Coronavirus

[jbcarioca]

Proverbial chicken and the egg . . .

If we wait for a complete dataset, people will die that could have been saved if we worked from a partial dataset.

Physicians face this problem every day. We simply make the best informed decisions we can from the data we have, and try our hardest to separate out the reliable data from the noise. There is a lot of both right now.

Physicians do have an inordinately difficult position when they are faced with a question outside their experience and training, with no specialist who knows the specific symptoms. For perfectly reasonable reasons most patients want to ascribe omniscience to their physician. The very notion of clinical trials is meant to make treatment decisions less fraught with better outcomes. That works well when the disease is well documented and the patient appears a couple of years after the fist clinical trials, not so much when one must guess based on inadequate information.

Just now there is intense worldwide effort to mitigate the problems. In the meantime it is all about 'best guesses' while facing potential life-threatening disease. Good luck!

 

[gerebgraus]

South Korea numbers directly contradict his 0.3% fatality rate assumption. Which he arrived at by "adjusting" Diamond Princess 1% rate, which itself is probably too low because tracking got spotty while there were still lots of unresolved cases.

I agree with his headline - we don't have reliable data in the US yet (due to total FUBAR by the federal government). Poor data means we have to do MORE, not less. If you know the hurricane's path you can focus your preparation. If you don't, then everyone along the entire coast has to board up and evacuate.

I respect that you took the challenge (although you failed.) South Korea does not contradict the 0.3% fatality rate. Although they have tested a lot more people than us (so they have the best data unlike the USA that initially sabotaged testing.) They have only tested 270,000 people obviously people with more symptoms or people who exposed to higher viral doses. (Pretty much the only healthy people who died where health care workers caring for the infected without proper protective equipment.). So that in fact suggests to me that the overall fatality rate was likely even lower than 0.3%
I do not know anything the Diamond Princess tracking.

 

[bhzmark]

The whole thing is probably a bitcoin scam . . . But there it is.

And here is what purports to be the paper of the chloroquine in-vitro-no-rct-in-nature bitcoin scam.

Hydroxychloroquine and azithromycin as a treatment of COVID-19.pdf

highlights:

 

[gerebgraus]

We can nit-pick specific examples of course, but physicians are better at this than everyone else when it comes to a pandemic.

You think things are bad now, just wait till parts of the US starts doing what Italy is doing. Triaging those we think have a chance to fight off the virus, and giving those we cannot save palliative care.

I am sorry but well trained statisticians are much better than physicians to evaluate data. Again the fundamental problem here that "falttenting the curve" optimizes the coping of the emergency room operations and not the overall health of the population. Health consequences of the collapse of the economy and also social isolation is much higher than the short term collapse of the emergency medicine operations even if it is difficult to attribute morbidity and mortality to these things. You can be sure that depressions and the number of suicides will go up. Domestic and all other violent crime will go up, etc. etc.

 

[BornToFly]

Had lecture from Infection Disease expert at our hospital this morning. Covid19 now renamed SARS-CoV-2. US death toll if we do nothing estimated at 2.2 Million. ICU bed peak occupancy expected around Mid-June.

 

[Dr. J]

Does no one remember SARS? It was literally 2 seconds ago and the exact same thing.

That word does not mean what you think it means, and that's literally two untruths in one infelicitous sentence! Wow.

 

[nwdiver]

Wow, a completely new level of freakout here today. Does no one remember SARS? It was literally 2 seconds ago and the exact same thing.

And if SARS had community spread in almost every country with ~200k known cases + ~2M likely unknown cases we'd be in a similar level of 'freakout' x~10 since SARS had a CFR of ~10% and didn't discriminate against older people as much.

 

[Dr. J]

I am sorry but well trained statisticians are much better than physicians to evaluate data.

Wait, wait! I have to get popcorn.

OK, go ahead.

 

[deonb]

Had lecture from Infection Disease expert at our hospital this morning. Covid19 now renamed SARS-CoV-2. US death toll if we do nothing estimated at 2.2 Million. ICU bed peak occupancy expected around Mid-June.

