Dalal.Holdings

Closing schools has already been shown to drastically reduce the spread of viruses like influenza. Any parent with young kids know that school/daycar is where infections spread from one child to another and then that illness is introduced to a new household. People who don’t use daycare don’t have that problem until school starts. This stuff has been proven over and over again in medical literature. Nothing rational about refusing to close schools. Relying on behavioral economics over much harder science is sure to prove unwise.

Yes, tests are being rationed due to shortage. Pence’s 1M tests is over a week late now and we are nowhere close. This increases the probability that we may end up like Italy and be rationing ICU beds and vents eventually as well... :-\

Unbelievable. Dalal, I hate to break it to you, but this is the USA's plan too. Britain is being honest. Trump is giving us bread and circus. I suggest you listen to their plan if you want to know what the true plan is here. It's the best we can do given that the federal gov't squandered what time we have. All they can do is try to manage the rate at which people become infected through social distancing. You are thinking about testing from the perspective of the individual. At this point, it's about the herd, not the individual. If I had to choose who would do better? All else equal, the country that communicates honestly, openly, clearly and with one voice would get my vote. On the federal level, My money is on Britain for having better outcomes. It’s a good thing then that we will still be able to travel to/from Britain. It’s like handcuffing the two slowest kids at school to each other for the big race.

I think I've found the country that is likely to have the worst outcome from all of this: https://www.ft.com/content/38a81588-6508-11ea-b3f3-fe4680ea68b5 Unbelievable.

https://www.bloomberg.com/news/articles/2020-03-13/-i-don-t-take-responsibility-trump-says-of-virus-test-shortage Right on the money.

A bit late but progress I’ll take: New Coronavirus Test 10 Times Faster Is FDA Approved https://www.bloomberg.com/news/articles/2020-03-13/roche-gets-clearance-for-coronavirus-test-that-s-10-times-faster Federal government has been a major bottleneck thus far. You can’t absolve this administration of blame when it comes to that.

Read the article again. This was not "random testing". The people tested were ones with symptoms who showed up sick to a Dr and met criteria for testing. Not at all random and a highly selective group. Seems the Ohio Health Director must have deeply misunderstood how to implement this estimator she picked up from the 2017 Morbidity and Mortality Weekly Report. Some training in probability & statistics 101 for her wouldn't hurt. Edit: but as a public health official, scaring Ohioans into thinking there are 100k people around carrying this virus may be a good psychologic trick to force people into precautionary actions. In the end, this misinformation may serve her needs well.

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.” I sure as hell hope you are right !

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.

https://www.wsj.com/articles/u-s-virus-testing-system-is-failing-fauci-tells-congress-11584042312 This is a lie. Doctors who are requesting testing are being denied despite many symptoms in patients. Doctors are not the hold up for lack of tests, but lack of test kits is a hold up (government failure). At this point, it is sounding Orwellian as if these guys don't want us to test too much because the headlines will look bad for them...

https://www.bloomberg.com/news/articles/2020-03-12/inside-the-oval-office-a-fierce-fight-over-trump-s-virus-speech What a bunch of clown medical experts he has surrounded himself with. We have exponential growth in cases and documented community spread from individuals with NO travel history outside United States. At this point, a Euro travel ban will not stop this. It is too late for travel bans. You cannot "buy time" by blocking outsiders anymore... Are travel bans and tax cuts the only thing we got? Not very effective against viruses. Why was testing not a focus of the speech???

https://www.theatlantic.com/ideas/archive/2020/03/who-gets-hospital-bed/607807/ This is what we have to fear: So much more than just a Flu outbreak. If testing were done early and extensively, it would have decreased the probability of infected individuals from spreading it--just like TESTING of a few NBA players has led to definitive actions that will prevent the virus from spreading throughout the League (see what benefit early testing can have? Wow, testing and positive result in two players causes quarantine and prevents further spread! Guess it's hard for some to see benefits of prophylactic measures). At the very least, it would have shifted infections rightward in time and not led to sudden, overwhelming demand of critical care resources. Just wait the median 2 week time from symptom onset to severe pulmonary symptoms and you will see the demand for ICU beds/vents overwhelm supply. Better hope Americans have some kind of innate immunity to this thing, because the clock is ticking. For the record, I hope I am very, very wrong.

