orthopa

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? The consensus for the origination of coronavirus is late November in Wuhan. It did not become a big deal until 2 months later. The way exponential growth works is that when you start with small numbers, it takes time for them to snowball into significant numbers. Once significant numbers are attained, then the growth becomes impactful and felt in a very real way. Berkshire Hathaway was a company not on too many people's radars in the 1960s and 1970s. Eventually it became impossible to ignore. Thanks, but I wasnt asking about Berkshire Hathaway. Can anyone else help on this?

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.

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?

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. ::)

Important to clarify given the contradiction between the username and claims made on here. Registered username as an orthopedic PA while in PA to DO accelerated program. Then ER training. Currently working in ER and Urgent care.

Your right. 2 options. Do you think Cuomo is going on record saying that thousands likely had the virus, recovered, and didn't know it if it was highly unlikely? In this climate? At this time? Thats pretty ballsy isnt it? Maybe he was joking? Q for u: if millions caught this month ago and it is only 2-3x deadlier than the flu (an underestimate based on our current data), how many people would have died without a formal diagnosis (since we wouldn't have been able to diagnose) in the past 2 mo? How many ICU patients with ARDS would we have had? In order for your theory to work, you must be arguing that COVID19 is much much LESS deadlier than the flu <<< 0.1%. That is a bold statement to be making now and I know what I think of the odds of that being even remotely true. I think you just typed out the answer. Why aren't we seeing more dead people/ARDS? You cant say this virus spreads rapidly in one breath and will kill everyone and on the same hand keep saying, its coming, its coming, its coming. How can you use current data? S. Korea has 51 million people but tested 140,000. Thats .27% of the population. How can you honestly use that data? Your going to extrapolate that for the other 99.63% of the population? Really? Secondly I want an honest opinion about Cuomo. Why would he come out and say that? In NYC. During a pandemic with massive panic in society? I don't look to elected officials to form objective opinions about reality, leaving aside the fact that it is in their interest that people in their area take crises seriously. The financial markets are offering you many opportunities to get rich beyond your wildest dreams right now if you are really as confident as you seem about this. Your right he must be speaking off the cuff and sticking his neck out during a pandemic/crisis and not talking to the medical professionals/epidemiologists, etc.

Your right. 2 options. Do you think Cuomo is going on record saying that thousands likely had the virus, recovered, and didn't know it if it was highly unlikely? In this climate? At this time? Thats pretty ballsy isnt it? Maybe he was joking? Q for u: if millions caught this month ago and it is only 2-3x deadlier than the flu (an underestimate based on our current data), how many people would have died without a formal diagnosis (since we wouldn't have been able to diagnose) in the past 2 mo? How many ICU patients with ARDS would we have had? In order for your theory to work, you must be arguing that COVID19 is much much LESS deadlier than the flu <<< 0.1%. That is a bold statement to be making now and I know what I think of the odds of that being even remotely true. I think you just typed out the answer. Why aren't we seeing more dead people/ARDS? You cant say this virus spreads rapidly in one breath and will kill everyone and on the same hand keep saying, its coming, its coming, its coming. How can you use current data? S. Korea has 51 million people but tested 140,000. Thats .27% of the population. How can you honestly use that data? Your going to extrapolate that for the other 99.63% of the population? Really? Secondly I want an honest opinion about Cuomo. Why would he come out and say that? In NYC. During a pandemic with massive panic in society? There was a shortage of tests in SK. They tested the people they did because government's have been tracking every case they can. That's why folks are mad at Italy and then the US's response. They stopped monitoring everyone adjacent to the virus. It's frustrating you're a doctor and won't read about this. WHO said its 5-6 day doubling vs ~3 days for some other viruses. Even if you start with 10 people one month ago, by month end we would project to have 320-640 cases. This is a 12-18 month problem. https://graphics.reuters.com/CHINA-HEALTH-SOUTHKOREA-CLUSTERS/0100B5G33SB/index.html I have read about it thanks. That wasn't my question. My question was a simple one. Im not looking for context. Again, do you trust data for .27% of the population for anything? You seem to like medicine/data. Would you trust data that said we tested .27% of the US population for Diabetes and 95% were found to have it. The testing was done after the scientists put out an ad for people to come in if they had symptoms of diabetes. Would you trust that data?