There was no rename AFAIK.

The virus is called SARS-CoV-2. The disease it causes is called COVID-19 (Coronavirus Disease).

 

[BornToFly]

I asked the infection disease expert this morning why the previous SARS was not as bad. The big problem with the current virus is that is it shed before symptoms start and with the mild symptoms early on. The previous SARS was not like that, and was more likely to kill the host and burn out.

 

[BornToFly]

Two of the slides from this morning.

 

[BornToFly]

Notice that even with all mitigation strategies, we are WAY above the red line, which is ICU capacity.

 

[bkp_duke]

View attachment 523087
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Two of the slides from this morning.

The "Highly prone to mutations" is new information. All data I've seen so far indicated a lower mutation rate than the seasonal flu.

 

[SageBrush]

I asked the infection disease expert this morning why the previous SARS was not as bad. The big problem with the current virus is that is it shed before symptoms start and with the mild symptoms early on. The previous SARS was not like that, and was more likely to kill the host and burn out.

I mostly disagree; I think the virulence prompted a much faster public health response and a very attentive populace. The world chatters about Covid-19 on the internet but the population is overall quite complacent ... until the wave comes crashing down.

If this was SARS even trump would have been smart enough to not label it a hoax.

 

[bkp_duke]

Notice that even with all mitigation strategies, we are WAY above the red line, which is ICU capacity.

Yeah, this one is going to be a nightmare.

I don't know what is happening with you, but I still have a TON of friends that text me daily thinking we are totally over-reacting to this. I've been trying to put the fear into them, but with only marginal success.

 

[TheTalkingMule]

I am sorry but well trained statisticians are much better than physicians to evaluate data. Again the fundamental problem here that "falttenting the curve" optimizes the coping of the emergency room operations and not the overall health of the population. Health consequences of the collapse of the economy and also social isolation is much higher than the short term collapse of the emergency medicine operations even if it is difficult to attribute morbidity and mortality to these things. You can be sure that depressions and the number of suicides will go up. Domestic and all other violent crime will go up, etc. etc.

The poorest parts of Philadelphia are 100% experiencing this as we speak. Saw the poor white folks up close yesterday and they're freaking out beyond belief. Neighborhoods that see a high level of domestic violence are going to implode as tensions ramp.

My girlfriend works in about the poorest black neighborhood and it's doing a bit better, but will certainly break down without financial relief and childcare for mostly single parent households.

And all that is with exactly 9(NINE!) cases identified in Philadelphia, the 4th largest city in the US. If pandemic effects do end up hitting the city, how's that gonna look?

 

[BornToFly]

Yeah, this one is going to be a nightmare.

I don't know what is happening with you, but I still have a TON of friends that text me daily thinking we are totally over-reacting to this. I've been trying to put the fear into them, but with only marginal success.

Everyone should listen to this podcast from a doctor in Italy on the front lines.
‎The Daily: ‘It’s Like a War’ on Apple Podcasts

 

[BornToFly]

I mostly disagree; I think the virulence prompted a much faster public health response and a very attentive populace. The world chatters about Covid-19 on the internet but the population is overall quite complacent ... until the wave comes crashing down.

If this was SARS even trump would have been smart enough to not label it a hoax.

The point is it is a SARS. SARS-CoV-2

 

[Open Interest]

There was no rename AFAIK.

The virus is called SARS-CoV-2. The disease it causes is called COVID-19 (Coronavirus Disease).

Had lecture from Infection Disease expert at our hospital this morning. Covid19 now renamed SARS-CoV-2. US death toll if we do nothing estimated at 2.2 Million. ICU bed peak occupancy expected around Mid-June.

What does “if we do nothing” mean here? Clearly employers and communities across the country are shutting down and doing things. Is the implication that even with American society closed down, we will reach 2.2 million? Will our efforts make any kind of impact here?

 

[nwdiver]

Everyone should listen to this podcast from a doctor in Italy on the front lines.
‎The Daily: ‘It’s Like a War’ on Apple Podcasts

Yep;