Read the Footnotes

Thanks for sharing Kaegi. This is really important. It shows what I was saying weeks ago regarding the data out of China. The risk to younger people is lower, but after adjusting for triage, you will see that the risks for young people have been understated and the risk for older people are overstated if you exclude periods when the health system is overwhelmed. During periods when the healthcare systems have been overwhelmed, out comes for older people became horrific. This break point needs to be understood and new data regarding the experience in the USA will really help. Any details about potential attributes among the 20-44 group, e.g., higher percentage of smokers, etc.? I'm not sure exactly what you're asking, but here are a couple of quick comments. There is some very disturbing information in other sources about sudden death involving heart attacks that gives reason to be very concerned about obesity as a comorbidity in the USA. The point at which cardiac function becomes a concern seems to be primarily so late in the disease progression, that I am not sure it will end up being a major factor in the USA for younger age groups, but is likely a major factor with increasing age. Smoking is more likely to be an issue among the 20-44 age group. The people who say that vaping and marijuana are not dangerous typically are not focused on the impact of particulates in the lungs. The cilia is responsible for removing particulate matter from the lungs, and the health of cilia will be a very important factor for survival of a severe cases of COVID-19. Anyone who has subjected their lungs to a particulate burden should try to reduce exposure immediately if they have any concerns about developing a severe case of COVID-19. This includes any type of smoking, or pollution, and particulate matter from sanding, industrial processes, construction, demolition, etc.

Thanks for sharing Kaegi. This is really important. It shows what I was saying weeks ago regarding the data out of China. The risk to younger people is lower, but after adjusting for triage, you will see that the risks for young people have been understated and the risk for older people are overstated if you exclude periods when the health system is overwhelmed. During periods when the healthcare systems have been overwhelmed, out comes for older people became horrific. This break point needs to be understood and new data regarding the experience in the USA will really help.

It's a huge development. . . . (Also bad news, for me, is that it exposed my ignorance of the field, since ordinary doctors like me are just barely amateur microbiologists or virologists. In my original post, I called the RT-PCR a "screening" test. Reading this latest article, I now understand that the RT-PCR is considered the diagnostic test for the acute infection. Time and clinical experience will clarify things the proper sequencing of testing - I anticipate the antibody blood tests will become the initial screening tests, and results will be confirmed with the RT-PCR to reduce false positives.) Good discussion. It's still a potential huge leap forward and an important step toward getting us back to normal. Testing is important for treatment of individuals, but also important for knowing who has had exposure and adjusting models based on that data, but also it allows the individual who is likely no longer susceptible to make informed decisions, and return to a more normal life. Draconian steps are likely needed. CV is so widespread within the USA and many other countries, that we need to do everything we can to rob the fire of fuel and oxygen. Shutdowns are one part of that equation, but antigen testing will allow us to return to normal much faster. Don't forget to make an estimate of how long it would take to roll out yet another testing system on a wide scale nationally. https://foreignpolicy.com/2020/03/18/america-united-states-lockdown-coming/

https://nypost.com/2020/03/18/in-one-day-1000-nyc-doctors-and-nurses-enlist-to-battle-coronavirus/?utm_source=reddit.com

I would refine this statement to say that the reasons we have to stay at home is: a) we wasted time arguing about whether is was just a cold or not, b) we don't know and we HAVEN'T known who has it for some time, and c) a lockdown of some sort was probably always going to be a utilized part of the toolkit, but it will all be much worse due to a & b above Again I would refine to say that extensive lock downs were not inevitable, but they are necessary now, due to the mismanagement mentioned above. I expect to see a national shelter in place order any day. That will allow time for the hospitals and time to get a robust national testing program together. The order can be lifted once the testing program can be trusted, but there will likely still be restrictions on movement and many other things. A program to identify and track who has immunity or likely immunity would also be very helpful as restrictions are lifted. Plus don't forget that ideas are viruses and we still have not eradicated the "it's just a cold" idiocy. It's just not as prevalent here as it was a short time ago. The "just a cold bro" virus is still endemic in parts of the US society though. Shelter in place will be necessary because of (a) above. So if you're keeping track of unnecessary costs, add that to your list if you are making estimates.