I think you have an excellent understanding of this at this point, and apparently able to put it down on paper better then me. Thanks. Just trying to make sure I fully understand the various perspectives. Again, apologies again for the comment before re: the profession you've chosen. It meant no disrepect. I do want to ask you - if you were to take a step back and think about your position, where could you be wrong? I could be wrong by how much of a hit this will be to the ICU/need for respirator, ie breakdown of health system. I can only think back to working during the H1N1 outbreak and the 17-18 flu season and that volume load which was ~15 million cases if I recall correctly. The system was stretched, but did not collapse, My opinion is the virus has been here for 6 weeks/months and cases are vastly under reported. So in my mind we are currently in an environment of where many think we will be from documented patient 1 say 4-6 weeks from now, already! Its in this mind frame I have a hard time rectifying a wickedly high death rate and medical system collapse if we are operating in this environment currently. I certainly could be wrong on this, I hope I'm right of course. We will see. The fact of the matter is if the cases are severely under estimated and we are handling it now maybe we are further along on the curve then we think, and handling it fine. Again, hope Im not wrong. We will see I guess.... Here's a question. I am no medical professional so maybe this is a silly question: Let's assume you are correct - coronavirus in some form has been in N America, say since January or early Feb. Therefore people have been experiencing flu-like symptoms and/or perhaps slightly more elevated symptoms than a normal flu. And some must have been going to a doctor or perhaps hospital. Doctors perform a flu test which would presumably come back negative. Would there have been some communication that doctors/hospitals are noticing a pretty decent amount of patients with flu-like or slightly elevated flu-like symptoms but testing negative for the flu? An amount of patient records to corroborate this? I am not saying it's impossible - frankly it may very well be true, and is therefore worth exploring - so would there some records to prove/disprove this? This is what has been happening for weeks, and weeks. There has been communication between myself, others, and regional ERs regarding this exact subject. In all reality knowing whether or not these people had corona would not have changed the symptoms. How do I know already? NO ONE HAS DIED AND ICUS ARE NOT FULL! You could retrospectively go back and look at the data but who would you convince? Look at the media/social media. They want closure, NOW! They will only accept a positive results. How would we know? Antibody testing via blood! Would show all of those recovered. Question I have for those constantly citing Italy as a reason for very high concern. The virus is in what? 170 countries now? All over the god damn world. Why is Italy the rule and not the exception? What is the implied Ro for the scenario where there are currently millions of active cases in the US (and similar spread outside the US)? That Ro contradicts everyone's reporting. The severe / moderate / mild case percentages you imply contradict everyone. The lowest CFR estimated contradicts your assumptions. You have yet to mention that CV progresses slowly, showing symptoms after several days and first deaths have come after ~25 days. So although there's almost certainly some case undercounting, there's also expected to be a longer lag between transmission and death. We saw a large spike in daily ER visits for flu and respiratory symptom in NYC https://a816-health.nyc.gov/hdi/epiquery/visualizations?PageType=ps&PopulationSource=Syndromic Your theory continually relies on no explanation of the disease, it's symptoms, how it progresses, and so on. You just say it's millions because it's been here since January (you make no effort to timeline where China was with cases at that time or estimate how many imported cases that would imply to get to millions of cases in 6 weeks). Your theory becomes further unlikely given the number of negative tests in many regions. WHO guidance that CV spreads slower than the flu. All you have is intuition, a few out of context quotes from various non-experts, and heavy fist pounding on the table. I can find doctors that predict the end of times, mid-single digit % death throughout the world, and other terrible things. That they are doctors doesn't make them right because their nonsense doesn't fit triangulated facts. Same with you. Your nonsense theory doesn't fit with triangulated facts from hundreds of sources. Your theory around no spike in admissions and no deaths is also consistent with all the triangulated facts that the disease has spread considerably in the last several days and symptoms are only starting to be shown. Similar to NYC's uptick. Trump is saying that this is bad and promoting social distancing. Every major country throughout the world has had some sort of shut down. Do you really think this is all somehow a MSM or Democratic plot, in coordination with every country in the world?!? I never said the shut down was a plot. Did I say something I wasn't aware of? Your right, its only, me a little ER, a network of ~50 urgent cares across NYS state seeing ~50 pts a week for a month, so 75k pts a month. Very small sample and data, except for all of the negative flus and viral syndrome diagnoses. Ill keep you guys updated! Oh so now it progresses, very, very slowly. Ok. A week ago we were talking about exponential growth. Now its progressing slowly and just got here. I have seen 23 people over the last 2 days with fever, ST, body aches, mild temp and negative flu. All went home, no breathing issues. Still waiting for testing in my area. Maybe its something else? :o I never said my data was official or inclusive and your right I just keep posting links/verbage that reinforces my opinion. But at the same time I can't help it. It just keeps coming out. Just following like you guys!

