Read the Footnotes

Then please cite the actual CDC best estimate and leave the other extrapolations out of it. https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html Scroll down to: Scenario 5: Current Best Estimate It would be great news if this doesn't turn out to be overly optimistic propaganda that was produced due to political pressure from the Trump administration, but I don't plan on holding my breath. The US CDC's reputation has probably been more tarnished than the other US agencies involved and this might just turn out to be another blow to the CDC's reputation, which may be a reflection of current leadership and not the vast majority of those at the CDC. These estimates don't seem to match other current research and at best it is on the extreme optimistic end of the spectrum and that apparent bias is already being criticized as such by some experts.

Yeah, sure there are some problems with the model in the short run, but what's the TAM? (am I doing this right?)

Indeed. Exactly why managing the situation well is so important, and mismanaging it is so costly and has strong non-linear effects (as expected from an exponential process). And the cheapest way to achieve that well managed situation is with clear consistent messaging based on the latest and best science. That really comes at a low cost which means that the cost benefit analysis is off the charts in the positive direction. Unfortunately, that is that part Trump can be most directly blamed for. It is low cost and high payoff and it was completely botched with no one else to blame.

I overheard a woman yesterday saying "i'm not drinking the cool-aid" (walked into the medical office without a mask). People have bought into the "this is just a hoax" line and won't take precautions. All fallout from politicizing the virus, and this only costs lives and economic damage. Anchoring Bias. Some of them will never update their estimate of the value of a mask. Same with Trump himself, once he anchored to the hoax narrative, it was all over. Can anyone find an example where Trump says he was wrong about something? At a minimum it doesn't seem to be common.

Eric, Cubs, Liberty, cwericb and others, please feel free to continue to work out your difference, but could I ask you to take this current discussion to the Politics section? For your convenience, I created a new thread for your current conversation, and maybe it will be useful for other in the future. https://www.cornerofberkshireandfairfax.ca/forum/politics/deck-chairs-on-the-titanic-coronavirus-edition/

You seem to have left out one of the other principal reasons for flattening the curve in the first wave, which is simply to buy time. The hope is that we will have more tools available than simply hand washing and physical distancing, the same tools we we had hundreds of years ago. A good analogy is to think of it as putting a patient in to a medically induced coma briefly in hopes that treatment will improve in the interim. The number of interventions large and small that can be developed in three months is often also underestimated buy those who oppose flattening the first wave. Those are all fair points. I'm just not sure if the public is aware of this as the main reason. Perhaps the message would be too grim if they were told, "we are just buying time, hoping to find a cure...and it could take over a year". By "cure" I assume you mean a vaccine, which will likely take a year at a minimum. There are people trying to compress the timeline, but it is a Manhattan Project level effort to improve on the best case timelines. Treatments are much more likely to be available on an expedited schedule such by the end of the summer. Chloroquine was Forsythia all along, but Remdesivir continues to show progress and there are about six other candidates that some analysts feel are even more promising than Remdesivir. Plus there is convalescent plasma which though there are many uncertainties at least has the highest probability of providing a benefit. But there are many smaller interventions that depend upon the supply chain or are simply information based. For example, the US CDC just added six new symptoms for the public to watch for, indicating that we have a long way to go both in understanding the virus and the disease and in communicating best practices to the public. Plus some of those best practices will be dependent upon the supply chain. Two months ago it would not have done that much good to admit that everyone should have been wearing facial coverings because there weren't enough available with on a national public health level would not have had much value. Pharmaceuticals and vaccines are going to be very important, but you also should not underestimate how much the standard of care has likely already improved. Outcomes have varied significantly from one hospital to another. Information sharing regarding best practices can likely continue to improve outcomes. Also, there have been so many reports from China that were dismissed as being incorrect that have proven to be true. It is unfortunate that time was wasted, but now that some unusual features of CV/COVID-19 have been validated in our own populations, and even more discovered, treatment protocols will likely continue to evolve and improve. To a large extent this is based upon observation, research and information sharing, and can be achieved more quickly that some of the other processes that are more dependent upon prolonged period limited science and biology or limitation imposed by the supply chain.

