About Those Other Immunocompromised People?

 

While much is being made of the course of COVID-19 in Italy, it is worth remembering a couple of things as we focus our efforts in the United States. It appears that the same disease which we are now encountering found a very different population and medical readiness in Italy.

1. Italy has been committing demographic suicide for decades. Italy is down to 1.3 live births per woman. A major author wrote a decade ago that the big Italian family was a myth today, that an Italian child is most likely to grow up with no siblings and only one first cousin. So, it should be no surprise that Italy’s median age is already over 47. That is, Italy was already vulnerable to a disease that especially threatens the elderly because that is where their population has been shifting. The same holds for much of Europe.

2. Before this latest pandemic, Italy was ranked behind Mexico on the Global Health Security Index, rating nations’ readiness to prevent, contain, and treat infectious disease outbreaks. So let’s not hear too much about 1st world medical systems in Italy.

In comparison, the U.S. median age is 38. We rank 1 on the GHS index, to Mexico’s 28 and Italy’s 31. So, yes, we should expect to see the disease run a somewhat less lethal course here. However, words matter. The real experts warned repeatedly that it is not just the elderly with underlying conditions, rather it is people with compromised immune or respiratory systems who face serious, life-threatening danger from COVID-19.

That brings us right back to Dr. Drew’s warnings for the past year, and it validates his call for a significant portion of the COVID-19 Congressional slush fund to get put directly to use in attacking the public health crisis of the homeless in Los Angeles, San Francisco, and Seattle. Dr. Drew’s comment was that he would completely change his assessment of the disease if it got loose in the Los Angeles homeless population: immunocompromised, already lacking basic immunizations, malnourished, living in close, crowded quarters, with no sanitation.

But, would that only mean more deaths of street people, who are already vulnerable to other sources of early death? No. If an infectious respiratory ailment gets into the homeless populations of major cities, then all the other people living and working in the area suddenly face much greater exposure. If it is time to deploy a public health army of sorts, this is where it needs to go.

Published in Domestic Policy
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  1. J Climacus Member
    J Climacus
    @JClimacus

    On the other hand, the United States is in the lead among major Western developed countries for one of the risk factors for COVID-19: Obesity. The U.S. is 33% obese and Italy 21%. Obesity is concentrated in our lower classes clustered in the major cities, who also tend to smoke and have poorer health in general, while naturally living right next to each other (being in the city). Not going to be pretty.

    • #1
  2. EODmom Coolidge
    EODmom
    @EODmom

    I believe the same people who castigate the President for his assertive actions to protect citizens – regardless of what the actions are are – will demand that there be no actions which would infringe any of the so-called rights of the homeless and illegal to be ill and infect others with their illness(es.) And no vaccines shall be required. 
    As to the demographics of Europe, it seems to me that no one is reporting nor considering the massive impact the intrusion of millions of non-citizens to otherwise stressed EU States like Italy and Greece. I can’t imagine that any of the invaders are fundamentally healthy and with current medical records. They seem to have comprised young adult males which one would presume to be stronger than others, but even if ill are they likely to seek care or continue to spread disease among their peers? 

    • #2
  3. Kozak Member
    Kozak
    @Kozak

    J Climacus (View Comment):

    On the other hand, the United States is in the lead among major Western developed countries for one of the risk factors for COVID-19: Obesity. The U.S. is 33% obese and Italy 21%. Obesity is concentrated in our lower classes clustered in the major cities, who also tend to smoke and have poorer health in general, while naturally living right next to each other (being in the city). Not going to be pretty.

    Italians have a significantly longer life span than US, overall actually healthier.

    Northern Italy has one of the best health systems in the world, comparable to our own, and it is overwhelmed.

    I suspect the big cities in the US are in for a wild ride.

    • #3
  4. JamesSalerno Coolidge
    JamesSalerno
    @JamesSalerno

    Doesn’t Italy also nationalize their healthcare?

    • #4
  5. Misthiocracy ingeniously Member
    Misthiocracy ingeniously
    @Misthiocracy

    JamesSalerno (View Comment):

    Doesn’t Italy also nationalize their healthcare?

    According to Wikipedia, health care spending in Italy is about 77% public.

    For comparison, Canada’s health care spending is about 70% public.  Health care spending in the USA is about 64% public.

    • #5
  6. Ultron Will Inject You Now Coolidge
    Ultron Will Inject You Now
    @Pseudodionysius

    JamesSalerno (View Comment):

    Doesn’t Italy also nationalize their healthcare?

    They have multiple tiers. Their first tier (private) is very good.

