Coronavirus

[Spekulatius]

LOL:

https://twitter.com/loudobbs/status/1240421216692961284?s=21

[gary17]

"The first coronavirus case in the U.S. and South Korea was detected on the same day. By late January, Seoul had medical companies starting to work on a diagnostic test — one was approved a week later. Today, the U.S. isn’t even close to meeting test demand"

 

https://www.reuters.com/article/us-health-coronavirus-testing-specialrep/special-report-how-korea-trounced-u-s-in-race-to-test-people-for-coronavirus-idUSKBN2153BW

 

Peter Attia:

 

"Just received word from an ICU doctor at a small NY hospital: They are officially out of ventilators and are now double venting patients with COVID (using the same ventilator for 2 infected patients). Do everything possible to avoid infection. PLEASE ISOLATE as best you can."

 

Testing works: "How one small town at the center of the outbreak has cut infections virtually to zero: test all 3,300 in town, isolate the 3 percent who tested positive. Infection rate 10 days later down to .3 percent."

 

 

This is the big difference between Asian countries and Western Countries -  not to be critical, but we value law, liability, freedom etc too much for government to effective in implementing measures.  In Canada, you have local, provincial federal having different responsibilities.  For example provinces look after healthcare while the federal government controls the border...  You need parliament to pass certain things, etc.    Similar in the US... 

 

in Asia things just move fast... even in democracies like Korea and Taiwan; the government will just step in and people jump on things.  I guess part of it is because of the density; everyone living in a relatively small space; messages come across fast.  Here... the countries are so big.... things happening in BC ; but some decisions are made in Ottawa  (similar to Washington and DC).

 

[minten]

https://www.en24.news/a/2020/03/hydroxychloroquine-would-be-effective-according-to-professor-raoult-of-the-ihu-in-marseille-after-a-first-limited-test.html

 

Bayer and Sanofi seem to have huge supplies of this stuff and seem to have offered donations to whatever country wants it.

 

Too early to tell obviously, but if approved, existing and widely available (combo of) medicines turn out to decrease the severity of the virus (at least for a large number of patients) obviously that would be a quick and complete game-changer.

 

some random dude on twitter wrote some interesting (and very bullish) comments on the French study I linked here yesterday: https://twitter.com/boriquagato/status/1240630279301033986 and posts below that. It's just one person's thoughts so who cares, but I found them interesting, and I'd like to be an optimist these days and tweets like these help.

 

what I and others had missed yesterday in this study was that it might have been remarkably succesful because of the combo of two seperate drugs working together, not just the hydroxychlorquine.

[Dalal.Holdings]

LOL:

https://twitter.com/loudobbs/status/1240421216692961284?s=21

 

Hannity and that Fox Business anchor told me this was all fake news a long time ago anyway. Just a democratic plot to hurt our president.

 

You can only hide behind lies for so long in times like this...

[Dalal.Holdings]

https://www.en24.news/a/2020/03/hydroxychloroquine-would-be-effective-according-to-professor-raoult-of-the-ihu-in-marseille-after-a-first-limited-test.html

 

Bayer and Sanofi seem to have huge supplies of this stuff and seem to have offered donations to whatever country wants it.

 

Too early to tell obviously, but if approved, existing and widely available (combo of) medicines turn out to decrease the severity of the virus (at least for a large number of patients) obviously that would be a quick and complete game-changer.

 

some random dude on twitter wrote some interesting (and very bullish) comments on the French study I linked here yesterday: https://twitter.com/boriquagato/status/1240630279301033986 and posts below that. It's just one person's thoughts so who cares, but I found them interesting, and I'd like to be an optimist these days and tweets like these help.

 

what I and others had missed yesterday in this study was that it might have been remarkably succesful because of the combo of two seperate drugs working together, not just the hydroxychlorquine.

 

SMH at people who think azithromycin, an antibiotic that works against bacteria and hydroxychlorquine, an agent that works against a parasite, is likely to fight a virus. Same as anti-HIV drugs for this which are anti-retrovirals (hint: COVID-19 is not a retrovirus).

[Read the Footnotes]

For now, I take some comfort in the fact that whether or not it is the complete story, articles like this one might serve to scare some of the subsections of our population who still are not as scared as they should be.

 

Sure. In practice however I'm afraid there is basically zero overlap between a) the subset of the population that should be far more scared and b) the subset of the population who would even consider reading an article like that.

