Coronavirus

[Liberty]

I dont see what people are complaining about regarding measures and steps to open things back up... Disagree? Continue hiding in your houses for the rest of your life. Re-opening the economy for those whom wish to work and live their lives doesnt force you to do anything.

 

Of course we have to re-open at some point. You're creating a false choice/strawman.

 

The idea is to do it well to minimize the chances of this thing getting out of control again, to minimize death and suffering, and to minimize eventual economic impact.

 

Just like if the US had done the early containment well, the problem would've been smaller and the economic impact would've been smaller. Now that ship has sailed, but it looks like the next phases aren't being handled much better than the early ones, with the daughter and son-in-law and some ex-TV hosts in charge.

[rranjan]

I dont see what people are complaining about regarding measures and steps to open things back up... Disagree? Continue hiding in your houses for the rest of your life. Re-opening the economy for those whom wish to work and live their lives doesnt force you to do anything.

 

The top 20% is the least impacted by lockdown and vast majority can work from home as well.

 

The bottom 20% is the most impacted by lockdown and vast majority can't work from home.

 

Just going by data published by labor department. Policymakers have to balance the economic damage vs health crisis. Bottom 20% is not the loudest voice here even though they may be most at risk of catching the virus. Top 20% may be a lot more comfortable with a longer lockdown.

 

Flatening the curve was goal to not overwhelm our health system and as long as country can operate without causing health crisis, opening should proceed with tons of centralized testing. Without centralized testing , we may be flying blind when some region gets a spike.

 

Good thing is that bottom 20% may be getting good money for the next 4 months, but it's also bad news if you want to open up. Some of them may be making more by not taking the job. Anyway, all jobs are not comng back so quickly. Slowly, but surely steps should be there to open economy. Longer it stays in shutdown , larger damage will be done and many job for bottom 20% may not exist for years if we keep economy shut for very long.

 

Debate sholdn't be taken as life vs economy to be honest. It's life vs life. Hospitals have started firing employees becasue we have shut down everything except virus cases. It's simply not sustainble even if Fed keeps prinintg money.

 

I also think using terms like stimulus or bail out takes the focus away from what's happening. Businesses are simply told to shut down by governemnt for a greater good. If goverment is giving them money to not fire emplyees then it's hardly a normal bailout situation.

 

[orthopa]

I dont see what people are complaining about regarding measures and steps to open things back up... Disagree? Continue hiding in your houses for the rest of your life. Re-opening the economy for those whom wish to work and live their lives doesnt force you to do anything.

 

Of course we have to re-open at some point. You're creating a false choice/strawman.

 

The idea is to do it well to minimize the chances of this thing getting out of control again, to minimize death and suffering, and to minimize eventual economic impact.

 

Just like if the US had done the early containment well, the problem would've been smaller and the economic impact would've been smaller. Now that ship has sailed, but it looks like the next phases aren't being handled much better than the early ones, with the daughter and son-in-law and some ex-TV hosts in charge.

 

I think its great and as good as an outline your going to get to control a population 328 million. If you think a more directed approach is needed we need way,way,way more man power then what is available as well as instant testing and tracing capabilities that likely dont exist yet or are not feasible.

 

We will continue to have a surge of cases over and over again until we reach herd immunity or get a good vaccine.

 

The way to minimize the most death and suffering is to do what we are doing, which is not possible, so yes there will likely be a good deal of death and suffering. Until a good vaccine comes out or treatments not much we can do about that if we plan to open the economy.

[orthopa]

I dont see what people are complaining about regarding measures and steps to open things back up... Disagree? Continue hiding in your houses for the rest of your life. Re-opening the economy for those whom wish to work and live their lives doesnt force you to do anything.

 

 

 

Debate sholdn't be taken as life vs economy to be honest. It's life vs life. Hospitals have started firing employees becasue we have shut down everything except virus cases. It's simply not sustainble even if Fed keeps prinintg money.

