Coronavirus

[Castanza]

You’re right, 102 years of medicine and healthcare advances may help fight this relative to 1918

 

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.

 

Lack of testing (thus giving visibility) and means of spread prevention are two different things in my opinion. They work together on some level for sure. But for something as infectious as this, if you miss a single person who is infected anywhere it is already too late. In fact the incubation period alone (14 days) is enough to come to the conclusion that stopping spread is pretty much impossible.

 

Even if the US and other countries started preparing for COVID-19 the minute the heard about it, the time frame for vaccine development would still likely be 1 year. If test kits were developed in masses on the first day it still would be too late because individuals are walking around for potentially 14 days with no symptoms. Eventually would most likely show "mild" symptoms that they probably wouldn't seek testing for to begin with.

 

 

This is wrong though. Basic epidemiology and how R nought works. Each person you contain prevents about 2-3 other infections.

 

You can only contain what you can see. If you're not showing symptoms, you're not getting tested. It's compounding regardless and as you said above there are no hospitals with enough beds. I guess the question is, would testing with quarantine of individuals who test positive slow the compound rate enough to reduce the impact on hospitals? Probably not. And I'm not saying they shouldn't test. I'm just saying everyone's focus on it seems bit overcooked.

 

For example: my wife works in the most advanced level 4 NICU east of the Mississippi. They have a whopping total of 62 beds...

[Dalal.Holdings]

You’re right, 102 years of medicine and healthcare advances may help fight this relative to 1918

 

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.

 

Lack of testing (thus giving visibility) and means of spread prevention are two different things in my opinion. They work together on some level for sure. But for something as infectious as this, if you miss a single person who is infected anywhere it is already too late. In fact the incubation period alone (14 days) is enough to come to the conclusion that stopping spread is pretty much impossible.

 

Even if the US and other countries started preparing for COVID-19 the minute the heard about it, the time frame for vaccine development would still likely be 1 year. If test kits were developed in masses on the first day it still would be too late because individuals are walking around for potentially 14 days with no symptoms. Eventually would most likely show "mild" symptoms that they probably wouldn't seek testing for to begin with.

 

 

This is wrong though. Basic epidemiology and how R nought works. Each person you contain prevents about 2-3 other infections.

 

You can only contain what you can see. If you're not showing symptoms, you're not getting tested. It's compounding regardless and as you said above there are no hospitals with enough beds. I guess the question is, would testing with quarantine of individuals who test positive slow the compound rate enough to reduce the impact on hospitals? Probably not. And I'm not saying they shouldn't test. I'm just saying everyone's focus on it seems bit overcooked.

 

For example: my wife works in the most advanced level 4 NICU east of the Mississippi. They have a whopping total of 62 beds...

 

Are you trained in epidemiology? This stuff is not rocket science and it is certainly not new. Your argument is like saying “so what if i lose 99% of my portfolio, the remaining 1% will continue to compound and I will be rich someday”.

[jmp8822]

 

“ Here is the President of the United States telling the country it's okay to go to work with Coronavirus.

 

I'm not kidding”

 

 

“To get a sense of how badly the US government is handling the coronavirus pandemic, consider that of this week they had only done 500 tests in a population of 330million.

 

Australia has tested 10,000 people with a population of 25million“

 

He did not say you should go to work if you are sick. Please stop posting your political views in every thread - it is annoying.

[Castanza]

You’re right, 102 years of medicine and healthcare advances may help fight this relative to 1918

 

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.

 

Lack of testing (thus giving visibility) and means of spread prevention are two different things in my opinion. They work together on some level for sure. But for something as infectious as this, if you miss a single person who is infected anywhere it is already too late. In fact the incubation period alone (14 days) is enough to come to the conclusion that stopping spread is pretty much impossible.

