orthopa

NY and WA are early in this course and predictors of what every other place will look like. The rest of the country is our France/Spain/Germany to the Italy (NY and WA). So what is going on in other places is irrelevant. Exponential growth blah blah I am in New York. I assume NYC is what you mean. The closest Urgent care in our network to NYC is Poughkeepsie. Ill call them and let them know what you said!

I dont practice in NYC, King County, LA etc but to just give some perspective whats happening here medically. 1. The urgent cares in our network have closed down centers within close proximity on weekends. 15% of centers now closed on weekends. Next step is closing at 6pm instead of 8pm. Volumes are down 80% across the board. 2. ER wait times online averaging 0-10 minutes. There are 5 hospitals in this IDN with these ERs. ~2400 beds total, not sure of bed count. 3. All elective surgery has been cancelled at local hospitals. Nurses are being told to take vacation time/furloughed as there are little no patients on the orthopedic/general surgery floors. OB/GYN still at normal volumes of course. No pre op/post op recovery being done. 4. Im still in contact with many in the orthopedic community and the largest non academic orthopedic group has asked all non provider staff to take 50% pay cuts going forward if salaried. Use vacation/sick time first. All PAs have been furloughed until further notice as its mainly a non trauma/orthopedic group. Ortho surgeons who do sports medicine better have a nice emergency fund saved up. 5. Local surgical centers have shut down. ENT, plastics, ophthalmology, GI docs/PAs, nursing staff same as above. The hospitals are all emptied, waiting, and ready to go. Maybe cobfadec and others/relatives/family working in the hospitals can give some color on what they are seeing.

I would go to lively for the HSA. I did and its great. Low fees, acces to TD ameritrade for investing/trading. The platform is very easy to use too.

Thanks Luke. Was this from their podcast? I know David Metzner is doing some podcasts for ACG. They really have been the most accurate thus far with their information so have to at least put their reputation behind it. Relisted as in on the NYSE? Rosner had advocated for this a while back. The idea is that it take it off the OTC and legitimizes the securities? I find it interesting that ACG had access to both treasury and FHFA, great if thats the case.

If he is right that 50 people have it for every 1 we know about, then 22 people have died out of 180,000 infected in NYC. You have to take into account time it takes for the virus to run its course, though. Daily exponential growth means the vast majority of infections are early stage and haven’t had time to create complications. Do we also upwardly adjust the 180,000 number to add back the number of people who were once infected but no longer are? Exactly, as I posted way, way back in the thread the death count is severely over estimated. Just like in finance this maybe just the first estimate down. https://www.newsweek.com/wuhan-coronavirus-death-rate-china-mortality-covid-19-1493201

Yes I want to follow S Korea. Italy did not do a good job of testing. USA is beyond where Japan ever was. This is an infection where it takes ~1 week to show symptoms from catching the virus and maybe ~2 weeks to severe symptoms and mortality. As the U.S. is early in this processes, as I have repeated on here (though some claim it has infected "millions for months" here), the fear is that the deaths are yet to come. S Korea is likely on the tail end so their deaths are probably going to level off. See the exponential mortality graph of U.S. I posted on here a few posts back. My local DOH is no longer testing in my county. I talked to the epidemiologist today and new recommendation is anyone with symptoms to quarantine for 14 days. No more tests for community unless pt is admitted. Give me your information so you can talk to this guy. Im sure he would love to hear from you.

According to a key part of your thesis, the virus has infected millions for months here. Strange why deaths are just now rising, then. Unless you propose that people died in January but we had no idea what the true cause of death was. Strange too that ICUs in NYC are just now starting to get loaded... Attached is a graph of U.S. mortality thus far from COVID. If I saw such a trend for cancer deaths, cardiovascular disease, or accidental deaths, I WOULD be concerned about those things. Not to mention the fact that none of these things that you mention that cause deaths are systemic, multiplicative (i.e. none of them are contagious) processes. A BIG difference. Im surprised your allowed in the ICU's in NY. I assume you have been to the ones in Kings county and LA too huh? ::) So its the graph that does it huh? Fuck the 1800 a day dying from heart disease? 179 so far from Corona virus. Avg 3.4 per state. You are not concerned about the other because you went your entire life not being aware 24 hours a day of cardiovascular disease. Your numb to it. This is new and exciting. Death does not concern you. You seem to relish in the fear, we all have our thing. You should make a graph from the start of the year to now, 1800 a day of cardiac deaths and map those out vs corona. That would be fun to watch. Oh, its how these people die, not that they die. Ok. I just think you get off on the fear, cool whatever. Its still coming huh? When will you be wrong? My early assumption already is if/when the deaths fail to take of exponentially you will pivot to the flattening the curve is working.

