I Don't Care About Statistics

[JBMmom, MSN, NP]

We have recently been fully immersed in the next wave in my ICU. Since August we've been hovering at 25-50% COVID patients in our small unit. When I left yesterday morning we had 10/12 beds with intubated COVID patients. Two coded and died yesterday (one was 38 years old) and then another not yet intubated, was admitted into one room and a NON-COVID! was admitted to the other. So we're 9/12, 8 intubated and we think one might survive, one probably died while I was home today. I'll find out when I get there for my shift tonight.

I was talking with my husband about whether if this had happened say 10-15 years ago, would we still have this seemingly political divide between vaccinated/not vaccinated. He was pointing out to me that the mortality rate is something like 0.016% and trying to rationalize something and I feel badly but I just sort of snapped at him. I told him I don't care what the mortality rate is. My pandemic is made up of those 0.016% and their deaths have been awful and frustrating and now that they largely seem preventable they're just worse. We put 10 people on ventilators in the past week knowing full well that almost all of them will die. I admit that four of the patients that have died since August were vaccinated. However, they all had significant comorbidities. The rest of them weren't vaccinated and many of them were angry at us right up until they went on the vent. And even if it is only 0.016%, it's going to end up being more than a million people in the US. A MILLION PEOPLE that were someone's mother, father, wife, husband, child, etc. 

I believe in science, so I guess it's hypocritical of me to say that I don't care about math. But I don't. Because a number doesn't capture people. And doesn't capture what it feels like to go into work knowing you can't do what you trained for. We can't save these people. They're dying ugly deaths and we can't do anything. 

[nursej22, MSN, RN]

My heart goes out to you and others who are out there in the thick of it. And then when I see and hear people trivialize the deaths I just feel sick. 

Please keep letting the world know just how truly awful it is. I am fearful that this cr@p is going to drag on for years and that we will lose the best of the best nurses as they reach their breaking point. 

Big, virtual hugs to you. 

[MunoRN, RN]

His mortality rate claim is more than a bit off, it's off by more than 100 fold.

My ICU is about half Covid and has been for some time.  That ratio isn't particularly unusual across the country.

That means that the amount of critical illness that Covid all by itself is responsible for is about the same as every other health condition and illness combined.  That's a very big deal.  

[toomuchbaloney]

3 hours ago, JBMmom said:

We have recently been fully immersed in the next wave in my ICU. Since August we've been hovering at 25-50% COVID patients in our small unit. When I left yesterday morning we had 10/12 beds with intubated COVID patients. Two coded and died yesterday (one was 38 years old) and then another not yet intubated, was admitted into one room and a NON-COVID! was admitted to the other. So we're 9/12, 8 intubated and we think one might survive, one probably died while I was home today. I'll find out when I get there for my shift tonight.

I was talking with my husband about whether if this had happened say 10-15 years ago, would we still have this seemingly political divide between vaccinated/not vaccinated. He was pointing out to me that the mortality rate is something like 0.016% and trying to rationalize something and I feel badly but I just sort of snapped at him. I told him I don't care what the mortality rate is. My pandemic is made up of those 0.016% and their deaths have been awful and frustrating and now that they largely seem preventable they're just worse. We put 10 people on ventilators in the past week knowing full well that almost all of them will die. I admit that four of the patients that have died since August were vaccinated. However, they all had significant comorbidities. The rest of them weren't vaccinated and many of them were angry at us right up until they went on the vent. And even if it is only 0.016%, it's going to end up being more than a million people in the US. A MILLION PEOPLE that were someone's mother, father, wife, husband, child, etc. 

I believe in science, so I guess it's hypocritical of me to say that I don't care about math. But I don't. Because a number doesn't capture people. And doesn't capture what it feels like to go into work knowing you can't do what you trained for. We can't save these people. They're dying ugly deaths and we can't do anything. 

 

What type of media does your husband consume? I wonder which of his media choices is telling him that covid isn't "that bad" while misrepresenting the data. 

[Guest219794]

2 hours ago, JBMmom said:

I believe in science, so I guess it's hypocritical of me to say that I don't care about math.

There are three kinds of people in this world: Those who understand numbers, and those who don't.

Let's assume that that number is correct.  If I offered your husband tickets to a football game, but casually dropped that there would be a sniper who was going to take out 16 people, he would probably watch it on tv instead. now if he was sitting on the fence, thinking that those were pretty good odds, I could let him know a bit more about the sniper.  He isn't going to shoot anybody in the head so they die instantly- the 16 are going to linger in the hospital, using  huge amount of resources before they die.  Also, for every one he kills he is going to injure another 100.  most will heal at home, but a whole bunch are going to be in the hospital, further using resources.  Because of all of this load on the hospital, a bunch of others are going die, or get substandard care because of this sniper.  And, all of the sick and dying will be alone, because the hospital won't allow visitors.  A certain amount of hospital employees will leave the field, making care for future patients as well.  The rest of the town will also be affected by this event, some businesses will close, jobs will be lost, houses foreclosed on.

When you look at the actual effects, rather than just focusing on the .016%, it changes your perspective.  

You aren't being hypocritical. You understand that that .016%, or whatever the real number is is irrelevant.  It's the tip of the iceberg.  

[BostonFNP, APRN]

10 hours ago, hherrn said:

Let's assume that that number is correct.  If I offered your husband tickets to a football game, but casually dropped that there would be a sniper who was going to take out 16 people, he would probably watch it on tv instead. n

I love this analogy!

