Coronavirus

[ChadS]

A couple of hundred posts ago, I mentioned that my brother-in-law is a nurse in Seattle. It happens that he works at the VA hospital.

Almost two weeks ago he had mild, generic flu symptoms. His tests for influenza and COVID both came back negative (although he was told there was a 5% rate of false negatives). He was asked to return to work, since the tests were negative and the need for workers was dire.

A few days ago, his symptoms (including fever) got MUCH worse. His wife (who had similar symptoms, but much milder) wasn't sure he was going to make it through yesterday. But he seemed to turn a corner last night, and was able to speak to my wife today. He noted that it felt worse than anything he had experienced in his life.

He didn't get a second test. He's worked with patients with COVID, and his symptoms seemed to match exactly...but without the test, we aren't sure. Maybe he doesn't have COVID? Regardless, he's not counted in the stats.

 

[dhrivnak]

The US trend line also is the steepest one of all countries so far. Does that say something about the health of the average American? Or the health system?

Or maybe our incredibly smart and caring President?

 

[wdolson]

Yahoo has an article titled “Shock claim: Deaths will top 80,000 in the next four months”. That’s shocking?
Why didn’t we shut down the economy in 2018 when 60,000+ died in the US from the flu? Why didn’t we spend $6 trillion when 43,000 people died from opioid overdose in 2019?

That 80,000 assumes agressive self isolation and hospitals will not exceed capacity and have to let savable patients die because they don't have the ventilators. With COVID-19 the number of people who have life threatening cases and require hospitalization or they will die is much, much higher than any flu outbreak since the 1918 flu.

Look at the hospital situation in many places that are hardest hit. In some places in Italy they have had to let savable patients die because they didn't have the ventilators and other resources. New York City, Atlanta, and New Orleans are on the verge of that point right now with cases growing in every city.

If we do aggressive self isolation, we can keep the death rate down to 80,000 in the next four months. If we don't, there is a study out of the UK that showed if the virus was allowed to run its course. In the UK, they would see 500,000 dead. The US in the same scenario would see 2.2 million dead. We would be done with the virus by mid to late summer because almost everyone left alive will have had it and gotten over it.

Then there are the long term consequences. There is news coming out of China that about 20% of those hospitalized who recover have permanent heart damage. Some percentage (probably fairly high) will have permanent lung damage too. About 68 million Americans are vulnerable to get serious cases. If all of them got it at once, a huge percentage of them would die and most of the rest would be left with permanent, chronic health conditions that will require treatment the rest of their lives.

If you want to see millions die and the economy melt down for a generation, go back to business as usual.

 

[deonb]

Sustain us how? I'm not going to see a penny. I'm going to lose a tremendous amount of income this year, which will greatly affect my ability to make purchases.

Your customers will be seeing the money, so when we get out of this they can purchase your products again rather than sitting on a street corner. That's the theory anyway. This will only be practice if everything is meticulously well executed... which... it's not.

 

[TheTalkingMule]

That 80,000 assumes agressive self isolation and hospitals will not exceed capacity and have to let savable patients die because they don't have the ventilators. With COVID-19 the number of people who have life threatening cases and require hospitalization or they will die is much, much higher than any flu outbreak since the 1918 flu.

Look at the hospital situation in many places that are hardest hit. In some places in Italy they have had to let savable patients die because they didn't have the ventilators and other resources. New York City, Atlanta, and New Orleans are on the verge of that point right now with cases growing in every city.

If we do aggressive self isolation, we can keep the death rate down to 80,000 in the next four months. If we don't, there is a study out of the UK that showed if the virus was allowed to run its course. In the UK, they would see 500,000 dead. The US in the same scenario would see 2.2 million dead. We would be done with the virus by mid to late summer because almost everyone left alive will have had it and gotten over it.

Then there are the long term consequences. There is news coming out of China that about 20% of those hospitalized who recover have permanent heart damage. Some percentage (probably fairly high) will have permanent lung damage too. About 68 million Americans are vulnerable to get serious cases. If all of them got it at once, a huge percentage of them would die and most of the rest would be left with permanent, chronic health conditions that will require treatment the rest of their lives.

