Dalal.Holdings

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.

South Korea's approach was very similar to Wuhan's from what I heard. Lots and lots and lots of testing and temperature taking everywhere, separating family members who are infected rather than at-home quarantine, etc. It wasnt just extensive testing, there was a lot of shutting down of things and shutdowns too, Real quarantine is essential. Self-isolation means you will just infect family and close contacts. South Korea did not have to impose lockdown as strict as Wuhan and Northern Italy. People self quarantined once they knew they were positive to reduce further spread. With or without self-isolation, the chance you infect people in your household is already very very high (after all, you are going to end up at home at the end of the day). The thing about testing people and letting them know they are positive is they can quarantine themselves from other people outside their household. The household catching it is a foregone conclusion, but reducing spread to new households is what we should be after.

There's a simple explanation: reliance on anecdotes over objective data, narrative fallacy, etc. Happens to a lot of clinicians because they see patients and extrapolate from those handful of clinical encounters to the larger population. Anyway--the rule is that if lots of people's lives are on the line, you should err on the side of caution ("prepare for the worst"), not assume "everything is going to be fine". Ie. board up your house even if it is 98% likely to be out of the hurricane's direct path. That's the precautionary principle in a nutshell.

Another (useless) graph for the "there's nothing we can do anyway" crowd. FYI South Korea achieved this WITHOUT A LOCKDOWN, but merely extensive TESTING. And South Korea's population is similar to Italy's. Source:

What I would recommend to a family member in your situation (take it with a grain of salt and follow your brother's own doctors' advice): 1 week of fever is nothing to dismiss without at least consulting a PCP. I would consider using acetaminophen to quell it if no contraindications and reach out to PCP if other symptoms (respiratory, etc) not as severe. If things are bad then urgent care/ED. I would give where ever you were going the heads up that corona may be an issue so they can give you precise instructions on how to arrive without potentially infecting others. The drive through testing is to be operational this week, but not sure how efficient it will be and your brother may have to wait in a car for a while in line if it is packed.

Important to clarify given the contradiction between the username and claims made on here.

Another Q: Usually when there is an impending crisis like a cat 5 hurricane about to hit your state, is it in the governor’s interest to get people in their state overly concerned or under concerned? Don’t know where you live, but New Yorkers are hard people to get concerned about things. Like I said, put your money where your mouth is and make some bets if you feel so confident.

Your right. 2 options. Do you think Cuomo is going on record saying that thousands likely had the virus, recovered, and didn't know it if it was highly unlikely? In this climate? At this time? Thats pretty ballsy isnt it? Maybe he was joking? Q for u: if millions caught this month ago and it is only 2-3x deadlier than the flu (an underestimate based on our current data), how many people would have died without a formal diagnosis (since we wouldn't have been able to diagnose) in the past 2 mo? How many ICU patients with ARDS would we have had? In order for your theory to work, you must be arguing that COVID19 is much much LESS deadlier than the flu <<< 0.1%. That is a bold statement to be making now and I know what I think of the odds of that being even remotely true. I think you just typed out the answer. Why aren't we seeing more dead people/ARDS? You cant say this virus spreads rapidly in one breath and will kill everyone and on the same hand keep saying, its coming, its coming, its coming. How can you use current data? S. Korea has 51 million people but tested 140,000. Thats .27% of the population. How can you honestly use that data? Your going to extrapolate that for the other 99.63% of the population? Really? Secondly I want an honest opinion about Cuomo. Why would he come out and say that? In NYC. During a pandemic with massive panic in society? I don't look to elected officials to form objective opinions about reality, leaving aside the fact that it is in their interest that people in their area take crises seriously. The financial markets are offering you many opportunities to get rich beyond your wildest dreams right now if you are really as confident as you seem about this.

That is the correct way to look at this--stochastic simulation. Here's another: People who are trying to project in their heads are kidding themselves.

Your right. 2 options. Do you think Cuomo is going on record saying that thousands likely had the virus, recovered, and didn't know it if it was highly unlikely? In this climate? At this time? Thats pretty ballsy isnt it? Maybe he was joking? Q for u: if millions caught this month ago and it is only 2-3x deadlier than the flu (an underestimate based on our current data), how many people would have died without a formal diagnosis (since we wouldn't have been able to diagnose) in the past 2 mo? How many ICU patients with ARDS would we have had? In order for your theory to work, you must be arguing that COVID19 is much much LESS deadlier than the flu <<< 0.1%. That is a bold statement to be making now and I know what I think of the odds of that being even remotely true.

The U.S. has a flu surveillance system that is in place. It looks out for reports of flu-like symptoms at healthcare sites around the country. There has been a recent increase in reports of symptoms similar to flu. It's strange that those arguing that the virus has been here for months and "millions already have it" cannot explain why there was no increase months ago when millions were supposedly catching this virus. https://www.bloomberg.com/news/articles/2020-03-14/flu-watchdog-spots-more-with-fever-and-cough-but-it-s-not-flu?srnd=premium

Incorrect.

