orthopa Posted April 22, 2020 Posted April 22, 2020 Let me repost my 5 things that people don't understand. [*]Exponential growth [*]It takes weeks between infection and hospitalization and death [*]Hospitals are not infinitely expandable--if enough people come in, hospitals run out of resources [*]If you're in the ICU with this, you are likely in there for weeks [*]That without ventilators, the death rate increases dramatically Maybe #5 not true Some 88% of Covid-19 patients in the New York City area who had to be placed on ventilators subsequently died. https://www.bloomberg.com/news/articles/2020-04-22/almost-9-in-10-covid-19-patients-on-ventilators-died-in-study?cmpid=BBD042220_BIZ&utm_medium=email&utm_source=newsletter&utm_term=200422&utm_campaign=bloombergdaily Overall, the researchers reported that 553 patients died, or 21%. But among the 12% of very sick patients that needed ventilators to breathe, the death rate rose to 88%. The rate was particularly awful for patients over 65 who were placed on a machine, with just 3% of those patients surviving, according to the results. Men had a higher mortality rate than women. What a crazy stat. As unpleasant as it sounds the best way to not overload the healthcare system is to not put these pts on a ventilator, try everything else possible and let them expire if unsuccessful. All you end up with is an ICU full of pts destined to die with a 3% survival rate.
LC Posted April 22, 2020 Posted April 22, 2020 It is really amazing to me. When all this anti-intellectualism, anti-expertise started with Trump there were questions posed like if you have the guy who operates on you to be a doctor? That was purely theoretical back then and didn't need to be addressed. Now fast forward to 2020 when you have a situation where it's not theoretical anymore. You actually need the doctors. Turns out that no, they still don't want the doctors. The best part is watching them squirm when their lack of knowledge is exposed. It's pretty hilarious, in a "laugh so you don't cry" sort of way.
KCLarkin Posted April 22, 2020 Posted April 22, 2020 this is BS Hj. the early data from china was definitive on excessive impact on elderly. and we knew the genomics of this virus very early on. we were not operating in the dark, we were just operating stupidly. This is BS, CZ. People have tried closing down nursing homes. It doesn't work, particularly when the President prevents testing. Your repeated assertions that it would work are silly. More BS from you RG. No visitors to nursing homes instituted by the industry late march. should have been late January. This whole theory is absolutely nuts! People are in nursing homes because they are no longer independent. You can lock all the olds up in a home and they won’t get the virus. But as soon as you have a worker come into the home, they are exposed to the virus. You have aircraft carriers in the middle of the ocean with massive outbreaks and you think you can somehow only isolate the vulnerable when they are 100% dependent on the outside world. Certifiably nuts.
Viking Posted April 22, 2020 Posted April 22, 2020 It is really amazing to me. When all this anti-intellectualism, anti-expertise started with Trump there were questions posed like if you have the guy who operates on you to be a doctor? That was purely theoretical back then and didn't need to be addressed. Now fast forward to 2020 when you have a situation where it's not theoretical anymore. You actually need the doctors. Turns out that no, they still don't want the doctors. The best part is watching them squirm when their lack of knowledge is exposed. It's pretty hilarious, in a "laugh so you don't cry" sort of way. Crazy how those in charge get a free pass. “But their intentions were good.” So it really doesn’t matter if they burn down the house with their stupidity. Actually, the stupidity is to be celebrated; and the more stupid the better. And then we are told that all this stupidity is just ‘common sense.’ It is explained and twisted in ways that reek of Animal Farm. George Orwell is smiling from the grave right now at all the irony.
ERICOPOLY Posted April 22, 2020 Posted April 22, 2020 It is really amazing to me. When all this anti-intellectualism, anti-expertise started with Trump there were questions posed like if you have the guy who operates on you to be a doctor? That was purely theoretical back then and didn't need to be addressed. Now fast forward to 2020 when you have a situation where it's not theoretical anymore. You actually need the doctors. Turns out that no, they still don't want the doctors. The best part is watching them squirm when their lack of knowledge is exposed. It's pretty hilarious, in a "laugh so you don't cry" sort of way. It doesn't help when Kushner is advising Trump and daughters tend to marry their fathers.
