DocSnowball

Working on strengthening the process and muscle of disconfirming the hypothesis. First at the start, then with fundamental changes. For an beginner investor like me, it's still very challenging as to what's disconfirming evidence versus what's noise - a learning curve. Other rules at the portfolio level that have helped me are deciding max position size limits early when forming the investment thesis, and not doubling down to try to catch a falling knife (and get killed in the process). Again, didn't come from simply reading this body of work, it is something that has taken past mistakes for the bad habits to be broken.

Jim Parrott and Ed DeMarco - the infamous GSE Net Worth Sweep

One important factor to consider is beliefs of the burden of disease versus beliefs of harm from the vaccine. This NEJM perspective article sheds light. IMHO cities and communities that have seen significant disease impact will have more successful vaccine rollouts. Go big and go fast - vaccine refusal and eradication https://www.nejm.org/doi/full/10.1056/NEJMp1300765

Calabria is a hero to his think tank buddies. Meanwhile middle class Americans must send more of their wages to mortgages (or apt landlords if they are shut out). The arbitrary and excessive buffer amount will likely turn into a political football with changes coming under every administration (assuming Seila's outcome is as expected). I can guess who Mr. Tim Howard is rooting for in 5 months. while my preference is for the trump administration to carry through on its "plan" for the next 4 years, I am beginning to see the silver lining of a Biden administration. I think the key question is still whether this is a binary investment in either admin? At this point, and after the companies hire financial advisors, that risk is getting lower and lower. How much the preferreds will be worth in the end is in the "too hard" or uncertain pile, but they will be worth much more than they are at present as long as the companies are recapitalized. If the companies are recapitalized, it seems just too unlikely to me that a financial and legal advisor will take the risk of recommending something that invites even more lawsuits. More likely they will suggest something that is CYA and placates all sides that are willing to be placated.

Excellent point. This is one of the things changing the mortality rate, along with having more hospital space and staff capacity available, and to some extent Remdesivir and IL-6 receptor blockers. It will be interesting to look at the mortality rate by severity category June onwards now that so much more is known.

Apologies if this has been covered already. Just digging into Moderna's phase 1 results. They studied the vaccine in 3 doses 25/100/250 in 18-55 age group. Proof of concept looks solid, based on having antibody titers comparable to those in recovering patients with all doses (including neutralizing antibody titers in 8 of 8 with 25/100 dose that have so far been tested). They had systemic side effects in 250 dose and won't go any further with that. Mouse studies showed prevention by these antibodies. Phase 2 will look into more efficacy and safety data likely with 25/50/100 or two of these. Phase 3 likely to be in July or August and study 18-55 age group and older age group, I'd say in a city with an outbreak at the time and/or healthcare workers. Company raised capital and is looking to expand manufacturing capabilities. Overall as much as I could have hoped for from a first of its kind mRNA vaccine. This is just a little outside my circle of competence, and I'm tempted to expand it and learn more. I guess I still wonder how immunogenic the lower doses will be in the elderly, what about kids, can the vaccine cause a cytokine storm in those who have had true infection before etc. On the whole, the product, the trial design, the team and the company appear impressive. Disconfirming views welcomed :) More details here: https://investors.modernatx.com/news-releases/news-release-details/moderna-announces-positive-interim-phase-1-data-its-mrna-vaccine https://investors.modernatx.com/events-and-presentations https://www.modernatx.com/modernas-work-potential-vaccine-against-covid-19