Your right. 2 options. Do you think Cuomo is going on record saying that thousands likely had the virus, recovered, and didn't know it if it was highly unlikely? In this climate? At this time? Thats pretty ballsy isnt it? Maybe he was joking? Q for u: if millions caught this month ago and it is only 2-3x deadlier than the flu (an underestimate based on our current data), how many people would have died without a formal diagnosis (since we wouldn't have been able to diagnose) in the past 2 mo? How many ICU patients with ARDS would we have had? In order for your theory to work, you must be arguing that COVID19 is much much LESS deadlier than the flu <<< 0.1%. That is a bold statement to be making now and I know what I think of the odds of that being even remotely true. I think you just typed out the answer. Why aren't we seeing more dead people/ARDS? You cant say this virus spreads rapidly in one breath and will kill everyone and on the same hand keep saying, its coming, its coming, its coming. How can you use current data? S. Korea has 51 million people but tested 140,000. Thats .27% of the population. How can you honestly use that data? Your going to extrapolate that for the other 99.63% of the population? Really? Secondly I want an honest opinion about Cuomo. Why would he come out and say that? In NYC. During a pandemic with massive panic in society?

Your right. 2 options. Do you think Cuomo is going on record saying that thousands likely had the virus, recovered, and didn't know it if it was highly unlikely? In this climate? At this time? Thats pretty ballsy isnt it? Maybe he was joking?

I think you have an excellent understanding of this at this point, and apparently able to put it down on paper better then me. Thanks. Just trying to make sure I fully understand the various perspectives. Again, apologies again for the comment before re: the profession you've chosen. It meant no disrepect. I do want to ask you - if you were to take a step back and think about your position, where could you be wrong? I could be wrong by how much of a hit this will be to the ICU/need for respirator, ie breakdown of health system. I can only think back to working during the H1N1 outbreak and the 17-18 flu season and that volume load which was ~15 million cases if I recall correctly. The system was stretched, but did not collapse, My opinion is the virus has been here for 6 weeks/months and cases are vastly under reported. So in my mind we are currently in an environment of where many think we will be from documented patient 1 say 4-6 weeks from now, already! Its in this mind frame I have a hard time rectifying a wickedly high death rate and medical system collapse if we are operating in this environment currently. I certainly could be wrong on this, I hope I'm right of course. We will see. The fact of the matter is if the cases are severely under estimated and we are handling it now maybe we are further along on the curve then we think, and handling it fine. Again, hope Im not wrong. We will see I guess.... Here's a question. I am no medical professional so maybe this is a silly question: Let's assume you are correct - coronavirus in some form has been in N America, say since January or early Feb. Therefore people have been experiencing flu-like symptoms and/or perhaps slightly more elevated symptoms than a normal flu. And some must have been going to a doctor or perhaps hospital. Doctors perform a flu test which would presumably come back negative. Would there have been some communication that doctors/hospitals are noticing a pretty decent amount of patients with flu-like or slightly elevated flu-like symptoms but testing negative for the flu? An amount of patient records to corroborate this? I am not saying it's impossible - frankly it may very well be true, and is therefore worth exploring - so would there some records to prove/disprove this? This is what has been happening for weeks, and weeks. There has been communication between myself, others, and regional ERs regarding this exact subject. In all reality knowing whether or not these people had corona would not have changed the symptoms. How do I know already? NO ONE HAS DIED AND ICUS ARE NOT FULL! You could retrospectively go back and look at the data but who would you convince? Look at the media/social media. They want closure, NOW! They will only accept a positive results. How would we know? Antibody testing via blood! Would show all of those recovered. Question I have for those constantly citing Italy as a reason for very high concern. The virus is in what? 170 countries now? All over the god damn world. Why is Italy the rule and not the exception?