 

Even if the US and other countries started preparing for COVID-19 the minute the heard about it, the time frame for vaccine development would still likely be 1 year. If test kits were developed in masses on the first day it still would be too late because individuals are walking around for potentially 14 days with no symptoms. Eventually would most likely show "mild" symptoms that they probably wouldn't seek testing for to begin with.

 

 

This is wrong though. Basic epidemiology and how R nought works. Each person you contain prevents about 2-3 other infections.

 

You can only contain what you can see. If you're not showing symptoms, you're not getting tested. It's compounding regardless and as you said above there are no hospitals with enough beds. I guess the question is, would testing with quarantine of individuals who test positive slow the compound rate enough to reduce the impact on hospitals? Probably not. And I'm not saying they shouldn't test. I'm just saying everyone's focus on it seems bit overcooked.

 

For example: my wife works in the most advanced level 4 NICU east of the Mississippi. They have a whopping total of 62 beds...

 

Are you trained in epidemiology? This stuff is not rocket science and it is certainly not new. Your argument is like saying “so what if i lose 99% of my portfolio, the remaining 1% will continue to compound and I will be rich someday”.

 

SARS R0 varied a lot during the epidemic. It ranged from 2-15 and hen fell all the way back down to 3. I think we agree more than what you think. There is no vaccine so R0 isn't all that helpful. Testing is helpful to a degree but absent a vaccine impact is minimal. Locking down high risk individuals and limiting their exposure is probably the best. So far 81% of cases have been "mild".

 

"The model we’ve used for our R_0 estimate is phenomenological, which means that it doesn’t aim to *explain* what’s happening on the ground but rather to *describe* it. This is a good option in information-scarce situations, like at the start of a novel viral outbreak (AKA now)."

 

— Dr. Maia Majumder (@maiamajumder) January 24, 2020

 

 

How much does R0 matter?

R0 is a useful number to understand when it comes to things like determining vaccine targets (the higher the R0, the more people you have to vaccinate to stop the disease from spreading). But the work of containing an outbreak can begin even before we have R0 nailed down.

 

The R0 depends on a few things, including how long a person is contagious, how many susceptible people they tend to interact with, and how transmissible the infectious agent is.

 

That means we can make an epidemic less likely to spread by attacking those particular factors. We can make fewer people susceptible to the virus; that’s what a vaccine does. (There’s no vaccine for the coronavirus yet, but perhaps there will be someday.) You can reduce the amount of time you’re able to spread the virus by staying home if you’re sick. And you can reduce transmissibility through measures like hand washing. These are all good actions to take no matter what the R0 turns out to be, and they’re good advice even for ordinary colds and flu.

[orthopa]

Just reading through some of these comments last couple of days some of you guys really bought into the panic of this huh? Reading and watching all of this reminds me of Y2K. I work in healthcare, have not seen any corona virus yet and honestly I hope if it comes to my area I hope I get it right away. Significantly limits my ability to get reinfected. All evidence points to at my age it will be mild and flu like and will allow me to eventually get back to my job with a low level of worry. I have a very low level of worry now. This seems to be affecting old/ immuno compromised people the most( like everything else) These people bluntly are going to die at some point in time sooner then their more resistant counterparts. Not much at this point any of us can do otherwise. The panic is irrational.

[matts]

Just reading through some of these comments last couple of days some of you guys really bought into the panic of this huh? Reading and watching all of this reminds me of Y2K. I work in healthcare, have not seen any corona virus yet and honestly I hope if it comes to my area I hope I get it right away. Significantly limits my ability to get reinfected. All evidence points to at my age it will be mild and flu like and will allow me to eventually get back to my job with a low level of worry. I have a very low level of worry now. This seems to be affecting old/ immuno compromised people the most( like everything else) These people bluntly are going to die at some point in time sooner then their more resistant counterparts. Not much at this point any of us can do otherwise. The panic is irrational.

 

I don't think many here are panicking that they might die from the virus. But the economic impact will be real and non-trivial.

