Coronavirus

[EinSV]

Online retailers are going to just print money. Especially the ones who sell wine/liquor.

 

[bkp_duke]

It will be very interesting to find out why C19 is not resulting in 0-10 age deaths. This might lead to a huge breakthrough in vaccine technology.

Kids are home from the shut down colleges, so we had to go grocery shopping. Wow. Scared people are scary. I've never seen this ever in America. Shelves were empty, hundreds of people in line at a grocery store near us at 6 am this morning.

Prior to the Kuwait invasion, and post 9/11 both saw hoarding but nothing like today. I guess whoever wanted everybody scared to death got their wish. There are no reported deaths in this area, and <10 cases out of 8,000,000 people.

This isn't uncommon, actually. As an example, kids get Hepatitis A frequently (esp. the pre-school age group). They just quickly fight it off and don't have very significant symptoms (they do have them if you know to look carefully). When those same kids bring it home from daycare, however, it makes their parents MUCH more ill. This is one of those "classic" infections we are taught about in medical school and just take them for granted.

 

[AlanSubie4Life]

don't understand that this is going to last months, not weeks, and if we start cancelling cases this early, patients who need spine surgery for pain and disability are going to be in trouble.

We don't even have any cases of community spread yet.

Agreed that it would be too early to stop elective surgeries for your location if you definitely did not have community spread. Unfortunately the testing situation is undersampling so much that it's probably hard to say whether you do. And if you do have community spread, hopefully starting social distancing, etc., earlier results in an earlier end to those measures.

In the end I don't know how a resumption to normal life can occur anywhere without an extremely rigorous testing system. You kind of have to get the situation under control everywhere, and once the number of cases is manageable (maybe just a handful nationwide - I have no idea), instant testing and contact tracing, etc. can resume, and people can be instantly diagnosed and quarantined from the community. I have no idea how else we will manage introductions from the rest of the world without a really excellent testing system. (Alternatively we have to shut everything down for months and months.)

 

[bkp_duke]

Just as has been repeatedly posted in the Coronavirus thread, no matter how manny times one posts that graph, it remains not a graph of the mortality rate. The denominator is not "the number of people who have the disease", it's "the number of people who've gotten tested and the test came back positive", which is an entirely different number. Dividing deaths by "people who tested possible" is a meaningless figure.

Correct - it is the CFR (Case Fatality Rate). Where Case is defined as someone ill enough to present for healthcare and a health provider decides to test them.

We will never know the true IFR (Infection Fatality Rate) for COVID-19, although as more data comes in from around the world we will get a reasonable extrapolation of that.

Keys there - CFR vs. IFR.

And yes, it all comes down to how you define a Case (which will vary from country to country and even hospital to hospital). IFR is an immutable number, you just likely will never know it for certain.

 

[bkp_duke]

I wonder if the UK "infect all the kids" concept is in part to avoid this - graph is from this excellent article posted here several days ago, from the Spanish Flu in 1918, and what happened when a city on lockdown released restrictions too early. Herd immunity would potentially avoid this. Still risky IMO.

Coronavirus: Why You Must Act Now

View attachment 521894

Caution should be taken when extrapolating results from the 1918 Influenza pandemic to this virus. Primarily because they have morbidities at opposite ends of the age spectrum.

 

[sparcs]

One thing i noticed locally is that retailers and restaurants are starting to roll out new policies to curb the spread and reassure customers. Seems like there has been a pretty big shift in the last few days in the USA. Sounds like a we are getting to the point of "acceptance" versus the weeks and months of denial.

Walmart for example: Walmart reduces hours at US stores to keep up with surge of shoppers

 

[kyzhk]

Correct - it is the CFR (Case Fatality Rate). Where Case is defined as someone ill enough to present for healthcare and a health provider decides to test them.

We will never know the true IFR (Infection Fatality Rate) for COVID-19, although as more data comes in from around the world we will get a reasonable extrapolation of that.

Keys there - CFR vs. IFR.

And yes, it all comes down to how you define a Case (which will vary from country to country and even hospital to hospital). IFR is an immutable number, you just likely will never know it for certain.

