Coronavirus

[FreshPrince]

INVESTIGATION: Cuomo Gave Immunity to Nursing Home Execs After Big Donations — Now People Are Dying


1. Cuomo got large donation from hospitals some time ago
2. made mistake of requiring nursing homes to accept released COVID-19 patient, which caused deaths
3. and recently signed law to shield hospital executives from liability (many hospitals own nursing homes)

One hand washes the other.

 

[Daniel in SD]

INVESTIGATION: Cuomo Gave Immunity to Nursing Home Execs After Big Donations — Now People Are Dying


1. Cuomo got large donation from hospitals some time ago
2. made mistake of requiring nursing homes to accept released COVID-19 patient, which caused deaths
3. and recently signed law to shield hospital executives from liability (many hospitals own nursing homes)

One hand washes the other.

It seems to me that what's going on is nursing homes are "forced" to provide care for their residents but they don't have the resources to do so and they don't want to to pay someone else to do so. This has led to disaster.
I can see arguments on both sides as to how much personal liability executives should have for nursing home deaths.

Here is Cuomo's interpretation of the situation on April 23rd:
"Nursing homes, they are our top priority. They have been from day one. Remember how the nursing home system works. They are private…
… [inaudible 00:15:00] how the nursing home system works. They are private facilities. They get paid to provide a service. They get regulated by the state government. There are certain rules and regulations that they must follow, and we put in additional rules and regulations on nursing homes in the midst of this crisis.
Staff must have appropriate PPE. They must have their temperatures checked before they come into the facility.
There are no visitors who are coming into the facility, which is a tremendous hardship, but it’s necessary to protect public health.
If they have a COVID-positive person in the facility, that person has to be in quarantine.
They have to have separate staff for the COVID residents versus the non-COVID residents.
If they can’t care for the person in the facility, they have to transfer the person to another facility. The nursing home is responsible for providing appropriate care. If they cannot provide that care, then they have to transfer the person to another facility.
They have to notify residents and family members, within 24 hours, if any resident tests positive for COVID or if any resident suffers a COVID-related death. That is a regulation that they have to follow.
They have to readmit COVID-positive residents, but only if they have the ability to provide the adequate level of care under Department of Health and CDC guidelines. If they do not have the ability to provide the appropriate level of care, then they have to transfer that patient or they call the Department of Health, and the Department of Health will transfer that patient. That is how the relationship works."

 

[dqd88]

I don't think there's any fear here. Just common sense and a desire to stop unnecessary deaths.

Here's a hypothetical:
Obv there is a cost to this. Let's say that that cost per person was known and taxed/billed to you directly. I want to know from you, what your reaction would be to various levels of cost. The more lives we save, the more the cost.
Again, it's just a hypothectical; don't over think it. Just react.

You can save 10% of lives (of those who would otherwise have died if infected) for a 10% tax or charge to you. 10% of your income (on top of e tax).
You can save 20% of lives for 20% tax.
30% lives for 30% tax.
50% lives for 50% tax.
75% lives for 75% tax.
100% lives for 100% tax.

Which do you choose?

I'm not saying this is exactly how it works out. But the point here is that there is a cost, to every citizen. You accept the cost in order to save lives. Now the cost to you is unclear. The fed govt is a billing proxy. It borrows and that money will have to be paid by taxpayers.
But what I'm trying to get at is, if you knew the actual cost (and there is an actual cost, we just don't know the amount nor do we have to face it right now), then, how would you react. Like, if you had to pay the cost right now, in real money.
Please answer.

Obviously we can save a lot of lives (even non-Covid lives) with a lot of cost. So it is a pertinent thought experiment. Don't shy away from this because it is difficult for you to answer. Please answer.

 

[AlanSubie4Life]

Alameda County coronavirus cases: Tracking the outbreak

ArcGIS Dashboards

Infections still increasing in Alameda and San Mateo counties. Santa Clara County is also increasing again, though well off their peak (they really had some success through mid-May). It is unclear how much of these changes are due to testing - I cannot find testing data by county. I did read an article from an Alameda County official stating that the increase is partially due to testing increases.

However, I think it is undesirable to have a chart that looks like this, most likely, unless testing has more than doubled recently.

On balance, I would guess that disease burden is increasing in the vicinity of Fremont. (I do wish I could find the testing numbers!)

Hospitalizations are trending upwards too over the last few days (supports the hypothesis of an increase in disease burden).

I continue to think this is a high threat environment. Definitely not as high threat as Los Angeles County (only about half as bad), but not great - not going the right direction.