I'm to the max I want with the preferred but will probably add some more here. Not surprising that the capital rule was delayed in the shit show the world is today. I think the risk that trump may not get elected has increased due to the virus. At least as of right now. It seemed to me more likely then not he would get re elected up to a month ago. If things stay hairy with the economy into the fall and it looks real close going into the election that may spur a little more action just before Nov 8th. Doing as much as they could just before the election and if losing in the 3 months afterward may have been the plan all along anyway. The selia case is still the most important on going thing of course.

Obviously only because of testing at this point. Its expected. With an 86% asymptomatic rate its the death rate where the meat is. That should be exploding any day now. That being said for those believe me (for the record I don't give two shits but whatever). Recently I have called the DOH 26 times over the past 2 days for pts that have symptoms of COVID. These are the ones with highest risk factors. Recent travel to endemic area, known covid exposure, negative Flu/rsv with fever. Unless they are showing signs of severe respiratory distress they are not getting tested and are being told to self quarantine for 14 days. I have not admitted any of these pts. Tests are limited as expected. Epidemologist believes multiple thousands of cases in county with 975 thousand people. Obviously anecdotal but I wanted to ask him.

Have been just sitting back and reading everyone's thoughts on things which is interesting for sure. My attention has turned more from what I think will happen with the virus (I think I have made my thoughts very clear). Some of my predictions so far have been close which feels good I guess but means nothing in the mess the world is today. Especially in light of the sick people, fear, society shut down and all the angst the market falling is causing many I'm sure. Like everyone here (except for Viking you bastard! ;) ) it blows watching the market implode unless short or all cash. Long term investing is not easy thats for sure. But what I am really starting to get worried about is what this will do to many, many, small business, restaurants, franchisees, bars, etc. This 15 day gov shut down and multiple state shut down is going to kill businesses, confidence, sky rocketing unemployment etc. I would like to think and hope it is a V or U shaped recovery but if your a business owner that goes out of business how long is it going to take your confidence to come back, workers etc? I would love to have a quick rebounding economy but if enough people get laid off, enough businesses bankrupt this could be a long time mess. I think Ackmans idea makes some sense but hes a billionaire. Sure you can have rent holidays, mortgage forbearance, don't pay your utilities etc but this is already crushing airlines, hotels, small business, restaurants and we are a couple days in. Some states want a month or more. Whats the unemployment rate after this month? That drops down fast? Idk. And sending 1-2k checks wont cut the mustard for many At some point I think you start to see people who say fuck it, enough. Stress levels and tension are extremely high. First it was fear, and still is, but in social media circles I have seen many start to question what we are doing and for who? That can get dangerous. Throw in not working, no money coming in, your kids not going to school driving you up the wall and every day you get up and the death rate in the US is at 100-125-150. I'm not saying we should get to a point where we choose who lives and who doesn't but at some point I think you have to look at the broader picture. I brought this way up earlier in the thread and some commented on it as the owns persons fault but some things to just consider. As of right now fear still predominates in the greatest economy in the world as well as other nations in the world. In every sense of the word we are in this together and I think fundamentally doing the right thing, but....we have shut down essentially the world, ruined daily lives, scared the ever living shit out of people. We will have bankrupted people. Some may commit suicide seen with financial crises, many other making huge sacrifices some of which will never recover from. Businesses will close. We will add trillions to the debt, the fed taking extraordinary actions to prevent the economy from seizing. Scrambling in chaos to find solutions with amounts of money that no one can comprehend for the millions, and millions of people who will be affected, emotionally, mentally, financially etc. Bankrupting our airline industry, possibly hotel, travel, leisure, restaurant, banking?? industry. Its turned into absolute chaos. And what are we afraid of ? A disease that we know may have an 86% as symptomatic rate, that so far has killed 8784 people out of 7.8 Billion people, .000116%. People who we know on average are nearing the end of their lives. People who succumb every day to diseases we are numb to. I know many are aware of the flu data on deaths but some aren't on the most common every day killers in the US. Every year in the US alone; 674,000 people die from cardiovascular disease 607,000 from cancer 170,000 from accidental deaths In the world; 17.65 million heart disease 8.93 million from cancer 3.54 million from respiratory disease My point is not to sacrifice people for money, and I am aware obviously the death rate world wide would be much higher if the above was not done in the US, China, Italy, Europe etc. But why is it ok for all of these people to die from the above? Are we just numb to it? Since the first corona case in the US 2 months ago based on the above data 112,333 people have died from heart disease. Every day we look at the Johns Hopkins map checking deaths and each day 1846 Americans and 48,356 in the world have died from heart disease. We are killing ourselves over ICU beds for Mary for Covid, while her friend from the Senior Center dies downstairs in the same hospital before they can get to the Cath lab. We want a vaccine in months for corona but are willing to go through multiple year trials for anticoagulants, cholesterol meds, and hypertension meds. That being said, do we really care as country how many people die? And who and how old they are? This has become an irrational obsession for the world, and with this virus. When you really look at what will kill you living in this country, and who we should be saving, the sooner you realize this has become insanity.