[shhughes1116]

You’re right, 102 years of medicine and healthcare advances may help fight this relative to 1918

 

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.

 

Lack of testing (thus giving visibility) and means of spread prevention are two different things in my opinion. They work together on some level for sure. But for something as infectious as this, if you miss a single person who is infected anywhere it is already too late. In fact the incubation period alone (14 days) is enough to come to the conclusion that stopping spread is pretty much impossible.

 

Even if the US and other countries started preparing for COVID-19 the minute the heard about it, the time frame for vaccine development would still likely be 1 year. If test kits were developed in masses on the first day it still would be too late because individuals are walking around for potentially 14 days with no symptoms. Eventually would most likely show "mild" symptoms that they probably wouldn't seek testing for to begin with.

 

 

This is wrong though. Basic epidemiology and how R nought works. Each person you contain prevents about 2-3 other infections.

 

You can only contain what you can see. If you're not showing symptoms, you're not getting tested. It's compounding regardless and as you said above there are no hospitals with enough beds. I guess the question is, would testing with quarantine of individuals who test positive slow the compound rate enough to reduce the impact on hospitals? Probably not. And I'm not saying they shouldn't test. I'm just saying everyone's focus on it seems bit overcooked.

 

For example: my wife works in the most advanced level 4 NICU east of the Mississippi. They have a whopping total of 62 beds...

 

Are you trained in epidemiology? This stuff is not rocket science and it is certainly not new. Your argument is like saying “so what if i lose 99% of my portfolio, the remaining 1% will continue to compound and I will be rich someday”.

 

SARS R0 varied a lot during the epidemic. It ranged from 2-15 and hen fell all the way back down to 3. I think we agree more than what you think. There is no vaccine so R0 isn't all that helpful. Testing is helpful to a degree but absent a vaccine impact is minimal. Locking down high risk individuals and limiting their exposure is probably the best. So far 81% of cases have been "mild".

 

"The model we’ve used for our R_0 estimate is phenomenological, which means that it doesn’t aim to *explain* what’s happening on the ground but rather to *describe* it. This is a good option in information-scarce situations, like at the start of a novel viral outbreak (AKA now)."

 

— Dr. Maia Majumder (@maiamajumder) January 24, 2020

 

 

How much does R0 matter?

R0 is a useful number to understand when it comes to things like determining vaccine targets (the higher the R0, the more people you have to vaccinate to stop the disease from spreading). But the work of containing an outbreak can begin even before we have R0 nailed down.

 

The R0 depends on a few things, including how long a person is contagious, how many susceptible people they tend to interact with, and how transmissible the infectious agent is.

 

That means we can make an epidemic less likely to spread by attacking those particular factors. We can make fewer people susceptible to the virus; that’s what a vaccine does. (There’s no vaccine for the coronavirus yet, but perhaps there will be someday.) You can reduce the amount of time you’re able to spread the virus by staying home if you’re sick. And you can reduce transmissibility through measures like hand washing. These are all good actions to take no matter what the R0 turns out to be, and they’re good advice even for ordinary colds and flu.

 

This interaction reflects some of the challenges with the current covid-19 situation.  There are a lot of people exchanging information and opinions on a topic for which most have not received training.  After a while, these "opinions" and "misconceptions" start becoming portrayed as facts, which is unfortunate. 

 

I am trained/educated as an epidemiologist (and biostatistician).  With this training/education/background, and work experience to support it, you start to realize how little we (as a society) actually know about this virus.

 

Social distancing is a means to bend the curve down.  It will not prevent all infections, and that is not the point.  BUT, it will reduce the rate of new infections, thereby buying time to find existing infections (provided you have a robust testing scheme in place), isolate them, and then treat them.  It will also help to spread out the demand for hospital beds over a longer period of time, allowing hospitals to better cope with the epidemic.  South Korea is a good example of doing this well, especially with their drive-through testing clinics.