 

 

 

I agree I believe you have to assume the eventual goal is herd immunity with the brunt of infections taken on by the younger lower risk crowd. Looking at the studies if we are able to keep those 65 and older protected as much as possible you remove the highest risk population and the projected CFR and projected medical need drops to a much more palatable level. The older group is more likely to be on SSN, have a pension, etc and if needed much easier to keep this group above water with new money if needed.

 

 

[orthopa]

https://www.statnews.com/2020/04/16/early-peek-at-data-on-gilead-coronavirus-drug-suggests-patients-are-responding-to-treatment/?mod=article_inline

 

Promising results so far. This would surely make opening easier.

[samwise]

I found this interesting: Dutch bloodbank reports in preliminary discussion antibodies found in ~ 3% of 4208 blood donors they have tested. All blood donors should be symptom free and not have had contacts with anyone with symptoms for 14 days before they are allowed to donate.

 

Is 3% much above the false positive rate for these anti-body tests?

 

Someone posted above that the rate of false positives might be 5-10%. lets assume it is down to 3% now. If thats true, you would see 3% positive results in absolutely clean samples with no infections. Thats noise, not signal. Bottomline is: When you have an inaccurate test, the numbers need to be much higher than the test's accuracy to have much significance.

 

This is a known issue in disease tests, which I remember reading about as an undergrad. See the example below, which can seem uninutitive until you go through it. They actually use known disease incidence as an input, but unfortunately thats what we are trying to figure out here.

 

http://sphweb.bumc.bu.edu/otlt/MPH-Modules/BS/BS704_Probability/BS704_Probability6.html

 

"A patient goes to see a doctor. The doctor performs a test with 99 percent reliability--that is, 99 percent of people who are sick test positive and 99 percent of the healthy people test negative. The doctor knows that only 1 percent of the people in the country are sick. Now the question is: if the patient tests positive, what are the chances the patient is sick?"

 

 

 

The intuitive answer is 99 percent, but the correct answer is 50 percent...."

 

Because the 1 person who is sick will test positive.

1 out of the other 99 will also test positive (false positive).

Of those 2 who test positive, only 1 has the disease. So 50% chance.

[Dalal.Holdings]

https://www.statnews.com/2020/04/16/early-peek-at-data-on-gilead-coronavirus-drug-suggests-patients-are-responding-to-treatment/

 

The University of Chicago Medicine recruited 125 people with Covid-19 into Gilead’s two Phase 3 clinical trials. Of those people, 113 had severe disease. All the patients have been treated with daily infusions of remdesivir.

 

“The best news is that most of our patients have already been discharged, which is great. We’ve only had two patients perish,” said Kathleen Mullane, the University of Chicago infectious disease specialist overseeing the remdesivir studies for the hospital.

 

The lack of a control arm in the study could make interpreting the results more challenging.

 

Looks promising. No control arm in the study is a caveat.

[mcliu]

Coronavirus clue? Most cases aboard U.S. aircraft carrier are symptom-free

https://www.reuters.com/article/us-health-coronavirus-usa-military-sympt/coronavirus-clue-most-cases-aboard-u-s-aircraft-carrier-are-symptom-free-idUSKCN21Y2GB

 

The Navy’s testing of the entire 4,800-member crew of the aircraft carrier - which is about 94% complete - was an extraordinary move in a headline-grabbing case that has already led to the firing of the carrier’s captain and the resignation of the Navy’s top civilian official.

 

Roughly 60 percent of the over 600 sailors who tested positive so far have not shown symptoms of COVID-19, the potentially lethal respiratory disease caused by the coronavirus, the Navy says. The service did not speculate about how many might later develop symptoms or remain asymptomatic.

 

 

[Liberty]

[Gregmal]

 

Why is it, that, regardless of content, the majority of the Twitter links you post are filled with losers who's posting history, 90%+ revolves around a Trump obsession?