One does not necessarily follow the other. Also not necessarily true. The real risk was always that Trump was delaying and minimizing and telling people it was just a cold. The risk is that if we instituted social distancing too late or locked down too late, or individuals continue to act irresponsibly, then the hospitals and healthcare systems could be overwhelmed. If our healthcare system becomes overwhelmed, then death rates could easily increase by thousands of percent during the peak. More people being asymptomatic or presymptomatic could actually make the doomsday scenario of a briefly non-functioning medical system even more likely. The peak would come faster, be briefer, higher and be more devastating.

This is incorrect, and dangerous thinking. It is true: accurate information is a critical factor, but it is not possible for humans to obtain such early in these viral outbreaks. The pandemic response is warranted - the precautionary principle is the only guide that would ensure the survival of the species. In these situations, you don't need accurate knowledge of the probabilities in order to know what to do. Our emotions and stress are wiser guide than our intelligence in deciding how to react. Strongly agree with this. That's how the precautionary principle works. When there is wide uncertainty with a lot at stake, you err on the side of taking things seriously and overreacting. I would have thought more people on this board would be fans of the margin of safety, but ¯\_(ツ)_/¯ By the way, I haven't been paying attention to the US election. Did Andrew Yang win? I hear the US Gov't is handing out cash now. Yes Andrew Young (UBI), Liz Warren (student loan interest rates forgiven) won, Bernie (Medicare for all) is next. It’s free for all, Airlines, Cruise lines are already fed in the soup line. Shale and Energy is begging. I guess the lobbyists for all the industries are working overtime. Clearly, we have an extraordinary economic situation, but it is still surprising to see much more government intervention than in countries that are called socialist here. I’d be more in favor of something that helps individuals, if we have learned anything from the GFC it should have been that. You stole my follow on jokes that I had planned. Pretty amazing isn't it. Quite a shift Trump has always been populist and a bit socialist. It's just a right wing and flyover state version of socialism. The real outrage here is simply that better leadership and earlier action would likely have resulted in lower overall costs, less disruption, and less panic. Consistent governance might be better leadership than slashing, then growing in a panic.

This is incorrect, and dangerous thinking. It is true: accurate information is a critical factor, but it is not possible for humans to obtain such early in these viral outbreaks. The pandemic response is warranted - the precautionary principle is the only guide that would ensure the survival of the species. In these situations, you don't need accurate knowledge of the probabilities in order to know what to do. Our emotions and stress are wiser guide than our intelligence in deciding how to react. Strongly agree with this. That's how the precautionary principle works. When there is wide uncertainty with a lot at stake, you err on the side of taking things seriously and overreacting. I would have thought more people on this board would be fans of the margin of safety, but ¯\_(ツ)_/¯ By the way, I haven't been paying attention to the US election. Did Andrew Yang win? I hear the US Gov't is handing out cash now.

I think there's little chance we are overracting, but a massive risk of people who don't understand the Heisenberg Uncertainty Principle will start saying some enormously ignorant things at some point. Calling it a cold is out of style now, but the next wave of ignorance will be various forms of denying the impact of interventions. Germany apparently recently said that controls could stay in place for two years. What I read was not inconsistent with scenarios from the model I built way back in January, but I agree most people aren't thinking this is going to last more than 2 weeks. Spek, Have you been keeping up on what Germany has been saying? Thoughts? For those looking for different ways that forecasts have been communicated in English, I would recommend: -The communication in England has been more direct and clear (regardless of what you think of their policy) -South Africa has also communicated admirably -Washington State's communications at one point was a better window than the federal Government. That gap has probably narrowed. I like your anecdotes. I'll reciprocate. I have been communicating with a lot of doctors from around North America. One of them I kept arguing with him not to do something stupid in his personal life. Well guess who's under quarantine now? Excellent doc, but just because he's good in his specialty doesn't mean he's good at stats, probability, or risk assessment.

This is incorrect, and dangerous thinking. It is true: accurate information is a critical factor, but it is not possible for humans to obtain such early in these viral outbreaks. The pandemic response is warranted - the precautionary principle is the only guide that would ensure the survival of the species. In these situations, you don't need accurate knowledge of the probabilities in order to know what to do. Our emotions and stress are wiser guide than our intelligence in deciding how to react. I disagree with the bolded statements. The first, we can obtain accurate (i.e. representative) information with widespread testing. The second, you cannot possible know this without knowing the first. The most you can say is, a pandemic response may be warranted: Pandemic responses are warranted in one of two cases: Case 1- We do know that we are dealing with a high-magnitude pandemic. Case 2- We don't know, and therefore are taking a precautionary stance. The US (and the world) is in Case 2. Globally we do not have reliable information as the article posted by minten illustrates. We are extrapolating from tens, hundreds, and thousands of cases to ten and hundred millions of cases. Statistically, our conclusions are subject to excessive sampling bias. We want to be in Case 1 - where we do know. The only way to do that is widespread testing, which did not happen. Now, we are potentially making inaccurate decisions. We are slowly moving from Case 2 to Case 1. I am arguing the speed of this movement is too slow, particularly from the US point-of-view where we had both the resources and head-start to achieve a Case 1 decision more efficiently. How times change. I'm glad this is finally now the level of conversation people are engaging in. Much better than "hoax" and "just a cold"