I think you have an excellent understanding of this at this point, and apparently able to put it down on paper better then me. Thanks. Just trying to make sure I fully understand the various perspectives. Again, apologies again for the comment before re: the profession you've chosen. It meant no disrepect. I do want to ask you - if you were to take a step back and think about your position, where could you be wrong? I could be wrong by how much of a hit this will be to the ICU/need for respirator, ie breakdown of health system. I can only think back to working during the H1N1 outbreak and the 17-18 flu season and that volume load which was ~15 million cases if I recall correctly. The system was stretched, but did not collapse, My opinion is the virus has been here for 6 weeks/months and cases are vastly under reported. So in my mind we are currently in an environment of where many think we will be from documented patient 1 say 4-6 weeks from now, already! Its in this mind frame I have a hard time rectifying a wickedly high death rate and medical system collapse if we are operating in this environment currently. I certainly could be wrong on this, I hope I'm right of course. We will see. The fact of the matter is if the cases are severely under estimated and we are handling it now maybe we are further along on the curve then we think, and handling it fine. Again, hope Im not wrong. We will see I guess....

Seems to? LOL. This is what is GOING ON!!!! Again. I treat patients in an ER and have been seeing this for weeks!!!! We just went back and retrospectively called all of our negative flu swabs from my clinic for 6 weeks. All 1450 people recovered NO ONE DIED. There were 2 hospital admission. Again no way to know if these were corona positive but again.....we are in a pandemic right?? ??? ??? ??? ??? are you holding cash or mostly invested? Mostly/fully invested. Eventually as more people are tested we will find the death rate plummets and thousands and thousands if not millions had the virus and recovered and were asymptomatic. We are slowly getting there. Cuomo is on board!