[RichardGibbons]

Flatening the curve was goal to not overwhelm our health system and as long as country can operate without causing health crisis, opening should proceed with tons of centralized testing. Without centralized testing , we may be flying blind when some region gets a spike.

 

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.

[Casey]

 

Why is it, that, regardless of content, the majority of the Twitter links you post are filled with losers who's posting history, 90%+ revolves around a Trump obsession?

 

Speaking of obsessed  ::) It's a nice day Gregmal, take a walk!

[buffetteer1984]

I agree I think alot of people think we need to get cases to zero before we open the economy again.  That wasn't the point of this lockdown.  It was to limit the deaths (but not prevent it entirely) by not overwhelming hospitals. 

 

In terms of mask, Dr Fauci originally stated masks weren't required but I believe he came around to suggesting it as an effective way of preventing transmission.  Originally I think the shortage of supplies for front line workers was the agenda behind the message of the masks effectiveness.  That may still be the case which is why they suggest most to wear scarfs, or some form of clothing around your mouth area instead of directly suggesting masks for the general public.

 

Flatening the curve was goal to not overwhelm our health system and as long as country can operate without causing health crisis, opening should proceed with tons of centralized testing. Without centralized testing , we may be flying blind when some region gets a spike.

 

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.

[minten]

I found this interesting: Dutch bloodbank reports in preliminary discussion antibodies found in ~ 3% of 4208 blood donors they have tested. All blood donors should be symptom free and not have had contacts with anyone with symptoms for 14 days before they are allowed to donate.

 

Is 3% much above the false positive rate for these anti-body tests?

 

The researchers claim the anti-body test is not accurate enough to tell a certain person on an individual basis whether or not they have antibodies because of the false positives, but by looking at an entire group the results are reliable for that group. I can only assume that means they are correcting for the false positive rate. This is a study by a research institute. We'd have to wait for the final results what they did exactly, but doesn't sound like this was a study done by some group of overenthusiastic amateurs who were not aware of this.

 

 

 

 

[Guest cherzeca]

I found this interesting: Dutch bloodbank reports in preliminary discussion antibodies found in ~ 3% of 4208 blood donors they have tested. All blood donors should be symptom free and not have had contacts with anyone with symptoms for 14 days before they are allowed to donate.

 

Is 3% much above the false positive rate for these anti-body tests?

 

The researchers claim the anti-body test is not accurate enough to tell a certain person on an individual basis whether or not they have antibodies because of the false positives, but by looking at an entire group the results are reliable for that group. I can only assume that means they are correcting for the false positive rate. This is a study by a research institute. We'd have to wait for the final results what they did exactly, but doesn't sound like this was a study done by some group of overenthusiastic amateurs who were not aware of this.

 

so this raises the question I have about how effective a covid antibody test can be...what it really means to say you have covid antibodies.  if you have had a lyme's disease test, what you have reported is not the presence of the bacteria, but the presence of antibodies combatting the bacteria...and then you get a doxycycline scrip if there are elevated antibodies...which of course implies that the body's generation of antibodies is not sufficient to insulate you from lyme's. I am wondering if this will be the same situation with corona.

[minten]

https://www.statnews.com/2020/04/16/early-peek-at-data-on-gilead-coronavirus-drug-suggests-patients-are-responding-to-treatment/

 

The University of Chicago Medicine recruited 125 people with Covid-19 into Gilead’s two Phase 3 clinical trials. Of those people, 113 had severe disease. All the patients have been treated with daily infusions of remdesivir.

 

“The best news is that most of our patients have already been discharged, which is great. We’ve only had two patients perish,” said Kathleen Mullane, the University of Chicago infectious disease specialist overseeing the remdesivir studies for the hospital.

 

The lack of a control arm in the study could make interpreting the results more challenging.

 

Looks promising. No control arm in the study is a caveat.

 

Market seems to absolutely love this. GILD up 15% in after hours, SPY up 3.5%. Wow.