If we use the actual case fatality rate in the US (currently 2%): 

• Average NFL game has 66,500 spectators in attendance. 
• Sniper would pick off 1,330 people per game. Another 4,322 would be seriously wounded. 
• Weekly NFL attendance deaths would equal more than eight times the deaths on 9/11. 

[BostonFNP, APRN]

Speaking of statistics, I had an interesting discussion with a male patient in his late 60's yesterday who told me he felt safe not being vaccinated because most of the deaths happened in "fat people" with "other illnesses".

He seems quite surprised to hear that he was part of that very statistic: over 65, BMI of 30, treated for hypertension, and a former smoker with emphysematous changes on his CT. He assumed comorbidity meant "cancer and stuff" and that a BMI of 30 made him one of the "fat people". 

[Horseshoe, BSN, RN]

On 12/10/2021 at 6:48 PM, JBMmom said:

The rest of them weren't vaccinated and many of them were angry at us right up until they went on the vent.  

Angry at you for what?

[toomuchbaloney]

1 hour ago, Horseshoe said:

Angry at you for what?

I suspect that their anger is generalized and poorly defined...

[JBMmom, MSN, NP]

5 hours ago, Horseshoe said:

Angry at you for what?

The anger we are experiencing comes from many aspects of ignorance related to the disease. I understand that one of the unusual aspects of COVID is that people are coming into the emergency room with oxygen saturation levels much lower than expected based on their physical presentation. Patients are able to tolerate oxygen levels even into the 60s with mild external symptoms. They may be able to talk in sentences, they're not hypercarbic and confused and not necessarily using accessory muscles and tiring out. So, some of these people come to critical care "feeling okay" maxed out on high flow oxygen. We have had numerous patient accuse us of exaggerating their illness because our hospital will get higher reimbursement for doing things like putting them on a ventilator. We've had family members telling us that their loved ones don't need a ventilator, one said we just needed to let her husband "go outside and get some air"- as if the 40 liters and 100% wasn't as much as a breath in the parking lot. He died a week later.

Just this week we had a patient swearing at us because he was NPO while maxed on BiPAP because whenever he came off the machine he would desat into the 70s. The next day he was intubated and coded, later dying of a presumed clot. But because he was almost 500 pounds we couldn't do CTA. 

People are angry that we have visitor restrictions and limitations of any sort. We currently have a visitor with two family members in the ICU that refuses to be compliant with our PPE requirements. She will remove her mask at times, she walks out of the room in the gown and has been touching the patients with bare hands. 

And I don't expect anyone to thank me for doing my job. That's not why I do it. But the gratitude we got during the first round has just been replaced with this attitude that somehow we put them in the situation to need the treatment we are giving. It's just frustrating. 

[JBMmom, MSN, NP]

On 12/10/2021 at 10:40 PM, hherrn said:

If I offered your husband tickets to a football game, but casually dropped that there would be a sniper who was going to take out 16 people, he would probably watch it on tv instead.

That is an awesome analogy! For what it's worth, he's vaccinated and doesn't argue with me about many aspects related to the pandemic. But he, like most, have the relative luxury of knowing someone down the street that got the sniffles from COVID, or maybe someone that spent a couple days in the hospital and then got better. Those aren't the people I see, so I realize our realities are each skewed in a different direction. 

[Susie2310]

@JBMmom

My comments are below yours, in italics.

We have had numerous patient accuse us of exaggerating their illness because our hospital will get higher reimbursement for doing things like putting them on a ventilator. 

I don't know if your facility is currently utilizing Covid Crisis Standards of Care, but for those members of the public who understand what this means, I can understand it if some patients/family members feel very angry about this.  Also, I think a patient/their family can find it very frightening when a patient is suddenly admitted to an ICU; I think it can be part of a defense mechanism to ask if the patient really needs to be on a ventilator or really needs an ICU level of care.  It's very frightening to have a loved one seriously ill. 

People are angry that we have visitor restrictions and limitations of any sort. We currently have a visitor with two family members in the ICU that refuses to be compliant with our PPE requirements. She will remove her mask at times, she walks out of the room in the gown and has been touching the patients with bare hands. 

I think the anger at visitor restrictions/limitations is understandable.  I think another fly in the ointment is that some health care workers refused to be vaccinated without true medical contraindications and continued to take care of patients, while patients' family members, who may have been fully vaccinated and fully compliant with mask wearing/social distancing, were prevented from being with their loved one, advocating for them, and providing them with support.

Additionally, some patients experienced acute illness and have died without their loved one even being allowed to be with them to care for them and support them; an enormous trauma for both patients and their family members.  The public is aware of these things.

I've read some nurses say that they are glad/were glad that patients family members were not allowed to be with the patient/visit the patient when they were hospitalized during Covid; I'm sure some members of the public are aware that some health care professionals hold this sentiment.

And I don't expect anyone to thank me for doing my job. That's not why I do it. But the gratitude we got during the first round has just been replaced with this attitude that somehow we put them in the situation to need the treatment we are giving. It's just frustrating. 

I think my comments above address this.  Not everyone perceives nurses/healthcare workers or the healthcare industry as being saviors, although I think the public acknowledges that healthcare workers often have a difficult job.  I also think that many members of the public are simply fatigued with the whole Covid situation, which has upended peoples lives.