Birx is lying when she says that hospitals aren’t debating changes in DNR policies

Rare is the person who can both exist in Donald Trump’s orbit and retain his or her dignity. For every Anthony Fauci, there are probably several hundred Deborah Birxes — people who, for whatever reason, have chosen to take the path of least resistance, and sublimate themselves before Donald Trump. In the case of Birxx, a legitimate doctor who once served as our nation’s Global AIDS Coordinator, one imagines that she’s made a deal with the devil, having come to accept that, in order to get a seat at the table in Donald Trump’s White House, one has to constantly debase oneself in front of our incredibly fragile, insecure, and narcissistic president. I’m sure, at some level, the calculus makes sense to her. She likely thinks that if, like yesterday, she goes out on the White House lawn and talks at length about how “attentive to the scientific literature, the details, and the data” Trump is, and his incredible “ability to analyze and integrate data,” that maybe, when it comes time to talk him out of reopening the economy on Easter over the objections of the entire scientific community, that he might actually listen to her. That’s never how it works out, though. Everyone who plays this game, regardless of how good their intentions, always comes out the other end, their legacy in tatters, with absolutely nothing to show for it. [Ask Rex Tillerson.]

Today, Birx did more lying for Donald Trump, saying in response to questions about the American citizens who will invariably die when we max out our ventilator capacity, “there is no situation in the U.S. that warrants that kind of discussion.” That, however, simply isn’t true. And we know it… Here, before we get to that, are the two clips of Birx noted above.

First, we now know that there are over 100,000 confirmed cases of COVID-19 in the United States. [This, by the way, assuming we can trust the numbers being reported in other nations, makes us the world leader when to comes to the disease’s proliferation.] Second, we know that the number of confirmed cases has been doubling every two days, as testing is just now starting to be done in earnest, despite the claims from the administration weeks ago that everyone who needed a test was getting one. Third, we know that some 20% of those diagnosed with COVID-19 are requiring hospitalization, and that most of those need some kind of breathing assistance. According to reporting by NBC News, “13.8 percent (of those diagnosed) had severe disease, including respiratory problems, and 6.1 percent had critical illness, including respiratory failure.” And, fourth, we know that, when all of this started we only had about 62,000 ventilators in use in the United States, with somewhere between 4,000 and 10,000 additional units being held in reserve by the federal government.

So, let’s say, for the sake of argument, that one million people come down with COVID-19 by the time that this is done. [That’s a pretty low estimate based on where we are already, and what current models are projecting.] That would mean that some 13.8% would have severe respiratory disease. That’s 138,000 — which is more than double the total number of ventilators in the United States.

Here in Michigan, we can see it playing out already. We’ve been told from public health professionals that we have roughly 1,000 ventilators in the entire state. And, as of today, we have over 3,600 confirmed cases of COVID-19 in the state. Furthermore, we’re already maxing out our ventilator capacity at Belmont and Henry Ford hospitals. [They’re currently sending cases to U-M, but, with the cases growing in Washtenaw County, one imagines it’s just a matter of time before options become more limited.]

Earlier today, as you may have seen, a memo was leaked from Henry Ford Health System in which administrators attempted to explain how they may have to make decisions as to who will receive care, ventilator access, etc, and who will not. “Patients who have the best chance of getting better are our first priority,” the memo said. “Patients will be evaluated for the best plan of care and dying patients will be provided comfort care.” This, of course, shouldn’t be a surprise to anyone. Of course our hospitals are considering this. They, just as well as you and I, can see the trajectory of the infection curve, and they know we have limited resources with which to meet that need. So, yes, Dr. Birx, people in the medical field are talking about this. This administration has left them no choice. [Donald Trump could have called for more ventilators to have been made two months ago, but he waiting until today.] They’re wondering what to do when the last ventilators are taken, and how they transition into a scenario where they no longer try to save the lives of those who “code,” but instead just move that patient’s ventilator to the next person waiting, and just provide palliative care to the elderly, as the young have a better chance of surviving.

This was going to be a longer post. Look for Part-II tomorrow.

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51 Comments

  1. Hyborian Warlord
    Posted March 27, 2020 at 11:58 pm | Permalink

    Max out our ventilators? Cuomo is sitting on thousands of them in New York delivered by the federal government. They are still in the warehouse because they don’t need them yet. GM just got commanded to make them. You are really trying to cause a panic aren’t you Barky?

  2. Frosted Flakes
    Posted March 28, 2020 at 12:18 am | Permalink

    I was curious about our ventilator situation compared to Italy. Not sure if I have my numbers right but from what I saw, as of 7 days ago Italy had 3k ventilators whereas USA has 160k. We are 6x larger population. So roughly 10x the ventilators per capita compared with Italy? Does anybody know if my numbers are inaccurate? I hope they are correct…

  3. Frosted Flakes
    Posted March 28, 2020 at 12:26 am | Permalink

    Here is the article that claimed we have 160k ventilators. Not sure if Mark’s numbers are incorrect…

    https://www.google.com/amp/s/www.nbcnews.com/news/amp/ncna1161651

  4. Frosted Flakes
    Posted March 28, 2020 at 12:34 am | Permalink

    Looks like it is actually 160k ventilators +10k that the federal government can deploy.

    From Mark’s link:

    62,000 full-featured mechanical ventilators.1 Calculations suggest that about 28,883 of these ventilators (46.4%) can be used to ventilate pediatric and neonatal patients. The study also reported an additional 98,000 ventilators that are not full-featured but can still provide basic function in an emergency during crisis standards of care.1

  5. Frosted Flakes
    Posted March 28, 2020 at 12:50 am | Permalink

    From the article I linked:

    “The U.K. has only 5,000 of the machines and estimates it will need 20,000 more “under a reasonable worst case scenario,”

    Adjusted for UK’s smaller population it would seem, if that 25k is enough for a worst case situation then 160k is more than enough for us.

    Experts please chime in. I am not knowledgable about this stuff. I am just noticing that certain numbers do not seem to add up.

  6. iRobert
    Posted March 28, 2020 at 1:14 am | Permalink

    From the abstract titled, “Mechanical Ventilators in US Acute Care Hospitals” referenced in the NBC News article you linked, FF.

    “There are considerably more pediatric-capable ventilators than there are for adults only on a population-adjusted basis.”

    What percentage of the 160k ventilators can be used with adults?

  7. Hyborian Warlord
    Posted March 28, 2020 at 1:14 am | Permalink

    It’s worst case scenario to need that many. Look at Bark Baynard trying to whip that hysteria up saying we are sure to run out of them. That’s cold, Barky. That’s cold. The People need something to lift them up, not amplify fear.

  8. iRobert
    Posted March 28, 2020 at 1:26 am | Permalink

    Hospitals in the country’s largest cities have already reached capacity on their ventilators. That is a fact you can find simply by looking at what health care professionals working in those biggest cities are posting on social media. The press is also linking to those social media posts in their articles.

  9. iRobert
    Posted March 28, 2020 at 1:36 am | Permalink

    A couple days ago, Mark posted a link to a social media post by a Novi nurse who was asked to help in Southfield. She reported that one of her patients was put on the last ventilator the Southfield hospital had.

    That is what is being reported at hospitals in most of the biggest cities in the US and is some other outbreak hotspots as well, such as New Orleans.

    New York is going to try to start reworking ventilators so they can add a second patron on to them. They wouldn’t be having to try this (a time consuming alteration) if they had the ventilators they needed.

  10. iRobert
    Posted March 28, 2020 at 1:53 am | Permalink

    Also, FF, remember, babies haven’t put their births on hold since the virus broke out. Maybe Trump can order them to. Then he can blame them when they don’t do as he’s said.

  11. iRobert
    Posted March 28, 2020 at 3:00 am | Permalink

    There aren’t 160k ventilators just sitting around not being used, waiting for that day when all the money spent on purchasing them might not have just been burned. The vast majority of them are in use.

    It’s good to see that in this difficult time you and HW are still working full time, though, even if it’s just to come up with excuses.