If you want to see millions die and the economy melt down for a generation, go back to business as usual.

And that's the danger of basing policy on one study. That report from the Imperial College pegged the overall mortality rate above 2%, which is around 10-20x greater than what we've seen out in the real world. Yes, 80M+ Americans are going to be infected with this coronavirus, but only about .2% or likely less will die.

The guy who published that report is a genius, and likely in the top handful of people qualified to write such a report, but he was wrong.

Staying locked down will probably help us flatten the curve, but this thing is spreading. There's not much we can do now since we decided not to test people, so that 80k(or I think more like 40k) are going to die eventually regardless of staying home. If the hospital crunch happens, it'll be worse.

 

[BornToFly]

Your customers will be seeing the money, so when we get out of this they can purchase your products again rather than sitting on a street corner. That's the theory anyway. This will only be practice if everything is meticulously well executed... which... it's not.

Yeah, the point I was trying to make (badly) is that the $2T bailout, the worsening Pandemic, and the rising stock market make no sense to me. Market should be red even with the bailout.

 

[MXLRplus]

If US history has taught us anything, it's that if we want a strong economy...
we need to declare war on somebody, anybody. Will it work if we declare war on a virus? That is a big unknown.
It will be interesting in any case.

Unrelated - If you've ever been on a modern cruise ship, you know what a nice disease haven is. From the port terminal, to the Welcome Aboard, to the Muster Drill, to the first dinner, you've come in close proximity with over 1000 people in less than 12h.

So how come the low infection rates on the Death Boats?

 

[Daniel in SD]

And that's the danger of basing policy on one study. That report from the Imperial College pegged the overall mortality rate above 2%, which is around 10-20x greater than what we've seen out in the real world. Yes, 80M+ Americans are going to be infected with this coronavirus, but only about .2% or likely less will die.

The guy who published that report is a genius, and likely in the top handful of people qualified to write such a report, but he was wrong.

Staying locked down will probably help us flatten the curve, but this thing is spreading. There's not much we can do now since we decided not to test people, so that 80k(or I think more like 40k) are going to die eventually regardless of staying home. If the hospital crunch happens, it'll be worse.

So why do you think you're so much smarter than him since your estimate seems to be entirely based on your own secret study?
And we're still waiting for where you got your fatality rate for SARS...

 

[AlanSubie4Life]

Market should be red even with the bailout.

It is puzzling, but there's always room for irrational behavior. It seems like there are strong headwinds and plenty of uncertainty about how this is going to play out. The market is behaving as I would have expected had there been a forceful, organized, federal response. But since there hasn't been any federal response, the current behavior does seem odd, since there is now a lot of uncertainty (a competent response would have eliminated basically all uncertainty).

Probably just a little pump and dump.

 

[wdolson]

Your customers will be seeing the money, so when we get out of this they can purchase your products again rather than sitting on a street corner. That's the theory anyway. This will only be practice if everything is meticulously well executed... which... it's not.

What we're trying to do is put the economy into an induced coma. If we pull it off, the economy will explode when it's safe to open things up again because the consumers will still have a roof over their head.

Everybody is taking a haircut. Those with money saved can live on their savings. Those with no ability to save because they don't make enough need to be given money to hold on when they can't work. The poorest people have no discretionary income, everything they make goes to necessities. If they miss a paycheck, they go hungry, lose their housing, have their utilities cut off.

For those who have enough savings to get through this, losing a paycheck hurts, but you're not going to end up homeless or starving.

The lockdowns is forcing those who would normally be spending discretionary income to not spend it. To a large degree that's pent up demand. When the all clear happens, those people will rush out to spend. If we can throw individuals and companies in trouble a lifeline so they can hold on, the economy will boom out of this. If we don't, the economy will be in recovery for a very long time because a huge segment of the population will be out on the street, and we will be facing a homeless crisis worse than the Great Depression.

 

[lascavarian]

Dr Birkx who spoke from Washington (White House) today made an important admission.