So at this point you have two options as an investor: 1) Trust some guesses/major assumptions based solely on anecdotes from people that millions in U.S. have been silently infected for months now 2) Go by what is being witnessed in other countries at this very moment and acknowledge that the United States is merely a couple of weeks behind (relatively early in the course of epidemic) The more probabilistically likely scenario is obvious to me. A majority may show mild/flu like symptoms but even if a minority get very sick, we would certainly have seen a spike in unexplained ARDS cases across U.S. if millions were infected months ago... Inversion tells me #1 is most likely wrong.

The flu death rate is pretty well documented as somewhere around 0.1%. 20x seems like it could be correct, but potentially up to 200x worse than that?? I could counter your "Where's your data to support that", because that's way over the highest estimate made by anyone ever. 1. Flu is also a big deal, which just isn't properly covered by the media. So, when you read xxx people have died in a country from the corona virus, you think: that's a lot and start to panic; when xxx people die because of the flu, you will never know. 2. Corona virus is an ever bigger deal than the flu, because it can potentially in the future become much bigger as nobody got immunity (yet). When flu season hits, we do nothing except vaccinate some elder people with a vaccine that doesn't really work that well to begin with. This hits, and we shut down entire countries. I'd say that response from countries we are seeing over the last three days is proportional to this being a big deal. I agree. Fortunately, Europe has been taking action these last few days, lots of it in fact. I was under the impression the US wasn't far behind, but perhaps I'm mistaken. On 3/6/20 WHO CV situation report stated that the common flu has a death rate well below 0.1%. Here they show the CFR of ~0.055% for 65+ year olds in the Americas: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6815659/ Here are the numbers for China: https://twitter.com/YoloCapMgmt/status/1238954857949585408 Yeah, it's much less than 0.1%, but rounded up to 0.1% because the average person would not understand a number smaller than 0.1%... This is much deadlier than the flu and we have already refuted the "just another flu arguments" many times on here. Ignore those who make them.

Will do. Can't believe we have people still saying there is no advantage to acting early when we see countries coming out of this who acted early. And then going on guessing that there will be future outbreaks again and mutations/etc so why bother doing anything (absurd). There was also earlier the "they're old people who were going to die anyway" shocking mentality. The "we're all screwed anyway" mentality makes absolutely no sense (and some of these people were initially saying "no big deal, just the flu". And calling this a supply shock when it is clearly a demand shock... Absurd. Almost as absurd as comparing a passenger in your backseat to a cinder block and saying human bodies become projectiles in car crashes and that's why we have seat belts, but oh well--the absurdities keep coming.

No, the UK is very wrong about it (questioned by WHO and medical experts/epidemiologists). Furthermore, the NHS is unlikely to handle the strain from achieving herd immunity and the inevitable large number of patients who will require ICU beds/vents, but clearly you continue to ignore the very real notion of healthcare system strain from sudden surge of cases and the situation in Italy. Delaying cases out to the future confers many advantages, not just merely waiting for eventual treatment. Your guess about "probably just see new clusters" is just a guess. Like saying "if I get in a major crash I am screwed anyway so I do not need a seatbelt". Furthermore, even if there are clusters later, the risk of healthcare strain much lower as the old patients would be out of the hospital by that point and now immune.

Who you test matters. In S Korea, they are testing anyone and everyone. In Italy, it's just symptomatic/"high risk" people (see also U.S.). This image shows there are a whole lot of people younger out there tested in S Korea who are likely asymptomatic/mild symptoms (hence not tested in Italy). These young people are likely unknowingly spreading disease to older/more vulnerable folks in Italy because they are never offered a test. In S Korea, they are actually aware they have COVID and therefore more likely to be careful (self quarantine, avoid parents/grandparents) and less likely to spread to others/more vulnerable people (less probability of further spread). This is one major benefit of widespread testing.

not just severity is a question, but also the length. i mean, china will have taken a large hit, but considering they seem to be coming back on track (and assuming the virus won't just hit them again) the effects seem rather limited. obviously, if things take longer to play out over here, the damage gets increasingly worse. anyway, might be contradictory, but i really believe locking things down now (as appears to be happening) will save a lot of damage to the economy in the long run. This is where the economic costs of precautionary principle come into effect. China/S Korea/Singapore etc took some upfront costs to mitigate spread early in the disease course. As a result, they are seeing the light at the end of the tunnel. The countries unwilling to bear that initial cost may see protracted crises that will prove much much more expensive over the whole crisis than if they took that initial ounce of prevention. It's like wearing a seatbelt--the initial cost low, the cost of injuries sustained without wearing one much greater and can lead to a lifetime of pain/suffering/debilitation. Wearing a seatbelt is not just about yourself. It keeps you from flying around the vehicle and killing everyone else. So if you want to apply this to current conditions, you have a few countries wearing seatbelts and the rest of the world without them. Unfortunately it doesn’t matter because it’s a global economy. Is Singapore somehow going to weather this global economic shit storm when the US, UK, and other major powers are running on E? If Australia managed to keep every case of covid19 out of their country they are still going to be taken to the woodshed economically because they are almost entirely reliant upon China. This is new information. I always thought in most crashes people hit the dashboard and a seatbelt stops this, not that they are human projectiles ready to hit other humans in the vehicle. Please show me studies on this thanks. ...Also, most cars are occupied by 1-2 individuals on avg. There goes the human projectile theory. At least people will be walking around eating out, doing retail shopping, traveling around within the country for work/personal/tourism reasons in S Korea/Taiwan/Singapore. In places where disease spread continues, this will not be happening. Australia is reliant on China. China is seeing the end of this crisis, so there goes your point about that.