    • #6
  7. Ralphie Inactive
    Ralphie
    @Ralphie

    Kozak (View Comment):

    J Climacus (View Comment):

    On the other hand, the United States is in the lead among major Western developed countries for one of the risk factors for COVID-19: Obesity. The U.S. is 33% obese and Italy 21%. Obesity is concentrated in our lower classes clustered in the major cities, who also tend to smoke and have poorer health in general, while naturally living right next to each other (being in the city). Not going to be pretty.

    Italians have a significantly longer life span than US, overall actually healthier.

    Northern Italy has one of the best health systems in the world, comparable to our own, and it is overwhelmed.

    I suspect the big cities in the US are in for a wild ride.

    My sister was in Italy last fall and said the tour guide, whose mother was a doctor, paid cash to go to a private clinic because the wait was too long. Her mother insisted.  I have no idea how to compare health systems, as you noted lifestyle is a major factor in longevity.   All I know is what I read and hear.  

    • #7
  8. Ontheleftcoast Member
    Ontheleftcoast
    @Ontheleftcoast

    Italy’s demographic suicide isn’t the lesson to be taken from this. It’s that Italy is imposing a near China-level quarantine on its citizens in an effort to slow the spread of the illness. 

    But as long as R0 is high enough, as long as on average each person with the virus infects enough people to keep it going. At R0=2.6, which has been reported in the West (China’s was >3 at the worst) the number of cases will double in a bit over 6 days. This matters.

    As Aesop notes,

    …there are 34 doubles from 1 to Everyone.
    The first ten get you to 1000. the second ten get you to 1M. So to get to 5M, you need 23 or so doublings. At 4-6 days per double, that’s 92-138 days. So if that’s the doubling speed, we will be at 5M cases by June, anyways…. But in a pandemic, doublings speed up and slow down, as the virus hits new pockets of people, and then runs through them.)
    Regardless, at some point, we’ll get to 1M Kung Flu victims who need a bed.

    5) None of that matters, because less than 10% of them will ever get in.

    6) Because long before then, we’ll either decide to stop seeing them, or hospital care at all will cease to exist, from staff infections, lack of supplies, people who’ll stop coming to work, etc.

    7) At that point, there will functionally be zero hospital beds.
    Either because no one with Kung Flu will be let in, or because there isn’t a hospital. I can tell you right now, we aren’t going to turn away heart attacks, strokes, and trauma patients so we can see people with Kung Flu, even if they’re really [expletive] sick. I’ve told you, Don’t get this virus. This is why.

     

     

    • #8
  9. Ontheleftcoast Member
    Ontheleftcoast
    @Ontheleftcoast

    This is what it looks like right now in northern Italy. Unless we get R0 down, this is coming before the election to a hospital near you.

    And that’s exactly what’s happening in Northern Italy, where the rationing has begun. A doctor in Western Europe described the dire situation doctors and patients face there and the chilling decisions medical professional are being forced to make:

    Most of my childhood friends are now doctors working in north Italy. In Milan, in Bergamo, in Padua, they are having to choose between intubating a 40-year-old with two kids, a 40-year old who is fit and healthy with no co-morbidities, and a 60-year-old with high blood pressure, because they don’t have enough beds. In the hallway, meanwhile, there are another 15 people waiting who are already hardly breathing and need oxygen.

    Northern Italy has been hit particularly hard by the coronavirus, with doctors reporting conditions we usually associate with wartime, as the death toll increases by the hour and hospitals are short-staffed and out of beds.

    Dr. Daniele Macchini, who works at the Humanitas Gavazzeni hospital in Bergamo, described the conditions in a lengthy Facebook, saying “The war has literally exploded and the battles are uninterrupted day and night.”

    “One after the other the unfortunate poor people come to the emergency room,” he wrote. “Now, however, that need for beds in all its drama has arrived. One after another, the departments that had been emptied are filling up at an impressive rate. The display boards with the names of the sick, of different colors depending on the operating unit they belong to, are now all red and instead of the surgical operation there is the diagnosis, which is always the same cursed: bilateral interstitial pneumonia.”

    Macchini called the epidemic a “tsunami that has overwhelmed us.”

    “Suddenly the emergency room is collapsing,” he continued. “Emergency provisions are issued: help is needed in the emergency room. A quick meeting to learn how the first aid management software works and a few minutes later they are already downstairs, next to the warriors on the war front.”

    While we have people – and a political party – in this country whose political careers would benefit from the epidemic spreading, we can be confident that their patriotism will outweigh their self-interest as it so often has in the past.

    • #9
  10. Ralphie Inactive
    Ralphie
    @Ralphie

    What about the push pack program started under Clinton to mobilize  treatment in case of a national emergency? Anybody know how that figures in here, or if it does?  This would be a good time to dust it off.  