Since I'm an MD, I can answer your question. The answer is yes. Probability/statistics is hard. Furthermore, it's probably the worst taught class in medical school, with the least interest for most med students, who are understandably more interested in anatomy, physiology, biochemistry, pathology, etc. The average doctor is no more proficient in formal probability and statistical concepts than the average layman, i.e., CoBF member. That said, and in defense of us MDs, ordinary clinical decisions are based on intuitive probability judgments that are made implicitly, and without the need for any tricky mathematics. Mathematical probability comes into play only on those rare occasions when the right answer turns out to be counterintuitive. It's not really relevant in everyday clinical practice. After completing my residency, I did a research fellowship which involved getting an MPH degree in biostatistics. But even if an MD has a good understanding of statistics, a medical opinion is nearly useless in this current coronavirus situation. Clinical decision making is based on statistical inference, whether it's explicit or intuitive. Statistical inference is based on well-designed experiments, clean data, and a well-understood scenario, none of which characterize this pandemic. Statistical thinking is retrospective, based on past data. With coronovirus, we have a whopping 4 months of chaotic short-term data. Probability judgments are prospective. They can be based on relative frequencies over time, relative frequencies in an actual group of patients, relative frequencies in an imaginary group of patients, or they can be subjective belief. Most of the speculation in this thread is based on the latter two. We're all guessing. Orthopa is clear on that. He is also self-aware because he admits he may be subject to the anchoring bias, having committed to a relatively controversial opinion. My local experience parallels Orthopa's so far (except for no cases of positive coronovirus tests yet, which is because there has been hardly any testing done around here as of this weekend). I'm in Orange County, California. My hospital's ER has a tent outside for overflow cases. It went up last week and hasn't been utilized. The hospital and ICU census is the usual at this time of year. (I know it's early.) My flow of office patients has actually slowed in the past week, possibly because patients are now thinking twice about coming to the doctor or hospital. (I know it's early.) My opinion that Orthopa's theory has a 70% probability of being correct is pure subjective belief, partly based on my local anecdotal scene. It's just a feeling. I don't think it's any more or less valid than any of the counter-opinions in this thread. We're all fooled by randomness. And I have not expressed my opinion in my community because I think people would misinterpret it and not do the right thing, which is to use the precautionary principle. In fact, I think it is a major mistake and dangerous to think that heavy speculative computation - seen on this thread - is at all helpful in these cases. For unknown unknowns like this novel coronovirus, the worst case scenario is bad enough. Put down the calculator and run like hell. Thanks for increasing my confirmation bias. That being said I also find it interesting no comments on your contribution. How can everyone else blame me/you I guess. Seeing is believing until it changes. Question for the math guys as Im learning a great deal. Ill leave the computation up to you guys. Again we know first infection Jan 20th, whether it was here before is up for debate and unknowable. At what date in the future do you start to say, wait a minute. This death rate is way over blown, maybe this isn't as bad as we thought it was. We should be looking at a significant exponential increase here soon right? Its been almost 2 months, lots of untested people and asymptomatic walking around. Social distancing and shut down just started. Going by quarantine guidelines that train left the station 14 days ago. The snowball is still growing for 14 more days. Increased death should follow. What are you guys looking at?

