Coronavirus

[Cosmacelf]

How much bigger is the US population compared to Italy? Isn't it a lot bigger, so wouldn't expect our numbers to be a lot higher?

Yes. And moreover, we seem to be instituting mitigation efforts before Italy did at the same stage. But whether mitigation is having much effect is yet to be known.

Also, the US is rather large geographically compared to Italy, and except for a few exceptions (New York!) population density is much lower and use of public transport much lower too. Then there are the age differences.

At this early stage, it may make more sense to track outbreak cities, like New York, versus Italy outbreak centers, since spread of virus to rural US is likely to be slow compared to spread inside a city.

Lots of different ways to slice up this statistical data, and more analysis should be done.

Update: Here's the link to the data set that that previous Italy/US graph was made from: Download today’s data on the geographic distribution of COVID-19 cases worldwide

 

[cusetownusa]

Part of the problem is the number of infections and deaths have a variable ratio. Early on that ratio favors a higher case fatality rate, probably again because by definition the early cases that come to attention tend to be more severe, and where individuals head into respiratory distress and hospitalization. A whole lot of people in the community on the other hand may never get pneumonia, and those folks may not enter your statistical pool without very extensive testing. My point is that we have no clue what the actual number infected people is in the United States. Safe to assume that the published stats are way, way under the actual number of Covid-19 infected individuals. We are flying blind in this country. People see widespread testing as some kind of panicky knee-jerk response. It's not. The only way you know what you're looking at. And therefore is the only way to plan intelligently.

The other problem is that without the early isolation and quarantining of affected individuals, you quickly swamp the healthcare system In terms of exceeding the number of ICU beds and Respirators. That easily doubles the mortality rate because a good fraction of people with severe pneumonia will recover If given respirator and other supportive care. There's already been dozens of postings on this so I won't post another graphic showing the difference between staying on the exponential ramp and moderating that so you reach a plateau. That plateau can be under your critical care threshold capacity. The exponential ramp always - eventually anyway - exceeds it. And that (the "unnecessary" deaths) always exacerbates panic and increasing societal disorganization.

gotcha. I agree.

 

[Snapdragon III]

When you tested positive, was zinc therapy with Chloroquine recommended?

Congrats on your recovery!

No. We were never contacted by anybody other than a quick phone call from the UW lab that ran the test, and a followup email. No recommendations for quarantine, or care, no contact from health department, etc.

 

[bkp_duke]

I don't know about you but I think the leukopenia combined with the elevated cytokines is a huge and telling bifurcation, but not well captured by any notion of an "improper" immune response. It suggests that the immune system in the folks that died was dropping the ball on B and T cell production. Again that's a finding associated with activation or lack thereof in the adaptive branch of the immune system. I think that this data suggests that exaggerated innate immunity and declining adaptive immunity may go hand-in-hand and script a bad outcome.

That is a possibility. As you are aware viral immune suppression, as evidenced by leukopenia, is a common occurrence in critically ill pneumonia patients. I would like to see how this compares with leukocyte counts in patients with other critical respiratory ailments. My recollection is that it is fairly common in those with SIRS and a compensatory mechanism is that the innate branch of the immune system ramps up in an attempt to compensate, hence the elevated cytokines.

I don't, however, believe that is unique to COVID-19 infections, but happens in general with critically ill patients that eventually die from their infection.

 

[bkp_duke]

Is it working? No. Give more $$$ to rich people. Working now? No. Keep giving money to the rich. Has it worked yet? No. Give more money to the rich. More!

The waitress down the street lost her job because all the restaurants are closed and can't pay rent! Well.... give more $$$ to the banks somehow that will help.

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What's the definition of insanity?

It's not insanity. The last time the banks REALLY failed was the beginning of the Great Depression. You want to put a political slant on this, but both sides recognize the importance of the banking system. It's why Obama propped it up during the Great Recession, and why the current administration is propping it up now.

 

[Cherry Wine]

Holy ****. Someone with actual bona fides needs to step in to fill the leadership vacuum on this issue or the US could be in for a seriously wild ride. If I sound alarmist it's because I'm alarmed. There is no reason the federal government should not be leading and coordinating this effort and bringing the full force of its economies of scale to bear.

Coronavirus Live Updates: Trump Tells Governors to Seek Out Respirators on Their Own

“Respirators, ventilators, all of the equipment — try getting it yourselves,” Mr. Trump told the governors during the conference call. via @jmartNYT

“Respirators, ventilators, all of the equipment — try getting it yourselves,” Mr. Trump told the governors during the conference call, a recording of which was shared with The New York Times.

“We will be backing you, but try getting it yourselves. Point of sales, much better, much more direct if you can get it yourself.”

The suggestion surprised some of the governors, who have been scrambling to contain the outbreak and are increasingly looking to the federal government for help with equipment, personnel and financial aid.

Mr. Trump used much of the call to repeat the same upbeat rhetoric he has offered in public, assuring the governors: “We’re going to get it remedied and hopefully very quickly.”