Weren't we just arguing about this in my example of extended contact at airport ? Now because he says it, its true? LOL Orthopa, do you think you can slow down a bit and try to communicate a little more clearly? I think you are making some good points, but it seems your points may not be getting across clearly or that you may even be misunderstood. This post in particular makes me think that is the case. I also thought your earlier point about testing the role of testing in a diagnosis is likely a good point, but was probably too hasty to get your point across. Maybe some other medical professionals could weigh in on that, especially if you're to busy to respond. I dont know how much more I can slow down. I have probably posted 50 times? Trying to get some points across. Am I completely right?, of course not but I have experience FWIW. Others have graphs, twitter links, and or political angles which are underwhelming at best sometimes. Again points that I have made that I believe are true FWIW (we are allowed an opinion right?) 1. The virus has been here for months, likely early January and has been seen/dealt with in the health system under other diagnoses for months. 2. The first test confirmed, was not the first test here. 3. There was nothing the government or any nation in the world could do to stop the initial spread 4. Older people and those most at risk will die. There is no cure, and viruses kill people. Elderly people should take appropriate precautions. 5. Because the virus has been here for months testing is borderline useless and your going to chase your tail the entire time. This is due to numerous contacts and the extended incubation period. 6. If you don't test everyone the virus will continue to spread quickly, again via asymptomatic people and kids. Best policy is to test everyone, but its impossible and too late. 7. Best way to prevent spread is standard precautions! This includes isolation, hand washing, yada, yada. NOT TESTING. 8. If a patient test positive and there has been minimal definite contacts say someone who is home bound with a handful of contacts testing may make sense but these are limited cases. 9. The the spring/summer will bring a reprieve in new cases and hopefully that was well as the fact that nearly everyone will have been exposed or infected this will limit virgin hosts. 10. A vaccine is useless if the virus mutates significantly. 11. The number of cases are vastly under reported, probably numbering in the millions by now in the US. 12. If someone you know or yourself had a cold/URI/flu symptoms that tested negative, and was "way worse" then the common cold there was very high chance it is/was the corona virus. 13. Every case of the virus is not severe, so don't model it as such. Corona virus dx does not = ICU and ventilator. 14. I believe eventually those in charge medically will come to the conclusion that its inevitable that this becomes a pandemic with everyone getting infected in time. 15. If your human, you will get the virus in your lifetime. Nothing you can do. 16. Flattening the curve makes sense but I question when the curve will bump as the virus again likely has been here for months. The virus finally hit my back yard. Told ya guys! https://www.wgrz.com/article/news/health/coronavirus/3-erie-county-residents-test-positive-for-coronavirus-cuomo-says/71-059af4e0-657f-4de6-9c4c-692b105ee327 ""We believe there are thousands of people who have coronavirus, maybe tens of thousands. We believe there are thousands of people, maybe tens of thousands who have had coronavirus and have resolved that never knew they had it. So the 524 cases doesn't mean there are 524 positive people. It means the testing capacity is going up." This should be evidence enough any calculation regarding death rate is completely useless. And its Cuomo, a democrat who hates Trump for all you partisan guys! Again question for everyone expecting dooms day. Slowly its coming to the realization 10s of THOUSANDS of people had the virus but the ERs aren't slamming yet? What gives???

It will not differ from anyone else. You will be triaged based on symptoms and treated accordingly. Nothing to worry about. Said person likely has had the flu and has been at just as much risk as a result. Fortunately your net worth does not matter in an emergency situation even if you have no "pull". If your asking for a "friend". Your friend will be fine.

Great explanation thanks!

This may have been discussed before but anyone looking at buying puts on the vxx? I know the implied volatility is very high but looking out to this summer and a realization that the virus is not deadly as well as general calm in the market should cause a huge fall in the vxx. Thoughts from those a little more versed on this?

I truly hope you are right and the regulatory bodies are wrong. No one is rooting for tragedy. Me too. It will allow our lives to return to normal as things re open as well as the market so we all hopefully will make some money.

Let's look at this article critically (as part of training as a Physician, it must be natural for you not just to look at complex publications, but also simple News 5 Cleveland articles like this with a critical eye): Let's look at where this 100k number came from. Read that bolded statement again. Now let me ask you a serious question: does that bolded statement sound at all scientifically rigorous to you? If you know of 2 people who have it from community spread you can "assume 1% of your population has it"? Is this some public health secret cheat code I am unaware of where you can extrapolate N=2 to a population based metric like "1% of population"? Why not extrapolate this new cheat code to worldwide--hey, if two people have it from community spread, then 1% of the world's population (80 million people!) must already have it. So easy see? Just because someone has "Dr" or "health director" in their name or title does not mean you take what they say as gospel. It ain't that simple. I know you like munger quotes, here is one for ya. “I'm right, and you're smart, and sooner or later you'll see I'm right.”