But this is where I'm trying to reconcile. You're saying that you're not seeing it. But evidence suggest that flue like cases are increasing significantly, but we don't know due to what. So I'm wondering if this is just a precursor of things to come, and you might not have seen it first hand. And I can't imagine that we are testing dead people for the virus - I would definitely save the testing capacity for those alive and potentially contained at this moment... So if that's the case, then are we undercounting BOTH deaths and people infected?? I never said I'm not seeing it. I currently don't have testing avail other then the protocol I just said came over from DOH. How can I diagnose someone without a positive Covid-19 test? I am seeing what you posted in that tweet. High increase in flu like symptoms with negative flu. I have made that clear I think multiple times haven't I? No they are not testing bodies at the morgue. You asked about testing people who come in with flu like symptoms. I don't believe I have heard of any cases of DOA(have you?) covid-19. Today, if you have someone on life support/ventilator anywhere in America I would hope to god its known whether or not they have Covid19. I don't mean to put words into your mouth, but I think you have said that a lot of people are infected and we're not seeing the deaths, so the conclusion is that CFR is lower than what's out there. So I'm asking - is the disconnect with what other countries are seeing that both infected and deaths are undercounted (vs. just denominator being undercounted)? Just another thought on this. That tweet said flu like illness spiked March 1st right? Assuming those were all new cases we are now 15 days out. If your only self quarantined for 14 days then it could be broadly assumed that your chance of dying is high in 14 days right? That being said is it reasonable to assume there should have been a HUGE spike in deaths? Its been 15 days right? How many in NYC 3? False. They spiked in the days leading up to March 12 as the graph clearly shows. Literally took 2 seconds to confirm. No it starts to increase March 1st, now that is giving a generous 14 day time to death! So we still have to wait some more?

But this is where I'm trying to reconcile. You're saying that you're not seeing it. But evidence suggest that flue like cases are increasing significantly, but we don't know due to what. So I'm wondering if this is just a precursor of things to come, and you might not have seen it first hand. And I can't imagine that we are testing dead people for the virus - I would definitely save the testing capacity for those alive and potentially contained at this moment... So if that's the case, then are we undercounting BOTH deaths and people infected?? I never said I'm not seeing it. I currently don't have testing avail other then the protocol I just said came over from DOH. How can I diagnose someone without a positive Covid-19 test? I am seeing what you posted in that tweet. High increase in flu like symptoms with negative flu. I have made that clear I think multiple times haven't I? No they are not testing bodies at the morgue. You asked about testing people who come in with flu like symptoms. I don't believe I have heard of any cases of DOA(have you?) covid-19. Today, if you have someone on life support/ventilator anywhere in America I would hope to god its known whether or not they have Covid19. I don't mean to put words into your mouth, but I think you have said that a lot of people are infected and we're not seeing the deaths, so the conclusion is that CFR is lower than what's out there. So I'm asking - is the disconnect with what other countries are seeing that both infected and deaths are undercounted (vs. just denominator being undercounted)? Just another thought on this. That tweet said flu like illness spiked March 1st right? Assuming those were all new cases we are now 15 days out. If your only self quarantined for 14 days then it could be broadly assumed that your chance of dying is high in 14 days right? That being said is it reasonable to assume there should have been a HUGE spike in deaths? Its been 15 days right? How many in NYC 3?

You said I didnt think I was ignorant. Liar! I like you how strictly adhere to statistics though! That takes a lot of confidence in medicine! I would never want to operate on you. Imagine going through the complication rates with you. Whoo! Maybe you can reconcile this questions for me since you guys are way better at the crunching the numbers then I am. Can we all agree Italy is a shit show right? Many have used it as an example of worst case scenario. 1. First case in Washington Jan 20th, First case in Italy Jan 31st. Cant argue that right? 2. Italy has 1809 deaths I think? Washington State 50, ~27 from infirmed elderly. 3. You guys have pounded the table about exponential growth. I clearly don't get it or calculate it. As as many have said for days, it is coming. No doubt, it is coming. 4. You guys are data driven guys. Whats up here? Also FWIW I dont believe your name is Richard Gibbons. Who would name their kid Dick Gibbons? j/k ;)