Alluding to the Federal Reserve’s emergency intervention, Mr. Trump also told the governors that the central bank’s purchase of $500 billion of Treasury bonds and $200 billion of mortgage-backed securities will “probably go up substantially from that level.”


Without directly faulting former President Obama, he said “we broke down a system that was broken, very badly broken” and vowed to create one “that I think is going to be the talk of the world.”

But aside from his rose-colored predictions — which are at odds with his medical advisers, who say the worst is yet to come — Mr. Trump often evinced little awareness of the severity of the contagion.

Explaining why he did not include the United Kingdom in his initial travel ban from Europe last week, Mr. Trump said “all of the sudden we were getting numbers that weren’t good so we had to put U.K. in.”

 

[bkp_duke]

We should be testing everyone that shows up with any flu like symptoms. My ex just went in to urgent care with a sore throat, tested for regular flu and strep. No Covid test. Now she is starting to have a fever at home. The ironic part is that she is a rep for one of the companies rolling out testing.

Tell her to keep trying. Same thing happened with my wife last week (and she had recent international travel). She decided to go to another testing location and they did test her. Results are pending (although I'm reasonably certain she has Adenovirus).

 

[bkp_duke]

Like I said, Oh well ...

Justin Trudeau says he will close Canada's border to non-citizens amid pandemic.​

Canada closing borders to non-citizens because of coronavirus, U.S. citizens exempt from ban 'for the moment'

At this time, US citizens are exempt from the Canadian border being closed. But I do expect it to change and have been talking with the client most of the morning trying to prepare them for this possibility.

 

[dfwatt]

That is a possibility. As you are aware viral immune suppression, as evidenced by leukopenia, is a common occurrence in critically ill pneumonia patients. I would like to see how this compares with leukocyte counts in patients with other critical respiratory ailments. My recollection is that it is fairly common in those with SIRS and a compensatory mechanism is that the innate branch of the immune system ramps up in an attempt to compensate, hence the elevated cytokines.

I don't, however, believe that is unique to COVID-19 infections, but happens in general with critically ill patients that eventually die from their infection.

As Sarah Palin once said "you betcha!" I'd only encourage you just to expand your frame/framing just a bit. Those classic findings actually also relate to inflammaging in other words the upregulation of the innate immune system as compensatory for declining adaptive immunity. I've got about 20 papers on this, including I think the original seminal paper by an Italian researcher some 15-18 years ago. I got turned onto this because it was really the only way to explain all kinds of contradictory findings in Alzheimer's disease (my area of neurobiology).

 

[Cosmacelf]

New Starbucks corporate policy is to allow sales but people must leave once they get their order. Picture of a Starbucks today where they stacked all chairs and tables into a corner. Feds and governors don’t need to tell companies anything, they are shutting down all on their own to avoid legal exposure...

 

[bkp_duke]

New Starbucks corporate policy is to allow sales but people must leave once they get their order. Picture of a Starbucks today where they stacked all chairs and tables into a corner. Feds and governors don’t need to tell companies anything, they are shutting down all on their own to avoid legal exposure...
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Restores a little bit of faith that not everyone is completely stupid with regards to this pandemic.

Currently, this is a reasonable compromise between closing completely (and the consequences to employees and their livelihood), and turning a blind eye to it and doing nothing. Time will tell how prudent this decision was.

 

[dfwatt]

Yes. And moreover, we seem to be instituting mitigation efforts before Italy did at the same stage. But whether mitigation is having much effect is yet to be known.

Also, the US is rather large geographically compared to Italy, and except for a few exceptions (New York!) population density is much lower and use of public transport much lower too. Then there are the age differences.

At this early stage, it may make more sense to track outbreak cities, like New York, versus Italy outbreak centers, since spread of virus to rural US is likely to be slow compared to spread inside a city.

Lots of different ways to slice up this statistical data, and more analysis should be done.

Update: Here's the link to the data set that that previous Italy/US graph was made from: Download today’s data on the geographic distribution of COVID-19 cases worldwide

Not sure where you're getting your information from but mitigation, quarantine, and isolating of contagious individuals is the only way to break human transmission chains. If you don't break those chains, you stay on what's been called the "exponential ramp". We know exactly where that goes - through the roof. That means a steady doubling of cases every five six seven eight days or so. That not only involves much more lethality but it gets you quickly to a situation where your Critical Care capacity is overwhelmed. That means everybody that needs Critical Care but that can't get it likely dies. That easily doubles your death rate if not triples it.

I think you're buying the notion that some version of a totally unnecessary Panic is behind people's concern about the exponential spread of the disease. Sorry but I think you've got the causality chain reversed. When there is an exponential spread of a disease and there's no known treatment and it has significant if still partial mortality and there's no coherent Public Health response that builds confidence that this mess is containable that scenario creates panic.

 

[Cosmacelf]

Restores a little bit of faith that not everyone is completely stupid with regards to this pandemic.

Currently, this is a reasonable compromise between closing completely (and the consequences to employees and their livelihood), and turning a blind eye to it and doing nothing. Time will tell how prudent this decision was.