 

You're right. Plus add in the fact that viral stupidity seems to spread faster than reasonable analysis.

Still it's better than nothing.

I would be more O.K. with all this if it would lead to an equitable distribution of Darwin Awards, but in this case the gene pool will not be cleansed.

[minten]

https://www.en24.news/a/2020/03/hydroxychloroquine-would-be-effective-according-to-professor-raoult-of-the-ihu-in-marseille-after-a-first-limited-test.html

 

Bayer and Sanofi seem to have huge supplies of this stuff and seem to have offered donations to whatever country wants it.

 

Too early to tell obviously, but if approved, existing and widely available (combo of) medicines turn out to decrease the severity of the virus (at least for a large number of patients) obviously that would be a quick and complete game-changer.

 

some random dude on twitter wrote some interesting (and very bullish) comments on the French study I linked here yesterday: https://twitter.com/boriquagato/status/1240630279301033986 and posts below that. It's just one person's thoughts so who cares, but I found them interesting, and I'd like to be an optimist these days and tweets like these help.

 

what I and others had missed yesterday in this study was that it might have been remarkably succesful because of the combo of two seperate drugs working together, not just the hydroxychlorquine.

 

SMH at people who think azithromycin, an antibiotic that works against bacteria and hydroxychlorquine, an agent that works against a parasite, is likely to fight a virus. Same as anti-HIV drugs for this which are anti-retrovirals (hint: COVID-19 is not a retrovirus).

 

It took me more time to look up what "SMH" means in your post than to find what you write just isn't accurate (or at least, a gross over-simplification)..

[Read the Footnotes]

This is the big difference between Asian countries and Western Countries . . .

They also have more experience with these issue and a greater expectation to continue to be ground zero for outbreaks so that likely makes a difference.

[jfan]

For those interested, here is a very detailed history of pandemic influenza (of which there are 4; 3 which are described here) and a comparative experience between Italy and South Korea

 

https://www.ncbi.nlm.nih.gov/books/NBK22148/#a2000c209ddd00098

 

https://medium.com/@andreasbackhausab/coronavirus-why-its-so-deadly-in-italy-c4200a15a7bf

 

Interestingly, the UK has decided on a different strategy that I thought initially to be crazy but perhaps there is an element of validity to it.

https://www.theatlantic.com/health/archive/2020/03/coronavirus-pandemic-herd-immunity-uk-boris-johnson/608065/

 

Prior pandemics suggest the following things occur:

1) Usually more than one wave of spread

2) novel viruses have a relatively higher mortality and morbidity for the younger population relative to themselves, but relative to the older population, the elderly person risk is much higher

3) individual immunity can develop if exposed, but the duration of effectiveness can be variable from one year to many

4) viral mutation over time can be influenced by health policy behaviors (interestingly, virulence goes down over time as less virulent strains are selected if less affected people are allowed to infect others UNLESS more virulent strains are aggregated together eg in hospitals and they escape into the public)

5) social distancing and isolation have been tried in the past with variable effectiveness (modelling suggests months to one year of social distancing may be required that would cause massive socio-economic havoc)

6) there is considerable variability of mortality between geographies and time of outbreak (1st vs 2nd waves).

 

I am not an expert in this matter but I wonder the following especially in a resource constrained environment with limited government ability to enforce social distancing and population movement in context of COVID-19:

 

a) instead of broad social distancing, focus this intervention on the vulnerable population (elderly, immunocompromised) to allow a natural process of selecting out less virulent strains to survive by allowing the asymptomatic or mildly symptomatic to carry on as usual with the potential benefit of developing individual and population immunity to reduce the impact of future waves

 

b) intense testing of asymptomatic health care workers and those that support the elderly to keep them protected until a vaccine can be developed which in this case to be deployed to middle-aged and young elderly first to maximize years-of-life saved

 

c) random population testing to monitor strain variability

 

It will be very interesting to see what happens to this pandemic over time between countries have be successful in the 1st wave containment (Singapore, China, Korea) vs those who were not (Iran, Italy).