You seem to have left out one of the other principal reasons for flattening the curve in the first wave, which is simply to buy time. The hope is that we will have more tools available than simply hand washing and physical distancing, the same tools we we had hundreds of years ago. A good analogy is to think of it as putting a patient in to a medically induced coma briefly in hopes that treatment will improve in the interim. The number of interventions large and small that can be developed in three months is often also underestimated buy those who oppose flattening the first wave.

Another simulator from MGH, Harvard, and Georgia Tech https://www.covid19sim.org/

He talks a good game on China, but his record is very weak. If you really wanted to be tough on China, you would not be isolationist. The USA shifting to isolationism creates a void for China to fill. For example, he is complaining about the WHO and Chinese influence on the WHO. China's influence on the WHO has undoubtedly increased during Trump's reign because of the Trump administration pulling back. So when he is surprised at the new degree of influence of China on the WHO, his solution is to de-fund them further reducing the US influence. It's going to be rich when he quits funding NATO or the UN and then complains about other countries having more influence. Similarly, several smaller countries including middle eastern countries have relied on the US CDC in situation like this in the past. They have publicly said that the US CDC's message has been so confused that they are no longer relying on the US and that it has been suggested that the Chinese CDC might be the best option for them instead. Someone needs to tell Trump to lead, follow, or get out of the way. In the case of Coronavirus, he is doing more harm than good and is wasting years of goodwill, influence and trust that the USA had built up.

The correct answer is for the king to say about his subjects "Let them eat Lysol"

I started posting in the this thread to help friends prepare their portfolios and their families. The writing is on the wall now for those who care to read. Best of luck to everyone. Read the Footnotes has left the chat.

Given the response above, that may be a safe assumption, but I would welcome anyone who can prove epidemiologists wrong as well as the most credible participants in this thread by sharing with us their own complex model and a cost benefit analysis. The person with the best model wins, and so far the entire world's experts on the subject seem to agree that the benefits merit the costs.

This could be excellent news. Hopefully more good news like this to come. https://www.biospace.com/article/releases/20-20-bioresponse-to-launch-rapid-coronavirus-test-kits-in-u-s-following-green-light-from-fda/

Not sure I understand this. A month ago, no one was dead in Italy. Now 3000+ plus are dead with an additional 400-500 coming in daily despite the fact the entire country has been shut down for 9 days. Similar numbers in the US would be 15,000 dead in 2 weeks time with a full shutdown - but we haven't done that yet. LA just announced it. Nowhere else has and we have over 100k confirmed cases w/o testing. This is already on course to be way worse than the 30k annually from the flu even w/ the shutdown which hasn't been implemented yet. I'm not trying to fear monger - just extrapolating the data that's available real simple. if you build a model and it tells you to do something stupid but you do it anyhow because you trust the model and have no common sense, then you do something stupid. Please share your model with us.

