, HIV, etc., we recognize these as a known risk we all took when entering the profession. We should all do our best to protect ourselves and our loved ones. Problem is, data is evolving on a weekly basis. What we may be doing now may not be very effective, but its the best evidence we have. We were behind when this started and have been playing catch up. Make no mistake, these are less than ideal circumstances and all we can do right now is our best. The 100 yr old injecting of serum from recovering patients seems to be showing promise. Maybe we can inoculate healthcare workers for round 2 this fall? My great thanks go out to all on the front lines who are putting themselves at risk by caring for these patients. I have said before, medicine is like football, its not for everybody. Lots of big, strong, fast people cant make it. I pray for these brave workers and their families every day.

I agree with you. What's frustrating is that we didn't have to be behind, or at least not as behind as we were.

 

[Raryn]

This is the stupidest thing I've ever heard of.

The incoming m1s at the vast majority of US institutions will be spending next year learning basic sciences. Yeah, in most schools it's no longer just traditional lecture halls, but if anything can be easily transitioned to online learning, it's that.

The m3s and m4s will be the ones who are completely screwed out of actual educational experiences if this continues. If anyone should be redirected to nontraditional experiences it's likely them. Residency interviews in such a scenario would likely all be transitioned to Skype/equivalent, so the M4s will probably have a ton of time on their hands anyway.

Also, the entire logistics make no sense. Who would start residency in 2024? You can't have a double size cohort 2021-2025 - the facilities can't support it.

 

[Goro]

Just being in the same room or even touching an HIV patient won't give you HIV. Viral burden in COVID is a thing, and being around lots of COVID patients can make your prognosis worse, apparently. So not only just being in the same room greatly increases your risk of getting it, but being around multiple patients with it can make your disease course worse.

So not quite the same.

Well, until 1985, no one knew what caused AIDS. All we knew at the time that it was really bad, and really lethal. That's a half a decade that doctors had to worry about getting AIDS from patient contact. Even after the virus was found, there was still the worry about blood splashes and needle sticks. There were incidents where staff, like food handlers would refuse to go into an AIDS patient's room,. and would merely leave the food tray outside the door.

Thus, having lived through that era as well, Angus' comment on AIDS are 100% accurate.

 

[Matthew9Thirtyfive]

This is the stupidest thing I've ever heard of.

The incoming m1s at the vast majority of US institutions will be spending next year learning basic sciences. Yeah, in most schools it's no longer just traditional lecture halls, but if anything can be easily transitioned to online learning, it's that.

The m3s and m4s will be the ones who are completely screwed out of actual educational experiences if this continues. If anyone should be redirected to nontraditional experiences it's likely them. Residency interviews in such a scenario would likely all be transitioned to Skype/equivalent, so the M4s will probably have a ton of time on their hands anyway.

Also, the entire logistics make no sense. Who would start residency in 2024? You can't have a double size cohort 2021-2025 - the facilities can't support it.

Agreed. I'm an MS1, and the only thing this has affected is that I do all my learning at home and our small groups are on Google Hangouts.

 

[Matthew9Thirtyfive]

Well, until 1985, no one knew what caused AIDS. All we knew at the time that it was really bad, and really lethal. That's a half a decade that doctors had to worry about getting AIDS from patient contact. Even after the virus was found, there was still the worry about blood splashes and needle sticks. There were incidents where staff, like food handlers would refuse to go into an AIDS patient's room,. and would merely leave the food tray outside the door.

Thus, having lived through that era as well, Angus' comment on AIDS are 100% accurate.

Oh, yeah I totally get it. I'm just saying, they had PPE and there wasn't really that high of a chance of transmission. They didn't know that, but we know there's a really high risk of catching COVID. But I'm not discounting the whole HIV epidemic at all.

 

[sunshinefl]

“Hup-two! Hup-two!” Old gonnif cries
With dreamy glory in his eyes
“All of you premeds, fall in line
And MARCH—don’t let me hear a whine!

“You whippersnappers ought to know
What WAR was like, so long ago!
When sammy drafts you for the FIGHT
I want salutes—stand straight—FULL might!