[Guest cherzeca]

https://www.statnews.com/2020/04/16/early-peek-at-data-on-gilead-coronavirus-drug-suggests-patients-are-responding-to-treatment/

 

The University of Chicago Medicine recruited 125 people with Covid-19 into Gilead’s two Phase 3 clinical trials. Of those people, 113 had severe disease. All the patients have been treated with daily infusions of remdesivir.

 

“The best news is that most of our patients have already been discharged, which is great. We’ve only had two patients perish,” said Kathleen Mullane, the University of Chicago infectious disease specialist overseeing the remdesivir studies for the hospital.

 

The lack of a control arm in the study could make interpreting the results more challenging.

 

Looks promising. No control arm in the study is a caveat.

 

Market seems to absolutely love this. GILD up 15% in after hours, SPY up 3.5%. Wow.

 

isn't a control group re a life threatening disease (at least with respect to this severely ill cohort) an ethical issue?

[Liberty]

 

Why is it, that, regardless of content, the majority of the Twitter links you post are filled with losers who's posting history, 90%+ revolves around a Trump obsession?

 

Speaking of obsessed  ::) It's a nice day Gregmal, take a walk!

 

When he can't deny the message, he has to try to attack the messenger. Ad hominem. ¯\_(ツ)_/¯

[Viking]

I agree I think alot of people think we need to get cases to zero before we open the economy again.  That wasn't the point of this lockdown.  It was to limit the deaths (but not prevent it entirely) by not overwhelming hospitals. 

 

In terms of mask, Dr Fauci originally stated masks weren't required but I believe he came around to suggesting it as an effective way of preventing transmission.  Originally I think the shortage of supplies for front line workers was the agenda behind the message of the masks effectiveness.  That may still be the case which is why they suggest most to wear scarfs, or some form of clothing around your mouth area instead of directly suggesting masks for the general public.

 

Flatening the curve was goal to not overwhelm our health system and as long as country can operate without causing health crisis, opening should proceed with tons of centralized testing. Without centralized testing , we may be flying blind when some region gets a spike.

 

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.

[Cigarbutt]

https://www.statnews.com/2020/04/16/early-peek-at-data-on-gilead-coronavirus-drug-suggests-patients-are-responding-to-treatment/

The University of Chicago Medicine recruited 125 people with Covid-19 into Gilead’s two Phase 3 clinical trials. Of those people, 113 had severe disease. All the patients have been treated with daily infusions of remdesivir.

“The best news is that most of our patients have already been discharged, which is great. We’ve only had two patients perish,” said Kathleen Mullane, the University of Chicago infectious disease specialist overseeing the remdesivir studies for the hospital.

The lack of a control arm in the study could make interpreting the results more challenging.

Looks promising. No control arm in the study is a caveat.

Market seems to absolutely love this. GILD up 15% in after hours, SPY up 3.5%. Wow.

isn't a control group re a life threatening disease (at least with respect to this severely ill cohort) an ethical issue?

You keep asking fascinating questions.  :)

I guess it has to do with how to collectively define rules to deal with uncertainty.

 

Let's say an institution has to decide who they choose in the future in order to invest an endowment. Cherzeca the great and cigarbutt the moron agree that the winner will be the one who has the greatest risk-adjusted return over ten years. After two years, cherzeca leads by 3% per year and declares victory. Is that OK?

 

New drugs need to go through investigational trials before adoption. Bringing trials to an end is controversial but there are rules. 1-The safety criteria: If investigators 'see' an unusual degree of significant and more or less unexpected side effects, under the first do no harm principle, the trial needs to be stopped and published. This happened not long ago with hydroxychloroquine (QT lengthening stuff and arrhythmias). 2-The futility criteria: If it becomes clear that results will be inconclusive, stop and publish. 3-The benefit criteria: This is a tough one. If results are clearly better, trial is stopped so that all can benefit.

 

The problem is defining "clearly better." Having a stock move up 15% after hours constitutes a significant incentive for positive results. The investigators need to pre-defined rules, rules have to reach statistical and clinical significance and need to meet peer recognition.