This seems like a strange model to me to be honest. The total infection rate (as I keep reading) when you do nothing would be 40-60%, spread out over a number of months. Why would everybody be sick at once? Well, in a lockdown nobody would be working at all, even worse. Plus apparently large percentages of patients don't have any symptoms at all (which seems to be the problem with this virus), so will be able to work just fine. At some point it'll come to this, especially once we have treatment options. The elderly will be asked to isolate until there's a vaccine next year. If thet do get sick, they can be treated better, while the rest of us go on with our lives. Nothing else makes sense, definitely not an extended lockdown. The forty percent statistic is a basic rule of thumb. Go check out the CDC's planning documents, or review the research literature in the field and you'll see it over and over again. Also, if you play around with exponential growth for just a little bit and you'll see that it is possible. Isolating vulnerable people, social distancing, herd immunity all accomplish the same thing through different mechanisms. They are all levers to pull upon. Finding the correct mix is the challenge. You also need to remember that there will be a huge variation by location. 40% is an average. What is more likely is that entire essential service departments could be simultaneously taken out in one town, and another town might have good luck. One town could be a disaster area and the other could have no cases at all and on average maybe you only have 10% out sick at one time. Do you really want to roll the dice? People should keep in mind that 40% is a hell of a distance to haul. Take Italy as a the worst case currently out there. If you add up the new known cases over the past 7 days what do you get? It is 25,000, 30,000 over the past 7 days (today was particularly bad)? Okay, assume that the asymptomatic and mild cases are 10-for-1 to the known cases. So, if that heroic assumption is true, there were only perhaps 300,000 total new cases in Italy. Well, the population of Italy is 60 million, and 40% is 24 million. You need 80 weeks that are just like this past week to achieve herd immunity across the country. It's a hell of a miserable distance to haul to achieve herd immunity. SJ SJ, to be clear, I was talking about 40% simultaneous illness, not 40% cumulative infections, or 40% herd immunity. Just wanted to make sure since those could easily be confused, and are frequently associated with 40%. I realized from your response that quick read might have resulted in confusion. I'll inject a bit of optimism by saying that if you study complex adaptive systems, you will realize that there are better outcomes possible than what has been discussed here recently. The secret is having good leadership and multiple levers to pull. If you can optimize for the system and get lucky, then a few weeks of shelter in place could pay huge dividends. The recent Bill Gates Reddit AMA to gives a sense of his optimism and some hints at how decisive action and a multi-pronged approach could be so much better than relying on a single tool in the tool kit.

This seems like a strange model to me to be honest. The total infection rate (as I keep reading) when you do nothing would be 40-60%, spread out over a number of months. Why would everybody be sick at once? Well, in a lockdown nobody would be working at all, even worse. Plus apparently large percentages of patients don't have any symptoms at all (which seems to be the problem with this virus), so will be able to work just fine. At some point it'll come to this, especially once we have treatment options. The elderly will be asked to isolate until there's a vaccine next year. If thet do get sick, they can be treated better, while the rest of us go on with our lives. Nothing else makes sense, definitely not an extended lockdown. The forty percent statistic is a basic rule of thumb. Go check out the CDC's planning documents, or review the research literature in the field and you'll see it over and over again. Also, if you play around with exponential growth for just a little bit and you'll see that it is possible. Isolating vulnerable people, social distancing, herd immunity all accomplish the same thing through different mechanisms. They are all levers to pull upon. Finding the correct mix is the challenge. You also need to remember that there will be a huge variation by location. 40% is an average. What is more likely is that entire essential service departments could be simultaneously taken out in one town, and another town might have good luck. One town could be a disaster area and the other could have no cases at all and on average maybe you only have 10% out sick at one time. Do you really want to roll the dice?

Population density. I would recommend physical distancing.

What did you know and when did you know it? https://www.wbur.org/npr/818192535/burr-recording-sparks-questions-about-private-comments-on-covid-19 On February 27, Richard Burr (R-NC) was warning donors that Coronavirus was going to rival the 1918 Pandemic. On the same day, Trump said: My belief all along has been that Donald Trump probably got a fair assessment of the risks in early December. How does that make you reassess his handling of this situation?

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. You say "Italy did not do a good job of testing." but the truth is that Italy also had bad luck. Both of you are making a great case for why we don't want to hope for the best or believe "maybe we'll get lucky". At one point it seemed like USA's approach was going to be that we were going to hope for good luck. We always should have demanded prudence and a margin of safety.

Jfan, you clearly put some effort in to organizing this. I applaud the effort. I have one huge issue to raise that should caution anyone from drawing too much from these valuable lessons of history. That is that when forecasting a pandemic, previous experience is no where near as instructive as building a model based on the parameters of the novel virus to the extent that they are known. In otherwords, it's good to study history, but every virus has it's own unique characteristics. The differences in parameters interact and become multiplicative or exponential. The result is that small differences in inputs to the model result in huge differences in the challenges and solutions. It's therefore crucial to have accurate estimates of the replication rate under different conditions and the case fatality rates under various conditions, as well as other critical factors. Simply comparing to previous outbreaks could lead to anchoring and adjustment bias, and other biases that lead to an underestimation of the true situation. It's better to treat each virus as its own unique problem. Keeping this one warning in mind will help to identify which lessons from history might be applicable. Thanks for the contribution.