“For MY wet dream, you all should know:
Premeds, with nowhere else to go
Should waste an extra year of life
Delay the fruits of 8 years’ strife
While drowning all the while in debt
Many who live like paupers yet—

Should be herded and promptly sent
To jobs that barely pay the rent
And possibly may risk their health
If not long-term concerns on wealth—“

“And—WHAT? You think it’s EXPLOITATION?”
(He swells with righteous indignation)
“You miserable, weak premed lot
Should be THANKFUL for what you’ve got!
The chance to train for NINE years straight
Is actually BETTER than eight!”

Now listen, gonnif, my good man
I’m just as much an ardent stan
Of action by community
I volunteer, glad as can be,

But this weird armageddon spiel
Is just too much for me to deal
Delete it, sir, before it leaks
It smacks of privilege—nay, it reeks

All that this war-like language nets
Is that the country all forgets
That docs AREN’T soldiers, and deserve
To question admins that they serve

So I’ll repeat, before I go
What you told me five years ago
A little rudely, on a post
Advice that will now help YOU most—
(Maybe that’s why I’m salty, still)—
Remember when you told me, “Chill?”

I love this! And instantly recognized the writing style as I had saved one of your other posts in my phone 5 months ago...

 

[HopeP]

3 months ago it was ridiculous to think that:
- we all would be fighting a war with social distance and obsessive hand washing.
- that virtually every school, college, senior center, public park, movie theater, shopping mall would be closed
- virtually every international flight would be cancelled and their planes grounded
- taking a cruise for a vacation would have you stranded at sea with dead bodies on board
- people would be buying of every paper towel, facial tissue, and roll of toilet paper they could find
-10 million, yes 10 million would be out of jobs in a matter of weeks.
- doctors, nurses and the rest would be begging, begging for masks and other PPE
- New York City would break the record and get more ambulance calls in day then they did on 9/11.
- NYC would continue to reach yet a new record EMS of calls each day this past week
- hospitals would look like a war zone with lack of beds, ventilators, and equipment
- multiple governors and the military would be begging all for retired doctors, nurses and medics to come back to active duty
- field and tent hospitals would be set up in convention centers, sports arenas, college dorms and Central Park
- hospitals would need to use refrigerator trucks and ice rinks as temporary morgues
- that by the end of today we have twice the number dead then we did on 9/11
- think that we may, if we are lucky, have only than 200,000 dead when this is all over
- I would be saying we have many more months and many more deaths to endure
- I would be saying it will take 6-24 months to return to any semblance of "normal" in our world
- I would be writing this to all the premeds on this site
- I would suggest that there may not be ANY med school admission this cycle

Sounds like a recommendation to book a flight for Mars.

 

[Raryn]

Have you been to any ICU lately?

Yes. The ICU censuses here are currently below the usual average, because all elective procedures got cancelled and the number of COVID patients doesn't make up for the decrease in other conditions.

Not all of us live in NYC.

 

[HopeP]

1) this isn’t a war, it’s a pandemic. 2) infection rates are already falling because of social distancing (yes they will go back up obv but we will have the summer to work in the PPE/ventilator supply) 3) I think you’ve been watching too much CNN

I thought Fox loves war and hawkish feed to their base. Am I missing something?

 

[Raryn]

Come to NYC; it isnt alarmist... it is what will be coming to the rest of the country in various episodic waves

 

[IDapplicant]

Come to NYC; it isnt alarmist... it is what will be coming to the rest of the country in various episodic waves

The rest of the country is nothing like NYC in terms of population density and interaction (public transportation) so most other places are not likely to become anything like NYC in terms of transmission and overwhelming cases.

 

[AmaranthMoor]

I love this! And instantly recognized the writing style as I had saved one of your other posts in my phone 5 months ago...

View attachment 301698

I am trying to tell you that this is likely what will happen. the social reality of any "wartime" footing is you throw the nearest bodies you have access to at the enemy

"Greetings"

This is the way the letters from whatever messaging platform you use would announce that you just have been selected for being watched carefully and kind of nervously by everyone around you, and possibly the FBI, for referring to medical students as "the nearest bodies," and I would suggest any other person on this forum who also agrees needs to assume that they should also be regarded with a similar look this coming year,

 

[squids82]

View attachment 301706

Most areas also have a different population density that NYC which has a major effect. The leadership there has been incredibly incompetent too during all this with Cuomo reacting late and De Blasio encouraging people to go the theaters in early March or go out to bars mid March; if anything, the spotlight should be on places like CA and SF for handling it well and not being bumbling idiots.