Liberty, I am not sure what sounds bad. In this times while the world is shut down, a test that takes $200K, a professor from Stanford had to take 5000$ to do the test which everyone agrees needs to be done? They didn't have any funds from the 2 trillion dollars to do the study? The plan was to keep making decisions without knowing the real extent of spread and who is getting how much? That is what sounds bad. Many studies (and I posted recently on this) confirmed Stanford result. The studies confirmed the Stanford study results, that there are lot of asymptomatic carriers and the infection fatality rate is much lower than thought before. The buzzfeed is an attack article because it fails to mention I believe a dozen more studies done since then by different teams across world, many of them are reputed hospitals or professors. Buzzfeed "forgets" to mention this and goes on attacking a scientist for doing his job which frankly, the task force should have done long back. We are really going back to Galileos times attacking the scientist rather than looking at the result and its confirmation in multiple studies and its consequences of this new information. This attitude of Buzzfeed can take us to medieval ages and it is really shameful article. I respectfully disagree. Maybe there are more perspectives to this. For starters, the people doing the study had very publicly stated what they were looking for find. Confirmation bias did the rest. A lot of flaws are valid. First, funding from anyone is ok. What's not ok is the funder first going through various indirect channels to fund the study, and then directly being in touch with those conducting the study and even their collaborators trying to push things along. Second, not entirely the scientists fault but something that changes interpretation, is how participants were selected and who would opt in. There is an inherent bias in who will want to show up to get a blood test in the middle of a pandemic shelter in place order. Those who may have had mild symptoms or someone sick in their family and want to know if they had SAR CoV-2 are more likely especially given the way participants were recruited by email here, rather than random sampling. Third, if the test was showing a lot of false positives, this means the true %positive likely is lower than what they suggest. Lastly, look at who the lead investigator is, someone I and many others revered before reading this article. Only the highest standards are expected from someone like this. It would be standard in the industry to carefully do the basics I'm noting, make sure the test is valid, randomly sample the population etc. This is why collaborators are sour. And while we're at it, let's throw in going all over town to talk about the results before properly peer reviewing them. Seems par for the course nowadays. As they say, it takes a lifetime to build a reputation, but 15 minutes to destroy it.

3 trial results came out the same day: NIH ACTT trial - discharge in 11 days vs 15, mortality 8% vs 11.6% in Remdesivir vs control arms ( so reduced morbidity, second order effects on reducing overburdened health care systems) https://www.niaid.nih.gov/news-events/nih-clinical-trial-shows-remdesivir-accelerates-recovery-advanced-covid-19 SIMPLE trial - 5 days and 10 days use showed no significant differences (so can be used in shorter course). IDK why they did not release any data about the control arm in this one, I thought it had it... https://www.gilead.com/news-and-press/press-room/press-releases/2020/4/gilead-announces-results-from-phase-3-trial-of-investigational-antiviral-remdesivir-in-patients-with-severe-covid-19 China Remdesivir trial 237 patients data - no significant mortality benefit https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31022-9/fulltext As far as the twitter poster goes, one point well taken is that the next population to study in trials would be earlier start of treatment (now that we have same day per testing) and high risk non-hospitalized patients (somehow delivering at home maybe). Sarilumab phase 2 data also came out, with phase 2 outcome met and phase 3 trial focusing on critically ill patients only where potential to reduce mortality is being seen. Thirdly a lot of attention is going towards the prothrombotic effects of the virus as well as proning early. Stacking all of them and what we know about the virus after all this time, I think mortality will be lower in the future, although a little bit lower not a lot lower (just my opinion).

Sorry haven't been able to keep up with this thread! This is an interesting report on future scenarios: https://www.cidrap.umn.edu/covid-19/covid-19-cidrap-viewpoint "In the first report, published Apr 30, 2020, "The future of the COVID-19 pandemic: lessons learned from pandemic influenza," Kristine Moore, MD, MPH, Marc Lipsitch, DPhil, John Barry, MA, and Michael Osterholm, PhD, MPH, paint a picture of the pandemic and detail how it's behaving more like past influenza pandemics than like any coronavirus has to date. And, because of that, certain inferences can be drawn — such as the fact that it may well last 18 to 24 months, especially given that only 5% to 15% of the U.S. population is likely infected at this point. Key recommendations from the report: States, territories, and tribal health authorities should plan for the worst-case scenario (which involves a large second peak of cases in the fall of 2020), including no vaccine availability or herd immunity. Government agencies and healthcare delivery organizations should develop strategies to ensure adequate protection for healthcare workers when disease incidence surges. Government officials should develop concrete plans, including triggers for reinstituting mitigation measures, for dealing with disease peaks when they occur. Risk communication messaging from government officials should incorporate the concept that this pandemic will not be over soon and that people need to be prepared for possible periodic resurgences of disease over the next 2 years. The first CIDRAP Viewpoint report lays out three scenarios for how cases might ebb and flow in the coming months. No one knows exactly how this virus will behave. But, based on what scientists have recorded so far and on previous influenza pandemics, the report illustrates some of the possibilities."