Spekulatius Posted April 23, 2020 Posted April 23, 2020 Let me repost my 5 things that people don't understand. [*]Exponential growth [*]It takes weeks between infection and hospitalization and death [*]Hospitals are not infinitely expandable--if enough people come in, hospitals run out of resources [*]If you're in the ICU with this, you are likely in there for weeks [*]That without ventilators, the death rate increases dramatically Maybe #5 not true Some 88% of Covid-19 patients in the New York City area who had to be placed on ventilators subsequently died. https://www.bloomberg.com/news/articles/2020-04-22/almost-9-in-10-covid-19-patients-on-ventilators-died-in-study?cmpid=BBD042220_BIZ&utm_medium=email&utm_source=newsletter&utm_term=200422&utm_campaign=bloombergdaily Overall, the researchers reported that 553 patients died, or 21%. But among the 12% of very sick patients that needed ventilators to breathe, the death rate rose to 88%. The rate was particularly awful for patients over 65 who were placed on a machine, with just 3% of those patients surviving, according to the results. Men had a higher mortality rate than women. What a crazy stat. As unpleasant as it sounds the best way to not overload the healthcare system is to not put these pts on a ventilator, try everything else possible and let them expire if unsuccessful. All you end up with is an ICU full of pts destined to die with a 3% survival rate. Actually, this mortality rate is an indication that the health care system in NYC was overloaded. A lot of patients admitted to hospitals went straight on the respirator. They probably had already organ damage from oxygen deficiency at that point. Earlier admission with oxygen supplementation (which is what Boris Johnson got) might saved many. The high mortality rate in NYC also indicates such.
RichardGibbons Posted April 23, 2020 Posted April 23, 2020 Let me repost my 5 things that people don't understand. [*]Exponential growth [*]It takes weeks between infection and hospitalization and death [*]Hospitals are not infinitely expandable--if enough people come in, hospitals run out of resources [*]If you're in the ICU with this, you are likely in there for weeks [*]That without ventilators, the death rate increases dramatically Maybe #5 not true Some 88% of Covid-19 patients in the New York City area who had to be placed on ventilators subsequently died. https://www.bloomberg.com/news/articles/2020-04-22/almost-9-in-10-covid-19-patients-on-ventilators-died-in-study?cmpid=BBD042220_BIZ&utm_medium=email&utm_source=newsletter&utm_term=200422&utm_campaign=bloombergdaily Overall, the researchers reported that 553 patients died, or 21%. But among the 12% of very sick patients that needed ventilators to breathe, the death rate rose to 88%. The rate was particularly awful for patients over 65 who were placed on a machine, with just 3% of those patients surviving, according to the results. Men had a higher mortality rate than women. What a crazy stat. As unpleasant as it sounds the best way to not overload the healthcare system is to not put these pts on a ventilator, try everything else possible and let them expire if unsuccessful. All you end up with is an ICU full of pts destined to die with a 3% survival rate. Actually, this mortality rate is an indication that the health care system in NYC was overloaded. A lot of patients admitted to hospitals went straight on the respirator. They probably had already organ damage from oxygen deficiency at that point. Earlier admission with oxygen supplementation (which is what Boris Johnson got) might saved many. The high mortality rate in NYC also indicates such. Yeah, so maybe #5 isn't true--I was incorrect in attributing the skyrocketing death rate to ventilators when hospitals become overloaded. Maybe it should be changed to "when hospitals run out of resources, the death rate skyrockets". Does that make sense? We've certainly observed that effect in multiple places.
Dalal.Holdings Posted April 23, 2020 Posted April 23, 2020 It is really amazing to me. When all this anti-intellectualism, anti-expertise started with Trump there were questions posed like if you have the guy who operates on you to be a doctor? That was purely theoretical back then and didn't need to be addressed. Now fast forward to 2020 when you have a situation where it's not theoretical anymore. You actually need the doctors. Turns out that no, they still don't want the doctors. The best part is watching them squirm when their lack of knowledge is exposed. It's pretty hilarious, in a "laugh so you don't cry" sort of way. Crazy how those in charge get a free pass. “But their intentions were good.” So it really doesn’t matter if they burn down the house with their stupidity. Actually, the stupidity is to be celebrated; and the more stupid the better. And then we are told that all this stupidity is just ‘common sense.’ It is explained and twisted in ways that reek of Animal Farm. George Orwell is smiling from the grave right now at all the irony. The problem is when we all share "the house" with them... Similar problem with the environment. Oh well.