  12. Frosted Flakes
    Posted March 28, 2020 at 4:11 am | Permalink

    iRobert,

    I am not trying to suggest we don’t have problem. I am trying to figure out how bad our problem is as a “lay person” Who admittedly is pretty stupid about this health related stuff. I took it to mean that a percentage of these “full features machines” could ALSO be used with children/ babies in addition to adults. I am assuming the 100k models that are adequate, but not full features, are mechanical but older models.

    The John Hopkins article linked in another article suggested the same thing but I might be reading it wrong: http://www.centerforhealthsecurity.org/resources/COVID-19/200214-VentilatorAvailability-factsheet.pdf

    I really quickly just wanted to compare US ventilator numbers to Italy. I am not trying to put out false numbers to make people feel safe. Just thought what I found , very quickly, was interesting and I welcome people telling me I am wrong.

    USA pop 325 M/160k ventilators
    Italy pop 60 M/ 3k ventilators
    UK pop 66M/ 5K ventilators

    I also heard that multiple people can be on some of these ventilators at the same time. Did anybody else hear that too?

  13. Frosted Flakes
    Posted March 28, 2020 at 4:27 am | Permalink

    I understand the federal government to have an additional 10k ventilators they can deploy strategically.

    Am I the only one who is leary of just handing Cuomo more ventilators? NY needs to show that they have completely maxed out capacity before we tie up a disproportionate ventilators there, endangering other areas. This is like war. Triage and rationing is normal and wise I think. Local cooperation keeps people honest in these difficult times.

  14. iRobert
    Posted March 28, 2020 at 5:14 am | Permalink

    The vast majority of those 160k ventilators are in use. Isn’t there a reason you are avoiding that detail?

    NBC’s 3,000 number of ventilators in Italy isn’t being explained in any detail. They haven’t said if that is the total number in existence in Italy (and in active use) or if those are just the number of them in reserve of some sort. Reporting is as shitty as is leadership on the federal level here in the US.

  15. iRobert
    Posted March 28, 2020 at 5:21 am | Permalink

    Ventilators should have immediately gone into maximum production as soon as the president was advised as to the profile of this outbreak. That was months ago.

    And, all ventilators currently in existence should have already been deployed and put to use, while new ventilators should have been in mass production.

    If this administration could mobilize the mass production of ventilators like their apologists produce excuses and time-wasting distractions, we’d all be guaranteed one.

  16. iRobert
    Posted March 28, 2020 at 5:23 am | Permalink

    Italy has more hospital rooms per capita than the US. I don’t believe they are very far off on equipment per capita as well.

  17. iRobert
    Posted March 28, 2020 at 5:28 am | Permalink

    Please tell me, FF, you aren’t under the impression that there are 160k ventilators just sitting around in storage in the US. Would that actually make sense to you?

    I would believe 10k may be in federal storage. But the suggestion that the health care industry would purchase ventilators to just let sit in storage is absurd.

  18. Frosted Flakes
    Posted March 28, 2020 at 5:50 am | Permalink

    Please tell me, FF, you aren’t under the impression that there are 160k ventilators just sitting around in storage in the US. Would that actually make sense to you?

    No. I trust Mark when he says 60k are in use. I am assuming the 60k are the “full feature” type—whatever that means. I am wondering what is the deal with the additional 100k ventilators which were described as adequate to put into service. I am assuming these are older models. I don’t know. I think we can agree there is a discrepancy in the numbers. A knowledgeable person might be able to explain the discrepancy to me. I am an idiot about this stuff…

    I am also under the impression that Italy has more beds per capita than the US but the 3k ventilator number is in other articles as well. Again, maybe somebody can explain the vast difference between USA per capita ventilators and Italy’s. I don’t know but it does not sound like you know either…

  19. Frosted Flakes
    Posted March 28, 2020 at 5:58 am | Permalink

    I don’t believe they are very far off on equipment per capita as well.“

    Based on what? I also believe that Italy has a lot more hospital beds per capita. However, a quick look made it seem like we have way more ventilators per capita though…Not sure. It would be a good thing if true—as we trying to avoid a situation like they have in Italy.