 

[EdgeTrimmer]

In other news, Dr. Fauci thinks schools can reopen in fall.

 

[meronebib]

“Hup-two! Hup-two!” Old gonnif cries
With dreamy glory in his eyes
“All of you premeds, fall in line
And MARCH—don’t let me hear a whine!

“You whippersnappers ought to know
What WAR was like, so long ago!
When sammy drafts you for the FIGHT
I want salutes—stand straight—FULL might!

“For MY wet dream, you all should know:
Premeds, with nowhere else to go
Should waste an extra year of life
Delay the fruits of 8 years’ strife
While drowning all the while in debt
Many who live like paupers yet—

Should be herded and promptly sent
To jobs that barely pay the rent
And possibly may risk their health
If not long-term concerns on wealth—“

“And—WHAT? You think it’s EXPLOITATION?”
(He swells with righteous indignation)
“You miserable, weak premed lot
Should be THANKFUL for what you’ve got!
The chance to train for NINE years straight
Is actually BETTER than eight!”

Now listen, gonnif, my good man
I’m just as much an ardent stan
Of action by community
I volunteer, glad as can be,

But this weird armageddon spiel
Is just too much for me to deal
Delete it, sir, before it leaks
It smacks of privilege—nay, it reeks

All that this war-like language nets
Is that the country all forgets
That docs AREN’T soldiers, and deserve
To question admins that they serve

So I’ll repeat, before I go
What you told me five years ago
A little rudely, on a post
Advice that will now help YOU most—
(Maybe that’s why I’m salty, still)—
Remember when you told me, “Chill?”

Irrespective of the debate that’s going on here, can we all take a moment to appreciate how well-written this is? Lol

 

[PreachyMusican39]

In other news, Dr. Fauci thinks schools can reopen in fall.

I'm a little skeptical about this. If social distancing is really the only reason that the death toll is so low and the curve is flattening than there's no reason to think that the virus won't just come back with a vengeance if we start relaxing policies over the Summer.

 

[PreachyMusican39]

I imagine that we'll keep cycling on and off stay at home orders until there is sufficient herd immunity (or a vaccine) if the economy can handle it. I'm actually really interested what everyone else thinks the U.S will do because I definitely don't know anything

 

[HopeP]

The likely reason that no one from any official position is discussing the long term (length of the pandemic, total sick, total death, need for restrictions) is it is politically unpalatable. But do understand the following:

A) The "flattening of the curve" is solely to spread out the number of cases; it will not reduce by much the total number of cases over time
B) Until there is wide spread diagnostic testing for who has it now; wide spread anti body testing to show who ever had, and effective, wide spread vaccination program, social distancing is the only weapon we have in this fight
C) Therefore, a need for some level social restrictions will be necessary for the foreseeable future. Failure to do so will just bring more outbreaks

All the major models, from Imperial College London, University of Washington, Columbia University, as well as CDC/WHO, all generally agree that over the entire course of this pandemic, without any mitigation, about 1/3-1/2 of all Americans would have been infected (50-150 million) and 2.2 million Americans would have likely died. If we are at 90% effective at mitigation, 5-15 million infected and 220,000 would die. The UW model assumes complete mitigation: that is every state is "locked down" thru the end of May. Some states still have no shelter in place order; many that do have such loose restrictions that have only partial lock down effectiveness. The Columbia University model assumes partial lock down. We are creating 200,000-300,000 additional beds in field hospitals over the next 2-6 months as well as expecting existing hospitals to be able to deal with 150%-200% capacity.

However, as with the major pandemics of the 20th century (1918-1920 "Spanish Flu", 1951-1953 Polio, 1957-1959 "Hong Kong Flu" and 1967-1969 "Hong Kong" Flu) the social reaction has followed the same pattern. First (less than full) season, it hits with large social reaction. But then subsides and people become lax in behavior. Second (full season) year is usually most devastating. Third sees a tapering off as a large portion of the population has had some exposure. There is no reason whatsoever to expect a highly contagious and infections virus such as the Novel Corona will behave any differently