 

We are also lucky in the sense that this is an enclosed virus - enclosed within a lipid outer layer.  This makes it especially vulnerable to basic/effective handwashing with soap and water.  Put on a mask to keep yourself from touching your face, wash your hands religiously throughout the day, and don't exchange bodily fluids with random people, and you will be fine.         

[Dalal.Holdings]

Just reading through some of these comments last couple of days some of you guys really bought into the panic of this huh? Reading and watching all of this reminds me of Y2K. I work in healthcare, have not seen any corona virus yet and honestly I hope if it comes to my area I hope I get it right away. Significantly limits my ability to get reinfected. All evidence points to at my age it will be mild and flu like and will allow me to eventually get back to my job with a low level of worry. I have a very low level of worry now. This seems to be affecting old/ immuno compromised people the most( like everything else) These people bluntly are going to die at some point in time sooner then their more resistant counterparts. Not much at this point any of us can do otherwise. The panic is irrational.

 

“Have not seen any corona virus yet”

 

“Reminds me of Y2K”

 

I will be fine. It’s just old ppl who will die, why worry?

 

Incredible.

[perulv]

The panic is irrational.

 

The panic of reduced earnings and increased bankruptcies, or the panic of dying? The first concern seems pretty real, with conferences, flights, marathons, all kinds of gatherings cancelled all over (Europe at least), and more and more people "working" from home. I agree with the latter being irrational for most people.

[LC]

don't exchange bodily fluids with random people

 

Now that doesn't sound like any fun at all :(

 

;D

[orthopa]

Just reading through some of these comments last couple of days some of you guys really bought into the panic of this huh? Reading and watching all of this reminds me of Y2K. I work in healthcare, have not seen any corona virus yet and honestly I hope if it comes to my area I hope I get it right away. Significantly limits my ability to get reinfected. All evidence points to at my age it will be mild and flu like and will allow me to eventually get back to my job with a low level of worry. I have a very low level of worry now. This seems to be affecting old/ immuno compromised people the most( like everything else) These people bluntly are going to die at some point in time sooner then their more resistant counterparts. Not much at this point any of us can do otherwise. The panic is irrational.

 

I don't think many here are panicking that they might die from the virus. But the economic impact will be real and non-trivial.

 

So sell your stocks, and draw from your emergency fund.

[orthopa]

The panic is irrational.

 

The panic of reduced earnings and increased bankruptcies, or the panic of dying? The first concern seems pretty real, with conferences, flights, marathons, all kinds of gatherings cancelled all over (Europe at least), and more and more people "working" from home. I agree with the latter being irrational for most people.

 

If your going to die from it, your going to die from it. WTF are you going to do about it?

[Dalal.Holdings]

I sold significant portions over weeks. See earlier post.

 

https://www.bloomberg.com/news/articles/2020-03-05/u-s-won-t-meet-coronavirus-test-rollout-goal-senators-say

 

The Trump administration won’t be able to meet its promised timeline of having a million coronavirus tests available by the end of the week, senators said after a briefing Thursday from health officials.

 

“There won’t be a million people to get a test by the end of the week,” Republican Senator Rick Scott of Florida said. “It’s way smaller than that. And still, at this point, it’s still through public health departments.”

[orthopa]

Just reading through some of these comments last couple of days some of you guys really bought into the panic of this huh? Reading and watching all of this reminds me of Y2K. I work in healthcare, have not seen any corona virus yet and honestly I hope if it comes to my area I hope I get it right away. Significantly limits my ability to get reinfected. All evidence points to at my age it will be mild and flu like and will allow me to eventually get back to my job with a low level of worry. I have a very low level of worry now. This seems to be affecting old/ immuno compromised people the most( like everything else) These people bluntly are going to die at some point in time sooner then their more resistant counterparts. Not much at this point any of us can do otherwise. The panic is irrational.

 

“Have not seen any corona virus yet”

 

“Reminds me of Y2K”

 

I will be fine. It’s just old ppl who will die, why worry?