Thanks for sharing. I think the framework presented will be useful for some people. Here are my thoughts after a quick skim: 1) Short-term impacts seem too optimistic 2) Long-term impacts seem too pessimistic 3) This was dated March 10, my guess is that if they could start from scratch today, they would use different assumptions and inputs A shallow dive on this subject without a deep and specific understanding will make it very difficult to see the future in this case.

Lurker for years, my first post on this forum. I had the sae thing in late January. Extreme stomach discomfort that started quite suddenly leading to bouts of vomiting. I couldn't even drive myself back home without puking into a bag. The stomach discomfort got better in 24 hours (mild fever also went away). Then the coughing started which later days. I'd wake up at nights to cough for few minutes each time. Chest tightness also began. I'm a lot better now, but my chest tightness isn't fully gone. If I fully relax my body I can feel a tiny bit of resistance to talking in a whole breath of air. I also have asthma and using my inhaler helped! CorpRaider, keep hope and stay happy. Positivity helps the immune system. Thank God for Netflix. I watched a ton of comedy when I was going through the bug, whatever it was. Stay hydrated!! I never considered Corona seriously but it does look like the symptoms are correlated. Now if there was community transmission in late January, just imagine how off we are with the denominator. I've been thinking about this a lot lately. The hard thing with exponentials is that it's easy to be way off if we are even slightly off in any parameter. What if we are wrong on the start date by a couple of weeks or so? Orthopa's anecdotes and line of thought seems reasonable to me. Thanks! I have little doubt about the denominator. I had to really search for accounts of these symptoms. I have said all along that I think there's some truth to Orthopa's observations and they should not be dismissed. I do think it's a mistake to see it as 100% good news or 100% bad news. With this virus it seems nothing is simple or easy to analyze. The analysts who were likely to do well with forecasting Coronavirus were the ones who dig deeply and account well for complexity. Heuristics and simple estimates had little use in understanding some features of the impact of this virus. On the positive side, it is possible that more people have already been inoculated, recovered and developed immunity this would: lower the CFR ultimately, once the final CFR is known On the other hand it means that in many places of the country they are even more likely to underestimate the risk that the healthcare system will become overwhelmed in the next couple of weeks. A different issue is that it is possible there have been people who died from COVID-19 and were never diagnosed It is also possible that college kids have been passing this amongst themselves symptomatically and the effect of dispersing the college kids throughout the country has not been full appreciated or prepared for.

Sorry to hear you may have it. It certainly sounds possible. Today's task force made it clear that PPE/containment is very difficult. Study up on the way it normally evolves, because it tends to evolve over time and you want to make sure you know what to look for. There are some threads we have started to help investors: https://www.cornerofberkshireandfairfax.ca/forum/general-discussion/hygiene-tips-for-coronavirus/ https://www.cornerofberkshireandfairfax.ca/forum/general-discussion/how-to-prepare-for-coronavirus/ The forecast that we will see more CoB&F members having the virus in the coming days seems true. Let's keep contributing to these threads that might help people!

Canada is building a wall and they're going to make America pay for it. https://nationalpost.com/news/canada/trudeau-travel-restrictions-ban-coronavirus-covid19-canada =>Canada closes borders to non-citizens.

Still nearly impossible to get tested for COVID-19. Two of them were telling me it takes hours to even get tested for flu and impossible to get the COVID-19 test. Yesterday afternoon I didn't know anyone, now I am losing count of how many friends and their immediate family members are being effected by this.

Has anyone heard of good practices for those who are treating at home? I just spoke to yet another board member who has it. He goes way back on the board and at the Fairfax meetings. Please share reputable sources. I have now spoken to several board members. Be VERY careful. All of them say it started so subtly that they didn't realize what was happening. The expected progression is that it will get much worse about day 7-9. If you are having mild symptoms it could be COVID-19 in the early days. People are also reporting feeling very anxious especially at night and they had difficulty sleeping. They and/or their healthcare providers dismissed it as anxiety surrounding the trouble events in the world, but eventually it became clear it was much more. I am having to communicate by text with one of them because he is too breathless to speak, but he can text.