But this is where I'm trying to reconcile. You're saying that you're not seeing it. But evidence suggest that flue like cases are increasing significantly, but we don't know due to what. So I'm wondering if this is just a precursor of things to come, and you might not have seen it first hand. And I can't imagine that we are testing dead people for the virus - I would definitely save the testing capacity for those alive and potentially contained at this moment... So if that's the case, then are we undercounting BOTH deaths and people infected?? I never said I'm not seeing it. I currently don't have testing avail other then the protocol I just said came over from DOH. How can I diagnose someone without a positive Covid-19 test? I am seeing what you posted in that tweet. High increase in flu like symptoms with negative flu. I have made that clear I think multiple times haven't I? No they are not testing bodies at the morgue. You asked about testing people who come in with flu like symptoms. I don't believe I have heard of any cases of DOA(have you?) covid-19. Today, if you have someone on life support/ventilator anywhere in America I would hope to god its known whether or not they have Covid19. I don't mean to put words into your mouth, but I think you have said that a lot of people are infected and we're not seeing the deaths, so the conclusion is that CFR is lower than what's out there. So I'm asking - is the disconnect with what other countries are seeing that both infected and deaths are undercounted (vs. just denominator being undercounted)? Ok yes I believe that is the case and I think that matches the data in the tweet you posted. How else do you explain the sudden increase in flu symptoms as of March 1st? Like I said they aren't faking it. What we would need to know is what the flu test results are. I would say you should have a very high suspicion that it is Covid19 during a declared epidemic, flu like symptoms, and negative flu. Huge increase in flu like symptoms coming into ER, and then likely being told to self quarantine according to DOH guidelines if symptoms are mild.

I think it's much higher than 2%. The reality is many people are sick and not dying of pneumonia - I would assume a portion of posters on this very thread are experiencing symptoms as well as the rest of the population, or had experienced symptoms in Jan/Feb and recovered. The first reported US case was January 21. This is an incredibly fast transmitting virus. The odds are, cases existed prior to Jan 21. And further, the odds are that the spread of this virus across the US was much faster than official reports claim. This is due to lack of testing i.e. lack of timely, accurate information. But ultimately, I agree w/ the principle of: better safe than sorry. For the obvious reason, and for the secondary reason as it provides a "trial-run" on a global basis for future pandemics. I am about 20% cash btw. If I didn't suffer from biases like anchoring and all that stuff I would think about 1/3 cash is the ideal amount right now. https://www.nejm.org/doi/full/10.1056/NEJMoa2001191 Question for you guys as I havent seem to be making any friends swimming against the tide! Above is the NEJM article on first case of corona virus. This is what I don't understand. First US case was January 20st, with 4 days of symptoms and as I have read this is a very fast transmitting virus. Some have said this is very fast, some fast, symptoms take a while to show up, agree. Please reconcile this for me. It has been exactly 2 months since this gentleman returned to the US from wuhan China. Is it out of the way to assume that there was community spread with this gentleman? 4 days of cough, fever, flew on a plane? Lets just work on that premise. Now I have become lost with all of the projections, graphs, charts, etc. Pick whatever model you want. My question is this: Its been 2 months since that virus was officially detected in a known area. I'm not aware of this so please help. Is there overload in the area where this gentleman was? Are there people dying? What does it look like? Are they running out of ICU beds? How is california? They were not far behind and have a HUGE population! I know there can be a delay in symptoms but isnt 2 months long enough for this virus to really get going, especially with lockdown, social distancing just happening now? 55 days from Jan 20 to March 15. Assuming doubling every 4 days, you have a bit less than 2^14 = 16K cases in US right now. But then you told us that you knew how to do math... Oh yeah your definitely right. 16,000 cases only in US so far sorry. ;D So how many in the Washington area by your estimation if 16k in US? 50-60 total?

Holy Shit. Maybe New York Times is slow to update the Washington death count? Still says 40. This guy must have seen a lot of deaths since the nursing home ones if he is numb. Looks like 42 still as of Sunday PM per Washington local news. Maybe they will be updated tomorrow. https://www.kuow.org/stories/live-coverage-covid-19-in-seattle-wa-state

But this is where I'm trying to reconcile. You're saying that you're not seeing it. But evidence suggest that flue like cases are increasing significantly, but we don't know due to what. So I'm wondering if this is just a precursor of things to come, and you might not have seen it first hand. And I can't imagine that we are testing dead people for the virus - I would definitely save the testing capacity for those alive and potentially contained at this moment... So if that's the case, then are we undercounting BOTH deaths and people infected?? I never said I'm not seeing it. I currently don't have testing avail other then the protocol I just said came over from DOH. How can I diagnose someone without a positive Covid-19 test? I am seeing what you posted in that tweet. High increase in flu like symptoms with negative flu. I have made that clear I think multiple times haven't I? No they are not testing bodies at the morgue. You asked about testing people who come in with flu like symptoms. I don't believe I have heard of any cases of DOA(have you?) covid-19. Today, if you have someone on life support/ventilator anywhere in America I would hope to god its known whether or not they have Covid19.