    There is a book called Germs: Biological weapons and America’s Secret war that could be a good read right now.

    • #10
  11. Rodin Member
    Rodin
    @Rodin

    Ontheleftcoast (View Comment):

    This is what it looks like right now in northern Italy. Unless we get R0 down, this is coming before the election to a hospital near you.

    And that’s exactly what’s happening in Northern Italy, where the rationing has begun. A doctor in Western Europe described the dire situation doctors and patients face there and the chilling decisions medical professional are being forced to make:

    Most of my childhood friends are now doctors working in north Italy. In Milan, in Bergamo, in Padua, they are having to choose between intubating a 40-year-old with two kids, a 40-year old who is fit and healthy with no co-morbidities, and a 60-year-old with high blood pressure, because they don’t have enough beds. In the hallway, meanwhile, there are another 15 people waiting who are already hardly breathing and need oxygen.

    Northern Italy has been hit particularly hard by the coronavirus, with doctors reporting conditions we usually associate with wartime, as the death toll increases by the hour and hospitals are short-staffed and out of beds.

    Dr. Daniele Macchini, who works at the Humanitas Gavazzeni hospital in Bergamo, described the conditions in a lengthy Facebook, saying “The war has literally exploded and the battles are uninterrupted day and night.”

    “One after the other the unfortunate poor people come to the emergency room,” he wrote. “Now, however, that need for beds in all its drama has arrived. One after another, the departments that had been emptied are filling up at an impressive rate. The display boards with the names of the sick, of different colors depending on the operating unit they belong to, are now all red and instead of the surgical operation there is the diagnosis, which is always the same cursed: bilateral interstitial pneumonia.”

    Macchini called the epidemic a “tsunami that has overwhelmed us.”

    “Suddenly the emergency room is collapsing,” he continued. “Emergency provisions are issued: help is needed in the emergency room. A quick meeting to learn how the first aid management software works and a few minutes later they are already downstairs, next to the warriors on the war front.”

    While we have people – and a political party – in this country whose political careers would benefit from the epidemic spreading, we can be confident that their patriotism will outweigh their self-interest as it so often has in the past.

    Pray God patriotism does outweigh, now, the self-interest. Some apparently failed to get the “patriotism” memo.

    • #11
  12. Ontheleftcoast Member
    Ontheleftcoast
    @Ontheleftcoast

    Rodin (View Comment):

    Ontheleftcoast (View Comment):

    This is what it looks like right now in northern Italy. Unless we get R0 down, this is coming before the election to a hospital near you.

    And that’s exactly what’s happening in Northern Italy, where the rationing has begun. A doctor in Western Europe described the dire situation doctors and patients face there and the chilling decisions medical professional are being forced to make:

    Most of my childhood friends are now doctors working in north Italy. In Milan, in Bergamo, in Padua, they are having to choose between intubating a 40-year-old with two kids, a 40-year old who is fit and healthy with no co-morbidities, and a 60-year-old with high blood pressure, because they don’t have enough beds. In the hallway, meanwhile, there are another 15 people waiting who are already hardly breathing and need oxygen.

    Northern Italy has been hit particularly hard by the coronavirus, with doctors reporting conditions we usually associate with wartime, as the death toll increases by the hour and hospitals are short-staffed and out of beds.

    Dr. Daniele Macchini, who works at the Humanitas Gavazzeni hospital in Bergamo, described the conditions in a lengthy Facebook, saying “The war has literally exploded and the battles are uninterrupted day and night.”

    “One after the other the unfortunate poor people come to the emergency room,” he wrote. “Now, however, that need for beds in all its drama has arrived. One after another, the departments that had been emptied are filling up at an impressive rate. The display boards with the names of the sick, of different colors depending on the operating unit they belong to, are now all red and instead of the surgical operation there is the diagnosis, which is always the same cursed: bilateral interstitial pneumonia.”

    Macchini called the epidemic a “tsunami that has overwhelmed us.”

    “Suddenly the emergency room is collapsing,” he continued. “Emergency provisions are issued: help is needed in the emergency room. A quick meeting to learn how the first aid management software works and a few minutes later they are already downstairs, next to the warriors on the war front.”

    While we have people – and a political party – in this country whose political careers would benefit from the epidemic spreading, we can be confident that their patriotism will outweigh their self-interest as it so often has in the past.

    Pray God patriotism does outweigh, now, the self-interest. Some apparently failed to get the “patriotism” memo.

    I was thinking of Loral, and Skolkovo, and Feinstein, and Biden, and Uranium One… and was trying to be high minded enough not to conclude with /sarc. Maybe the horse will learn to sing.

    • #12