 

 

 

[Liberty]

Gavin Baker: https://medium.com/@gavin_baker/viruses-recessions-imagination-and-the-end-of-the-beginning-1b6342e61390

 

Working Paper, Eliminating COVID-19: A Community-based Analysis:  https://static1.squarespace.com/static/5b68a4e4a2772c2a206180a1/t/5e737b95403f772d8ce0e04a/1584626591711/CommunityPrevention.pdf

[DRValue]

@jfan

 

I have wondered myself whether social distancing should only be practiced by at risk groups. The consequences of not doing so will soon be outweighed by the impact to the economy.

Whole population isolation is not proportionate imo.

 

Best action would be herd immunity amongst the general populace and isolation of a subset.

[ERICOPOLY]

China says no new cases today.  Is this true?  They recently expelled US journalists.  Faced with 40% plunge in GDP, are they telling the truth or are they trying to calm the US down?

[LC]

Eric, difficult to say:

 

Around a dozen reporters could be required to leave, in a move that Beijing said was reciprocation for the United States’ forcing out of about 60 Chinese reporters, who worked for propaganda outlets, this month

 

Best guess is to (1) trust international groups operating within China; and (2) overweight data sources outside China

[james22]

China says no new cases today.  Is this true?  They recently expelled US journalists.  Faced with 40% plunge in GDP, are they telling the truth or are they trying to calm the US down?

 

I'd guess the latter.

 

42% Say China Should Pay Some of World’s Coronavirus Costs

 

https://www.rasmussenreports.com/public_content/politics/current_events/china/42_say_china_should_pay_some_of_world_s_coronavirus_costs

[Guest]

China says no new cases today.  Is this true?  They recently expelled US journalists.  Faced with 40% plunge in GDP, are they telling the truth or are they trying to calm the US down?

 

 

muscle, any insight on this?

[Investor20]

 

It should be noted that due to testing shortage, those young folks and everyone else tested are likely to be the more symptomatic ones due to strict testing criteria in the U.S.. So even looking at hospitalizations as % of positive cases is likely sampling bias--you are not counting all the young folks walking around with this who have no or mild symptoms because they are never offered or are flat out denied testing.

 

 

This is correct IMO.  The rate of spread ought to be higher amongst the young as well (think malls, night clubs, and party party party).  So it stands to reason there are simply far more cases amongst the young because of rate of spread.

 

CDC on clinical criteria for testing...

 

https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html

 

Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested. Most patients with confirmed COVID-19 have developed fever1 and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing). Priorities for testing may include:

 

Hospitalized patients who have signs and symptoms compatible with COVID-19 in order to inform decisions related to infection control.

Other symptomatic individuals such as, older adults and individuals with chronic medical conditions and/or an immunocompromised state that may put them at higher risk for poor outcomes (e.g., diabetes, heart disease, receiving immunosuppressive medications, chronic lung disease, chronic kidney disease).

Any persons including healthcare personnel2, who within 14 days of symptom onset had close contact3 with a suspect or laboratory-confirmed4 COVID-19 patient, or who have a history of travel from affected geographic areas5 (see below) within 14 days of their symptom onset.

 

This testing recommendation from CDC effectively biases those who get tests to older folks or people with preexisting medical problems (again, more likely to be older folks). Furthermore, it also depends on symptom severity and generally we know younger folks (based on data from China) show mild/no symptoms hence they are unlikely to get approved for a test in the United States. The older folks are more likely to throw a fever and develop shortness of breath.

 

This leads one to conclude that the younger people who test positive for this illness must be the sicker younger folks who have this (because they were not denied a test) and we are excluding younger people with mild/no symptoms (who are denied testing). So the overall mortality/ICU stay skews higher since we are only looking at younger patients who are sicker to begin with.

 

Again, for the 100th time explains the downside of being limited on testing. The U.S., being among the last developed nation to get this outbreak is among the most unprepared. A travesty of leadership.

 

"The U.S., being among the last developed nation to get this outbreak is among the most unprepared."

 

US has lot of travel both to Europe and China.  Why do you  think they are last in getting this outbreak?

 

May be the policies are better that US held it off longer than any one else?  May be everyone start date (outside China) is same.

Why would Europe or Korea have earlier exposer than US?

 

If you check deaths, they are lowest for US of most developed countries on per capita basis (worldometer numbers). 

 

For example US has 170 vs Korea with 90 for total deaths.  But US population is 6.7 times more, making it much, much better. 

Korea adjusted for population to US would be 603 deaths.

 

Even for "New Deaths", US has 21 vs S. Korea 7. 