I posted this earlier in the thread. I do not claim to be an expert on this. Just brainstorming like you guys. Thats a good question, and I think this is alot of the reason for concern that it will spiral out of control in US. To be honest I don't know why Italy when to shit so fast. I have never worked there, don't know their facilities, protocols, patient populations, medications available, etc. Stuff that I would throw at a wall to see if it sticks? 1. Older population or population centers where disease has hit, we know it affects older people more, like nursing home in Washington. 2. More smokers? Covid 19 would be murder on someone with COPD, severe asthma, smoker etc. 3. Lower admission threshold? I dont know their protocols but medicine and treatment is not universal town to town, state to state, and certainly not country to country I would argue it has nothing to do with testing vs Korea though why? Latest updates are Italy 12462 positive, 827 deaths, Korea 7869 positive 66 deaths. How do you explain the difference? Again there is no cure for Covid 19 so its not like Korea is curing people and Italy isnt. Again whether you are tested or not if you are to the point that you need a respirator (think dying) you will go in and be treated. Even if you test positive on day 1 you can do down hill quick if your old and immuno compromised so drive through testing would be great but your ass would still be in the ICU if you body couldn't handle the disease. Is it the case that S. Koreans are healthier? Maybe. Less lung disease? Maybe So to summarize testing is not a cure, its a diagnosis, a label. Treatment for those positive is fluids, rest, tylenol for fever, steriods/breathing treatments for breathing issues. If you go down hill, its happening regardless of your test results as there is nothing to decrease the viral load. My assumption is S. Koreas actually hands on treatment isnt much better in this day and age then Italy's so that leaves the pts. I have read some believe S. Korea have been giving super super high doses of vitamin C IV with success. Maybe they are having success and never picked up the phone to call Lombardy. Idk. Many people have cited Italy as a concern which is very valid. I think a good thought to ponder is why is Italy the rule and not the exception? This has hit 180? countries by now. How is medicine and access to healthcare in the third world?What the hell is going on there? The first patients in South Korea were young. The first patients in Italy were older. South Korea and Italy have nearly identical death rates by age bucket. It's ok to just say I don't know. Didn't I just say I didn't know? I didn't ask the question. Your right. The age rates are identical per bucket! So how do you explain other then the patient make up? Why do you think Italy had more deaths? It shouldnt matter who was first. The virus doesn't care who it spreads to right? Or your saying Old Koreans don't get the virus as easily as Old Italians?

I told you earlier maybe I was anchored right? We will see, not only that told you I was willing to eat crow if wrong! Like I have anything to gain arguing with you guys about this. ::) Orthopa - do you have any thoughts on this data? Seems to be in your region. I’m also hearing a lot of people (docs) on Twitter say that they’re seeing the uptick in similar symptoms but without testing they just send people home. So is it possible that people are sick and dying but without tests we don’t know the “cause” definitively? I can give you our update recommendations that just came through from local DOH on fax 5 minutes ago. If pt has suspected Covid19 with mild symptoms pt is to go HOME and self quarantine for 14 days. If pt has high suspicion of Covid19 infection we are supposed to call the local DOH and speak to an epidemiologist, the criteria are: 1. A person who has been in close contact with someone who has covid-19 2. A person who traveled to area with high incidence. 3. Person who has tested negative for flu/RSV A joint decision is then made regarding need for testing. Anyone with life threatening symptoms is to go by ER. Sorry but can you answer the question on the data above? If the uptick that the data is pointing to is related to Covid19 it would suggest something is happening, even if we don't know for sure 100% due to the lack of testing. Well it looks like data is presenting with flu symptoms. Does not mention deaths. I would hope to god if people died they were tested for covid19. Dead people get just as much of a right to a test as living plus in this day and age a requirement I would imagine. I would imagine the data is due to. 1. Covid19 of course, it has flu like symptoms 2. Worries individuals/paranoid. Otherwise how do you fake flu symptoms? "Katie S @scoville_katie Replying to @chrislhayes I noticed about a month ago that we were treating a lot of patients for the flu that had negative flu tests. My mind goes back to that and I just wonder if we missed the bus even before we thought we did." Maybe I work where Katie works LOL! jk. Worth a read of her thread!