Assuming spring will take the numbers down, and assuming fall would cause an upflare, it seems reasonable to me to practice social distancing (or lockdown, if need be) for everybody to keep the numbers down until spring, which shouldn't be more than a couple of weeks. And then use spring and summer to develop better treatment options, produce more of what we are currently short on, and much, much better and more testing. So when it does come back, everybody will be better prepared and informed, cases on average will be much less severe, this thing won't have such an enormous impact and, most of all, won't create such a ridiculous panic in the economy. So herd immunity, yes, but only when we're ready. But what do I know. Unfortunately, seasonality is likely overstated. The real benefit is that though COVID-19 will increase through the summer, cold and flu season will decrease and offset some of the demand from COVID-19. https://ccdd.hsph.harvard.edu/will-covid-19-go-away-on-its-own-in-warmer-weather/

Several real important statistical/mathematics points here. Most importantly the USA has just announced that they will focus the new testing capacity on the elderly and medical professionals. Medical professionals makes sense, but the elderly may not be a very good plan. The elderly typically get sick quickly and acts as a giant red flag. In S. Korea and China they believed 50% of cases were caused by asymptomatic by 20-29 year olds. S. Korea has focused on this age group to prevent asymptomatic spreaders. The USA plans to do the complete opposite process of what may be the most successful program in the world. https://www.forbes.com/sites/sciencebiz/2020/03/15/covid-19-who-is-infectious/#3dedb7a44d89

This is largely because South Korea was VERY quick to contain the spread. Italy and the rest of the Western works have not been. Containment is likely no longer an option - now we're onto mitigation. South Korea aggressively tested the 20-29 age group which has a much higher proportion of asymptomatic spreaders. The testing by age group data between the two countries (SK vs Italy) is very stark in that age group. Instead of waiting for symptoms to test, you slow the spread at its root by testing and restricting the younger spreaders who are more asymptomatic and stay so longer for some reason (perhaps stronger immunity?). Devil's Shadow, do you have citations you could share? This seems a VERY important insight. Asymptomatic young people could easily be responsible for infecting far more than their proportionate share of the infected population. This population could do a huge amount of damage. I had already suspected this see my previous posts about college students saying that they could not be prevented from coming to class sick. That they had a right to come to class if they wanted to. I've pasted a couple of quotes I found in a Forbes article, but I'd be interested in seeing what more CoB&F can turn up. https://www.forbes.com/sites/sciencebiz/2020/03/15/covid-19-who-is-infectious/#6ba8504d8961 If this is true, that the 20-29 year olds are the superspreaders, then we should help get the word out on that.

Thank you, DocSnowball. Several board members I respect have been following John Campbell. He seems to be capable of explaining ideas well to the general public. Some of these ideas could keep us safer and help us do a better job of building or updated our models whether a mental model or an explicit model of this pandemic. Here's John's YouTube channel: https://www.youtube.com/channel/UCF9IOB2TExg3QIBupFtBDxg One idea I got from John Campbell is to get a thermometer, pulse/oxymeter, scale with % body fat. Combine that with a SPREADSHEET and you can track the DATA. If hospitals are overwhelmed, the odds of getting help early in the disease progress could be low. In many parts of the world the system is so inadequate, that the recommendation is basically that you should stay home until you get to the point you can't breathe for yourself anymore. I have heard from board members that they are being turned away from the hospital to care for themselves and that tests are not available to them in north america. If you find yourself in this situation, this information could help you track your vitals and perform a function that might be performed for you by a nurse in better times. **Importantly, the time to start this in my opinion is BEFORE you get sick. The reason is that it could serve as an early warning system that your body is fighting something.** Further information here: That's right. Spreadsheets and data, this should be right in your wheelhouse! John Campbell on the importance of not taking NSAID's If you want to lay in Supplies: Expectorant and cough suppressant-this was recommended as the most likely early treatment back in January and that has not changed Gatorade Interesting assortment of things to drink: tea, propel, seltzers, etc Tylenol (acetomenophen)

Tweet taken down. Crossed my fingers it was all untrue. This is a reminder to be scrupulous with our sourcing during this time. If disinformation is an issue during the good times, this would be a fantastic opportunity for disinformation. Yet another reason that members of this board, a lot of whom have known each other for years could contribute to analyzing the situation for the common good. It's pretty amazing how close my estimates came to what has happened. Many people I know through this board also were very accurate in their forecasts. Let's get on the same side of the table and work together.