Just finished doing a session of healthcare workers in the NYC/CT relating their own and their family's experiences with COVID (entirely anecdotal stuff coming up)... A lot of the time the entire household was infected, except for kids under 10 It was very hard to get testing unless you were very sick or fought tooth and nail (remember these are healthcare workers, still could not get tested easily in the beginning - later guidance started to include them in testing prioritization) Hospital staff capacity was at breaking points consistently, with it being difficult for those admitted to even get food to eat within a couple of hours of schedule - due to staff out sick, expanded capacity, and proning of ICU patients taking a lot of time It is a nightmare to communicate with someone admitted to the hospital - very limited, it is extremely lonely and isolating for both those in the hospital and their families outside the hospital I'm trying to make meaning out of these anecdotes - likely there are a lot more infected than testing indicates (we all know that by now). This excess number includes those who are mildly ill but never got tested, and then double that total to include those who were infected could have been asymptomatic. So multiply case counts by 2-5x. This is how we are getting to 0.6-15% total infected population in different geographies that have released data so far. While CFR may be lower, the people who did get to the front of the queue and got tested is testimony to the fact how many moderate to seriously ill patients are out there. This is not a virus to mess with. The hospitalization rate and critical illness rates are quite staggering as well. This explains why hospitals are so overwhelmed. Nothing much except COVID care is going on in most hospitals in our region for the last month.

https://www.wsj.com/articles/charlie-munger-the-phone-is-not-ringing-off-the-hook-11587132006?mod=hp_lead_pos10 Quoted excerpt below: Will Berkshire step up now to buy businesses on the same scale? “Well, I would say basically we’re like the captain of a ship when the worst typhoon that’s ever happened comes,” Mr. Munger told me. “We just want to get through the typhoon, and we’d rather come out of it with a whole lot of liquidity. We’re not playing, ‘Oh goody, goody, everything’s going to hell, let’s plunge 100% of the reserves [into buying businesses].’” He added, “Warren wants to keep Berkshire safe for people who have 90% of their net worth invested in it. We’re always going to be on the safe side. That doesn’t mean we couldn’t do something pretty aggressive or seize some opportunity. But basically we will be fairly conservative. And we’ll emerge on the other side very strong.” Surely hordes of corporate executives must be calling Berkshire begging for capital? “No, they aren’t,” said Mr. Munger. “The typical reaction is that people are frozen. Take the airlines. They don’t know what the hell’s doing. They’re all negotiating with the government, but they’re not calling Warren. They’re frozen. They’ve never seen anything like it. Their playbook does not have this as a possibility.”

I think that this is an extremely good point that has gotten lost over the past month or two. The goal is to avoid overwhelming the healthcare system, not to eliminate every potential death from the virus by remaining shut for a year. (Based on Canadian polling, it's pretty clear that Canadians in aggregate don't get it.) On the "how to reopen" list, it shocks me that they aren't bothering to require masks, since it seems to be a cheap and easy solution to reduce transmission (and deaths and medical costs). I wonder if there was some reasoning behind that, or if they were just writing down stuff on autopilot, and not really thinking. If they decided not to include it for cultural reasons, that puts the US at a competitive disadvantage relative to other countries that are more open-minded about such things. When you ‘mismanage’ the virus outbreak you have to resort to lock down. (And by mismanage i mean not being able to control the virus.) We all know that lock down exacts an enormous toll on the economy. While in lock downs governments have a small window of time to pull together experts and implement a very detailed national strategic plan to combat the virus. This involves switching from playing defense to playing offense. The playbook is pretty straight forward: massive focussed and prioritized testing, quick results (within 24 hours), massive group of people to contact trace. How effective governments are with this stage will determine how quickly they can unlock the economy. And also, more importantly, how long the economy will remain unlocked. If you have no detailed national plan for phase 2 (reopening of the economy) you are likely screwed. As you try an reopen the economy all that will happen is the virus will win again. It will start to silently spread. Clusters will form and governments will need to resort to lock down again. We will find in the coming months which governments are up to the challenge. This is NOT a debate about ‘health’ OR ‘economy’. This is a debate about leaders who are effective and leaders who are ineffective. I fear the healthcare workforce is going to be the biggest loser in this mismanagement. Still trying to figure out what this will mean to healthcare workers long term. Many who are high risk (or their family members are) may choose to walk away after a few rounds of mismanagement...