As for the Chinese, their centralized political, social, and economic structure as well as their experience with SARS, made them uniquely equipped to deal with this and far beyond what is possible or acceptable in the USA.
1) They had the ability and will to order a complete lockdown of an entire city of 150 and the police to enforce it.
2) they could transfer some 50,000-100,000 medical personnel to Wuhan en masse as a centralized army of health care workers
3) they could inspect all people on the street at multiple times (leaving any building, entering any building, going in to store, etc)
4) if you found with any symptoms or even had exposure, you could be taken and forcibly placed in a quarantine dorm. This was especially true with taking family members out and isolating them. Essentially anyone who had any level of disease or even suspected exposure, you were quarantined.
5) they had the central economic ability to ordered huge production of PPE and provide to all medical staff. if you saw how there assembly line ideas were also applied to how doctors/nurses were "suited up" almost like astronauts (including diapers) in 3 layers at one end of the hospital and then after shift, decontaminated at the the other end of the hospital, you would be shocked as comparison to here

Even so, China is beginning to set up quarantine and lock down in cities now as millions of Chinese start returning home. They know full well

If you want call what I say hysteria, but all the current data, the medical facts, and past history of similar events, is the reality I describe. If you think I am trying to scare people, you bet your ass I am. Its a warning, one based on on the observational evidence and not the political spin. We will be living under some sort of restrictions for sometime and ultimately, the world-wide total death toll from COVID over the next 1-3 years is likely to exceed the all the death that have ever been attributed to HIV, about 40 million

Whether you think that using medical students as "draftees" in this battle is a good idea or not, it is what will come to pass

Deploy all boomers at front lines of homeland war!

 

[LizzyM]

Rural areas are not exempt.

The epicenter at the moment in NYC but one huge outbreak on a population basis (per 100,000 of population) is in very rural Albany Georgia Coronavirus Updates

The outbreak there was traced to a pair of funerals in the small town. It only takes one person visiting from outside of a closed community to spread something throughout a rural area, particularly because those who are infected can feel well while shedding virus and spreading it to others.

How two funerals helped turn one small Georgia city into a hotspot for coronavirus

Albany, Georgia is no longer a coronavirus outlier. Instead, it serves as an example of how the virus can impact smaller, sprawling rural areas as much as it can larger cities.

www.cnn.com

 

[deleted621740]

I thought Fox loves war and hawkish feed to their base. Am I missing something?

CNN is alarmist, Fox is calling it a war while also downplaying it. Liberals are generally glass-half-empty, conservatives are glass-half-full. It's so arbitrary and funny to see political leanings impact how people view coronavirus seriousness. Especially since conservatives tend to be more crisis-averse, or at least my family is.

 

[thegrind33]

I would have to say from personal experience that your statement is inaccurate for the following reasons. In the 60s and 70s, practicing physicians could tell the insurance company that they wanted to raise their "Profile", aka, what the insurance company pays you, and the insurance company would agree. So yearly pay increase from the insurer. Secondly, there were no limits on what you could put away in your qualified pension plan. You could put 100k into it if you liked. There have been limits on this now for decades. Its around 40k a year I think. These doctors retired quite well from a financial standpoint. This told to me by family friends and older retiring partners when I was a young attending.

Fair point, but Docs who are at the end of their careers did not have to face 300-400k in compounding debt and declining reimbursements along with their autonomy being sold away. And the powers that be wonder why less people want to enter a primary care field

 

[deleted621740]

I'm a little skeptical about this. If social distancing is really the only reason that the death toll is so low and the curve is flattening than there's no reason to think that the virus won't just come back with a vengeance if we start relaxing policies over the Summer.

Oh, the virus will certainly come back when we start opening up. But the point of shutting everything down is to get our ducks in a row vis-a-vis PPE, hospital beds, ventilators, and so forth. It was never to prevent deaths caused directly by coronavirus but to avoid a triage scenario in which unnecessary deaths would occur (a la Italy). Thus, even if we open up, we will have the resources to deal with another spike by that time. Or at least we hope we will.

 

[KnuxNole]

Actually, most employment contracts give the employer the right to reassign you to a different role in the company. If the company has now contracted say with a health care system or actually work in admin role in a system, their choice is to accept or quit. I just an advisee's SO have this issue last week.

If it was me I would laugh and quit.