I have faulted the president for not acting quickly and that an ounce of prevention is worth more than a pound of cure, because we don't even have a cure. So I am going to do my best at reacting quickly and trying to contain the thought virus you risk spreading. This is dangerous thinking. The list of reasons is so long, but I will give you two: 1) most influenza models predict that without physical distancing an illness as infectious as this one would quickly spread through the country and that forty percent of the population would be sick at once. How much of the country can you afford to be sick at once without the collapse of society? Certainly a two week period with forty percent not reporting to work would be disastrous. If you ask sick people to report to work, the fabric of society is further torn and the CFR would likely skyrocket, because rest is probably the key treatment that prevents mild cases from becoming severe cases. 2) see #1 You can play around with assumptions, but I doubt you will disprove that #1 is a concern that would also require social distancing and flattening the curve.

They also have more experience with these issue and a greater expectation to continue to be ground zero for outbreaks so that likely makes a difference.

Sure. In practice however I'm afraid there is basically zero overlap between a) the subset of the population that should be far more scared and b) the subset of the population who would even consider reading an article like that. You're right. Plus add in the fact that viral stupidity seems to spread faster than reasonable analysis. Still it's better than nothing. I would be more O.K. with all this if it would lead to an equitable distribution of Darwin Awards, but in this case the gene pool will not be cleansed.

No disputing that. However, the hospitalization rate is much higher than I expected. I thought for me (in the 20-44 group) - it was going to be a bad flu. I didn't think i'd have a 1/5 to 1/7 chance of going to the hospital. With n=705 for 20-44, I think you really need more information about the characteristics of the 100 that were hospitalized to know what the increased risk factors are and whether you have any. We think we know some (smoking, obesity), so assuming those don't apply to you, you're hospitalization rate ought to be lower. What it actually is though, remains unclear. It should be noted that due to testing shortage, those young folks and everyone else tested are likely to be the more symptomatic ones due to strict testing criteria in the U.S.. So even looking at hospitalizations as % of positive cases is likely sampling bias--you are not counting all the young folks walking around with this who have no or mild symptoms because they are never offered or are flat out denied testing. One of the advantages of widespread testing is you also throw in mild/asymptomatic in so those people reduce the spread (by cancelling their Spring Break plans and staying away from grandma and grandpa) and people freak out less about mortality. Many of the questions we all want answered can't be answered except with hindsight in a couple of years. That is always the case with NOVEL epidemics or pandemics. The article gives us some good, but not perfect data to work with that will allow people to make somewhat more informed decisions regarding their individual risks and the risks to society. Unfortunately, some of us are better equipped to interpret the data than others. This situation is laying bare my belief that a larger emphasis in education on statistics and probability would be a huge benefit for society. This board as a group is probably more sophisticated than most, but even among us their is a wide variation. Plus one of my friends who teaches statistics loves to remind me that even PhD specialists in stats, make boneheaded basic mistakes because it's hard for most all of us to overcome the way our own brains work. For now, I take some comfort in the fact that whether or not it is the complete story, articles like this one might serve to scare some of the subsections of our population who still are not as scared as they should be.

https://nypost.com/2020/03/18/in-one-day-1000-nyc-doctors-and-nurses-enlist-to-battle-coronavirus/?utm_source=reddit.com So are they selfless servants of the people, who are taking on a considerable risk to themselves out of an altruistic desire to help others? Or are they uninformed and have not pulled up the morbidity and mortality numbers? Really, this virus is one that 70+ year-old people should be desperately trying to dodge. SJ You are certainly right to be concerned for them, but remember there are ways to minimize the risks some of which I addressed in our first discussion of this topic a week ago: Hospitals will be doing their best to provide physical separation between COVID-19 patients and the rest of the hospital. In the best cases, they might be completely separate buildings and access will be strictly controlled to protect the non-COVID-19 hospital. This has been successful in the past in some cases depending upon controls being rigorously imposed.