The numbers they are getting are not consistent with their modeling SW.

If I have it correctly, either of 2 cases are implied by the actual data.

1. They are seeing the tip of a very broad triangle of infections

2. They don’t have the transmission method correct.

She kept referencing a ratio of 1 per 1,000 coming up which conflicted with their model.

I thought this was big deal but I hear crickets. I connected this with The rise in market the last 3 trading days.

 

[Thekiwi]

And that's the danger of basing policy on one study. That report from the Imperial College pegged the overall mortality rate above 2%, which is around 10-20x greater than what we've seen out in the real world. Yes, 80M+ Americans are going to be infected with this coronavirus, but only about .2% or likely less will die.

The guy who published that report is a genius, and likely in the top handful of people qualified to write such a report, but he was wrong.

Staying locked down will probably help us flatten the curve, but this thing is spreading. There's not much we can do now since we decided not to test people, so that 80k(or I think more like 40k) are going to die eventually regardless of staying home. If the hospital crunch happens, it'll be worse.

Can you please stop repeating your totally unqualified assertion that the fatality rate will be "0.2% or less" - it has no support in reality.

And another thing, even with your assumption that 80m million Americans will be infected, the hospital system would be vastly overwhelmed spiking the death rate far far higher than it otherwise would be under a countrywide lockdown.

 

[linux-works]

What we're trying to do is put the economy into an induced coma. If we pull it off, the economy will explode when it's safe to open things up again because the consumers will still have a roof over their head.

really concise way of explaining it. bravo.

 

[Oil4AsphaultOnly]

And that's the danger of basing policy on one study. That report from the Imperial College pegged the overall mortality rate above 2%, which is around 10-20x greater than what we've seen out in the real world. Yes, 80M+ Americans are going to be infected with this coronavirus, but only about .2% or likely less will die.

The guy who published that report is a genius, and likely in the top handful of people qualified to write such a report, but he was wrong.

Staying locked down will probably help us flatten the curve, but this thing is spreading. There's not much we can do now since we decided not to test people, so that 80k(or I think more like 40k) are going to die eventually regardless of staying home. If the hospital crunch happens, it'll be worse.

Earlier in this thread, I was with you, but the more I'm learning, the more I see everyone else's point. That 0.2% death statistic you cite is based on a functioning health-care system. If 80M get infected, even at 1-2 weeks apart, the hospitals would be overwhelmed, and all the statistics showing critical cases (10x that of death so far) would become the new death cases column, since people who are in critical condition won't get the ventilators they'll need to survive.

Looking at the death to recovered ratio in China makes me believe that the 0.2% death rate is much too low to use for a "almost everyone infected" scenario anyway.

I've seen your posts about the infected cases being under-reported, but that's only a valid assumption if you believe the death rate to be static/correct - a cart-before-the-horse logic. The death rate should only be certain AFTER we know that the infected cases are correct.

Sorry, but I think you need to rethink this, especially since shelter-at-home seems to be working for CA. My kids are still stir-crazy, and I still think that we need a viable exit strategy VERY SOON, but maybe deliberately getting sick isn't a low risk solution after all.

 

[MXLRplus]

Dr Birkx who spoke from Washington (White House) today made an important admission.

The numbers they are getting are not consistent with their modeling SW.

If I have it correctly, either of 2 cases are implied by the actual data.

1. They are seeing the tip of a very broad triangle of infections

2. They don’t have the transmission method correct.

She kept referencing a ratio of 1 per 1,000 coming up which conflicted with their model.

I thought this was big deal but I hear crickets. I connected this with The rise in market the last 3 trading days.

This today?