IFR would be subjected to concept drift (in the context of bayesian inference as prior probability) i.e. population characteristic distribution would have a great effect on IFR, which can change over time and would likely also be very different in different countries.

 

[bkp_duke]

IFR would be subjected to concept drift (in the context of bayesian inference as prior probability) i.e. population characteristic distribution would have a great effect on IFR, which can change over time and would likely also be very different in different countries.

Correct. The greatest thing that causes a shift in IFR over time is the build up of immunity to said pathogen.

 

[shootformoon]

I think as a doctor your mind set is too simple. If everyone like you, i.e. very logic, very informed and very disciplined then your method would work. At this moment, too many stupid people still treat this as a bad flue and do so many things to endanger themselves and others. Only when they see the large number of people actually tested positive and so many celebrities and VIPs also have it then they would consider changing their behavior. Then the society would accept the social new norm. Then we buy time to vaccine/cure.

A better course of action is to instruct ANYONE with respiratory symptoms to self isolate. This is actually the current WHO and CDC recommendation.

 

[JRP3]

At some point, the countries prioritizing a low death toll will be at an economic disadvantage to the countries that prioritize herd immunity at the cost of a high death toll. When the public realizes that, you’ll see one country after the other switch to the herd immunity strategy.

China took drastic measures and seemed to have containment in about a month

South Korea is similar

 

[bkp_duke]

I think as a doctor your mind set is too simple. If everyone thinks like you, i.e. very logic, very informative and very disciplined then your method would work. At this moment, too many stupid people still treat this as a bad flue and do so many things to endanger themselves and others. Only when they see the large number of people actually tested positive and so many celebrities and VIPs also have it then they would consider changing their behavior. Then the society would accept the social new norm. Then we buy time to vaccine/cure.

We used to have a saying where I worked in residency . . . "Sorry, I don't have a cure for stupid."

 

[KSilver2000]

I think as a doctor your mind set is too simple. If everyone like you, i.e. very logic, very informed and very disciplined then your method would work. At this moment, too many stupid people still treat this as a bad flue and do so many things to endanger themselves and others. Only when they see the large number of people actually tested positive and so many celebrities and VIPs also have it then they would consider changing their behavior. Then the society would accept the social new norm. Then we buy time to vaccine/cure.

For some people, it takes their idol being affected or themselves taking a hit to the face or wallet, unfortunately. I’m exhausted trying to explain to certain people who argue why everyone is so fixated on a single flu when there’s poverty and other daily issues.

We used to have a saying where I worked in residency . . . "Sorry, I don't have a cure for stupid."

The truth. Can’t cure stupid.

 

[Highway2Heel]

I'm assuming you're joking. Whether you like him or not, the President of the United States getting sick and going into intensive care would not be good.

An attempt at levity....I can’t stand the guy....

 

[linux-works]

Online retailers are going to just print money. Especially the ones who sell wine/liquor.

I see a short term (at least) business op for an 'under 30' (years old) delivery service. risk is lower for younger people and this seems a natural way to get thru this time.

 

[shootformoon]

This is exactly you need testing capability everywhere. Each area needs different level of measures based on the testing results. Because it is very hard to expect people to do months of containment.

Wait a second. Are too many of us (including me!) getting too cautious about Covid-19, at least prematurely?

No question that Covid-19 can spread wicked fast in a community, and with fatal consequences that we should be trying to minimize.

But that doesn’t mean Covid-19 will spread wickedly fast in all areas with dense populations, or even most of them.

Take Italy, (please!) If I’m reading the case report map correctly, there are hardly any cases reported as having come from Milan itself. Milan hospitals are being overtaxed, but that is from driving in nearby citizens. Similarly in Rome, which has closed many business and events, only has a handful of cases repotted. Rome is closing up human activity by social distancing as fast as Milan, perhaps with even less justification. Rome is also in a hotter climate, and getting hotter, and there is some research that suggests the heat of Rome will deter community spread there.

Rather than throwing a wet blanket on the entire planet, it might make sense to do better surveillance and spot testing to determine early specific places it is spreading, and urge just residents and visitors in that specific area to limit social interaction. Something like this occurred this week when Gov Cuomo put restrictions on one town - New Rochelle.