That makes adjusted for population, S. Korea 46, well above US 21.

 

Sweden with population of 10 million has total deaths of 11, adjusted to US population, it is  374.

 

Norway with population of 5.4 million has total deaths of 7, adjusted to US population, it is 476.

 

IMO all countries outside China got exposed around same time.  If anything US having so much trade with China, probably has lot more travel with China and had more exposer.  Yet in deaths, after four months (first case in Nov), US is doing better than any other nation in west or S Korea.

 

Now, if you really want to follow, it is Japan.  They controlled it pretty well. 

 

Japan with population of 127 million has total deaths of 32 and new deaths of 3, adjusted for US population, total deaths of 86 and new deaths of 8, better than US.

 

But Japan didn't test much or have lock downs....now figure that out!

 

 

 

[BG2008]

This is the big difference between Asian countries and Western Countries . . .

They also have more experience with these issue and a greater expectation to continue to be ground zero for outbreaks so that likely makes a difference.

 

From my anecdotes, you just can't stop 16-28 year old Americans from trying to get laid. 

[Dalal.Holdings]

 

It should be noted that due to testing shortage, those young folks and everyone else tested are likely to be the more symptomatic ones due to strict testing criteria in the U.S.. So even looking at hospitalizations as % of positive cases is likely sampling bias--you are not counting all the young folks walking around with this who have no or mild symptoms because they are never offered or are flat out denied testing.

 

 

This is correct IMO.  The rate of spread ought to be higher amongst the young as well (think malls, night clubs, and party party party).  So it stands to reason there are simply far more cases amongst the young because of rate of spread.

 

CDC on clinical criteria for testing...

 

https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html

 

Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested. Most patients with confirmed COVID-19 have developed fever1 and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing). Priorities for testing may include:

 

Hospitalized patients who have signs and symptoms compatible with COVID-19 in order to inform decisions related to infection control.

Other symptomatic individuals such as, older adults and individuals with chronic medical conditions and/or an immunocompromised state that may put them at higher risk for poor outcomes (e.g., diabetes, heart disease, receiving immunosuppressive medications, chronic lung disease, chronic kidney disease).

Any persons including healthcare personnel2, who within 14 days of symptom onset had close contact3 with a suspect or laboratory-confirmed4 COVID-19 patient, or who have a history of travel from affected geographic areas5 (see below) within 14 days of their symptom onset.

 

This testing recommendation from CDC effectively biases those who get tests to older folks or people with preexisting medical problems (again, more likely to be older folks). Furthermore, it also depends on symptom severity and generally we know younger folks (based on data from China) show mild/no symptoms hence they are unlikely to get approved for a test in the United States. The older folks are more likely to throw a fever and develop shortness of breath.

 

This leads one to conclude that the younger people who test positive for this illness must be the sicker younger folks who have this (because they were not denied a test) and we are excluding younger people with mild/no symptoms (who are denied testing). So the overall mortality/ICU stay skews higher since we are only looking at younger patients who are sicker to begin with.

 

Again, for the 100th time explains the downside of being limited on testing. The U.S., being among the last developed nation to get this outbreak is among the most unprepared. A travesty of leadership.

 

"The U.S., being among the last developed nation to get this outbreak is among the most unprepared."

 

US has lot of travel both to Europe and China.  Why do you  think they are last in getting this outbreak?

 

May be the policies are better that US held it off longer than any one else?  May be everyone start date (outside China) is same.

Why would Europe or Korea have earlier exposer than US?

 

If you check deaths, they are lowest for US of most developed countries on per capita basis (worldometer numbers). 

 

For example US has 170 vs Korea with 90 for total deaths.  But US population is 6.7 times more, making it much, much better. 

Korea adjusted for population to US would be 603 deaths.

 

Even for "New Deaths", US has 21 vs S. Korea 7. 

That makes adjusted for population, S. Korea 46, well above US 21.

 

Sweden with population of 10 million has total deaths of 11, adjusted to US population, it is  374.

 

Norway with population of 5.4 million has total deaths of 7, adjusted to US population, it is 476.

 

IMO all countries outside China got exposed around same time.  If anything US having so much trade with China, probably has lot more travel with China and had more exposer.  Yet in deaths, after four months (first case in Nov), US is doing better than any other nation in west or S Korea.

 

Now, if you really want to follow, it is Japan.  They controlled it pretty well. 