 

Incredible.

 

I think its incredible how unhinged you have become. Remind me to be no where near you when the shit really hits the fan. You will have everyone sucking on the barrel of a 12 gauge shot gun praying to Jesus. In all honesty you might feel better if you just got it right away and survived?

[Dalal.Holdings]

Lol. Let’s revisit in 3 months—that’s June 5th. For the record, I hope you will be correct and able to say “I told you so”. Ok?

[Jurgis]

Priceline has $36 per night for a Carnival 5 night cruise to the Bahamas.

 

I heard they extend it for 2 weeks for free.

[orthopa]

The panic is irrational.

 

The panic of reduced earnings and increased bankruptcies, or the panic of dying? The first concern seems pretty real, with conferences, flights, marathons, all kinds of gatherings cancelled all over (Europe at least), and more and more people "working" from home. I agree with the latter being irrational for most people.

 

What amazes me is how everyday, patients I see in the office, overweight, cholesterol through the roof, no exercise, smoking, drugs, family hx of dz (DM, high Chol, CA, etc), etc  and everyone one of these motherfuckers are guaranteed, a statistically early death, significant loss of quality of life, very high likely hood of limb loss, etc etc and not one of them gives a shit about it. Not a single one.

 

They are GUARANTEED to die much sooner then everyone else and like the vast majority of america they do no care. Not one bit. So yes the panic of dying due to a disease that has killed ~3k people vs the ones that have year after year, after year, after year has killed MILLIONS and will continue to kill MILLIONS is irrational.

 

This whole thing is the definition of irrationality. Because I guarantee more then 1 person sitting here reading this panicking is WAY overweight, eating like shit, smoking cigarettes, with high cholesterol, possibly early undetected cancer,  and a horrible family history/genetic disposition that already GUARANTEES a statistically early death. AND THESE PEOPLE HAVE THE POWER TO PREVENT THIS AND WONT DO ANYTHING!

 

Its irrationality, not a fear of dying. That is bullshit.

[Kaegi2011]

 

I work in healthcare...

 

This seems to be affecting old/ immuno compromised people the most( like everything else) These people bluntly are going to die at some point in time sooner then their more resistant counterparts. Not much at this point any of us can do otherwise. The panic is irrational.

 

I'm sorry, you work in healthcare?  As in caring of people who are ill, with the goal of them getting better? 

[Kaegi2011]

What amazes me is how everyday, patients I see in the office, overweight, cholesterol through the roof, no exercise, smoking, drugs, family hx of dz (DM, high Chol, CA, etc), etc  and everyone one of these motherfuckers are guaranteed, a statistically early death, significant loss of quality of life, very high likely hood of limb loss, etc etc and not one of them gives a shit about it. Not a single one.

 

They are GUARANTEED to die much sooner then everyone else and like the vast majority of america they do no care. Not one bit. So yes the panic of dying due to a disease that has killed ~3k people vs the ones that have year after year, after year, after year has killed MILLIONS and will continue to kill MILLIONS is irrational.

 

This whole thing is the definition of irrationality. Because I guarantee more then 1 person sitting here reading this panicking is WAY overweight, eating like shit, smoking cigarettes, with high cholesterol, possibly early undetected cancer,  and a horrible family history/genetic disposition that already GUARANTEES a statistically early death. AND THESE PEOPLE HAVE THE POWER TO PREVENT THIS AND WONT DO ANYTHING!

 

Its irrationality, not a fear of dying. That is bullshit.

 

The difference is that all the things you mentioned above are controllable by those individuals who make conscious decisions regarding their lifestyle.  Any consequence of their lifestyle choices are theirs (and the tax payers) to bear.  The issue here is that we have a contagious disease that doesn't care whether the host is one of hte people you described above, or someone on the other end of the extreme. 

 

So while I understand how you think your logic applies to specifically the people you are talking about, it is not irrational for other people to be concerned. 