  20. Frosted Flakes
    Posted March 28, 2020 at 6:11 am | Permalink

    iRobert,

    It is not clear to me that we are using all of the 160k ventilators. I don’t know. It could be that we are only using all of the “full feature” ventilators in the hotspots like NYC and Detroit. I don’t know.

    I think the first step in figuring it out is agreeing on the number of ventilators. Is it 60k or 160k+? I don’t know.

    Maybe I am cynical but I would not put it past leaders of communities or leaders of hospitals to spin facts in order to get their hands on as many “full feature” ventilators as possible. Triage and rationing happens. Nobody likes it. Lobbying for limited resources happens too.

  21. iRobert
    Posted March 28, 2020 at 6:16 am | Permalink

    Based on Italy not being a third world country. Health care in northern Italy is considered pretty good.

    It’s possible that Italy has only 3k ventilators in their country. But the US does not have 160k available ventilators. The vast majority of those are already in use, and people aren’t already on ventilators just for the hell of it. I would be surprised if the majority of those 160k weren’t already keeping babies and the very elderly alive. I doubt the US has much more than 20k available, it that.

    Excuse makers (propagandists) are quoting the total number of ventilators in existence, rather than the actual numbers available, for purposes of defending their incompetent administration.

  22. iRobert
    Posted March 28, 2020 at 6:22 am | Permalink

    The vast majority of those 160k ventilators have been in use prior to this virus showing up here. I’d estimate only a few thousand are being used for COVID-19 patients so far. We have tens of thousands of more patients to be added in just the coming week.

  23. iRobert
    Posted March 28, 2020 at 6:27 am | Permalink

    I think NBC may be referring to available ventilators in Italy, not all ventilators in existence in Italy.

    Whereas, Trumpian bullshitters are referring to all ventilators in the US and not AVAILABLE ventilators in the US.

    For Trumpians is all a PR battle. That’s not going to go well for them over the next several weeks.

  24. Frosted Flakes
    Posted March 28, 2020 at 6:32 am | Permalink

    iRobert,

    The John Hopkins article Mark linked in another article suggested we have 160k+ total ventilators. 60 is not 160. It might be that the discrepancy boils down to how we interpret terms like “in use” versus “available” versus “able to be put into service”. Vague. Not sure. But it does not sound like you know either. Maybe we should wait for someone knowledgeable to explain it? I can’t look into more right now.

  25. Frosted Flakes
    Posted March 28, 2020 at 6:42 am | Permalink

    It is obvious there is a lot mistrust between different groups…That is for sure…Haha.

    About Italy—I am confident the 3k number was not referring to the number of “available and ready to use by anybody” who happens to need a ventilator. They were only giving ventilators to people under 60 years of age according to one article I read.

  26. Frosted Flakes
    Posted March 28, 2020 at 7:15 am | Permalink

    https://pubmed.ncbi.nlm.nih.gov/21149215/

  27. Frosted Flakes
    Posted March 28, 2020 at 7:19 am | Permalink

    https://www.medpagetoday.com/infectiousdisease/covid19/85462

  28. I bet HW that McCabe wouldn’t be fired and all I got was this stupid name
    Posted March 28, 2020 at 7:55 am | Permalink

    Aloha, the only important thing to remember is that none of this is Trumps responsibility. It is all the fault of others. Says he is going to utilize the Defense procurement act, and he did a week later. Its not like that weeks delay is important or anything. It is obviously Inslee and that woman in Michigan who are the problem— get with the program. Find a scapegoat and keep repeating until the sheple listen.

  29. Jean Henry
    Posted March 28, 2020 at 10:11 am | Permalink

    Oops! There goes the last of Brix’ credibility.
    https://www.factcheck.org/2020/03/birx-spins-extraordinarily-low-numbers-of-coronavirus-cases/

    Did anybody notice her touching Trump’s sleeve when he got off mic? So much for social distancing. Also, ewww.