 

Japan with population of 127 million has total deaths of 32 and new deaths of 3, adjusted for US population, total deaths of 86 and new deaths of 8, better than US.

 

But Japan didn't test much or have lock downs....now figure that out!

 

It is clear from every global tracking system that U.S. was among the last places (after Europe, after Korea, Taiwan, Japan, etc) to get this outbreak. A lot has to do with the travel ban to China which, IMO was the only good early measure this administration took. This administration only understands measures like travel bans, tariffs, and tax cuts, while everything else is beyond its comprehension, so not difficult to see why this occurred.

 

To compare U.S. today to S Korea today is laughable. S Korea is way ahead of U.S. and has now flattened its curve. U.S. still in early stages of rapid exponential growth. I guess this is what happens when you look at numbers too closely without considering broader context of things...

[Dalal.Holdings]

Have been just sitting back and reading everyone's thoughts on things which is interesting for sure. My attention has turned more from what I think will happen with the virus (I think I have made my thoughts very clear). Some of my predictions so far have been close which feels good I guess but means nothing in the mess the world is today. Especially in light of the sick people, fear, society shut down and all the angst the market falling is causing many I'm sure.

 

Like everyone here (except for Viking you bastard! ;) ) it blows watching the market implode unless short or all cash. Long term investing is not easy thats for sure. But what I am really starting to get worried about is what this will do to many, many, small business, restaurants, franchisees, bars, etc. This 15 day gov shut down and multiple state shut down is going to kill businesses, confidence, sky rocketing unemployment etc. I would like to think and hope it is a V or U shaped recovery but if your a business owner that goes out of business how long is it going to take your confidence to come back, workers etc? I would love to have a quick rebounding economy but if enough people get laid off, enough businesses bankrupt this could be a long time mess.

 

I think Ackmans idea makes some sense but hes a billionaire. Sure you can have rent holidays, mortgage forbearance, don't pay your utilities etc but this is already crushing airlines, hotels, small business, restaurants and we are a couple days in. Some states want a month or more. Whats the unemployment rate after this month? That drops down fast? Idk. And sending 1-2k checks wont cut the mustard for many

 

At some point I think you start to see people who say fuck it, enough. Stress levels and tension are extremely high. First it was fear, and still is, but in social media circles I have seen many start to question what we are doing and for who? That can get dangerous. Throw in not working, no money coming in, your kids not going to school driving you up the wall and every day you get up and the death rate in the US is at 100-125-150.

 

I'm not saying we should get to a point where we choose who lives and who doesn't but at some point I think you have to look at the broader picture. I brought this way up earlier in the thread and some commented on it as the owns persons fault but some things to just consider.

 

As of right now fear still predominates in the greatest economy in the world as well as other nations in the world. In every sense of the word we are in this together and I think fundamentally doing the right thing, but....we have shut down essentially the world, ruined daily lives, scared the ever living shit out of people. We will have bankrupted people. Some may commit suicide  seen with financial crises, many other making huge sacrifices some of which will never recover from. Businesses will close. We will add trillions to the debt, the fed taking extraordinary actions to prevent the economy from seizing. Scrambling in chaos to find solutions with amounts of money that no one can comprehend for the millions, and millions of people who will be affected, emotionally, mentally, financially etc. Bankrupting our airline industry, possibly hotel, travel, leisure, restaurant, banking?? industry. Its turned into absolute chaos.

 

And what are we afraid of ? A disease that we know may have an 86% as symptomatic rate, that so far has killed 8784 people out of 7.8 Billion people,  .000116%. People who we know on average are nearing the end of their lives. People who succumb every day to diseases we are numb to. I know many are aware of the flu data on deaths but some aren't on the most common every day killers in the US. Every year in the US alone;

 

674,000 people die from cardiovascular disease

607,000 from cancer

170,000 from accidental deaths

 

In the world;

 

17.65 million heart disease

8.93 million from cancer

3.54 million from respiratory disease

 

My point is not to sacrifice people for money, and I am aware obviously the death rate world wide would be much higher if the above was not done in the US, China, Italy, Europe etc. But why is it ok for all of these people to die from the above? Are we just numb to it? Since the first corona case in the US 2 months ago based on the above data 112,333 people have died from heart disease. Every day we look at the Johns Hopkins map checking deaths and each day 1846 Americans and 48,356 in the world have died from heart disease. We are killing ourselves over ICU beds for Mary for Covid, while her friend from the Senior Center dies downstairs in the same hospital before they can get to the Cath lab. We want a vaccine in months for corona but are willing to go through multiple year trials for anticoagulants, cholesterol meds, and hypertension meds.