[Jurgis]

It seems one reason for not testing more widely is the fear (probably fact) of running out of testing-equipment.

 

That is likely one of the reasons of not testing more widely in US too.

[Jurgis]

Don’t get me wrong, I have some disaster hedges, but I’m also fully infested and corona will certainly not stop that.

 

I hope you're not.  :-[

[thepupil]

Don’t get me wrong, I have some disaster hedges, but I’m also fully infested and corona will certainly not stop that.

 

I hope you're not.  :-[

 

hahaha, well my wife works at a Washington DC hospital...so probably eventually going to get it

[orthopa]

 

I work in healthcare...

 

This seems to be affecting old/ immuno compromised people the most( like everything else) These people bluntly are going to die at some point in time sooner then their more resistant counterparts. Not much at this point any of us can do otherwise. The panic is irrational.

 

I'm sorry, you work in healthcare?  As in caring of people who are ill, with the goal of them getting better?

 

There are goals and there are realities. The reality is if your old and/or immuno compromised your more likely to die if you get the corona virus. Without a cure what exactly would you like a healthcare worker to do in that situation?

[orthopa]

What amazes me is how everyday, patients I see in the office, overweight, cholesterol through the roof, no exercise, smoking, drugs, family hx of dz (DM, high Chol, CA, etc), etc  and everyone one of these motherfuckers are guaranteed, a statistically early death, significant loss of quality of life, very high likely hood of limb loss, etc etc and not one of them gives a shit about it. Not a single one.

 

They are GUARANTEED to die much sooner then everyone else and like the vast majority of america they do no care. Not one bit. So yes the panic of dying due to a disease that has killed ~3k people vs the ones that have year after year, after year, after year has killed MILLIONS and will continue to kill MILLIONS is irrational.

 

This whole thing is the definition of irrationality. Because I guarantee more then 1 person sitting here reading this panicking is WAY overweight, eating like shit, smoking cigarettes, with high cholesterol, possibly early undetected cancer,  and a horrible family history/genetic disposition that already GUARANTEES a statistically early death. AND THESE PEOPLE HAVE THE POWER TO PREVENT THIS AND WONT DO ANYTHING!

 

Its irrationality, not a fear of dying. That is bullshit.

 

The difference is that all the things you mentioned above are controllable by those individuals who make conscious decisions regarding their lifestyle.  Any consequence of their lifestyle choices are theirs (and the tax payers) to bear.  The issue here is that we have a contagious disease that doesn't care whether the host is one of hte people you described above, or someone on the other end of the extreme. 

 

So while I understand how you think your logic applies to specifically the people you are talking about, it is not irrational for other people to be concerned.

 

Sure concern is warranted but we are seeing first hand an evolutionary response (fight/flight) that is kicking in big time. Sure we can take measures to limit the spread but in all reality there is little we can do.

[SnarkyPuppy]

Just reading through some of these comments last couple of days some of you guys really bought into the panic of this huh? Reading and watching all of this reminds me of Y2K. I work in healthcare, have not seen any corona virus yet and honestly I hope if it comes to my area I hope I get it right away. Significantly limits my ability to get reinfected. All evidence points to at my age it will be mild and flu like and will allow me to eventually get back to my job with a low level of worry. I have a very low level of worry now. This seems to be affecting old/ immuno compromised people the most( like everything else) These people bluntly are going to die at some point in time sooner then their more resistant counterparts. Not much at this point any of us can do otherwise. The panic is irrational.

 

The arrogance of portions of the medical community to date is concerning.  To think there are no *potential* second order effects in a scenario where hospitals have clear capacity constraints is just getting nonsensical.  The US had a two month head start on this and as of 10:30am today only 35 people in nyc have been tested.  Risk mitigation at this point restricted to tracking indirect contacts of positive tested patients & asking the general public to wash their hands are clearly insufficient.  Why is this debatable?