Cigarbutt Posted April 23, 2020 Posted April 23, 2020 ... this is BS Hj. the early data from china was definitive on excessive impact on elderly. and we knew the genomics of this virus very early on. we were not operating in the dark, we were just operating stupidly. cherzeca, you've been a regular contributor to this thread and the diversity of opinions is welcome. Some comments: -You now imply that the obvious strategy would have been to "protect" the 'vulnerables' from the onset (isolate, masks and gloves). However, your initial contributions at the onset suggested that the virus should have been allowed to run its course. It's OK to change opinion but trying to retroactively instate a new opinion is a kind of misrepresentation. It's still unclear, in practice, how isolation of older (at some point you mention age 80 or above and then modify gradually to include immunosuppressed and eventually delegate to the government for the definition and handling of the at-risk groups, about a third of the population in the US)) could be accomplished while allowing (even encouraging) community spread. Some above mentioned the common sense statement that the institutionalized elderly population needs a high workforce ratio from outside who could be at-risk themselves or who could have at-risk individuals in their own household. Presently, i'm involved (in various degrees) in strategy modification efforts in chronic care institutions and common sense experience shows how difficult it is to "isolate" nursing homes when the virus has already spread widely in the community. -You also tend to recommend various treatments based on anecdotal observations which is weak evidence, especially if such recommendations are tied to controversial theories or to theories that are not globally supported by relevant peers, when the threshold for proof then should be extremely elevated. -You still also recurrently equate CV with the flu, "this is the flu". While there are many common themes, there are also fundamental differences, the major ones being that natural immunity for CV is much lower than the flu and the most frequent cause of death is not bacterial secondary infection but a viral-induced inflammatory reaction in the lung tissue. -Mortality rate in the US now is above 47K. In a few months, the total mortality from CV and flu will result in a very high and unusual number of virus-related deaths. You often underestimated the number of deaths and the duration of the CV episode, at times suggesting that the containment efforts actually contributed to an increase in number of deaths which is contrary to most evidence and most common sense. In all likelihood, the containment efforts contributed in a reduction of mortality. And while there are costs, a more relevant discussion may concern ways to maximize the cost-benefit equation. Tough questions need to be asked especially, at this point, about the exit strategies and i will look forward to your inputs.
Dalal.Holdings Posted April 23, 2020 Posted April 23, 2020 https://www.bloomberg.com/news/articles/2020-04-22/top-health-official-says-he-was-ousted-over-trump-touted-drug A top U.S. health official who was helping lead efforts to find a coronavirus vaccine said he was removed from his post because he insisted on limiting the use of a drug President Donald Trump has pushed as a Covid-19 treatment despite little clinical evidence it works. Rick Bright was abruptly pushed out of his position as the director of the Biomedical Advanced Research and Development Authority on Tuesday and given a smaller role at the National Institutes of Health. BARDA is helping pharmaceutical companies develop a vaccine for the novel coronavirus. The drugs Trump has touted, hydroxychloroquine and chloroquine, “clearly lack scientific merit,” Bright said in a statement through his lawyers on Wednesday. There seems to be a disease that is endemic. No, I am not talking about Covid. I am talking about the epidemic of pride in ignorance that afflicts this administration and its supporters. There is unfortunately wide collateral damage beyond the administration & its supporters. And people ask how dare we criticize this administration w moves like this? Please.