 

That being said, do we really care as country how many people die? And who and how old they are?

 

This has become an irrational obsession for the world, and with this virus. When you really look at what will kill you living in this country, and who we should be saving, the sooner you realize this has become insanity.

 

According to a key part of your thesis, the virus has infected millions for months here. Strange why deaths are just now rising, then. Unless you propose that people died in January but we had no idea what the true cause of death was. Strange too that ICUs in NYC are just now starting to get loaded...

 

Attached is a graph of U.S. mortality thus far from COVID. If I saw such a trend for cancer deaths, cardiovascular disease, or accidental deaths, I WOULD be concerned about those things.

 

Not to mention the fact that none of these things that you mention that cause deaths are systemic, multiplicative (i.e. none of them are contagious) processes. A BIG difference.

[hillfronter83]

China says no new cases today.  Is this true?  They recently expelled US journalists.  Faced with 40% plunge in GDP, are they telling the truth or are they trying to calm the US down?

 

 

muscle, any insight on this?

 

From what I heard from my friend this morning, China seems to have things under control. They are still tracking everybody's movement and require people to wear face masks in public. But governments clearly think the worst may be behind and are now encouraging people to get back to normal life, such as going to restaurants, opening school etc. This is a small city in Jiangsu.

[Investor20]

 

It should be noted that due to testing shortage, those young folks and everyone else tested are likely to be the more symptomatic ones due to strict testing criteria in the U.S.. So even looking at hospitalizations as % of positive cases is likely sampling bias--you are not counting all the young folks walking around with this who have no or mild symptoms because they are never offered or are flat out denied testing.

 

 

This is correct IMO.  The rate of spread ought to be higher amongst the young as well (think malls, night clubs, and party party party).  So it stands to reason there are simply far more cases amongst the young because of rate of spread.

 

CDC on clinical criteria for testing...

 

https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html

 

Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested. Most patients with confirmed COVID-19 have developed fever1 and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing). Priorities for testing may include:

 

Hospitalized patients who have signs and symptoms compatible with COVID-19 in order to inform decisions related to infection control.

Other symptomatic individuals such as, older adults and individuals with chronic medical conditions and/or an immunocompromised state that may put them at higher risk for poor outcomes (e.g., diabetes, heart disease, receiving immunosuppressive medications, chronic lung disease, chronic kidney disease).

Any persons including healthcare personnel2, who within 14 days of symptom onset had close contact3 with a suspect or laboratory-confirmed4 COVID-19 patient, or who have a history of travel from affected geographic areas5 (see below) within 14 days of their symptom onset.

 

This testing recommendation from CDC effectively biases those who get tests to older folks or people with preexisting medical problems (again, more likely to be older folks). Furthermore, it also depends on symptom severity and generally we know younger folks (based on data from China) show mild/no symptoms hence they are unlikely to get approved for a test in the United States. The older folks are more likely to throw a fever and develop shortness of breath.

 

This leads one to conclude that the younger people who test positive for this illness must be the sicker younger folks who have this (because they were not denied a test) and we are excluding younger people with mild/no symptoms (who are denied testing). So the overall mortality/ICU stay skews higher since we are only looking at younger patients who are sicker to begin with.

 

Again, for the 100th time explains the downside of being limited on testing. The U.S., being among the last developed nation to get this outbreak is among the most unprepared. A travesty of leadership.

 

"The U.S., being among the last developed nation to get this outbreak is among the most unprepared."

 

US has lot of travel both to Europe and China.  Why do you  think they are last in getting this outbreak?

 

May be the policies are better that US held it off longer than any one else?  May be everyone start date (outside China) is same.

Why would Europe or Korea have earlier exposer than US?

 

If you check deaths, they are lowest for US of most developed countries on per capita basis (worldometer numbers). 

 

For example US has 170 vs Korea with 90 for total deaths.  But US population is 6.7 times more, making it much, much better. 

Korea adjusted for population to US would be 603 deaths.

 

Even for "New Deaths", US has 21 vs S. Korea 7. 