not just severity is a question, but also the length. i mean, china will have taken a large hit, but considering they seem to be coming back on track (and assuming the virus won't just hit them again) the effects seem rather limited. obviously, if things take longer to play out over here, the damage gets increasingly worse. anyway, might be contradictory, but i really believe locking things down now (as appears to be happening) will save a lot of damage to the economy in the long run. This is where the economic costs of precautionary principle come into effect. China/S Korea/Singapore etc took some upfront costs to mitigate spread early in the disease course. As a result, they are seeing the light at the end of the tunnel. The countries unwilling to bear that initial cost may see protracted crises that will prove much much more expensive over the whole crisis than if they took that initial ounce of prevention. It's like wearing a seatbelt--the initial cost low, the cost of injuries sustained without wearing one much greater and can lead to a lifetime of pain/suffering/debilitation.

Another useless chart. 74.4k confirmed cases outside China right now. Within 24h, cases outside China will exceed cases inside China... Growing about 15-20% a day...(doubling time is ~every 4 days)

So now estimating 1-1.5 years for a vaccine (the administration and more sophisticated people were saying weeks to months recently). Strange. I thought all the fat margins we'd been handing to pharma for decades would have resulted in tremendous amount of R&D infrastructure to handle something like this more rapidly. Instead, they've spent it on inversion mergers and patent defense litigation. It's ok. I am sure the 1-1.5 years is a conservative/pessimistic scenario. After all, look at what a good job we've done with rolling out testing in this country. We can't even match a recently "emerging economy" like S Korea.

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. Let’s see. This thing seems rare to me in how it doesn’t harm kids as much as the elderly. I think the risk is not how many get it - it is going to spread no matter what we do - but limiting intra-family interactions to protect the elderly. But that’s it from me. If you disagree I’m not going to argue, because I don’t hold my views as strongly as you clearly do. Only time will tell. We don't need beliefs. We know the best ways to manage pandemics like this. It's just economically costly. Ironically, the economic costs of acting earlier will be <<< delaying action to later. This crisis will be much more expensive for Italy than South Korea/Taiwan/Singapore. "An ounce of prevention is worth a pound of cure" But what do I know, I just chant dumb sayings from dead wise men

Not too many assumptions, just basic supply/demand (of critical care resources) principle with that chart. If everyone went to their bank to take out all their money right now, the bank would fail. Withdraw money gradually over time, no problem. Like I said, there are real live examples of this occurring right now (Italy), no dogma required. To dismiss the advantage of precaution is reckless. Furthermore, if there are future positive black swans (treatment/vaccine development), then delaying infections out into the future is much much better. The British and American responses are more reactive than proactive and you will see the consequence of that over many months. Precautionary principle is not just a nerdy term for people who read books.

We have data from places like China—question is if you can trust it. Based on this data, Locking down Hubei had a major impact on spread throughout the other provinces. Turns out there are actions you can take to nip this in the bud instead of infecting 60% to achieve “herd immunity”. Don’t misunderstand British policy. Britain will lock down. But it’s at an earlier stage than many other countries and locking down too early is potentially catastrophic. Plus, as your flu/Christmas example demonstrates, the problem comes when you *lift* the lockdown. That’s why herd immunity matters. For interest: If you close schools for the period of infection: 2-3 weeks and then restart school, there will be no spike in infections because the disease will have run its course and those kids will be immune and not bring it back to school with them. That's what happened with Hubei lockdown as well--contain an area for enough time for already infected individuals to have disease run its course and not spread it to uninfected people. Furthermore, slowing spread over time prevents healthcare/crit care resources from being strained beyond capacity which has been stated on this thread many many many times by many individuals (and Italy is a living example of this). Taking action early is better than taking it later when things spiral out of control...exponential growth yada yada. I prefer this tweet on British policy:

We have data from places like China—question is if you can trust it. Based on this data, Locking down Hubei had a major impact on spread throughout the other provinces. Turns out there are actions you can take to nip this in the bud instead of infecting 60% to achieve “herd immunity”.