    In every case, I think these advisors with actual expertise are managing up to Trump which is what ppl do to an incompetent leader when they want to retain their positions. But it’s also what they do when they care about what’s at stake enough to be subservient to an asshole. I’m empathetic in many ways. It just always feels like the strategy fails as Mark has said.

    It’s in line with the idea that sleeping with the boss will help your career when it’s more likely to give you a brief taste of power before it gets you kicked out on your ass with no future prospects at all.

  30. Posted March 28, 2020 at 10:25 am | Permalink

    All hospitals are considering this. It’s not just Henry Ford. This is new territory for them. They aren’t in the habit of having to turn people away, or made decisions as to who they’re attempt to save. They don’t know what kind of legal exposure that puts them in. And they aren’t sure of the protocols that they should follow. And, sadly, the feds don’t seem to be offering any guidance.

  31. Posted March 28, 2020 at 10:37 am | Permalink

    As I noted in this post, there’s good reason to believe that other countries, like China and Russia, are underreporting their deaths. Here’s a new datapoint.

  32. iRobert
    Posted March 28, 2020 at 11:17 am | Permalink

    It makes sense that China is lying about their number of cases and deaths. They lie about everything, and often very automatically.

  33. Frosted Flakes
    Posted March 28, 2020 at 11:41 am | Permalink

    Are our numbers straight?

  34. Nobody
    Posted March 28, 2020 at 12:03 pm | Permalink

    It would be nice if the industries that are best suited to dealing with this were to be nationalized, coordinated, and mobilized immediately:

    Amazon and FedEx for logistics.

    ESRI + NYT graphics staff for a dashboard interface to show where the PPE and ventilators are, how many in use, how many warehoused, how many in production, where, anticipated ship dates, locations, current and projected needs, number of ICU beds, number anticipated to come on line, etc.

    (whatever the ERP software equivalent is) for resource allocation of the national supply.

    I don’t know who is qualified to be the director of an effort like this though. Right now it is a cluster.

  35. Nobody
    Posted March 28, 2020 at 12:04 pm | Permalink

    … and the proper solution looks a hell of a lot like “socialized medicine”.

  36. Frosted Flakes
    Posted March 28, 2020 at 12:50 pm | Permalink

    https://youtu.be/KhZrbHlkFZ4

  37. Jean Henry
    Posted March 28, 2020 at 1:22 pm | Permalink

    Amazing:
    https://www.newyorker.com/news/california-chronicles/the-coronavirus-spurs-a-movement-of-people-reclaiming-vacant-homes

  38. iRobert
    Posted March 28, 2020 at 1:29 pm | Permalink

    I haven’t looked any further into the numbers, FF. But I’m sure for-profit hospitals don’t purchase equipment and then not use it. There is certainly some fluctuation in usage, but any unneeded equipment would be donated or sold.

    We weren’t prepared for this pandemic before it broke out in China, and no other big countries were either. Only places like Singapore and Hong Kong had some plans they quickly put into action. Everyone else needed competent leadership to analyze the developing situation, anticipate what was obviously coming and act decisively and effectively. The counties which were lucky enough to have some forewarning had the opportunity to reduce the inevitable impact significantly.

    Having an absurd idiot at the helm surrounded by a skeleton crew of kiss-ass cronies dramatically handicaps a country. What happens over the next several weeks is almost entirely inevitable now. Trying to paint details to look more favorable isn’t going to change much, but possible leave a lot more people feeling betrayed and angry later.

    I’m all in favor of actually taking action to make the most positive impact we can on how this all continues to play out. But I’m not going to join in the President’s game of trying to save face by pretending the situation isn’t what it obviously is.

  39. iRobert
    Posted March 28, 2020 at 1:41 pm | Permalink

    Oh, FF, I think it’s pretty clear US COVID—19 confirmed cases totals are lagging significantly behind actual cases, though I’m guessing death totals being reported are pretty current and accurate.

    Have there been reports that US totals are not?

    I have no doubt China is lying about their numbers. They always do, in every situation.