Complement to Cobafdek, in the middle of the (tribal) fight. Your question is difficult to answer (it feels like: What's the risk of shorting Tesla stock?) and it includes the evaluation of tail risk. Since my background has some relevance and since i need to address this question now, here's a tentative answer. It seems that the opening will be gradual and the rate of opening will be inversely proportional to virus resurgence. So you'll need to adjust your risk management for your area and with the evolving picture. I work with a scenario of localized and limited resurgence activity during the opening with no second or third wave although this could become low-grade seasonal. I'd say testing will be useful for certain areas of concern but it's hard to see how testing at large will be useful for local decisions. I would also add that herd immunity is not a black or white concept. Relative herd immunity may be much lower than the often 60-70% quoted. 1st risk: risk that you become a spreader without being sick This is a population-level risk but also an individual risk as you may bring the disease to loved ones who may be susceptible (known risk factors or even rarely idiosyncratic). Then, your cumulative (i share DocSnowball's realism about molecules and timeline) individual risk is likely lowish (and will evolve over a fairly long time), especially if you take basic precautions (basic distance, washing hands, and avoiding social contacts with older (or frail) friends or family members). The concept of position sizing (extent of your social participation along the activity risk spectrum you describe) could be applied as a degree of conviction that your area is safe (from publicly announced statistics, hospital activity level etc). 2nd risk: risk that you become significantly sick Apart from idiosyncratic risk, which is very low, your risk will be proportional to risk factors (age, lung disease, obesity, diabetes etc) with individual risk factors being likely more than additive and serious event risk going up exponentially with the overall level of frailty. Assuming not super vulnerable means no major risk factors, it seems that your risk of becoming significantly sick is very low (do your own work :) ). What you do as an individual is also tied to your risk personality. If you used to go for the flu vaccine every year versus not even worrying about becoming sick will have an influence on future behavior vs CV. It's possible CV becomes old news very rapidly especially if other events take eyeballs off the bug (and its consequences). @Jurgis: personally I wait for one incubation period to start to trust the data - cases in your state have gone down and stayed down for 14 days; and for two incubation periods for giving the all clear - cases are in single digits or zero in your state for 28 days. Try to phase your return back towards activities in that way. The most essential activities come first, and the lowest risk will be where you're not within 3-6 feet of others and are outdoors. The highest risk will be going to healthcare facilities and crowded indoor gatherings. One thing I've learned is this virus is 2 SD beyond what I've expected of it in spreading, so better to be safe than sorry. The fact that it spreads so easily in healthcare facilities (10k healthcare workers infected in the US!!! cities with public transport really hit hard) tells me there is effective transmission beyond droplets, perhaps it lives well on surfaces + asymptomatic/presymptomatic people spread it early on...(you fill in your thoughts) Maybe a smart idea to build a checklist of do's and don't to follow before, during and after going out and test-drive/refine it when you start going out. I'll try to get it started. Is this activity essential? What is the risk in this activity? How can it be substituted or minimized? Hand sanitizer - check. Wipes - check. Mask - check. Keeping social distance, minimizing touches, minimizing time spent/risk incurred in the activity Sanitize when done, dispose mask and take footwear off safely on return Hand washing when home Dispose clothes for washing later, hand washing again

Randomized trial for hydroxychloroquine being run in the US is still to finish. While the above data gives one pause, here is the larger issue if HCQ is not effective: The only other anti-viral being studied seriously is Remdesivir from Gilead. It is an intravenous drug, so using it at scale for treating everyone with mild or moderate symptoms, or for protection of healthy exposed individuals is a non-starter. So if there is no oral drug, we'd continue to wait for people to get admitted/ seriously ill before giving them effective therapy. The second class of drugs being studied is IL-6 receptor blockers Tocilizumab or Sarilumab, for which trials are being run for patients in intensive care, most on the ventilator. So drugs to use in reducing death rate in the very late stage. Only HCQ or an oral drug has the game changer potential. Not anchoring as a scientist, but hoping as an imperfect human we get something to work with on HCQ treatment and prophylaxis trials. Finally, HCQ, Remdesivir, and IL-6 receptor blockers are ALREADY being widely used across the US. So the mortality rate is what it is despite widespread use. Unless the drugs were causing the deaths, we won't get very dramatically different results even if a trial shows efficacy (although we will see some improvement). On the whole, I remain pessimistic on the healthcare and therapeutics front...