That makes adjusted for population, S. Korea 46, well above US 21.

 

Sweden with population of 10 million has total deaths of 11, adjusted to US population, it is  374.

 

Norway with population of 5.4 million has total deaths of 7, adjusted to US population, it is 476.

 

IMO all countries outside China got exposed around same time.  If anything US having so much trade with China, probably has lot more travel with China and had more exposer.  Yet in deaths, after four months (first case in Nov), US is doing better than any other nation in west or S Korea.

 

Now, if you really want to follow, it is Japan.  They controlled it pretty well. 

 

Japan with population of 127 million has total deaths of 32 and new deaths of 3, adjusted for US population, total deaths of 86 and new deaths of 8, better than US.

 

But Japan didn't test much or have lock downs....now figure that out!

 

It is clear from every global tracking system that U.S. was among the last places (after Europe, after Korea, Taiwan, Japan, etc) to get this outbreak. A lot has to do with the travel ban to China which, IMO was the only good early measure this administration took. This administration only understands measures like travel bans, tariffs, and tax cuts, while everything else is beyond its comprehension, so not difficult to see why this occurred.

 

To compare U.S. today to S Korea today is laughable. S Korea is way ahead of U.S. and has now flattened its curve. U.S. still in early stages of rapid exponential growth. I guess this is what happens when you look at numbers too closely without considering broader context of things...

 

OK... at least you agree that early travel ban was good decision, which was criticized by press at that time.

 

Coming back to numbers, even in "latest deaths", US is better than Korea.  I guess under your definition, US "rapid exponential growth" is better than Korea "flattened out" death rate. Koreans have more than double US "latest deaths" in per capita terms.

 

Also, setting aside US for a moment.  Japan did much better than most countries.  But Japan did not have heavy testing or lockdowns.

But S. Korea and Italy had heavy testing. 

 

You want to follow S. Korea and Italy with heavy testing rather than look at what Japan did?

[Read the Footnotes]

@jfan

 

I have wondered myself whether social distancing should only be practiced by at risk groups. The consequences of not doing so will soon be outweighed by the impact to the economy.

Whole population isolation is not proportionate imo.

 

Best action would be herd immunity amongst the general populace and isolation of a subset.

I have faulted the president for not acting quickly and that an ounce of prevention is worth more than a pound of cure, because we don't even have a cure. So I am going to do my best at reacting quickly and trying to contain the thought virus you risk spreading. This is dangerous thinking.

 

The list of reasons is so long, but I will give you two:

1) most influenza models predict that without physical distancing an illness as infectious as this one would quickly spread through the country and that forty percent of the population would be sick at once. How much of the country can you afford to be sick at once without the collapse of society? Certainly a two week period with forty percent not reporting to work would be disastrous. If you ask sick people to report to work, the fabric of society is further torn and the CFR would likely skyrocket, because rest is probably the key treatment that prevents mild cases from becoming severe cases.

2) see #1

 

You can play around with assumptions, but I doubt you will disprove that #1 is a concern that would also require social distancing and flattening the curve.

[Dalal.Holdings]

 

OK... at least you agree that early travel ban was good decision, which was criticized by press at that time.

 

Coming back to numbers, even in "latest deaths", US is better than Korea.  I guess under your definition, US "rapid exponential growth" is better than Korea "flattened out" death rate. Koreans have more than double US "latest deaths" in per capita terms.

 

Also, setting aside US for a moment.  Japan did much better than most countries.  But Japan did not have heavy testing or lockdowns.

But S. Korea and Italy had heavy testing. 

 

You want to follow S. Korea and Italy with heavy testing rather than look at what Japan did?

 

Yes I want to follow S Korea. Italy did not do a good job of testing. USA is beyond where Japan ever was.

 

This is an infection where it takes ~1 week to show symptoms from catching the virus and maybe ~2 weeks to severe symptoms and mortality. As the U.S. is early in this processes, as I have repeated on here (though some claim it has infected "millions for months" here), the fear is that the deaths are yet to come. S Korea is likely on the tail end so their deaths are probably going to level off.

 

See the exponential mortality graph of U.S. I posted on here a few posts back.