[Guest cherzeca]

@cigar

 

a lot of control groups are given placebos...meaning they are given something which purports to be a therapeutic but really isn't...hence the ethical issue for severely ill cohorts where you are in effect practicing deception...arguably good for science but not for the control group cohort

 

so I just think the lack of a control group in this GILD anti-viral example is a feature and not a bug

[Viking]

And now we begin to see what the nationally coordinated plan is for the US for phase 2. After all this is a war (according to the President). The US is at the beginning of what is expected to be the worst recession since the Great Depression. This is a chance for Trump to show what he is made of and that he is up to the challenge.

 

As testing outcry mounts, Trump cedes to states in announcing guidelines for slow reopening

- https://www.washingtonpost.com/politics/as-testing-outcry-mounts-trump-cedes-to-states-in-announcing-guidelines-for-slow-reopening/2020/04/16/202ec300-7ffa-11ea-8013-1b6da0e4a2b7_story.html

 

Trump’s the-buck-stops-with-the-states posture is largely designed to shield himself from blame should there be new outbreaks after states reopen or for other problems, according to several current and former senior administration officials involved in the response who spoke on the condition of anonymity to discuss internal deliberations.

 

Governors have said one of the most important factors in making those determinations is testing data, but Trump’s plan does not contain a national testing strategy. Senior administration officials said that although the federal government will try to facilitate access to tests, states and localities will be responsible for developing and administering their own testing programs.

 

[Viking]

 

Tim Duy’s Fed Watch: https://blogs.uoregon.edu/timduyfedwatch/2020/04/16/its-ugly-out-there/

- https://blogs.uoregon.edu/timduyfedwatch/2020/04/16/its-ugly-out-there/

 

... Still, on the theme of pragmatism, don’t dismiss the importance of that first pop of activity. It marks a turning point, a place to begin rebuilding the economy. The level won’t be where we want it to be and we will need to maintain pressure for ongoing policy support to foster the economy, but the economy will be moving in the right direction. Don’t become too enamored with either the pessimists or the optimists; the reality will fall somewhere in-between.

 

Bottom Line: Controlling Covid-19 requires drastically constricting economic activity; the proof that the plan is working is that the data collapses and we bend the infection curve. The former has definitely happened and it looks like the latter will as well – social distancing works. We still have a long way to go until we return to some semblance of normality, but expect people to begin working in that direction when the restrictions on activity ease. Most important now is to keep the pressure up on Congress to provide sustained support for the economy; that support should be open-ended, based on economic conditions not time or dollars.

[Dalal.Holdings]

All hail Kathleen Mullane, woman who moved markets round the world after hours.

 

What a world we live in!

[Cigarbutt]

@cigar

a lot of control groups are given placebos...meaning they are given something which purports to be a therapeutic but really isn't...hence the ethical issue for severely ill cohorts where you are in effect practicing deception...arguably good for science but not for the control group cohort

so I just think the lack of a control group in this GILD anti-viral example is a feature and not a bug

When does speculation become investment?

When do you decide that conviction is sufficient to put 10% of your net worth in a specific investment?

---)You need to define a threshold.

I fully realize that comparing an investment decision to a life or death situation is different but you (we) need a framework.

 

It has been suggested (from various observational and rational reasons) that remdesivir could result in better outcomes than doing nothing for CV. We don't know the answer to this question. In order to answer that question, trials that involve randomized blind trials with control groups will be essential unless several trials done in different centers with different patients clearly show an advantage (pre-defined targets). When patients are recruited for the studies now, they have a choice to accept (and potentially get drugs that are potentially useful {or not and with negative side effects}) or not. Given the difficult situation, patients may get access to remdesivir through a company-sponsored expanded access program or through a compassionate program. The results do look promising and that should speed up the process.

The approach is obviously not perfect but has provided the shoulders on which future generations could see. How could you know if you don't know?

The pharma cemetery is full of ideas that looked good at some point.