Wednesday, November 25, 2020

Swiss ICUs and end-of-life wishes

Among the Western countries, the otherwise hyper-PC Sweden is unique because its medical elite was capable of keeping the nation in a good psychological shape, extinguishing unnecessary Covid fear, rejecting the "global duty" to wear face masks, and avoiding the closure of schools and shops at all times (although mass events are still restricted; and the border was closed for some time). The pictures of Swedish cities have looked like a different world since March. "Everyone else" thought it was common sense to be hiding in the basement like a rat (and tens of millions ludicrously think that the world will never get to the "old normal" again); meanwhile, millions of Swedes continued their normal lives.

Some Swedes were still hiding like rats but they did so on the private basis which is exactly how things should be (I think that a much higher percentage of Swedes is willing to hide in this way, relatively to more "individually courageous" Czechs, and that's why we saw a much faster Covid dynamics here in Czechia). In November, the Swedish statistics page makes it clear that Sweden's approach was a great success. 6500 Swedes died with Covid but the actual "excess death tally" is just about 1000-2000 i.e. 1-2% of the annual deaths (which is pretty much undetectable by eyeballing if you look at the annual charts). Czechia already has 7499 deaths with Covid so our more stringent spring lockdown almost certainly wasn't a good investment for the final tally. The second wave came to Sweden because \(R_0\) is higher in these months than what it was in late spring and the summer, so the required fraction for herd immunity is higher (which is why these diseases are seasonal). The peak "deaths per day" were 34 in this wave so far, well below 115 in the spring, so Sweden is pretty much the least affected Western European country now. The total number of casualties of this "next wave" will be some 1/6 of the first wave. With a third wave, expect something like a geometric series: you may just ignore other waves.

The Swedes were likely to choose this strategy because they have some – non-democratic but in many contexts helpful – respect to the government experts and bureaucracy. And doctors generally do know that it is plain stupid to adopt a metaphysically new, hysterical set of policies to fight against something that is effectively just another strain of flu. It's always the uneducated, irrational people – plus those who want to profiteer from the scientific illiteracy of the masses – who are behind stupid things such as lockdowns.

Swedes belong to a "Nordic race" which is sometimes associated with certain policies – although the association is mostly a random aspect of the history, I think. But I do believe that the survival in the cold conditions has forced them (well, selected their DNA molecules) to be "tougher". So I think it is not quite a coincidence that Svante Arrhenius, the prominent Swedish chemist (who also wrote a mostly wrong but pioneering paper on the greenhouse effect), was a staunch eugenicist. He wanted to create a cohort of more resilient and skillful Swedish children by sending the electric current into their bodies! ;-) If no "natural selection" is involved (murder of children), I think it doesn't really work because the theory that it does work is a version of Lamarckism if not Lysenkoism.

For some reasons, the other Scandinavian Germanic nations – Danes and Norwegians – chose more pro-lockdown policies. But are there other similar Western European nations that could be "tough" due to the weather? Well, the Netherlands is not far but it is a flatland adjacent to the sea (or immersed in the sea) which prevents the temperature from going too low. OK, here you have the other country, Switzerland (which starts with SW... just like Sweden; both are ŠV... in Czech). There are mountains there, the Alps, and the weather may get very cold. Due to the current mild Swiss Covid restrictions, the Coronazis have called Switzerland the new Sweden and given the Coronazis' being total scum, you may be sure that they think that this praise is actually damning.

This photograph titled "Global warming comes to Switzerland" shows you the condition in which the Swiss normally find their cars. ;-) OK, fine, Switzerland has had some Covid restrictions but they're again far milder than the restrictions imposed by all the nearby countries. As the World'o'meters page makes clear, Switzerland (8.6 million people) had a not-quite-negligible spring Covid wave peaking at 50 deaths per day – significantly smaller (per capita) than Italy much much higher than Czechia. And in the autumn, they have had up to 21926 positive tests on November 2nd while the deaths-with-Covid per day reached about 100 now.

In Czechia, we saw a similar fast growth but famously enough, Czechia has always had an excess of the ICUs. When the ICUs occupied by Covid patients peaked at 1244 on November 3rd, Czechia could still afford "almost a doubling" of such patients (now we have 800 Covid-positive people in the ICU units and almost 1000 free ICU beds). So even this overhyped disease – combined with a relatively relaxed, fearless behavior of Czechs as individuals – was very far from overloading our system (in some cases, medical students hired as doctors may have helped, a simple reasonable way to give them a lesson and help the nation, too). However, Switzerland has some 13% fewer ICUs per capita (the pages for Switzerland and Czechia show the number per million people, not 100k, right?) and other things were different... so the ICUs in Switzerland were said to be full a few days ago.

A Covid-hysterical acquaintance of mine was stunned by the news
Swiss doctors urge COVID vulnerable to declare end-of-life wishes in advance
An organization of Swiss intensive care doctors has encouraged vulnerable people, especially those above 60 and especially those with extra conditions such as diabetes, to make the bold end-of-life wish "not to be cardiopulmonarily resuscitated" (I turned the first term into an adverb!). This "graceful exit" of such patients with low chances for a full recovery may lead to a better utilization of the currently overloaded Swiss ICU resources (this situation won't last for more than weeks, of course).