 

[madodel]

As previously pointed out, the FLAW in that logic is that for every single thing you listed there is a form of treatment or vaccine. I.e. a good intervention. Heart disease is a byproduct of the US being a fat ass nation. It's a choice of lifestyle.

There is NO INTERVENTION for SARS-CoV-2 except social distancing, masks, and hand washing. For the sickest patients there is an antiviral, but that only has moderate efficacy.

Once again, those promoting this analogy really haven't thought it through very well.

Hey those unhealthy folks keep my wife in business. 7 weeks she did nothing but complain about no cardiac patients. Hospital has been working itself back to normal for two weeks now and yesterday she is back to having to go in on Saturday to catch up on all the electronic charting. Now all she wants is to be able to get her hair done before the second wave comes back. No hair salons allowed to open in our part of PA yet, but no shortage of heart disease now.

 

[AlanSubie4Life]

Obviously we can save a lot of lives (even non-Covid lives) with a lot of cost. So it is a pertinent thought experiment. Don't shy away from this because it is difficult for you to answer. Please answer.

Not a difficult question to answer at all, especially at this point when it's very clear how the costs work.

I pick none of the above because that is not how the costs work. Clearly, at this point, the lowest cost solution would have resulted in the fewest deaths! So actually the cheapest solution saves the most lives.

Definitely I want to keep the monetary cost down as much as possible! That's why I'd like to put an end to this epidemic ASAP!

Let's spend that $200B right now or whatever it is (the number really doesn't matter) so we don't need to extend UI benefits in July and continue to inflict massive costs.

The more we spend, and the sooner we spend it, the more we save.

So in answer to your question, I would pick whatever the cost was that saved the most lives (which otherwise would have been lost due to coronavirus), going forward (obviously "zero" may not be optimal, but you get the idea). Will be the minimum cost to the taxpayer, roughly.

Pretty easy question. Thanks for asking - definitely an important point to consider. For whatever reason this is not intuitively obvious to a lot of people (gets lost in the political noise I guess) but it's now demonstrably true.

 

[dqd88]

Not a difficult question to answer at all, especially at this point when it's very clear how the costs work.

I pick none of the above because that is not how the costs work. Clearly, at this point, the lowest cost solution would have resulted in the fewest deaths! So actually the cheapest solution saves the most lives.

Definitely I want to keep the monetary cost down as much as possible! That's why I'd like to put an end to this epidemic ASAP!

Let's spend that $200B right now or whatever it is (the number really doesn't matter) so we don't need to extend UI benefits in July and continue to inflict massive costs.

The more we spend, and the sooner we spend it, the more we save.

So in answer to your question, I would pick whatever the cost was that saved the most lives due to coronavirus deaths, going forward (obviously "zero" may not be optimal, but you get the idea). Will be the minimum cost to the taxpayer, roughly.

I did not say that "this is now the costs work".
It is a thought experiment. Let's take Covid out of the experiment to make it clearer.

Let me reword it.
The govt creates a plan. You, AlanSubie, can save lives. But it will cost you as citizen.
The govt has figured out that, by charging you an extra 50% per year, the country can reduce the overall death rate by 50%. The money will go to feed the hungry, do very early and frequent screening for cancer, provide free vaccines (which become mandatory for every citizen), outlaw saturated fat, outlaw sugar, provide 100 face masks for free to every citizen per year, eliminate auto deaths by retrofitting every car with sensors and artificial intelligence... and more!

The govt will send you the bill yearly.
Do you agree?
If not, why would you not agree to this? Is it not worth the cost to save these lives?

 

[Daniel in SD]

Obviously we can save a lot of lives (even non-Covid lives) with a lot of cost. So it is a pertinent thought experiment. Don't shy away from this because it is difficult for you to answer. Please answer.

I think your model doesn't work for infectious diseases. Obviously for things like healthcare and automobile safety the proper thing to do is to put a value on human life and minimize the costs (this is done all the time). With COVID-19 I think the lowest cost option (even with zero value to human life!) is to suppress the virus. I predict that countries like South Korea, China, Japan, Australia, New Zealand, etc. will have the least economic damage.

 

[dfwatt]

The only way to get R0 down is a combination of as many measures as possible. T brain currently doesn't handle anything at all, but that can't stop any of the ongoing efforts.

T brain? who dat?

 

[dqd88]

With COVID-19 I think the lowest cost option (even with zero value to human life!) is to suppress the virus.