VOO bought over second and third week of March

Thanks for starting this and thanks for sharing. Same feelings and situation here, financially prepared but not personally or professionally. Wonder how I'll put my family through something like this again after all this is over. For some it's a 1 in 100 year event, for our line of work something rears it's head every few years. First thoughts are to live in the moment and take it one day at a time....regroup after making it safely on the other side.

Interesting input on Lancet ID Case fatality rate - if there were a few people dying outside the hospitals in China, then CFR is much higher than the data shows.

New model published in Lancet ID based on China, Diamond princess and those who came out of China to the rest of the world, revising fatality rates down. Attached fatality rates table by age groups. See Table 1 for fatality rates and Table 3 for projected hospitalization rates by age group (does not go deeper into those with high risk conditions). Time will tell! https://www.thelancet.com/action/showPdf?pii=S1473-3099%2820%2930243-7 A state by state healthcare system and population based projection here from IHMI: It models the burden on hospital resources and deaths for the US and for each state. NY is predicted to peak on 6 April, and the US as a whole in mid-April. Although there are wide confidence intervals, the number are sobering. They predict about 80K deaths. The IHME has been the lead on the global burden of disease study – the definitive ongoing study of disease burden (mortality & disability) for more than 350 diseases and 84 risk factors in 195 countries (https://vizhub.healthdata.org/gbd-compare/). https://covid19.healthdata.org/projections Lancet_ID_Table_1.pdf

New model published in Lancet ID based on China, Diamond princess and those who came out of China to the rest of the world, revising fatality rates down. Attached fatality rates table. Anyone know how good their "estimate" is in making the leap from "cases" to those who are potentially "infected". Overall quite reassuring if you're under 50. NYTimes reports that White House will release the models they are using today as well. Will be interesting to see. https://www.thelancet.com/action/showPdf?pii=S1473-3099%2820%2930243-7 A second healthcare system and population based projection here from IHMI: This is the best modeling I have seen for COVID-19. It models the burden on hospital resources and deaths for the US and for each state. NY is predicted to peak on 6 April, and the US as a whole in mid-April. Although there are wide confidence intervals, the number are sobering. They predict about 80K deaths. The IHME has been the lead on the global burden of disease study – the definitive ongoing study of disease burden (mortality & disability) for more than 350 diseases and 84 risk factors in 195 countries (https://vizhub.healthdata.org/gbd-compare/). https://covid19.healthdata.org/projections Lancet_ID_Table_1.pdf

+1 And this is not priced into the markets yet...especially that the social distancing will need to go on another month or so and it's financial impacts

"Covid 19 Protecting Your Family" Take a listen, excellent practical explanations. Well worth your time!

OMG! Never seen anything like this graph in 15 years of tracking these seasonal flu curves!!!