I posted this earlier in the thread. I do not claim to be an expert on this. Just brainstorming like you guys. Thats a good question, and I think this is alot of the reason for concern that it will spiral out of control in US. To be honest I don't know why Italy when to shit so fast. I have never worked there, don't know their facilities, protocols, patient populations, medications available, etc. Stuff that I would throw at a wall to see if it sticks? 1. Older population or population centers where disease has hit, we know it affects older people more, like nursing home in Washington. 2. More smokers? Covid 19 would be murder on someone with COPD, severe asthma, smoker etc. 3. Lower admission threshold? I dont know their protocols but medicine and treatment is not universal town to town, state to state, and certainly not country to country I would argue it has nothing to do with testing vs Korea though why? Latest updates are Italy 12462 positive, 827 deaths, Korea 7869 positive 66 deaths. How do you explain the difference? Again there is no cure for Covid 19 so its not like Korea is curing people and Italy isnt. Again whether you are tested or not if you are to the point that you need a respirator (think dying) you will go in and be treated. Even if you test positive on day 1 you can do down hill quick if your old and immuno compromised so drive through testing would be great but your ass would still be in the ICU if you body couldn't handle the disease. Is it the case that S. Koreans are healthier? Maybe. Less lung disease? Maybe So to summarize testing is not a cure, its a diagnosis, a label. Treatment for those positive is fluids, rest, tylenol for fever, steriods/breathing treatments for breathing issues. If you go down hill, its happening regardless of your test results as there is nothing to decrease the viral load. My assumption is S. Koreas actually hands on treatment isnt much better in this day and age then Italy's so that leaves the pts. I have read some believe S. Korea have been giving super super high doses of vitamin C IV with success. Maybe they are having success and never picked up the phone to call Lombardy. Idk. Many people have cited Italy as a concern which is very valid. I think a good thought to ponder is why is Italy the rule and not the exception? This has hit 180? countries by now. How is medicine and access to healthcare in the third world?What the hell is going on there?

Trevor Bedford has put together an excellent thread to estimate the current number of cases (not confirmed testing, but a model of where actual cases might be). Some relevant quotes: The full thread is worthwhile, and his posts are generally helpful. I believe the cases you were seeing in the ED during January and February were normal cold and flu, not COVID19. You must mean colds sir. Their flu's were negative. So I had a whole bunch of colds (they were presenting differently too) come in while a novel virus was erupting across the world with daily direct airplane travel, no vaccine, no cure, a 4-6 week head start and no travel restriction for weeks?

Better answer for him: "If you truly think the whole world is wrong and you are right, the futures market opens at 6 pm EST" Come on Dalal! What do you think my question regarding the numbers and deaths. Your a numbers guy right? I cant keep up. First its doubling fast, then slow, and there is exponential growth, but we still have to wait. Im waiting for the futures to open just like you!!!

Exactly. The virus is really getting going and there is a lag of, say 6 weeks, until you see the deaths. There is widespread, undetected, uncontained community spread in the US. Canada is seeing that when we test people coming from the US. Major parts of the US will look like Italy shortly. Canada is probably a week or two behind the US. Q: if you start with 1 case and it doubles every 3 days, how long until we actually notice it? It will take many doublings until we feel it and news picks up. Furthermore if mortality is in single digits, it will take even longer for us to notice it. This has been here since January but exponential growth starts slowly with small numbers until they snowball and you can no longer ignore it. See my Berkshire example. To think that just because there were a few cases in Jan implies there were millions in the U.S. at that time is a major major stretch. Ok so we will say it doubles every 3 days, so its been 2 months. Thats 20 doubles? So your comfortable with saying there reasonable suspicion there are 1,048,576 infections in the area alone where this gentleman is with no apparent stress on the healthcare system. And that being said there is still the rest of the state to be counted and so far 60 deaths?

Exactly. The virus is really getting going and there is a lag of, say 6 weeks, until you see the deaths. There is widespread, undetected, uncontained community spread in the US. Canada is seeing that when we test people coming from the US. Major parts of the US will look like Italy shortly. Canada is probably a week or two behind the US. Wait a second. Wasn't I just getting filleted for this last week?