Hospitalizations are not all unhappy in the same way

I was pleasantly surprised by this Atlantic article about recent attempts to figure out what COVID hospitalization rates are telling us. It avoids hyperbole and rigid black-or-white thinking, instead focusing on a spectrum of results that are influenced by age and immunological status (natural or vaccine-induced). The author notes that case counts are of little use without a way to distinguish asymptomatic cases from symptomatic or serious ones, and that death rates are a lagging indicator besides often failing to distinguish between deaths from or with COVID. Hospitalization rates suffer from some of these same problems, but studies that focus on oxygenation rates can be very helpful.

The studies cited in the article confirm the news from other sources that perhaps half of "COVID admissions" really are admissions for other reasons where a routine COVID test reveals a previously unsuspected infection. By looking at oxygenation rates, the studies provide more insight into how many people are still being hospitalized specifically for COVID complications, how intensively they have to be treated, and how quickly they can be released.

The article quotes a doctor who says he has patients who complain, "Why did I bother with the vaccine if I'm still in the hospital?" to which he answers, "But you're going to leave the hospital alive." A brief supportive stay in the hospital may not be a huge deal, much as we'd like to avoid it. A bad COVID hospital stay can be a real nightmare even if you survive it. The case that spooked me early on was a fellow in his 20s from my county, the son of a co-worker, who came down with a severely unlucky case, hugely complicated for no obvious reason, which kept him in an Austin hospital for months teetering between life and death. He was so young and otherwise healthy that they really pulled out all the stops for him, using convalescent serum and all kinds of treatments that were quite experimental in early 2020. He did survive, but lost some toes to sepsis. Although I know that's an extreme outlier, a sort of auto-immune storm that's almost impossible to predict, it still made me a lot less likely to go out into public unnecessarily until the vaccine came along.

There are some protective measures that aren't 100% effective but are still worth the effort. Masks may be among them, though I'm not entirely convinced of it, and not at all convinced in the case of casual cloth masks, particularly for asymptomatic people (symptomatic ones should be home anyway). Staying out of public surely helps even though it's not observed rigidly. As I read the data, vaccination is very, very helpful even though it's not a panacea. These are all things I'm happy to see people voluntarily put into practice; I've practiced many of them myself and often recommend them, not counting masks.

The lack of attention to monoclonal antibodies is puzzling and frustrating, so I tout this treatment whenever I get a chance, especially because you have to be ready to move fast once symptoms declare themselves, so you need to have figured out where they're available and what hoops you'll have to jump through to get access to them. If we really want to avoid clogging up hospitals, we should stop downplaying antibody infusion centers, which can administer their treatments in a 2-hour outpatient procedure that needn't even be administered anywhere near a hospital. But I swear I tell people about them all the time and get blank stares: all the oxygen in the room is taken up by fights over whether 2-year-olds need to be forcibly masked and massive numbers of people need to be driven out of their jobs by vaccine mandates.

My society has simply lost its mind. All I can conclude is that we're very bad at assessing and responding to brand new types of risk, so we revert to primitive thinking and superstition.