Ok so 100,000 MINIMUM cases in ohio, fuck it say 5 million in US Deaths according to the super scary virus tracker in Ohio 0 and in US 36 I think? https://coronavirus.jhu.edu/map.html I know you guys like spreadsheets. Dalal said medical guys dont learn about numbers in school so I need you guys do it for me. How is that death rate looking now folks?

Weren't we just arguing about this in my example of extended contact at airport ? Now because he says it, its true? LOL Orthopa, do you think you can slow down a bit and try to communicate a little more clearly? I think you are making some good points, but it seems your points may not be getting across clearly or that you may even be misunderstood. This post in particular makes me think that is the case. I also thought your earlier point about testing the role of testing in a diagnosis is likely a good point, but was probably too hasty to get your point across. Maybe some other medical professionals could weigh in on that, especially if you're to busy to respond. I dont know how much more I can slow down. I have probably posted 50 times? Trying to get some points across. Am I completely right?, of course not but I have experience FWIW. Others have graphs, twitter links, and or political angles which are underwhelming at best sometimes. Again points that I have made that I believe are true FWIW (we are allowed an opinion right?) 1. The virus has been here for months, likely early January and has been seen/dealt with in the health system under other diagnoses for months. 2. The first test confirmed, was not the first test here. 3. There was nothing the government or any nation in the world could do to stop the initial spread 4. Older people and those most at risk will die. There is no cure, and viruses kill people. Elderly people should take appropriate precautions. 5. Because the virus has been here for months testing is borderline useless and your going to chase your tail the entire time. This is due to numerous contacts and the extended incubation period. 6. If you don't test everyone the virus will continue to spread quickly, again via asymptomatic people and kids. Best policy is to test everyone, but its impossible and too late. 7. Best way to prevent spread is standard precautions! This includes isolation, hand washing, yada, yada. NOT TESTING. 8. If a patient test positive and there has been minimal definite contacts say someone who is home bound with a handful of contacts testing may make sense but these are limited cases. 9. The the spring/summer will bring a reprieve in new cases and hopefully that was well as the fact that nearly everyone will have been exposed or infected this will limit virgin hosts. 10. A vaccine is useless if the virus mutates significantly. 11. The number of cases are vastly under reported, probably numbering in the millions by now in the US. 12. If someone you know or yourself had a cold/URI/flu symptoms that tested negative, and was "way worse" then the common cold there was very high chance it is/was the corona virus. 13. Every case of the virus is not severe, so don't model it as such. Corona virus dx does not = ICU and ventilator. 14. I believe eventually those in charge medically will come to the conclusion that its inevitable that this becomes a pandemic with everyone getting infected in time. 15. If your human, you will get the virus in your lifetime. Nothing you can do. 16. Flattening the curve makes sense but I question when the curve will bump as the virus again likely has been here for months. 50x100,000 is 5 million no?

Orthopa, the problem is that what you're saying doesn't seem to align with evidence. It seems fairly clear that a bunch of people have died in Italy, Iran, and China as a result of COVID-19. You seem to be claim is that millions in the USA have been infected a long enough time ago that we'd already be seeing lots of deaths if COVID-19 were a big deal. But USA has not seen lots of deaths. So, to be credible, you need to make it simple for us to understand this disconnect. Are Americans just more robust than the Italians, Iran, or Chinese? Do Americans have some sort of herd immunity that makes them less likely to die? Are Italy, Iran, and China simply pretending to have all these deaths, when really, they don't? Is there something about American culture that allows millions to catch COVID-19, but nobody to die? If you don't have some explanation for this disconnect between your hypothesis of millions infected but nobody dying, the most reasonable thing for people to believe is that your hypothesis is wrong. Particularly considering that there doesn't actually appear to be any evidence for your hypothesis except "some people got sick this flu season and didn't die, and it's conceivable that those people had COVID-19". (That said, I don't think you're ignorant. I think you've got the "I'm smart and know a lot about the topic, so my hypothesis unsupported by evidence must be right, and I'll defend it unto death" thing going. Pretty well all smart people make that mistake occasionally.) Orthopa's general point is this. (correct me if I'm wrong) As testing is rolled out nationwide what statistic will compound at a higher rate of discovery? A.) Terminal cases B.) Mild cases The correct answer is B Duh. The counterpoint has been that widespread testing will reduce the number of illnesses at any given time and that Orthopa's ranting is in complete contradiction to every health oversight agency Nope, sorry bro. https://www.news5cleveland.com/news/continuing-coverage/coronavirus/ohio-department-of-health-says-100-000-ohioans-are-carrying-coronavirus "Currently, Ohio has five confirmed cases of the virus. Three of the cases are in Cuyahoga County, one is in Stark County and the newest case—announced Wednesday—is a 55-year-old man in Trumbull County."