Great. The govt is happy to hear that you are on board.
Now, the govt has decided that, instead of borrowing and paying off the bill at a later date, that it will send you a bill directly, immediately. Cool?

I mean, you're still ok with "suppressing the virus" even if the cost is payed by you now rather than later right? Or are you only ok with it if it's paid later?

 

[AlanSubie4Life]

I did not say that "this is now the costs work".
It is a thought experiment. Let's take Covid out of the experiment to make it clearer.

Let me reword it.
The govt creates a plan. You, AlanSubie, can save lives. But it will cost you as citizen.
The govt has figured out that, by charging you an extra 50% per year, the country can reduce the overall death rate by 50%. The money will go to feed the hungry, do effective preventative medicine, provide free vaccines (with strong mandatory public education on vaccine benefits for every citizen so they can choose intelligently), reduce auto deaths by retrofitting every car with sensors and artificial intelligence... and more!

The govt will send you the bill yearly.
Do you agree?
If not, why would you not agree to this? Is it not worth the cost to save these lives?

I guess it's hard to say. Since we're taking coronavirus out of this I've made a bunch of edits to your quote. I think likely I'd pay an extra 50% per year, if I took home 30% more, or something like that (which seems like it could easily be a conceivable outcome in the hypothetical above). It's not clear that encouraging interaction with the health care system will save lives since medical errors are one of the leading causes of death in this country - but public health measures might

Obviously you have to do cost/benefit analysis and take into account all the knock-on effects of the policy. It's a critical part of good public policy making - to make sure incentives are properly aligned and the benefits are correctly measured.

For example, most likely particulate emission reduction & lead mitigation would be hugely beneficial public policy initiatives which we could do more with in this country, that we're still not doing enough with. Spending a great deal more on quality public education would also likely be hugely beneficial to the country and my income.

There are a bunch of good public policy measures we could implement that would cost me more in taxes (which I would happily pay), which would overall lead to lower costs for me, a higher quality of life, a longer life, and a higher income.

But this is kind of off-topic for the coronavirus thread so we should not discuss further. The hypothetical is so vague it's very hard to say.

I have no problem paying more in taxes, that's for darn sure, especially if it's for a good cause, helps me out and helps others out, and the tax structure is equitable. I think my marginal tax rate is something like 40% after accounting for state and local taxes, but I wouldn't mind paying more. At the moment I'm definitely not pleased with how the dollars have been spent, though. I have known for a couple decades that the party currently in charge was weak on national security and weak on constraining spending and costs, but this crisis has really solidified that in my mind. I really know how to vote to maximize the utility of my tax dollar now!

 

[dqd88]

As previously pointed out, the FLAW in that logic is that for every single thing you listed there is a form of treatment or vaccine. I.e. a good intervention. Heart disease is a byproduct of the US being a fat ass nation. It's a choice of lifestyle.

There is NO INTERVENTION for SARS-CoV-2 except social distancing, masks, and hand washing. For the sickest patients there is an antiviral, but that only has moderate efficacy.

Once again, those promoting this analogy really haven't thought it through very well.

So, obviously, you are ok paying your fair share of the cost of limit Covid deaths right?
Kids and the poor can't pay. Your bill is proportionate to your income.
The total cost will end up being what? $10 trillion? That should cost you, bkp_duke, somewhere between $100k-$500k. Cool if the govt sends you a bill? Or nah?

 

[Daniel in SD]

Great. The govt is happy to hear that you are on board.
Now, the govt has decided that, instead of borrowing and paying off the bill at a later date, that it will send you a bill directly, immediately. Cool?

I mean, you're still ok with "suppressing the virus" even if the cost is payed by you now rather than later right? Or are you only ok with it if it's paid later?

Personally I'd be fine with that (I have plenty of money). From a macro economic standpoint though that would be a bad idea. During recessions it's best for the government to borrow and spend money. During a boom it's best to pay down the debt. I'm a Keynesian, countercyclical spending FTW!

 

[ram1901]

As previously pointed out, the FLAW in that logic is that for every single thing you listed there is a form of treatment or vaccine. I.e. a good intervention. Heart disease is a byproduct of the US being a fat ass nation. It's a choice of lifestyle.

There is NO INTERVENTION for SARS-CoV-2 except social distancing, masks, and hand washing. For the sickest patients there is an antiviral, but that only has moderate efficacy.

Once again, those promoting this analogy really haven't thought it through very well.

And yet, with all the treatments, they still die at a high death rate.