When I was 5, my notebook said "I need to invent the plans making sure that not a single human being or animal will die again". It was emotionally cute and I was an idealist leftist of a sort – but just a few years later, I already thought that it was very stupid. The world would be a terrible place if death didn't exist. The world without death would actually resemble an increasingly chaotic and overfilled world that is full of zombies and that is much more scary than to say "good-bye" to someone once in 80 years. If you weren't able to maintain your right to occupy more land than a 500-year-old zombie, that would be the ultimate horror and failure of meritocracy.

OK, an elderly people's NGO disagreed with the Swiss intensive care doctors. But still, you can see the independent spirit of Switzerland. They simply are different from the EU – and North America. I think that in the EU, no organization of doctors would dare to make this recommendation explicit. They would be attacked as cruel. "Lives must be saved regardless of the costs," the prevailing politically correct attitude says. Of course, like other PC slogans, this one is incredibly stupid, too. First, it is just destructive to sacrifice a huge part of the economy for a relatively small number of (not quite full-blown) lives. Second, all lives won't be saved even if a nation decided to pay everything it has simply because it is fudging physically impossible to make the people perfectly immortal! In fact, one may argue that the lockdowns and similar restrictions haven't improved the medical situation at all, at least not in the medium and long term.

So the Covid patients undergoing the pulmonary resuscitation represent a group where the difference between the "costs" and "benefits" of the ICU treatment is particularly high. The Swiss ICU resources are being intensely depleted these days – and when they're overloaded, they could be exploited for "more promising" patients who are more likely to achieve full recovery, and do so faster.

Note that the Swiss doctors say, to a small minority of the nation (whose extremely tiny fraction will actually face the possible pulmonary resuscitation), "be brave and do something for the nation by declaring your end-of-life wish not to be a huge burden for your compatriots". The non-Swiss, PC attitude tells these people "we will surely save you and make you immortal no matter the costs" while the remaining millions of the nations are being told "be brave and sacrifice a big part of your wealth and freedom – a year or two years of your normal life – in order to make the vulnerable Covid patients immortal". Both approaches basically say something like "sacrifice something in the name of your whole nation's well-being". The real question is which of these recommendations urges a "more sensible sacrifice".

Of course, even in the case of the tense Swiss ICU system, I think that the Swiss system is better – especially because it affects a vastly smaller number of people (millions of person-years are crippled by the lockdown of a country; only thousands of person-years are shortened by a hypothetically premature Covid death); and because it is much more effective in bringing some results (which lockdowns and quasi-lockdowns clearly can't guarantee). The Swiss doctors' recommendation isn't actually a plan "to pay some people's lives for preserving the economy", as the Coronazi demagogues may love to say. Instead, it's a plan to save a greater number of human lives by using the existing hospital resources more effectively, through a prioritization! And be sure that just like the morgues, the prioritization isn't an invention of the Covid era. Dieners have worked in morgues for centuries and doctors have been making "priority decisions" for centuries, too. If you've never realized such "cruel" facts, you shouldn't try to influence these policies because you know less than a baby about these matters!

Another general strategy is to simply have a higher number of ICU units and the doctors, like Czechia had (next time, it may help). But this is clearly not a feasible "universal solution" to all such conceivable situations. A nation can't realistically afford millions of ICU beds which means that there will always exist a possibility that a "bigger epidemic or medical event" than the recent ones will overload the system! And if you never get really close to this situation, it means that your system was wasteful – you have paid for the production of too high a number of ICU beds; and you are probably paying too many doctors who don't do much and who are just waiting for a rare medical event in which they may be useful. Even after the autumn Covid wave, we may argue that almost 1/2 of the money previously paid for the Czech ICUs were wasted.

So in the real world, I find it obvious that the number of ICU beds (and similar capacities) simply has to be a certain finite number that implies a nonzero risk that the system may get overloaded at some time. When it happens, the hospitals may still try many things. Buy new ICU beds and store them in field hospitals, hire students as doctors and/or soldiers as nurses, move the patients to another hospital (perhaps in another country), and more. It is possible that even these options become impossible in some situation(s). In that case, the hospital system simply fails to work. It is not a fudging end of the world (although it may increase the probability that some individual people will experience the end of their life). People are paying for the health insurance but it is unavoidably an "imperfect contract". The health insurance company cannot pay an infinite amount of money – also because it doesn't collect an infinite amount of money. So the contract involves the assumption that the guaranteed care starts to shrink in the unlikely situation that the resources become overloaded. You may also make the health insurance companies "obliged" to guarantee the same care no matter what but this care will become so impossibly expensive that these companies (or whole countries, if you thought that you may change something about these matters by socialism) will go bankrupt and the care will get heavily reduced, anyway! The real world simply has limits and guarantees and entitlements can never become "absolute". You're a fudging pile of snowflakes if you don't realize this elementary point (which has thousands of variations in many human activities).

Covid-19 is not a very serious disease. It has a very similar impact – and very similar dynamics of propagation – as yet another strain of flu. Flu epidemics sometimes overload medical systems, too. But this dilemma is more general, of course, and the main point of this text is that there always exist some limitations and when resources get depleted, the likelihood that you will get one treatment or another (gradually or abruptly) changes. These changes may look "inhuman" but they just follow from the laws of Nature and if you get psychologically unstable while thinking about these matters (and about the prioritization that takes place in hospitals etc.), you should avoid thinking about these matters or following the media that pump them into you. It is not your job and you are not sufficiently psychologically strong and stable to deal with such issues. Doctors must deal with them every day. You couldn't be a doctor. You are just a brainwashed, cowardly, hysterical Coronazi sheep, dear Petr Nachtmann, OK? So return to your hole in the basement and stop watching news like that which exceed your abilities.

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