Dalal.Holdings

I work in healthcare. The only advances that we have come up with in that time that are effective against this are 1) hand washing, 2) contact isolation, 3) mechanical ventilation (but by this point it is already way too late). Also, we severely lack # of ICU beds and resources which will become apparent soon. It is already apparent we lack resources if you look at how testing for this has rolled out.

To compare this to Spanish flu 100 y ago where world was vastly less interconnected and it took weeks to travel to diff continent is laughable. If you try to model a black swan’s effects by studying the past, you will likely get hurt. But that’s human nature I guess: trying to predict the future by looking at the past. What’s that investing adage about studying past performance ?

Princess Cruise Ship held off the coast of CA... NY area guy who caught it spread it to multiple families, attended religious services/events while likely infected (but "untested"): https://www.washingtonpost.com/local/social-issues/new-york-coronavirus-westchester/2020/03/04/a9e0c5e0-5e48-11ea-b014-4fafa866bb81_story.html It begins, America. Washington state may seem like the "epicenter" now, but due to compounding, severe under testing due to bungling by Federal Gov't, and several week delay for onset of symptoms, this has likely spread throughout the major population areas...and continues to spread as more and more undetected infections are generated on a daily basis. Do u think Pence/Trump understand this? What about the career Republicans who are in charge of what should be scientifically based agencies? What we are witnessing is what happens when we elect scientifically illiterate people into power who strip out the budgets for these things. It is fine most of the time, but when shit hits the fan, you know the value of preventative measures that could have been. Guess we can all wait for the pvt sector "invisible hand" to save us. Black swans are easy to underestimate early on. China was mocked for dismissing early cases, but once they understood the seriousness, literally locked down tens of millions of people... Guess few understand the precautionary principle with systemic, multiplicative, and nonlinear processes such as this one. As was once said "an ounce of prevention is worth a pound of cure" -BF.

Yeah. It isn't. In the Canadian system, it's all about getting diagnosed, going to your appointments, and getting the help you need as you need it without being bankrupted. That said, the parking at hospitals can be pricey--like $15 a day! "Not being bankrupted" sounds very appealing to me. So does drug prices that are a fraction of what they are across your southern border. So does aggressive testing in a province with just 5 million people for COVID-19 (BC) where you test more than the entire United States (whose CDC botched production of kits and arrogantly refused WHO issued kits). Even as of March 4, it seems more have been tested in British Columbia than all of USA...let that sink in.

Greatest healthcare system in the world! Worth the high prices they charge us too!!

#of coronavirus cases outside China compounding daily at the same rate that Bekrshire Hathaway compounded annually with WEB at the helm. Nothing to see here folks! Just liberal propaganda.

Exponential trend in ex China cases intact. Graph does not include large swath of cases in U.S. likely missed due to under testing.

Hospitals in many places incl NY still (as of today) cannot test locally for the disease and must ship to CDC in Atlanta for testing. Test kits sent out by CDC in recent weeks were defective. Epic fail. https://www.businessinsider.com/coronavirus-cdc-atlanta-lab-faulty-test-kit-investigation-2020-3

https://jamanetwork.com/journals/jama/fullarticle/2761659 So far reports of cases show the infection to be mild in children, infants. It’s the old folks who are susceptible to high morbidity and mortality. Ironically, because kids have mild symptoms (cold symptoms), they likely spread it to each other at school/daycare and then the infection is spread to the household to more vulnerable grown ups. From this standpoint, school closures make sense.

https://www.cnbc.com/2020/03/03/who-says-coronavirus-death-rate-is-3point4percent-globally-higher-than-previously-thought.html Something for those in the “just another flu” camp to chew on. And something for the “well there’s nothing we can really do to help the situation” camp (ie. compare Singapore/Taiwan w USA):

Black swans are frequently underestimated, esp early on. People don’t think about 2nd and 3rd order effects and are more reactive than proactive which is why fighting things like climate change are difficult. What’s surprising is how dismissive a supposedly intelligent group of investors is of this stuff, but then again you look at the politics section here and then it all makes sense.