Yes, didn't NYC outlaw sitting in restaurants only allowing take out? Similar response...

 

[Cherry Wine]

New Starbucks corporate policy is to allow sales but people must leave once they get their order. Picture of a Starbucks today where they stacked all chairs and tables into a corner. Feds and governors don’t need to tell companies anything, they are shutting down all on their own to avoid legal exposure...
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The US's litigious and liability-averse culture saves the day, lol.

 

[jbcarioca]

See my previous posts on this. From a scientific standpoint your statement is wrong, or at least it is so misleading as to be virtually wrong. Older people are not necessarily immunosuppressed. It's not that simple. That's a simpleminded and therefore appealing but ultimately misleading concept.

As previously posted and as seen in nearly all epidemiological study for communicable disease, age is often used, but is so simplistic as to be equivalent to any other prejudice. The diseases most common in old people are themselves frequently casually correlated with any viral disease including COVID-19. Healthy old people have, as they age, gradually increasing expected vitality. As with nearly all disease, the more robustly healthy one is the longer one remains robustly healthy. There is a common canard, common even among many MD's that old people are immunosuppressed.

Off-topic. I have studied this topic extensively. As a healthy, 12km/day active person with zero medications and zero negative outlook I admit to a personal vested interest. Bluntly, bad health is a precursor to more bad health. Poor diet is a precursor to various bodily impairments. Lack of cardiovascular exercise is bad too. All these points are true.

Most of the data currently available has been sourced from Wuhan. As several people have noted, most such data does not include sufficient documentation to permit validation. We do know that smoking is endemic in that part of China, as is a less sanitary environment than might be typical in other locations, as is air and water pollution. All those factors play a role.

There is no way we will have a clear statistical basis to judge any assumptions at all today. Six months from now we will be able to adjust for many pertinent factors. Today, we have guesses. Educated ones, but guesses.

Everyone should know that the best minds in the world cannot answer the most pertinent questions without data, lots of data. In most situations like this we make the best judgements we have based on analogies. That is happening now. However, nobody knows how good those analogues really are.

 

[Cosmacelf]

Not sure where you're getting your information from but mitigation, quarantine, and isolating of contagious individuals is the only way to break human transmission chains. If you don't break those chains, you stay on what's been called the "exponential ramp". We know exactly where that goes - through the roof. That means a steady doubling of cases every five six seven eight days or so. That not only involves much more lethality but it gets you quickly to a situation where your Critical Care capacity is overwhelmed. That means everybody that needs Critical Care dies. That easily doubles your death rate if not triples it.

I think you're buying the notion that some version of a totally unnecessary Panic is behind people's concern about the exponential spread of the disease. Sorry but I think you've got the causality chain reversed. When there is an exponential spread of a disease and there's no known treatment and it has significant if still partial mortality and there's no coherent Public Health response that builds confidence that this mess is containable that scenario creates panic.

Huh? How did what I write imply this? I think you're reading way too much into what I wrote. What triggered you?

 

[dfwatt]

Huh? How did what I write imply this? I think you're reading way too much into what I wrote. What triggered you?

Apologies if I misconstrued your prior post. I thought you were suggesting that the isolation and shutdown was premature? If you are not saying that again my apologies. So we are in agreement then that the federal response has been a joke? Not the state responses those have been pretty uniformly responsible and pretty timely. All this is going to make me a federalist yet! Kidding!

 

[GabrielB]

Hi BKP
What do you think? Sorry for the long post!

I think the Prius, Chevy Bolt, BMW-i, & Porsche-Taycan forums have got nothin on us!
Thank you all for your insights! I have learned more useful things about Covid-19 and the medical & societal implications here than anywhere else. You clinical folks have gathered the data and have shared it intelligently with the rest of us looking for sensible advice.
It is a testimony to the sharp and forward thinking our general Tesla family has.

 

[Cosmacelf]

The US's litigious and liability-averse culture saves the day, lol.

Yeah, but I should add that that I don't know if that's why Starbucks made their decision, I am just guessing. Nonetheless, considering people can sue in the US at the drop of a hat (the class action legal system is very, um, efficient), it's a reasonable assumption. The ski resorts are the ones that surprised me. That's an outdoor activity with much lower risk of exposure (but I guess lift lines aren't great), yet they en mass closed over the weekend.

Since this is an investment thread (or at least in the investment section), I suspect we will be hearing a lot more stories like this through the day and week. People will be modeling what this means for the economy. Goldman already put out a note over weekend that predicted a sharp 5% GDP contraction in the second quarter. Prepare for the media to start showcasing all the service workers who are being laid off. Of course, they won't talk about the big employment boom in delivery workers...

 

[jerry33]

Yeah, but I should add that that I don't know if that's why Starbucks made their decision, I am just guessing. Nonetheless, considering people can sue in the US at the drop of a hat (the class action legal system is very, um, efficient), it's a reasonable assumption. The ski resorts are the ones that surprised me. That's an outdoor activity with much lower risk of exposure (but I guess lift lines aren't great), yet they en mass closed over the weekend.

In March the ski season is just about over anyway.