Dalal.Holdings

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”.

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. I am confident about stuff that has a lot of evidence backing it. Every year in the United States, new flu cases (also spread by respiratory droplets) drop drastically around end of December. Why is that? Winter break for all K-12 kids. In January, infections ramp back up.

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.