Atrocious. I'm not sure that I quite understand the fixation on having "correct" and up to date statistics. What would governments in the US do differently if they had "good" statistics resulting from more prevalent testing? So, suppose that there was more testing being done of people who sought medical attention for respiratory disorders and it came back that there were 1,000 positive Covid-19 cases. If that were true, how many cases would there be that had not sought medical attention because the symptoms were not so severe? Perhaps it would be 1,000 more that wouldn't show up in the official statistics? And then what would the US government do with those numbers? Look, either this virus can be controlled and we can put the genie back in the bottle, or it cannot be controlled and the genie is on the loose. If you are in the camp that this thing has already spread so much that the world has lost control of it, then "good" statistics don't strike me as too useful. If you are not going to impose mandatory quarantines and if you are not going to suspend international travel, what are the remaining levers that governments can pull and how are better statistics actually useful? I guess that I'm in the camp that the genie is out of the bottle and that it's time to focus on managing a situation which is no longer preventable. But, maybe I'm alone in that camp? SJ It makes a huge difference. Investors are supposed to understand exponential growth, right? This means that time matters a lot and early interventions in the right places, in the right ways, giving correct info to population so they can act in the right way, etc, can have a tremendous impact on the rate at which things unfold. Since healthcare system capability isn't built for huge peaks, these delays can help it absorb increases much better and will result in saved lives. Also, vaccines and other drugs are being tested and developed, and delays help get more people across that line. In short, bungling the public health response will cost lives, could be your grand-parents or some friend who has a weaker immune system because they survived cancer or have asthma or whatever. Ironically doesn’t seem like too many people understand significance of exponential growth on a value investing site. So the greatest country on earth with the *greatest healthcare system* had a huge headstart on tackling this and bungled it up, far worse management than Canada or Europe and people on here asking “so what”. Lol. The only good thing this admin did was cutting off travel with China early which helped us have a delay in cases. Everything else was botched.

So if this is being "handled" incorrectly, what is your hypothesis? Is it: 1) People in the US are actually getting sick from Covid-19, but are electing to not seek medical help? 2) Doctors across the US (who generally work in private practice and are not public employees) are treating people for respiratory illness, they suspect Covid-19, but are failing to inform local public health authorities? 3) Local public health agencies in thousands of cities in the US are collaborating to not test people to confirm the existence of Covid, and they are also collaborating to not forward presumptive diagnoses or suspected cases to the state public health agencies? 4) The 50 different state public health agencies are in cahoots to hide the real numbers from the federal government and are forwarding incorrect numbers to the CDC? So, in your book, where are the facts being hidden? SJ As was posted recently, up until a few days ago, British Columbia had tested more people than all of the United States. CDC refused to test someone in CA who ended up having the disease...so the failure of U.S. is...not testing enough. Hence, sick people will go undetected (and stay out in the community) and confirmed cases will be falsely low. According to new outlets, govt plans to substantially increase testing. Don’t be surprised if U.S. cases shoot up as a result. The China numbers are certainly not to be trusted. China did mishandle this in early stages...but black swans are hard to accept as real in the beginning. Diff between U.S. and China is that U.S. has had head-start of months to prepare. U.S. has clearly not prepared and we are reactive more than proactive. https://www.npr.org/sections/health-shots/2020/02/28/810520187/cdc-defends-its-handling-of-new-coronavirus-case-in-california Add to that flaws in the testing kits/reagents and the fact that you had to mail samples to the CDC to get the test done... As one of the last places to start getting cases, the U.S. has actually had a head start compared to most of Asia and Europe in having time to prepare for this. Too bad it was squandered.

@GeorgieBoy Which country should we NOT be looking at as far as handling this? So far, it's the USA. Like I said, ratio of deaths to # of cases is abnormally large, larger than most places (even Iran). USA is the outlier. And not in a good way.

There are now 6 dead Americans and 102 confirmed cases. 6/102...about 6%...that ratio is much larger than elsewhere in the world (in Italy it's 2.5%). Perhaps it's because that denominator is falsely depressed by our great American healthcare system/CDC that has missed at least 50% of cases that would have been detected in other nations...hope those undetected 140 or so people have self quarantined! Edit: and about half of those 102 detected (45 people) were evacuated from the Diamond Princess Cruise ship. So far a terrible job at testing for infections. A national disgrace.