Dr. Birx - "THE MODEL DON'T MATCH THE REALITY ON THE GROUND IN CHINA, SOUTH KOREA OR ITALY. WE ARE FIVE TIMES THE SIZE OF ITALY. IF WE WERE ITALY AND DID ALL THOSE DIVISIONS, ITALY SHOULD HAVE CLOSE TO 400,000 DEATHS. THEY ARE NOT CLOSE TO ACHIEVING THAT. MODELS ARE MODELS. WE ARE -- THERE IS ENOUGH DATA OF THE REAL EXPERIENCE WITH THE CORONAVIRUS ON THE GROUND TO REALLY MAKE THESE PREDICTIONS MUCH MORE SOUND. WHEN PEOPLE START TALKING ABOUT 20% OF A POPULATION GETTING INFECTED, IT'S VERY SCARY, BUT WE DON'T HAVE DATA THAT MATCHES THAT. AND THE SITUATION..."

 

[Daniel in SD]

So how come the low infection rates on the Death Boats?

Which one are you thinking of? 696 of 3,618 got it on the Diamond Princess which doesn't seem low to me.

 

[TheTalkingMule]

So why do you think you're so much smarter than him since your estimate seems to be entirely based on your own secret study?
And we're still waiting for where you got your fatality rate for SARS...

I'm not making any predictions, just looking at data. That report was from 3/16 and was likely written long before any definitive outcomes in China/Korea/Germany. The crisis is essentially over in some countries and we can tally up the impact. Look at the deaths and likely number of infections.

 

[Beltsbear]

If US history has taught us anything, it's that if we want a strong economy...
we need to declare war on somebody, anybody. Will it work if we declare war on a virus? That is a big unknown.
It will be interesting in any case.

Unrelated - If you've ever been on a modern cruise ship, you know what a nice disease haven is. From the port terminal, to the Welcome Aboard, to the Muster Drill, to the first dinner, you've come in close proximity with over 1000 people in less than 12h.

So how come the low infection rates on the Death Boats?

30% of everyone got it and they were separated much of the time.

 

[Norbert]

I think you may have missed the point.



There's actually a paper that sort of touches on your hypothesis above. They even include some code if you want to play with it. They use this to estimate underreporting. Obviously if reporting behavior changes over time, the true number of CURRENT cases is still hard to determine, but it's just an estimate...a model...so it can be thrown off by a phenomenon not accounted for in the model.

Using a delay-adjusted case fatality ratio to estimate under-reporting

It looks like they use a lognormal distribution of delay to death, with a mean of 13 days.

They conclude that in the US, we have reported about 15% of our cases.

So if I'm reading the conclusion correctly, that would suggest we have about 550k active cases in the United States right now. Obviously there are some error bars on that. Anyway, just something to peruse - it is interesting.

Our testing situation has improved quite a bit over the last 13 days, so I definitely think this estimate is on the high side (I still guess the real number is closer to 250k as of today), because our current case number is much higher than it would have been, if we still had the pitifully undersampled testing regime in place that we had 13 days ago.

Anyway, it's basically the same method I've discussed before, and you also discussed above. Just with a more sophisticated model for the distribution of delay...

May be of interest to @TheTalkingMule and @Norbert as well, as they have discussed this.

Yes, very interesting. I'll need to study it carefully. I'm not quite clear about the distinction between infected cases and symptomatic cases. CV apparently has an untypically significant difference between the infected and the symptomatic case.

It is well known that not everyone who is infected gets tested. So we don't know the percentage of infected overall. Due to the lack of symptoms, that would either require testing everyone, or random sampling as is done for voter polling. So far we don't have enough testing capacity for that either.

What is less well known, if at all, is that the number of known "total cases" (today 85,377) is apparently currently limited to: (test capacity * 14%). The number for tomorrow may increase only in so far as our testing capacity increases. Or maybe it is limited in NY, but not elsewhere, or so.

So there are two kinds of unknowns: How many are infected? Even as a statistical value?
And: how many would be found to have CV if every fever-and-symptoms person could be tested?
Apparently we are also not counting how many are symptomatic, tested or not, as otherwise we could simply multiply that number with 14% and have a good statistical approximation of how many are seriously sick with CV. Which we apparently do not have.

Hope that makes sense.

 

[MXLRplus]

Which one are you thinking of? 696 of 3,618 got it on the Diamond Princess which doesn't seem low to me.

19% in a floating petri dish?