[Dalal.Holdings]

Since you folks love anecdotes, here is a cautionary tale on the importance of social distancing (and avoiding large family gatherings for now--FYI none of these people fall into the 80 year old+ demographic whose actuarial tables you guys seem to consult often):

 

https://www.nytimes.com/2020/03/18/nyregion/new-jersey-family-coronavirus.html

 

Now, her close-knit clan is united anew by unspeakable grief: Mrs. Fusco, 73, died on Wednesday night after contracting the coronavirus — hours after her son died from the virus and five days after her daughter’s death, a relative said.

 

Four other children who contracted coronavirus remain hospitalized, three of them in critical condition, the relative, Roseann Paradiso Fodera, said.

 

Where did the infection come from?

 

A person who had contact with a man who died in New Jersey on March 10, becoming the state’s first coronavirus-related fatality, had attended a recent Fusco family gathering, the state’s health commissioner, Judith M. Persichilli, has said.

 

So the man who died on March 10 likely spread it to this family in late February/early March and it is only now (March 18) when the matriarch of the family passed away...consistent with several week incubation + delay to severe symptoms/death.

 

Very very unfortunate that intelligent people continue to dismiss this. This family has been incredibly and suddenly hit by this SYSTEMIC, MULTIPLICATIVE cause of death. Compare that to cancer or accidents or heart disease at your own peril.

[Read the Footnotes]

For those interested, here is a very detailed history of pandemic influenza (of which there are 4; 3 which are described here) and a comparative experience between Italy and South Korea

 

https://www.ncbi.nlm.nih.gov/books/NBK22148/#a2000c209ddd00098

 

https://medium.com/@andreasbackhausab/coronavirus-why-its-so-deadly-in-italy-c4200a15a7bf

 

Interestingly, the UK has decided on a different strategy that I thought initially to be crazy but perhaps there is an element of validity to it.

https://www.theatlantic.com/health/archive/2020/03/coronavirus-pandemic-herd-immunity-uk-boris-johnson/608065/

 

Prior pandemics suggest the following things occur:

1) Usually more than one wave of spread

2) novel viruses have a relatively higher mortality and morbidity for the younger population relative to themselves, but relative to the older population, the elderly person risk is much higher

3) individual immunity can develop if exposed, but the duration of effectiveness can be variable from one year to many

4) viral mutation over time can be influenced by health policy behaviors (interestingly, virulence goes down over time as less virulent strains are selected if less affected people are allowed to infect others UNLESS more virulent strains are aggregated together eg in hospitals and they escape into the public)

5) social distancing and isolation have been tried in the past with variable effectiveness (modelling suggests months to one year of social distancing may be required that would cause massive socio-economic havoc)

6) there is considerable variability of mortality between geographies and time of outbreak (1st vs 2nd waves).

 

I am not an expert in this matter but I wonder the following especially in a resource constrained environment with limited government ability to enforce social distancing and population movement in context of COVID-19:

 

a) instead of broad social distancing, focus this intervention on the vulnerable population (elderly, immunocompromised) to allow a natural process of selecting out less virulent strains to survive by allowing the asymptomatic or mildly symptomatic to carry on as usual with the potential benefit of developing individual and population immunity to reduce the impact of future waves

 

b) intense testing of asymptomatic health care workers and those that support the elderly to keep them protected until a vaccine can be developed which in this case to be deployed to middle-aged and young elderly first to maximize years-of-life saved

 

c) random population testing to monitor strain variability

 

It will be very interesting to see what happens to this pandemic over time between countries have be successful in the 1st wave containment (Singapore, China, Korea) vs those who were not (Iran, Italy).

 

Jfan, you clearly put some effort in to organizing this. I applaud the effort.

 

I have one huge issue to raise that should caution anyone from drawing too much from these valuable lessons of history. That is that when forecasting a pandemic, previous experience is no where near as instructive as building a model based on the parameters of the novel virus to the extent that they are known.

 

In otherwords, it's good to study history, but every virus has it's own unique characteristics. The differences in parameters interact and become multiplicative or exponential. The result is that small differences in inputs to the model result in huge differences in the challenges and solutions. It's therefore crucial to have accurate estimates of the replication rate under different conditions and the case fatality rates under various conditions, as well as other critical factors.

 

Simply comparing to previous outbreaks could lead to anchoring and adjustment bias, and other biases that lead to an underestimation of the true situation. It's better to treat each virus as its own unique problem.

 

Keeping this one warning in mind will help to identify which lessons from history might be applicable.

 

Thanks for the contribution.