 

[HopeP]

“Hup-two! Hup-two!” Old gonnif cries
With dreamy glory in his eyes
“All of you premeds, fall in line
And MARCH—don’t let me hear a whine!

“You whippersnappers ought to know
What WAR was like, so long ago!
When sammy drafts you for the FIGHT
I want salutes—stand straight—FULL might!

“For MY wet dream, you all should know:
Premeds, with nowhere else to go
Should waste an extra year of life
Delay the fruits of 8 years’ strife
While drowning all the while in debt
Many who live like paupers yet—

Should be herded and promptly sent
To jobs that barely pay the rent
And possibly may risk their health
If not long-term concerns on wealth—“

“And—WHAT? You think it’s EXPLOITATION?”
(He swells with righteous indignation)
“You miserable, weak premed lot
Should be THANKFUL for what you’ve got!
The chance to train for NINE years straight
Is actually BETTER than eight!”

Now listen, gonnif, my good man
I’m just as much an ardent stan
Of action by community
I volunteer, glad as can be,

But this weird armageddon spiel
Is just too much for me to deal
Delete it, sir, before it leaks
It smacks of privilege—nay, it reeks

All that this war-like language nets
Is that the country all forgets
That docs AREN’T soldiers, and deserve
To question admins that they serve

So I’ll repeat, before I go
What you told me five years ago
A little rudely, on a post
Advice that will now help YOU most—
(Maybe that’s why I’m salty, still)—
Remember when you told me, “Chill?”

You are admitted, no MCAT, no interview.

 

[PreachyMusican39]

Oh, the virus will certainly come back when we start opening up. But the point of shutting everything down is to get our ducks in a row vis-a-vis PPE, hospital beds, ventilators, and so forth. It was never to prevent deaths caused directly by coronavirus but to avoid a triage scenario in which unnecessary deaths would occur (a la Italy). Thus, even if we open up, we will have the resources to deal with another spike by that time. Or at least we hope we will.

That's a really good point. I definitely wonder if we'll be able to ramp up in time, the original models showed us being insanely overwhelmed before social distancing became so effective. I hope we can ramp up in time and hopefully have a somewhat effective treatment. I think it would be unethical to open up before a treatment looks like it will be around to meet the need.

 

[Engrailed]

That's a really good point. I definitely wonder if we'll be able to ramp up in time, the original models showed us being insanely overwhelmed before social distancing became so effective. I hope we can ramp up in time and hopefully have a somewhat effective treatment. I think it would be unethical to open up before a treatment looks like it will be around to meet the need.

I think these will factor into how quickly society can attempt to return to normalcy (however one may define it):

- How quickly the govt + private sector (nationally, globally) can channel efforts toward promising therapeutics (vaccines or treatments)
- Testing availability (kits, labs etc)
- Supplies (GM, 3M etc are making ventilators, masks..)
- Clinical trials using serum/antibodies from recovered patients
- Antibody testing to see who has already recovered from it.

How quickly these can be scaled will be the bottleneck toward getting people back out in society IMO.

 

[deleted966164]

Yes. The ICU censuses here are currently below the usual average, because all elective procedures got cancelled and the number of COVID patients doesn't make up for the decrease in other conditions.

Not all of us live in NYC.

I don't.

Rural areas are not exempt.

How two funerals helped turn one small Georgia city into a hotspot for coronavirus

Albany, Georgia is no longer a coronavirus outlier. Instead, it serves as an example of how the virus can impact smaller, sprawling rural areas as much as it can larger cities.

www.cnn.com

THIS.

 

[deleted1005514]

I’m not the premeds you’re addressing (I’m an M3/rising M4) but I just went back and re-read my personal statement. It’s all about bonding with patients/patient relationships. Literally nothing about forced drive-through testing of strangers.

Mine was about serving in underserved rural areas, like the one I came from...I guess my number will come up first in the "draft"?

 

[thegrind33]

I bet if government officials kids got "drafted" to be on the frontines a solution for this pandemic and our current way of life would be accelerated tremendously.

 

[Goro]

View attachment 301706

According to the CDC, that chart is pretty accurate. My ID colleague tells me that numbers are even a bit higher on the Johns Hopkins SPH page for COVID19!

Coronavirus Disease 2019 (COVID-19) in the U.S.

View the number of confirmed cases COVID-19 in the United States.

www.cdc.gov