Yes, where we go from here is the million $ question. Three weeks ago looking at China, South Korea, Iran and Italy provided great insight of what was coming to North America. We got confirmation when the cluster was confirmed in Washington State and a week later in New York. The impact of the virus on a country for the first month or so has been fairly predictable. The challenge looking forward is each country has taken rather different approaches to managing the virus. The asian countries have similar strategies built around testing, contact tracing and some social distancing measures. Europe and North America have executed very different strategies built around limited testing (resulting in rampant community transfer) followed by soft or hard lock downs (depending on severity). Looking forward, i can see the asian countries path forward. They have been able to get control of their destiny. Again, it is built around aggressive testing and contact tracing and social distancing; slowly they will be able to find ways to bring more parts of the economy back on line. So my view is the asian countries will see their economies slowly start to grow again, but still slower than is expected. The virus is still present and strict measures will need to be in place, likely until a vaccine is ready (12-18 months?). What is the path forward in Europe and North America? We are still out of control, with no articulated plan to get in control of our destiny. We also will need time to execute said plan. This tells me we are still in the early stages in our battle with this virus. And we are now losing precious time and falling behind asia in the process of recovering from this epidemic. This means it will take us longer for us to re-open our economy up (compared to asia). Another learning from asia is what your economy looks like once you get the virus somewhat under control. It is definitely not V shaped recovery for the economy. Perhaps L For a couple of months with the prospect of U afterwards. if you do a great job of not letting the virus to get re-established. The economy needs time to adapt to a world where the virus is ever-present and trying to break out again. All of the above leads me to the following conclusion: the time it takes to get control of the virus in Europe and North America is going to be much longer than people think. Therefore the economic impact is going to be worse than currently expected. And once we eventually get control of the virus in Europe and North America the ’recovery’ is going to be slower as The virus will still be with us and it will take time for everyone to adjust (people, companies and governments). +1 First order effects are now obvious. But social distancing has not been done in a systematic manner in the US. NYC is as ongoing disaster; unfortunately the Northeast is seeded now without fully realizing it because of inadequate testing. I think a prolonged phase is not priced into equities, the bounce back isn't making sense in terms of fundamental developments (US is the pandemic epicenter now and will remain for the next month, digest that and reflect if you thought that would be the case two weeks ago). I'm waiting for second order and third order effects to show as this plays our over a longer period of time.

@Orthopa - there is always value in considering the disconfirming opinion. One data point that I have not been able to reconcile, while clearly being in disagreement with your views, is why deaths have plateaued in countries like Iran - is the CFR lower and it burns through the population after a few weeks? I don't know, will have to watch Europe and NYC to support or refute this. But I'm curious to see the death curve flattening out after a few weeks first in China and then Iran. Italy is still in the mid-700s daily deaths, but has stopped going up further. Social distancing is the obvious intervention everywhere and confounds this data. Another aspect is why so few cases in Asia south of China, despite fewer measures - is it much less contagious in warmer weather? It looks like that at this point. There was a publication to support that higher temperatures and humidity make it less contagious. One new data point I'm seeing is that China and Korea continue to have about 100 or so cases daily. Until these go to zero for a months or two, one has to consider that the virus will remain in the human population somewhere around the globe and new outbreaks can occur despite the upfront economic costs we are incurring.

The successful counties all have a number of things in common: robust, aggressive testing process in place. Information is communicated via their cell phone (personal freedom is secondary). Their populations are also educated and supportive of containment measures. Most everyone wears masks when they are out. Until we are able to do all these things we will need to keep everyone in lock down (very blunt instrument). Much should change in the next 8 weeks. Smart people should be able to figure this out. The sooner the better. I am least optimistic on the timing front; politicians and elected officials are often not the best and the brightest (and i say that will all due respect). FDA has now approved the routine nasal swab for COVID testing. Removes another bottleneck. Expect testing to be widespread and easily available. 45-60 minutes turnaround time for inside the hospital, a day or at the most two for drive through testing. https://www.fda.gov/emergency-preparedness-and-response/mcm-issues/coronavirus-disease-2019-covid-19 CMS did a nationwide conference call with physicians today (Seema Verma and Deborah Birx were on it) - what is notable is how quickly this administration is removing roadblocks to Telehealth, and to COVID testing. FDA has also set up numerous clinical trials for treatment and prophylaxis, so that we find out what works and what doesn't. While the planning phase was an obvious botch up, it's been more than a decade since anyone in administration has been even bothered to talk with or listen to physicians in this country. On the downside, if we open too soon, while the economy may or may not improve quicker (don't know enough to comment), what is certain is COVID clusters will show up in hospitals uninvited and be a healthcare transmitted infection (plenty of precedent with MERS-CoV in Middle East). I shudder to think of the safety of our healthcare workforce in the coming months. What's not clear from the decision makers isn't "what we will do", rather "how we will decide". I'd think the data about daily cases and deaths will drive this decision, as well as lessons learned from European countries a few days ahead of the US.