    I assume Iran is too. Most countries in the third world are simply lagging dramatically behind in their identifying and reporting.

  40. Frosted Flakes
    Posted March 28, 2020 at 1:58 pm | Permalink

    iRobert,

    It is normal for businesses to replace equipment with newer “full feature equipment” and to put the older and less advanced equipment in storage. I provided 3 links that strongly suggest that 100k older ventilators could be put back into circulation. The numbers were apparently based off surveys that the hospitals filled out within the last decade. Even the 60k ventilators appears to be a lot more per capita for than the number Italy and UK appear to have per capita. Those were the only two places I even checked…

    My point about us getting our numbers straight was pointed to the fact that we are not even in agreement about a basic number like how many ventilators we have. Unwillingness to face the discrepancy on something so basic seems to be at least possibly politically motivated. Similarly CCP lying there asses off seems like it might possibly be politically motivated…

  41. Frosted Flakes
    Posted March 28, 2020 at 2:04 pm | Permalink

    To reiterate I am not a ventilator expert. I hate discussing medical stuff. I hate going to the doctor. If someone who is more knowledgable about this stuff explains the discrepancy then I will probably accept what they say. I am just sharing my thoughts which are admittedly from a place of ignorance. I do find it hilarious that everybody is suddenly an epidemiologist. “Brix has no credibility”….”35k got the flu”…Etc…

  42. iRobert
    Posted March 28, 2020 at 2:06 pm | Permalink

    Michigan now has 111 confirmed deaths from COVID-19.

  43. Jean Henry
    Posted March 28, 2020 at 4:09 pm | Permalink

    How many words does it take for FF to say he doesn’t know anything but has a question? But also that if we are not epidemiologists then he’s really not interested in answers. Hell, he’ll probably go on speculating with inadequate information until one shows up.

  44. Frosted Flakes
    Posted March 28, 2020 at 5:04 pm | Permalink

    But nothing was answered Jean. I felt like I needed to keep reiterating I am speaking from ignorance because of the way iRobert was responding—saying I was “bullshitting”. The numbers used in most media do not seem to add up. If is discrepancy is easy to explain away the do it. Be my guest. But don’t pretend like you know things if you do not know.

  45. Sad
    Posted March 28, 2020 at 5:50 pm | Permalink

    Looks like Michigan might pass California in number of cases.

    Oh well.

  46. Jean Henry
    Posted March 28, 2020 at 7:40 pm | Permalink

    FF– People have a right to ignore you.

  47. Jean Henry
    Posted March 28, 2020 at 7:46 pm | Permalink

    I don’t have any interest in answering your query. Just because something intrigues you doesn’t mean we care. Please feel free to do your own research if you have a question and seek expert opinion. That’s what curious people do. On the other hand, people trying to make a questionable rhetorical point in a vacuum of accurate information will harp on as though they have revealed some great and damning inconsistency.

  48. Frosted Flakes
    Posted March 28, 2020 at 8:20 pm | Permalink

    Jean you don’t need to let me know when you are uninterested in something I am talking about. I’m good. But since you mentioned accuracy are you claiming that it is accurate to say the USA hospitals only have 60k ventilators + 10k controlled by the federal government? I gave 3 sources that seemed to indicate otherwise. Mark and I shared a source even. If you are content with the veracity of your info that is your business. Why am I hearing from you?

  49. iRobert
    Posted March 28, 2020 at 10:26 pm | Permalink

    We will have the answers to your questions about ventilator numbers soon, I’d assume.

    I’m guessing we’ll be reading a lot more about where and when the ventilators will be becoming available to COVID-19 in the coming days.

    Do you have anything to say regarding Brix?

  50. iRobert
    Posted March 29, 2020 at 4:34 am | Permalink

    Are Brix’s false statements helpful in your mind, FF?

    Do you see them as counterproductive at all?

  51. Posted May 25, 2020 at 9:59 pm | Permalink

    Birx was asked a few days ago to explain how she’d gotten it so wrong.

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  1. […] « Brix is lying when she says that hospitals aren’t debating changes in DNR policies […]

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