Should Miami be cancelling concerts now despite less than a handful of cases in the area?

This may be a time when we have woefully underserved the need for preventative intervention in places where Covid is spreading, and at the same time are being prematurely alarmist in the places where it’s not.

 

[yttrasil]

Well, I just got a message that they maybe cancelling "elective" cases at the University of Utah and Intermountain Medical Center (both Level 1 trauma centers), as well as all the smaller hospitals and surgical centers in the Salt Lake City area. We don't even have any cases of community spread yet. I think the idiots in charge don't understand that this is going to last months, not weeks, and if we start cancelling cases this early, patients who need spine surgery for pain and disability are going to be in trouble. Also, will surgeons like me get "unemployment checks" for the next 4 months?

You are thinking too narrowly, you and any extra staff that can be had will be on full time duty treating the corona patients, you have 100x more experience than anyone else out there except the experts. All wards and doctors will be turned into ICUs for that for shortterm, thats that happened in Italy, will happen in most European countries and probably also the US. So no, no staying home getting a paycheck and no, plenty job for you very soon. Probably too much so get well rested until you need the energy.

 

[SMAlset]

BTW, Trump's test is negative

I read that most people won't show symptoms after infection from 5 - 12 days. From the news the Mar-a-lago Brazilian visit and was on March 7 and the next night was the GOP birthday party at Mar-a-lago, so one week so far.

COVID-19 symptoms typically appear 5 days after infection

 

[KSilver2000]

An attempt at levity....I can’t stand the guy....

You know, though, a positive test could have convinced tens of thousands of people still denying the situation to take the virus threat more seriously.

Similarly, I’m sure Donovan Mitchell getting infected probably convinced many NBA fans who were being nonchalant.

 

[Doggydogworld]

You know, though, a positive test could have convinced tens of thousands of people still denying the situation to take the virus threat more seriously.

Most would just blame it on Brazil.

There was zero chance of a positive result.

 

[AlanSubie4Life]

It's funny, lots of people here and the liberal side of the media are bashing Trump for every decision he makes (granted the far right side praises everything he does). If he does nothing, his inactivity is going to kill people, if he does something, like stop travel from highly infected European countries (the smart ones with great healthcare systems), he is causing chaos and confusion.

Here's the predicted effectiveness of that travel ban from an epidemiologist; do read the entire thread:

Trevor Bedford on Twitter

And it appears the implementation has made it a virtual guarantee of generating a superspreading event (likely multiple events) - remember the Biogen event created 77 cases which spread coronavirus across the United States:

Jeremy FLATTEN THE CURVE Konyndyk on Twitter

Carl T. Bergstrom on Twitter

So that's the reason why people are upset about the travel ban - the virus is already in the United States, in massive numbers, and stopping flights from Europe in the absence of other measures (which is what was done on Wednesday) was clearly going to be ineffective.

far higher rate if infections and deaths. Maybe American will turn out far worse (according to the haters, we're all dead because Trump is an idiot and screwed this all up), who knows.

That's a bit of a straw man - no one has said we would all be dead. Right now I predict the US will be at about 100,000 cases in 3 weeks (though perhaps it will be higher - we're already at possibly 20000 cases nationwide, and if that's the case we'll be over 250k in 2 weeks!). If all goes well, the rate of increase of cases will probably peak right about then, and then hopefully the containment strategies will really start to show their effects. Maybe we'll end up at 150k cases in the end. If we're lucky and get our hospitals properly prepared, we'll have "only" 2000 deaths or so over the entire event.

This is assuming reasonably optimal implementation of strategies by the gov't - not the airport debacle above.

If I'm wrong, I'll gladly post it. Just like you said.

Please do so in a few weeks.

There was zero chance of a positive result.

That's probably too low a probability. Though since the guests weren't showing symptoms at the time (and had not been ill previously I guess) it was presumably fairly low risk for the President. It's possible, though unlikely, that he may test positive in the future - depends on the sensitivity of the test and the degree of virus replication at this point in time. Still unlikely though.