They should do infra. But they can't really do infra or anything economy boosting until the pandemic has passed. OK, they can actually throw money on producing tests and building ICU units in 2 days like China did... They could throw money at delivering meals to people who are out of work because of shutdown and quarantine (assuming there's a way to do it safely). Possibly would cost less and deliver more than just cutting the rates. BWDIK. Agree. We need a wartime mobilization for the health of the citizenry and not bad for the economy either. Also, in wartime, people grew victory gardens and organized themselves and mobilized themselves. Please try to think about ways you can help or we can help. Time to start contributing and stop waiting on the calvary to arrive, I am especially looking at you small government types ;)

I now know multiple CoB&F board members who have it and/or their families have it. These are fantastic contributors to the board. I won't reveal who, but you would want to help them. The list will grow. It won't happen to all of us at the same time and some of us will live in areas that get lucky. A lot of us are going to be at home for months. While we are cooped up, let's use our skills to benefit each other and society. Here are some of the skills represented on this board: quantitative analysis, contrarian thinking, communicating complicated ideas simply, soothing scared clients and helping them make choices under conditions of uncertainty forecasting and modeling finding unique opportunities or under-recognized opportunities research methods compiling data and reference materials It's time to apply these skills like we are executing a full out war mobilization against this virus. Please identify your unique skills and find a way to contribute by starting a thread or contribute to helping in this fight. I'm convinced we can have an impact. Can we start new threads to help each other out? We are good at analyzing and collecting data. I would suggest: 1) Some forecasts of how much further behind we are relative to Italy. Rank ordering of Seattle, Boston, NYC, LA, etc and the days separations between when the curves will go vertical, the risks for each area of hospitals becoming overwhelmed, etc. 2) It would be great to see some polls created to use the wisdom of crowds to forecast the unknowable 3) New threads that focus on links to the best information on how to take care of yourself in expectation of getting sick and how to treat once sick. It would be great if someone could curate this the way Norm curates the CoB&F Fairfax Lollapalooza thread 4) A thread specifically for analyzing the bellwether town(s), I assume Seattle, but maybe another will emerge. 5) How long lock downs are likely to last 6) When and how long hospitals are likely to be at their maximum capacity, above their capacity or failing 7) What percentage of medical personnel and others will be impacted and at what point will it impact delivery of services 8 ) Brainstorm other, potentially better ways to organize and contribute Finally, if you're convinced this is going to be bad, please contact friends, especially healthcare professionals and essential service providers, you would be surprised how many are still not taking this seriously or they take it seriously but they are not getting leadership from above and they need to be encouraged to speak up for everyone's benefit. If these first responders, medical professionals etc are still in denial in some areas of the country, then it won't go well for people there.

Want to re-emphasize this great post. Stochastic simulation is a powerful way to understand what measures you can take to curb this disease progression. Anyone who says "I know what will work!" without running real simulations or consulting data from other countries with N>1000s is poking around in the dark. We cannot afford to listen to such people. This shows that social distancing (even with 25% of people not compliant) works even better than quarantines. If you combine social distancing with mass testing and quarantining of known positives (until they are "recovered"), it is likely to work even better. Simulations with 10,000 iterations or more is 100% the correct way to really understand the issues here. On the other hand if you have the experience of having built a ton of similar models and run simulations in the past, you really don't need to build one in this case to know that this is not just a cold. It's so glaringly easy to see.

Couple of quick points based on skimming the previous pages: 1. Herd immunity is an important part of any approach to the process. Different countries have different options and different challenges. 2. Prevention is better than cure, especially when there is not a cure 3. Early action saves money and lives in the long run 4. Mixed messages create panic, costs lives and costs money 5. Every assumption I've seen in the past 5 or 10 pages of posts about how long this will take is likely WAY too optimistic. This is a marathon, not a sprint. 6. Things are changing very rapidly all over North America right now. The people who are involved in making the changes are too busy to be arguing on this board right now. 7. The national guard will likely to be visiting your town soon 8. China is NOT back to normal. The social distancing measures and hygiene practices there are extreme still. Just because life goes on does not mean things are back to normal. They aren't going to be for some time.