Orthopa, the problem is that what you're saying doesn't seem to align with evidence. It seems fairly clear that a bunch of people have died in Italy, Iran, and China as a result of COVID-19. You seem to be claim is that millions in the USA have been infected a long enough time ago that we'd already be seeing lots of deaths if COVID-19 were a big deal. But USA has not seen lots of deaths. So, to be credible, you need to make it simple for us to understand this disconnect. Are Americans just more robust than the Italians, Iran, or Chinese? Do Americans have some sort of herd immunity that makes them less likely to die? Are Italy, Iran, and China simply pretending to have all these deaths, when really, they don't? Is there something about American culture that allows millions to catch COVID-19, but nobody to die? If you don't have some explanation for this disconnect between your hypothesis of millions infected but nobody dying, the most reasonable thing for people to believe is that your hypothesis is wrong. Particularly considering that there doesn't actually appear to be any evidence for your hypothesis except "some people got sick this flu season and didn't die, and it's conceivable that those people had COVID-19". (That said, I don't think you're ignorant. I think you've got the "I'm smart and know a lot about the topic, so my hypothesis unsupported by evidence must be right, and I'll defend it unto death" thing going. Pretty well all smart people make that mistake occasionally.) Im glad you dont think Im ignorant, I dont either. Maybe read this article? Title says Ohio department of health says 100,000 ohians carrying corona virus. 8) https://www.news5cleveland.com/news/continuing-coverage/coronavirus/ohio-department-of-health-says-100-000-ohioans-are-carrying-coronavirus

https://www.yahoo.com/news/dont-panic-says-us-woman-recovered-coronavirus-055155667.html Was I a bit early maybe? This was about a week ago. We will see. Ill be sure to check back and quote this when we get a similar narrative above in the media. 8) For an uneducated opinion, this is reasonable. But how do you reconcile with what is happening in Italy? And given how quickly things went out of control in Italy, why don't you think the same thing will happen in the US? 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.

Your first statement would be true if there was a treatment. As Im sure we all know there isnt, and wont be by the time this is mostly done and over with. Im not saying test everyone my point is in general it is too late from a containment standpoint to 1. meaningfully contain the disease by testing. 2. As I mentioned before to be effective in this type of situation you either test everyone or no one. What utility is there now in testing the entire Utah Jazz team? Its been passed on, Donovan Mitchell, and Gobert picked it up or gave it to one another and while playing likely exposed while symptomatic the most recent teams they were playing, training staff, crowd behind them during game, family, etc. Wheres the utility in that? Especially when there is no treatment! I guess you get closure of a diagnosis but thats about it. And those 2 will recover just fine and will end up on ESPN talking about it or writing a memior. What I think will really change the attitude about the virus is mass testing and a slow realization by the media, normal everyday people, and the market that it isnt a death sentence and nothing to fear unless your at risk. No question testing will help expose this. But no emergency treatment will be needed. If your in need of an ICU bed you will get to the hospital without the diagnosis of covid-19. For those that haven't seen it someone needing a respirator or intensive care is quite obvious. These people will get treatment without testing, its not like your positive test is your ticket in the door.