That's all fine and dandy. But we don't exactly have an oversupply of tests....so wouldn't it be best to put them to the most efficient use? High risk individuals. Yes, we have an undersupply. That is the problem we are saying needs to be addressed urgently. We need more tests. That's what we are saying. CDC is responsible for that and extending approval to states/labs for testing on their own. We are already limiting testing due to undersupply to only those with travel history to known places or known contact with positive individual. It is already only going to "high risk" individuals and we are missing large swaths of other people who have this and are spreading it. For some reason, the United States, among the last places to get significant cases, appears to be among the most unprepared nations and we continue to fiddle while Rome burns and this is very very alarming. EDIT: here is the evaluation algorithm for COVID-19 that healthcare providers follow: https://www.cdc.gov/coronavirus/2019-ncov/downloads/public-health-management-decision-making.pdf As you can see, only someone who went to China or known contact with positive individual is deemed a risk. This is categorically false and asinine as a Europe travel ban at this point because we have community spread. I can assure you that the cost vs benefit of widespread testing is MUCH more favorable than a 30 day Euro travel ban or even payroll tax holidays--think about the economic costs of these other things

Well then as long as you agree that testing helps reduce further spread, we are on the same page. The "hindsight" remark didn't make it seem that way. Right now, we are only testing those with travel Hx or known contact a.k.a. "high risk individuals", likely due to shortage of tests. This after we know there is community spread. There are patients with flu like symptoms who are flu negative who do not have travel or known contact who are denied testing, in many cases given a mask, and sent back out into the community without diagnosis. Is that acceptable? And no, we would not overburden hospitals with asymptomatic cases--we can do tests in clinics, urgent care, etc. Asymptomatic individuals who are positive would merely be told to go home and quarantine. It would not burden hospitals. Moreover, you can do what is more innovative which is drive thru testing in Korea which would 1) prevent spread to others in clinic/hospital and 2) not burden hospitals.

https://www.npr.org/sections/goatsandsoda/2020/03/12/814522489/singapore-wins-praise-for-its-covid-19-strategy-the-u-s-does-not Which group would you rather your country be a part of? Maybe the comparison to HK and Singapore is a stretch for U.S., but what about Korea? Japan?

Gretzky didn't play hockey with a blindfold on. You need to know where the puck is to know where it is going. Testing is preferable to not testing. It really is that simple. It's like saying that not telling sexually promiscuous individuals whether they are HIV positive or not will not impact future spread. This is categorically false and we do not need to go back to 20th century discoveries in medicine each time to address these points that have been shown decades ago. There are some points being made (against testing, action) that can be easily dismissed, but they are brought up almost hourly on here.

I think being a medical professional is a red herring. Physicians are not trained in population level health policy, they are trained to treat patients. We need to listen to epidemiologists, who are saying to close down. Hopefully we do so broadly soon. There have been big changes this week in sentiment, and hopefully that leads to communities being more proactive. Absolutely. Most physicians have no quantitative training. Med school is largely memorization exercise.

What is the cost of widespread testing? Low. The benefits? Tremendous as people who know they have it more likely to quarantine/reduce further spread. This is NOT a theoretical, abstract discussion. At this moment you see countries who took aggressive action seeing the end of this crisis and those that stood by and let cases go undetected stuck in a rut. There are several controlled experiments running right now that we can learn from. Taking single anecdotes of people who recovered (N=1) is not a useful way to study this. You can look at countries (N=10s of thousands) to better get an idea of what happens when you either intervene or do not. It ain’t pretty if you sit by and let this build (Iran, Italy).

It does matter. But you guys need to calm down. China is already getting back to work. South Korea is quickly approaching that stage. Yes, there have been and will continue to be second infections of the same individuals. But life has not fundamentally changed in China so it isn't going to fundamentally change in the west. You keep saying that you can see the wave coming because you saw what happened to China and extrapolated to the US. Congrats, you were more correct than many in this thread. But are you now conveniently not extrapolating what is happening in china NOW? and I don't want to argue about timing. Because no one knows. But eventually, we will go back to our regular lives with a much more aggressive flu/COVID season. The question is which country do we most resemble in terms of management of this and population? I do not think we thus far resemble China or S Korea which took and are taking aggressive steps. I believe we may most resemble Italy. Very different outcomes among those three places. Now, Italy's CFR may be skewed higher due to its much older population--for more on that, I've just retweeted some good analysis of why Italy skews higher (adjusted may be 2% not 6.6%. Twitter is not all noise).

This is a tragedy in the making and all along intelligent people are saying "just the flu" and "nothing we can do". Due to weeks delay in severe symptoms/mortality from onset/catching this thing, we are being lulled into a false sense of security. We may be in the calm before the storm... :-\ Intervention helps and it's up to U.S. citizens to push for it: S Korea Deaths % of cases: ~0.7% Italy Deaths % of cases: ~7% Seven. Percent. And that's after S Korea had initial surge due to cult members spreading this. Management of this outbreak matters.