Lol. You mean spend more $$ for poorer outcomes strength and power? See Viking's post above mine. If you are hoping to be saved by U.S. healthcare system/pharma, prepare to be disappointed. Don't worry, the Republicans, led by Pence, are already using their greatest weapon: "thoughts and prayers". It works after every gun rampage, why not now? Science is useless and agencies like the EPA and CDC are socialist money pits that deserve to be starved of funding (but we'll sure miss them when we need them!).

Cases ex China. Trend continues.

If America finds a cure faster than other countries then perhaps the fattening of the pharmaceutical companies has been worthwhile. Do you think another country (socialized medicine or otherwise) has a better chance? Well during the last Ebola outbreak it was a lab in Winnipeg that developed the vaccine. And a lab in Saskatoon that was created to deal with exactly these types of viruses and has tons of experience with corona viruses (including developing vaccines for them) has a already been working on this for a while. So we'll see... Vaccines are cheap. Not that much money to be made bd a minefield for lawsuits. It’s one of the best return on investment for public health, but not for Pharma or biotech companies. It’s one field where public funding is needed. Not necessarily. GSK set to make $2B in sales on Shingrix, a vaccine for a very target demographic. Vaccines can be very lucrative, esp in a case like this where just about everyone will want one. Vaccines are also probably the most bang for your buck thing our healthcare system does -- a great man once said "an ounce of prevention is worth a pound of cure", so it's probably ok if they cost a bit (an individual only requires 1-2x shots with them unlike the recurring revenue treatments like humira earn on individual patients). Even the ebola vaccine took years for rollout (which would have been late without containment). Anyone who has ever looked at companies in drug development knows -- best to temper expectations with respect to drug approval and rollout. Developing new drugs is much easier said than done.

You could make a better argument that the CDC should spend less time advocating against guns, etc. and more time protecting us from infectious diseases. https://www.usatoday.com/story/opinion/2014/10/05/ebola-cdc-jobs-tasks-multitasking-thomas-duncan-column/16766801/ If you think bringing up how ebola was handled will make this cdc look good, then just lol. This is a clown show in comparison to how ebola was contained. Not enough tests out there by dismantled cdc means people have unknowingly been spreading it. High risk people were denied testing. Supposedly the province of British Columbia has tested more individuals than all of the U.S. (https://globalnews.ca/news/6610416/bc-covid-19-testing-more-than-united-states-premier/). When your boss calls it “Democrats’ hoax” I guess it must not be that important. Oh, how dare I bring politics into this—when POTUS makes a comment like that, it is totally apolitical and rational. But hey, it’s just like the EPA-an unnecessary arm of the govt to be dismantled. Serves no public purpose. Let’s put pseudoscientists in charge of it and see what happens.

Wonder what concoction of drano they'll be recommending to the public. Wow, supercomputers! This will surely help. This is what happens when Republican rubber stamp "scientists" are put in charge. This one in the famed Trump Dept of Energy, almost as skilled as Rick Perry--must be still looking for that "clean coal" recipe. Science is the pursuit of truth. With this crisis, these clowns have nowhere left to hide anymore and unfortunately for us, they're in charge. Elections have consequences it turns out. Well, on Tuesday, PatofthePig drafted a post for us providing a link to a newspaper article that suggested that chloroquine appears to reduce the length and severity of the coronavirus. I have not read anything else about it since, but it's interesting that a relatively old, off-the-shelf malaria treatment could end up having another use. Interestingly, it's been off-patent for 50-ish years now, so if it is actually found to be useful, it might be a treatment that is cheap enough for use by the world's poor. If the US government is trying to pick some low-hanging fruit by testing the efficacy of a broad range of existing medications, I'm all for it. SJ Malaria is a protozoan parasite. Very diff from a virus. I highly doubt an agent effective against malaria would have effect on this. Coronaviruses aren’t new. The chances that there is a common agent out there effective against them that we do not know about is slim. A lot of noise out there. Strange that Republicans who tout the private sector are relying on gov’t labs to find a cure.

https://www.bloomberg.com/news/articles/2020-02-29/trump-team-testing-off-the-shelf-drugs-to-cure-coronavirus Wonder what concoction of drano they'll be recommending to the public. Wow, supercomputers! This will surely help. This is what happens when Republican rubber stamp "scientists" are put in charge. This one in the famed Trump Dept of Energy, almost as skilled as Rick Perry--must be still looking for that "clean coal" recipe. Science is the pursuit of truth. With this crisis, these clowns have nowhere left to hide anymore and unfortunately for us, they're in charge. Elections have consequences it turns out.