 

[dqd88]

Obviously you have to do cost benefit analysis and take into account all the knock-on effects of the policy.

Ahhhh I see! ... Cost-benefit and knock-on effects...
Now please calculate the knock-on effects of a lockdown!

 

[AlanSubie4Life]

Ahhhh I see! ... Cost-benefit and knock-on effects...
Now please calculate the knock-on effects of a lockdown!

I definitely think we should have locked down sooner, or even "locked-down" so early that we did not have to lock down at all (I mean just suppress the virus), if that's what you're asking. I'm on record saying that here at the time. I was taking extreme actions in late January and the government should have been too - so as to minimize the knock-on effects, minimize the length of the shut down (the sooner you shut down the shorter it can be) and maximize the benefit. It's not like what we have experienced up to now has not been nearly 100% predictable (I did get my death numbers wrong - at one point I predicted 3k deaths - but that prediction was based on immediate action, which didn't happen for a few weeks, so it's pretty reasonable that a 2-3 week delay would take us from 3k to 100k deaths, and cost a few trillion extra).

What's really much more tricky is predicting what will happen from here.

But definitely I am all about getting the most mileage out of my tax dollar (I am efficiency obsessed, after all). Hence my continued recommendation to eliminate the virus ASAP. Super cheap! Better late than continuing to wait. At least it takes the guess work out of having to predict what might happen if we just kind of see what happens with no actual strategy.

 

[dqd88]

Personally I'd be fine with that (I have plenty of money). From a macro economic standpoint though that would be a bad idea. During recessions it's best for the government to borrow and spend money. During a boom it's best to pay down the debt. I'm a Keynesian, countercyclical spending FTW!

The govt is happy to hear this.
The bill for $500k will arrive shortly. Payment can be made via paypal, zelle, venmo, or wire transfer. Thank you!

 

[ram1901]

@ram1901, I'm sure this has been mentioned before (and I've been lurking on this thread since it began, and have read all 815 pages), we're just about 42% of the way through 2020 and are at >100k deaths for Covid. IMO (and this is solely my observational opinion) there are basically 3 possible short-term outcomes:

1) As a society, we tilt towards more responsible behavior and infection rates fall - regardless of successful drug/vaccine treatment discoveries (least likely)

2) The USA continues on the path we're on - localized & fragmented behavior, with varying effectiveness, resulting in a more or less consistent infection rate - and the rate of new infections/deaths stays about the same (more likely)

3) Our fearless leadership continues to push for reopening, restarting the economy, ignoring science and undermining responsible individuals, health/medical organizations, ideas & behaviors, and we experience a large second wave, similar to the 1918-1920 flu pandemic; infection rates dramatically increase (most likely)

For option #1 that will land Covid somewhere just below cancer and well above Alzheimer's.

For option #2, it would put us on track for roughly 250k deaths in 2020 assuming the math stays consistent and no effective treatments are discovered before the end of the year. This would put Covid as the 3rd leading cause of death.

For option #3, prediction is a little more difficult for a non-medical professional like myself, but will most certainly approach cancer and heart disease as the most common causes of death, by the time 2020 is over. And if we don't get a handle on it by 2021....well...I don't want to think about that.

Again, this is all my opinion/observation and I'm no doctor, epidemiologist or public health professional.

/TCP

PS: There is always the chance that an anti-black swan event will somehow make the coronavirus disappear, but as they say in the military, hope is not a strategy.

With the rapid increase in testing there are likely going to be more positive results. However, with lessons learned, controlling major outbreaks should be easier to accomplish especially since we know that anywhere from 50-75% of the deaths in some states were in nursing homes.

 

[Daniel in SD]

The govt is happy to hear this.
The bill for $500k will arrive shortly. Payment can be made via paypal, zelle, venmo, or wire transfer. Thank you!

I'll have to look into moving to New Zealand.
I think I'm still young enough and have enough education to meet their criteria...

 

[bkp_duke]

And yet, with all the treatments, they still die at a high death rate.

I have no cure for stupid, I could retire and my progeny for 100 generations would be set if I did. If the US population would exercise and not be fat, their death rates from cardiovascular disease would be gone (heart attacks are rare in countries not on a "western" diet). Cancer would see a reduction of about 50% (yep, obesity raises your risk for pretty much all types of cancer).

We are a country of idiots, as proven over and over. Anyone that has watched how we have on average treated our bodies for the past 30 years should not be surprised at all by how people are in denial about SARS-CoV-2.