Almost like shorting Tesla and dismissing this virus was really bad for your financial health. (*Smugness intensifies*). From now on, my posts will be only for geeky financial type eyes only (even though I myself don't work in finance). If you do not belong in that category, please ignore. I will do my best to refrain from being confrontational and insulting with those I disagree with going forward as well. I thought I only needed to wait a month for markets to realize what we are in for. Turns out due to our brilliant leadership, it was only 4 days. Here is the only analysis you need for this (again, for geek eyes only): https://ichef.bbci.co.uk/news/800/cpsprodpb/10115/production/_107031856_blackswan3.jpg In all seriousness, though I have been repeatedly posting graphs on growth of cases outside China (still discouragingly exponential as the U.S. enters the fold), you do not need any sophisticated models to project this in the United States. With the U.S., we have the benefit of a several week delay from other countries and you can just see how this has evolved in those countries with similar management as the United States. And remember it takes weeks from onset to severe pulmonary symptoms and mortality on avg... Unfortunately, the United States seems more and more headed on the path of Italy (or worse) due to incompetent initial and continued management (beyond anything I could have predicted) when this could have been slowed. FYI Italy currently has near 7% deaths as percentage of confirmed cases (and their testing per capita is much higher than U.S.)...

Has everybody in this discussion actually concocted a model for this? Seriously, 15 minutes with a spreadsheet can be quite instructive. You soon learn that the potential of flattening the curve is driven largely by your assumptions of 1) How many people seek medical help and are instructed by physicians to self isolate, vs how many have mild symptoms and just continue with day-to-day life; and 2) What is the effective R0 for those who self-isolate vs the R0 of those who have mild cases and just continue on with business as usual. If you are in the camp that there is a large group that is not destined to self-isolate, there's not much that can be done to flatten the curve. Seriously, if people haven't already done so, go ahead and model it. And by the way, if somebody disagrees with your modelling assumptions, don't accuse him of not understanding math or being stupid. SJ Spreadsheets and models are for geeks who wear thick framed glasses! And apparently so is the precautionary principle! Do you have some sort of obligatory quota which demands that you issue at least one insult or an otherwise denigrating comment per post? SJ Yes, especially when others are put at risk.

Has everybody in this discussion actually concocted a model for this? Seriously, 15 minutes with a spreadsheet can be quite instructive. You soon learn that the potential of flattening the curve is driven largely by your assumptions of 1) How many people seek medical help and are instructed by physicians to self isolate, vs how many have mild symptoms and just continue with day-to-day life; and 2) What is the effective R0 for those who self-isolate vs the R0 of those who have mild cases and just continue on with business as usual. If you are in the camp that there is a large group that is not destined to self-isolate, there's not much that can be done to flatten the curve. Seriously, if people haven't already done so, go ahead and model it. And by the way, if somebody disagrees with your modelling assumptions, don't accuse him of not understanding math or being stupid. SJ Spreadsheets and models are for geeks who wear thick framed glasses! And apparently so is the precautionary principle!

Everything you are saying is based on this assumption, which has no proof! Obviously the lack of testing in the US means this could be true. But extremely unlikely based on what we are seeing in other countries. In Ontario, we have tested just under 3000 people and 36 were positive. That is just over 1% positive from people deemed high risk of the virus. This is not a virus that has been silently going around for months. You are just wrong on this. And repeating it 50 times does not add value. The danger of loudmouth cabbage brains is they convince people in charge and that leads to danger for all of us. This is not an extinction event, but it sure makes you realize exactly how we would approach a real extinction threat—in the same way. This thread is toxic.

And be thought a fool by everyone with a strong opinion? Better to remain silent. ;) @orthopa I think what folks are saying when saying testing is important is that identifying as many spreaders as possible is key to containment. You can't catch them all. Don't let perfect be the enemy of the good. Some folks spread to 1 person. Some spread disease to dozens. You want to eliminate as many spreaders as possible so that the disease population can't reach escape velocity. Basically to the point above about the number sick at any given time being semi-controllable. Whats your plan for asymptomatic people/kids who don't seem to be affected and dont go to the doctor? I already answered. You can't catch everyone. Any additional you do catch early can moderate the number sick at any given time. You might not be able to control total number to get sick, but spreading that number out over a longer period leads to far better outcomes in aggregate. That's why people are testing. Further, WHO says adult to child transmission is more common than reverse, as opposed to seasonal flu. To the "it's been here for 1+ month" comment, viruses compound when no one has immunity. I don't understand "why bother trying, just make fun of the try-hards" attitude just because we can't be perfect in prevention. Best not waste time arguing with brains turned to cabbage. They keep on pounding it in as Munger says. He’s not the only one with healthcare experience. Anyone who mocks those who look at graphs, reads Taleb, etc is in for a reckoning. Edit: it is clear there are countries doing a good job vs not and clear which way the U.S. is headed. What we have to fight is inertia and those saying “just another flu” or “nothing can be done”. Those things are categorically false just by observing how certain countries are approaching this right now. If you want to try and predict where the U.S. will be several weeks from now, the unfortunate guide seems to be Italy (except 5x the size) more and more due to pathetic response. :-\