How surprising is the current COVID-19 situation? Dr. Anton Titov, MD. Because the high probability and expected burden of a pandemic have been well described in scientific reports and. Fiction books, movies, they all vividly paint the disasters effect over pandemic. Medical second opinion is important. Dr. David S. Jones, MD. I’m a little bit surprised at that the world’s powers that be an act so surprised because first Dr. Anton Titov, MD. You know, there is billions of profits in various industries in healthcare and transport industries, these are all paid out to investors, most of whom are institutional. The hedge funds. The,. The various financial institutions. Then there is we have complaints that there are not enough ICU beds, there are not enough ventilators that made where these things have been predicted. The response and the requirements are well known. Medical second opinion is important. Isn’t that a predictable outcome? Dr. Anton Titov, MD. Because, now we have again. The public bailing out. Essentially. The private profits, profits are private. The costs are public. Why does society keep stepping into the same trap again and again? Dr. Anton Titov, MD. What historical perspectives that can teach us? This is a case where historical perspectives go in two different directions. Medical second opinion is important. One of them is a reassuring direction. This is that epidemics that cause mass mortality are incredibly rare in human history. Wait, you don’t want to look just at the number of deaths, because you need to normalize that for the size of the human population. Medical second opinion is important. What you’d like to do is have a list of all of the Epidemics in human history that have killed 1%, or half of a percent of the human population. The data isn’t good enough to allow robust assessments of that. But it is likely the case that epidemics that kill a half or 1% of the population happen a few times a millennium, there only three or four or five examples over the past 2000 years. Aids, flu, bubonic plague, it is hard to be confident about others. So that suggests that category mortality is rare. Then there is also the counter-argument that human societies since 1918, have done everything possible to increase the likelihood of a catastrophic epidemic. Dr. David S. Jones, MD. We live in huge cities of ever-increasing population density. Dr. David S. Jones, MD. We are interconnected with a global air travel that allows epidemics to spread much more quickly than they ever could have in the past. Dr. David S. Jones, MD. We have systems of industrial agriculture that bring humans and animals into close contact in various ways that help facilitate the spread of pathogens across this opposing species barrier. This isn’t much of a barrier. Then the other thing that has left us vulnerable, especially in the United States, is the healthcare system. Even though we spend an enormous amount on health care. 20% of the GDP. The health care system has been under tremendous financial pressure to make itself as efficient as possible. Hospitals still have a long way to go. But most good hospitals are wrong. At baseline at 98, or 99%, occupancy, it is very hard to make money unless you keep your hospital full all the time. At baseline, you want the beds full; you want the intensive care units full. Dr. David S. Jones, MD. That is how hospitals are designed. This is great for usual times. But as we have now seen, it creates a huge liability in the setting of a disaster, where we don’t seem to have much surge capacity. Sometimes COVID-19 starts to cause hundreds or thousands of hospital admissions a day, where do you put them for hospitals that were already designed to be full of unusual diseases with heart disease, cancer, pneumonia. Everything else? Dr. Anton Titov, MD. Some patients have asked, Well, how is it that our healthcare system is so unprepared for this? Dr. Anton Titov, MD. Well, it is because the healthcare system did exactly what we wanted to do. Run it exactly full capacity all the time at baseline so that we are not wasting healthcare resources. But what would have been considered waste six months ago would now be considered a useful surplus capacity to have today. So part of the problem is that we weren’t willing to pay in advance for what we need right now.
How can patients avoid mistakes when dealing with a medical problem? Leading doctors share wisdom: