orthopa

In the "greatest health care system in the world", basic public health containment measures are impossible? If so, how did the Koreans manage it with less resources per capita than the US has at its disposal? M. The greatest heathcare system in the world to contain this virus would need the cooperation of every citizen, all 372 million of them, as well as the say 1, 2, 3 Billion people who continue to have access to this country via plane, train, foot, boat, etc. Its impossible, you know this.

Interesting strategy. Couple questions for you. 1. As I'm sure you know symptoms are cough, difficulty breathing, fever, as well as common cold symptoms. We are still in cold and flu season as you know. That means since symptoms are similar we would need to test 10s of millions of people over the period of a couple of weeks with cold symptoms, pneumonia symptoms, strep throat symptoms, mono symptoms, asthma symptoms, COPD symptoms, flu symptoms, CA, viral URI symptoms, etc etc. You laid out your ABCs, how do you plan on doing this? Honestly? You guys are worried about overload of the medical system with ventilators, ICU beds etc. Jesus Christ. Its not feasible. 2. Im assuming you mean isolating those that test positive. Not above, not realistic. 3. How do you trace the known contacts of someone who traveled with virus? Who is doing this? The physician? The DOH? the CDC? The family? Your going to call the airline?, the hotel?, the restaurant?, etc and trace all known contacts? Honestly? I could see friends and family, but those are not all known contacts. Great idea but what your suggesting is impossible. These are great questions, and this is how I would approach them. First, concentrate on the states with the currently highest known case loads (I know this is a moving target), but let's say Washington, Oregon, California, NY, MA. In these highest risk states, public health officials should be out in the hot spots testing anyone who is symptomatic - just like they did in Korea with their road side checks. Everyone who presents to a doctor with Upper respiratory tract infection symptoms anywhere in the country, who also does not have another proven diagnosis (i.e. Strep Throat, Flu, bacterial pneumonia, etc) should get a nasal swab sent for Covid-19 PCR. This would add a total of 15 seconds to the patient encounter while you uncork the swab stick it up their nose and apologize for the discomfort. There is already an infrastructure in place for flu PCR testing and surveillance across the country, you would basically bolt on the covid-19 testing to the flu surveillance network. People who are symptomatic with no known cause should self-isolate while they wait for their test results. Those who test positive go into quarantine and the source contact tracing and testing pathway. To answer your second question, I would only quarantine folks who tested positive, not all symptomatic people. To answer your 3rd question, the Department of Health should be tracing contacts of known infected cases. This is of course an inexact process, but we should try. There is a well established methodology for doing this and we've been systematically doing this as a society for a couple of hundred years - https://www.theguardian.com/news/datablog/2013/mar/15/john-snow-cholera-map The Koreans were publishing infection travel patterns on a public health website and sending push notifications to phones of folks in the effected areas. For example, "A patient with Covid-19 was identified who was at Jim's Bar at 11pm, and at a Conference in 'So-and-So' building this morning at 8am. If you were at either location and have upper respiratory tract infection symptoms, please present to medical care for testing". I understand this might all seem overwhelming, but it is manageable. The government recently announced $8.5billion in emergency economic aid around Covid-19. All of the measures I describe above, would cost less than half that much money, and would have cost even less if they were started earlier. M. PS. Let's assume it costs $100 per test to test all 10 million folks in the US who currently have upper respiratory tract infections. That would still only cost $1billion, but as I mentioned above, likely less because those with obvious clinical explanations for their symptoms like Strep Throat, Ear infections, Pneumonia, flu, etc would be exluded. So you want to start by testing states with 75 million people? Yikes. The covid-19 nasal swab doesn't exist yet, you know this. Secondly. That would have been great, back in December. Whats your plan for asymptomatic patients and children who show no symptoms? Surely they have to be tested too. Otherwise they become an immediate vector. We just let them go? This all sounds great on paper but just very unrealistic.

Not sure why Othopa doesn't understand these basics. I mean the facts s/he is stating are true, but just totally ignorant of basic math. It really boggles the mind. Yeah Im ignorant.

Ok now trace all known contacts in last 14 days and test everyone. ::) ::) ::) ::) ::). Then quarantine them.

Interesting strategy. Couple questions for you. 1. As I'm sure you know symptoms are cough, difficulty breathing, fever, as well as common cold symptoms. We are still in cold and flu season as you know. That means since symptoms are similar we would need to test 10s of millions of people over the period of a couple of weeks with cold symptoms, pneumonia symptoms, strep throat symptoms, mono symptoms, asthma symptoms, COPD symptoms, flu symptoms, CA, viral URI symptoms, etc etc. You laid out your ABCs, how do you plan on doing this? Honestly? You guys are worried about overload of the medical system with ventilators, ICU beds etc. Jesus Christ. Its not feasible. 2. Im assuming you mean isolating those that test positive. Not above, not realistic. 3. How do you trace the known contacts of someone who traveled with virus? Who is doing this? The physician? The DOH? the CDC? The family? Your going to call the airline?, the hotel?, the restaurant?, etc and trace all known contacts? Honestly? I could see friends and family, but those are not all known contacts. Great idea but what your suggesting is impossible.

How about people with symptoms who doctors want to test and haven't been able to? Then the people they have interacted with? Look at the news, look at Twitter, look at the changes in the CDC guidelines. Doctors cannot get symptomatic cases tested. Meanwhile, South Korea has been a model of testing, with contact tracing, 100,000+ tests, mobile/drive through testing,etc. and are seeing results already! The US may already be beyond contact tracing in many locations, due to failures in implementing testing. I've consulted with my friends who are MDs, PhDs. They are already scared of being overwhelmed by shortages in PPE and lack of ICU beds, and every one of them says we must test patients who are symptomatic. How is that controversial?? Wait, and the coming weeks/months will reveal. Please, and Im not trying to be obtuse here. You understand that in S. Korea everyone who tests negative, unless they have a genetic predisposition and can never get it(happens but unusual), can get it in say 1 month when an individual who is asymptomatic goes to S. Korea and sneezes on someone who has never had the virus. You understand this basic fact right? The virus does not go away when new cases trend down. The only sustainable way that new cases trend down is that there is no virgin host for the virus to infect!!!!! Has S. Korea locked down the country?

Which medical expert? The one who's flooding this thread with his opinions? Or the ones that work on the disease in question and publish their opinions in medical literature/sites? You never let the cat get your tongue before, where do you stand?

Thank you for posting... so perhaps, with effort, the virus can be contained. Great news! The virus will not be contained until every single human on earth gets it, we develop a genetic resistance to it over time by natural selection, it stops/no longer mutates and a vaccine is developed one an individual or population becomes so remote that they have no human contact. ie outer space, deep amazon etc. Your confusing covid19 with small pox, polio etc. As soon as an infected person goes into S. Korea after the containment/quarentine they will infect all of those who did not develop immunity or never had the virus.

How can you have a highly contagious disease that spreads rapidly that wil over load health systems all over world killing millions and after 4 months has been attributable to 4090 deaths? The first part of that sentence doesnt mesh with the last. Can anyone please recitfy this for me? And no quaranteening isnt doing it, either are standard precautions for reasons I have exhausted discussing before. Testing isnt doing it either, thats bullshit, and if you dont believe me flesh out for me how even a 1% false negative rate or 99% sensitivity would not make high volume testing completely useless. The more you test the more false negatives you get!!!!! I have no dog in this fight, no money to be made, no axe to grind. Orthopa, I think you and many other people are lost in the weeds on this whole issue. i say this will all respect; our mental models are what they are. My focus is on the big picture and what think will happen in the future. Not what i think should happen. Big, big difference. What do all of these governments have in common? China, South Korea, Japan, Taiwan, Singapore, Iran, italy (i could list many more) etc. they have nothing in common. But wait, yes, there is one issue where they are on the same page: their eventual response in dealing with this virus. There is much to learn here for people and countries; but like my teenage kids, ’the teacher appears when the student is ready, not the other way around’ (to my frustration sometimes). Big picture: The US is not ready, specifically Trump. Watching this thing unfold in the US it reminds me of how an outbreak was likely handled in the medieval ages where you had a despot in charge of things. Mistrust of science (no testing); misinformation; followers loyal to king (above nation), self serving and paranoid leader; situation spiralling out of control (look at bond and stock market the past few weeks). King Donald is firmly in control. His number one priority is reelection. I see no examples in other parts of the world where this approach has lead to a successful approach in dealing with the virus. But Trump might be right; i just don’t think his approach will work. We will know in about a month. Why are all the countries listed above dealing with the virus the same way? Are the politicians in every one of those countries stupid? Are they misinformed? They are 1 to 2 months into the battle with this virus... maybe they know something we do not? Health care is important to people the world over. Getting proper health care is important. People also do not want to die, including those who are old or in the high risk groups. Politicians/leaders are the same the world over. In my Political Science 101 course from 30 years ago the professor asked students what causes revolutions. People answered ‘poverty’. No. ‘Treating people like shit’. No. What causes revolutions is when expectations are not met. Americans, just like every other person in the world, expect the government to look after them when they are sick. BINGO. Someone better tell King Donald... The natives are getting restless... Im not getting into the weeds, or making it political. Many have strong opinions/outlooks. I have presented some rational real life situations and questions, but no answers. Please again how does a virus that has been spreading since early December, that is highly contagious, spreads easily, has a 1% kill rate, is present all over the world, and in populations now numbering what? 4,5,6 Billion people only kill 4,262 people? What gives? Secondly reading my scenario of contact with persons/spread, and the fact that this virus is essentially all over the world. We are talking, billions, and billions, and billions of people here. Why is the death rate only 4262 people. Surely cases are in the millions. What is taking so long?

I realize this is an investment website but that wasnt my question. Your advocating for more testing. You feel strongly about this. What I presented has been happening every day for weeks. Who do we test? Whats your plan?

Agree, as well as the cab/uber driver that took him too and from the airport, EVERYONE in the airport. The guy who touched his baggage on accident at the carrosel. The guy who touched the elevator button after he did. The guy that touched the escaltor rail after he did. The woman that picked up his scarf when he dropped it leaving the air port. The attendant he bought a magazine from in the airport. EVERYONE on the plane. EVERYONE in the hotel, the person that touched the door knob into the hotel after he did, the cleaning lady who cleaned his room, the waiter that waited on him. The people that sat next time in the restaurant he went to. The woman who he handed a tip to at the bar. The person that sat in the same chair at the airport after his flight left, and everyone at the conference that had the same interactions he did. Ok guys, your turn, of the above who do we test? An employee working at facebook tested positive for coronavirus. I know someone who works very near that person (also at FB) with all the symptoms.. can't get tested. (this is my only personal story). A nurse who treated a coronavirus patient has all the symptoms! Can't get a test -- denied by the CDC -- told... if you took the proper precautions you won't need it! This tells me, the US is not prepared. Please answer my question that I pose as well as feasibility, expected outcome, source of the test patients, etc.

This has only been a few weeks....look at the curves. This is still exploding and we don't even have accurate test numbers. Add in an incubation period before people need hospitalization and ICU level care, and you can see what's coming. Just wait two weeks and look at Seattle, SF, NYC. Then see who has the next clusters.... Seasonal flu changes because influenza is cultivated by ducks (which are crucibles for changes in the influenza virus) which live near livestock (pigs) that can transmit the flu to pigs, which are intermediate carriers but can transmit the flu to humans. Coronaviruses are primarily from bats, and bats rarely interact with humans (but sometimes do). There may be mutations, but as with many pandemic viruses for which vaccines exist, the conditions for significant mutation do not exist the same way as for influenza. That's not to say that a vaccine is a sure thing, however it's possible (although the development of vaccines is 18-24 months at best). Buying time through social distancing, NPIs, school closures and other measures is the best way to prevent a pandemic from becoming even more massive, and spacing out the spread of cases to keep it within the capacity of hospitals. Why are you assuming the virus was here only with the first positive test. How can you make an assumption when the symptoms mimic the flu and/or patients can be asymptomatic?

Glad you contributed, please answer my question above. Whats your plan? Likelyhood of completing? Expected outcome?

Agree, as well as the cab/uber driver that took him too and from the airport, EVERYONE in the airport. The guy who touched his baggage on accident at the carrosel. The guy who touched the elevator button after he did. The guy that touched the escaltor rail after he did. The woman that picked up his scarf when he dropped it leaving the air port. The attendant he bought a magazine from in the airport. EVERYONE on the plane. EVERYONE in the hotel, the person that touched the door knob into the hotel after he did, the cleaning lady who cleaned his room, the waiter that waited on him. The people that sat next time in the restaurant he went to. The woman who he handed a tip to at the bar. The person that sat in the same chair at the airport after his flight left, and everyone at the conference that had the same interactions he did. Ok guys, your turn, of the above who do we test?

I'm not sure where I land on this issue as I'm definitely not a qualified expert, but perhaps I can ask you, who is someone more qualified - why are countries such as South Korea testing like crazy? I'm trying to put myself in your shoes, and please don't take offense, but I'm having a hard time reconciling what govts are doing vs. someone on the internet saying it doesn't matter. Likely due to patient demand, and in an about face due to the fall out from SARS and MERS from years ago. The more you test the more positives you will get. What does that get you? IMHO it probably lowers your death rate. Does it prevent the spread. NO!!!!! If you have even 1% of population asymptomatic it will defeat the entire purpose of testing. Again testing is not a zero sum game. It will not catch everyone. Anyone aware of what the sensitivity, specificity etc is? What do you do with an even 1% false negative rate (which is extra ordinary in non serum test). That person has it, and walks, and spreads it. Either you test every soul, ALL OVER THE WORLD, or you are essentially delaying the envitible infection of every human in the world. Whats the qualification to get the disease? Your a human. Eventually everyone will get this, very little relatively speaking will die. Like Viking said, testing gives you more information and a better picture of the facts -- to make appropriate decisions. -- not 3 confirmed cases out of 9 tests bullshit that we've gotten so far. That gives people a sense that it's not here. Delaying is the key and why Italy is locked down, why school is out in Japan, Taiwan, South Korea, and Hong Kong among other places. Why is delaying so important -- it gives hospitals MORE time to prepare, it gives schools the ability to launch virtual classes, the federal and state governments MORE time to prepare it gives researchers MORE time to possibly come up with a vaccine or medicine. Yes nobody can stop the disease but delaying and slowing the spread is crucial. If we continue to go out about our daily lives like they did in italy, what makes you think we won't be experiencing the same exact problems they're facing now. Having returned from Japan a couple weeks ago there was literally 0 screening at JFK. It seems to me that our government has completely dropped the ball on this one. Testing does not give you a better picture of facts and information unless you test EVERYONE!!! Tell me what you do with your vaccine when covid 19 mutates and its useless. Your aware this happens every year with the flu shot correct? Its too late the stop the spread, its all over world, in every state, in every community. Corona has been in US for months. How come the hospitals are overloaded in the US? I thought this was an exponential parabolic etc.

How can you have a highly contagious disease that spreads rapidly that wil over load health systems all over world killing millions and after 4 months has been attributable to 4090 deaths? The first part of that sentence doesnt mesh with the last. Can anyone please recitfy this for me? And no quaranteening isnt doing it, either are standard precautions for reasons I have exhausted discussing before. Testing isnt doing it either, thats bullshit, and if you dont believe me flesh out for me how even a 1% false negative rate or 99% sensitivity would not make high volume testing completely useless. The more you test the more false negatives you get!!!!! I have no dog in this fight, no money to be made, no axe to grind.

I'm not sure where I land on this issue as I'm definitely not a qualified expert, but perhaps I can ask you, who is someone more qualified - why are countries such as South Korea testing like crazy? I'm trying to put myself in your shoes, and please don't take offense, but I'm having a hard time reconciling what govts are doing vs. someone on the internet saying it doesn't matter. Likely due to patient demand, and in an about face due to the fall out from SARS and MERS from years ago. The more you test the more positives/negatives you will get. What does that get you? IMHO it probably lowers your death rate. Does it prevent the spread. NO!!!!! If you have even 1% of population asymptomatic it will defeat the entire purpose of testing. Again testing is not a zero sum game. It will not catch everyone. Anyone aware of what the sensitivity, specificity etc is? What do you do with an even 1% false negative rate (which is extra ordinary in non serum test). That person has it, and walks, and spreads it. Either you test every soul, ALL OVER THE WORLD, or you are essentially delaying the envitible infection of every human in the world. Whats the qualification to get the disease? Your a human. Eventually everyone will get this, very little relatively speaking will die.

Testing doesnt prevent the spread of the disease. Once you understand this it makes wrapping your head around the utility of testing much easier. If you dont test everyone, your effort will be futile. Which strains are you testing for? What your sensativity? Specificity? How are you going to deal with false positives? Negatives? Assuming that testing prevents the spread of the disease is ignorant. That is not the case. It will help quarantine but the fact that there are asymptomatic patients, even 1% ruins the whole notion.

What's scary is that even if you don't die, it sounds like complications from lung fibrosis can have long-lasting/permanent deleterious effects in at-risk populations like the elderly. Its even more scary for the 1B+ smokers who are probably 10,100,1000x times more likely to die due to smoking related complication. Funny I never heard anyone worrying about them.

And then someone from another part of the world drives in/flies in or walks in after 20 days and starts it all over again. It doesnt work this way.

Funny, ERICOPOLY, as you were a big influence to me the past few weeks. When you made a bag back in the day spending $30k on options or whatever it was, you saw that the world was not what it seemed. Italy is totally locked down. Iran is in chaos. China was on full lockdown and still largely is. South Korea is doing well and testing, and will still have a brutal time. Oil fell 25% in a day, and treasury buyers are flocking to safety. The US is so clearly following the path of the worst hit places, that by the time we get around to quarantines our problems will be enormous. Italy had 3 confirmed cases a few weeks ago! Look what happened to Asian tourist locations after SARS. This is 10x as big and still growing extremely fast. We are just getting started. I actually can't believe the market LACK of reaction the past few weeks. I am in the camp that every single one of us will get this virus in the coming years if we live full lives. I have had the flu several times and most of us have. We will call it cold, flu, and coronavirus season and many people will still ignore the free annual vaccine program. I just don't see how all of that translates to WFC and BAC at tangible book. Why? Get a grip Mr. Market. Ericopoly, this is an extinction level event. Why did China put its whole country lockdown, risking serious unrest and the end of the CCP (as people can't go out, businesses are under great stress, etc.)? Why did democratically elected Italy put its whole country on lockdown, cancelling all sports, weddings, funerals, travel? This is an awful disease that has overwhelmed healthcare systems everywhere it's been with enough time so far (China, Iran, Italy). How many businesses are surviving with no people going out for months? I agree that everyone is going to get it, except that it's not going to be "over our lifetime." It's going to be in the next three months. If healthcare systems don't get overwhelmed, it's probably a 2M+ people dead and 30M+ people hospitalized just in America. And then, like other viruses, it can come back again and again. Any business that is levered and / or dependent on funding markets is in great danger. Like the banks, all of them. Already, airlines, hospitals, events, etc. are laying people off. Next will be oil and gas, retailers, etc. Have you seen what happened to bond yields and how the Fed has greatly increased its repo facilities? No bank wants to lend to anyone at any price. They'd rather hoard 30Y government bonds at under 1% per year than lend. There are three separate, 80%+ likelihood events that would each be enough to cause a serious recession: 1. The biological effects of a disease that will kill millions in the US and hospitalize tens of millions. Who is just going back to their normal routine after that? Even if you think you are, I guarantee a large portion of consumers will not. 2. The already baked in vicious cycle effects of layoffs (airlines, hotels, cruise ships, oil and gas, retailers, port workers, truck drivers, etc.), lower business investment (no one is going to buy planes, class 8 trucks, build factories, etc.), etc. This is already happening -- you don't even need to predict it 3. The banking system shutting down and refusing to lend. Again, this is already here. The banks are saying (through yield curves, FRA / OIS curves, the Fed desperately upsizing repo offerings) "We won't lend at any price to anyone." Together they will likely cause a depression. Buying the market down 10% in 1929 didn't work out well then, and it's not going to work out now. Your 2009 successes were an inspiration and great example, which is the reason I'm writing this post. In some weird way, I feel like I owe you. But this time, there's nothing we can even do to stop the pandemic -- not that we're doing anything anyway (schools remain open, planes arrive from Seattle, NYC, Europe, etc. every day, events and sports go on uninterrupted, etc.). We will be lucky to get Italy's experience, and that will be enough to destroy many businesses and banks. No offense but this is one of the most ridiculous things I have ever read. Honestly. Absolutely ridiculous .

https://newyork.cbslocal.com/2020/03/09/coronavirus-update-new-jersey-patient-speaks-out/ "Cuomo also made a surprise announcement. One of the latest cases is a top transportation official in charge of the airports: Rick Cotton, executive director of the Port Authority. Cotton is in his mid-70s and is asymptomatic."

Is this the case where you practive? If so how well did the area handle H1N1 in 2008?

I have not watched the video yet and responding without as I don't have the 45 minutes right now to do so. I don't think there is much a government can do against an novel airborne disease that has a 2-14 day incubation period, symptoms ranging from none to life threatening, was previously undiagnosed, tested, treated and studied. I think that is the problem many non medical people have a hard time understanding. Governments can't make viruses go away. Governments cant stop panic, hysteria, or fear. Governments can quarantine people but again they cant prevent humans from under reporting, being non compliant, sneezing, coughing, touching, etc. It would be much simpler if the virus was visible to the naked eye and humans didn't panic. It would also be simpler if you had a population with more common medical knowledge but as we all know we dont. We will probably never know the true mortality rate of the disease other then covid-19 specific antibody testing. Until then speculation will rage.

https://abcnews.go.com/Health/early-mortality-rates-covid-19-misleading-experts/story?id=69477312 Something to chew on, sure there will be counter factual articles but time will tell I guess.