Boeing, Lockheed and Northrop have remained domiciled in the U.S. though and sell planes/gear abroad and the discount to the gear they sell is not as steep as Pharma discount of U.S. drug prices vs even Canada. So defense co profits are brought back home and they pay U.S. taxes. Compare that to tax inverted pharma co now domiciled in Ireland that Medicare has no power to negotiate with. If the burden of world security is on America, tell that to the Pres who is asking for NATO members to chip in for their fair share. Fact is, the gap between America and ROW has narrowed over past 70 years, so the burden for pharma R&D and other stuff should not rest so disproportionately on Americans. Also, you think that all that excess $$ from ripping of Americans going to drug companies went to more lab benches and scientists? More was probably spent on patent attorneys than scientists (For Abbvie/Humira, it seems like $$ well spent--a great ROI! For patients & society, not so much). I could go on and on, but easier to just stick to Munger's brevity and call the U.S. system a "national disgrace". Like I said, as far as development of an effective treatment/vaccine rollout for Coronavirus is concerned, prepare to be disappointed.

If America finds a cure faster than other countries then perhaps the fattening of the pharmaceutical companies has been worthwhile. Do you think another country (socialized medicine or otherwise) has a better chance? Sure there are good actors out there who might deploy capital more favorably, but there are many more co's out there with behavior not too dissimilar to Valeant. They rip off American taxpayers (by overcharging Medicare) and relocate headquarters off shore to some low cost country so they cut down on U.S. tax bill--screwing American taxpayers both ways (Pfizer, et al). Congress (McConnell, et al) make it so Medicare has no power to negotiate drug prices. Mylan used political influence to convince schools to buy $600 epi pens Abbvie has somehow extended its humira patent in the U.S. (hey, maybe you can be a lucky patient and apply for a "rebate" from Abbvie, still doesn't spare our healthcare system tho)--Europeans didn't indulge them in that though. These co's fatten their bottom lines and then use that capital to do mega mergers (often with an overseas co so they can relocate their HQ to cut U.S. taxes: Pfizer was going to pay $160B for Allergan in 2016--that's money largely reaped from overcharging Americans that would not have gone to R&D but into Allergan equity/debt holder pockets for a tax inversion)--they don't plow it all into R&D. Waste. Waste. Waste. *If* America finds the cure--there is no evidence that American co's will (not to mention a lot of these are no longer American co's bc they moved out to dodge our taxes)--why is the burden for funding the world's pharma R&D being put on U.S. taxpayers???

We will learn the true cost of not having socialized healthcare with this crisis. As with a lot of things (e.g. climate change), we are not very good at anticipating and protecting against complex, nonlinear phenomena that pose 2nd and 3rd order effects. As Churchill said: "Americans will always do the right thing--only after they have tried everything else" Or Munger: We'll have single payer healthcare as soon as Dems take WH and Congress. Or "America's healthcare system is a disgrace". Let's see how fattening up the pharmaceutical company bottom lines over the years help us with this black swan. Let's see how much they put into R&D and how long it takes to get treatment/vaccine out. Prepare to be disappointed.

https://www.businessinsider.com/how-much-does-coronavirus-treatment-cost-cdc-health-insurance-2020-2 U.S. Healthcare System is a Joke though and that will become so much more apparent to everyone as this unfolds. Americans who don't (or can't) pay the healthcare bills will not get tested/treated and instead spread this in the community compared to just about every other developed country where the cost of healthcare visit is low. This, along with the revelation of what happens when a marketing guy conman President faces a true crisis, may very well lead to the United States electing its very first socialist president in 2020.