Guest cherzeca Posted April 23, 2020 Posted April 23, 2020 @cigarbutt 1. I believe I have been consistent in stating that given limited resources, we should have focused our mitigation efforts on the elderly and the immune-compromised, which turned into the elderly and those with underlying conditions. we knew early on that the average mortality age was around 80, and a little later on that only 2% of those who died with covid did not have advanced age or other conditions (obesity/hypertension). this would have required a focused effort to close nursing homes to visitors, outreach to all other elderly with masks etc., and yes testing/masking of care workers. all of this is not easy, but much easier and smarter than shutting down almost the entire economy. mass hysteria favors only those like the michigan governor who want to control your life, and is good for no one's health. 2. I have an 85 year old friend who contracted covid, was hospitalized, prescribed plaq/z-pack and immediately recovered...released in two days (he had no underlying conditions other than advanced age). I also have 4 MD friends (one a pulmonologist critical care MD) who report that hospitals at where they practice have had good results with this regimen...not 100% recovery, but good enough to become the default regimen until something else that is better comes along. it would be criminal not to use it until something else more effective comes along. so yes anecdotal, but more relevant to me than a bureaucrat telling us what we all know, which is that it hasn't been "proven". by the way, the pneumonia you mention as a distinguishing cause of death is exactly why plaq-z-pack makes sense. most people dont realize that z-pack is a senolytic, which is important. 3. I expect when we have a better grasp on the scope of covid infection without symptoms, we will find that the mortality rate compared to the flu is in the same ballpark. many more people have been infected without symptoms than the epidemiologists are using in their models...and of course breathlessly reported by the media. mass hysteria is also good for the media, not just for people like the governor of michigan. 4. exit strategy can't be imposed by government bureaucrats, with or without MDs. this is a local decision to be made based upon local facts, and I am referring to each business making its own determination based of course with input from federal and state level advisors. but this stalinesque attitude of governors like in michigan is bad public policy and a bad precedent for the future of freedom in my beloved country. this whole shutdown was intended to avoid a hospital crowding crisis, and the only place where that was close to happening is NYC (and maybe Detroit and New Orleans). and the navy hospital ship in NYC sits mostly empty. exit strategy cannot be an ego trip of governors but a careful reliance upon the good common sense of the businesses and private actors who were forced to shut down. this is still America. edit: I do believe "the containment efforts actually contributed to an increase in number of deaths ". closing schools did not serve the public interest, but only sent many covid carring kids not at risk and without symptoms to spend much more time in confined households with elderly in residence (see queens, Brooklyn and bronx). again, a focused effort protecting teachers would have been smarter than increasing covid exposure to elderly family members. this is common sense.
LC Posted April 23, 2020 Posted April 23, 2020 Some factual context, here is the most recent European mortality numbers Note on interpretation of data: The number of deaths shown for the three most recent weeks (shaded area) should be interpreted with caution as adjustments for delayed registrations may be imprecise.
perulv Posted April 23, 2020 Posted April 23, 2020 Some factual context, here is the most recent European mortality numbers Note on interpretation of data: The number of deaths shown for the three most recent weeks (shaded area) should be interpreted with caution as adjustments for delayed registrations may be imprecise. I know this is pointing out the obvious, but it would be interesting to see the same graph for a parallel-universe Europe where we did not put in place the most severe restrictions on movement etc since WW2. Attached is a graph of hospitalizations due to covid-19 in Norway. The shut-down went into effect 13th march. (edit: smaller picture-size)
clutch Posted April 23, 2020 Posted April 23, 2020 'Up to half' of Europe deaths in care homes, WHO warns https://www.bbc.com/news/live/world-52391597
clutch Posted April 23, 2020 Posted April 23, 2020 A humanitarian reason for opening up the economies around the world: "Coronavirus pandemic will cause global famines of 'biblical proportions,' UN warns"\ "While dealing with a Covid-19 pandemic, we are also on the brink of a hunger pandemic," David Beasley told the UN's security council. "There is also a real danger that more people could potentially die from the economic impact of Covid-19 than from the virus itself." https://www.cnn.com/2020/04/22/africa/coronavirus-famine-un-warning-intl/index.html Yes, it is from CNN, not Fox.
Gregmal Posted April 23, 2020 Posted April 23, 2020 Killing people passively is far easier to take than killing them aggressively. People were going to die here, regardless. Which is why everyone was in between a rock and a hard place. Its why many countries delayed, because the choice was not easy. But it seems many took the gutless approach...passively via economic suicide, akin to tossing a living person off a boat without a life raft in the middle of the ocean and driving away while they are still alive, vs, dealing with the repercussions of "you didn't lock down the economy and a bunch of old people died as a result of getting the virus"... we are continuing to see that the elder and at risk will die regardless, but now the economy is hitting hard all people, from infant to elder in its effects.
Guest cherzeca Posted April 23, 2020 Posted April 23, 2020 'Up to half' of Europe deaths in care homes, WHO warns https://www.bbc.com/news/live/world-52391597 "The state concedes that 3,448 residents of nursing homes or adult-care facilities are known to have died from the coronavirus, or nearly 25 percent of all deaths in New York. More than 2,000 of the total are in the five boroughs, and officials acknowledge that the real numbers are almost certainly higher." https://nypost.com/2020/04/21/cuomo-coronavirus-nursing-home-policy-proves-tragic-goodwin/ sitting ducks for a failed public policy
KJP Posted April 23, 2020 Posted April 23, 2020 Have there been any studies on the virus's ability to spread via HVAC systems in office/multi-family buildings?
Liberty Posted April 23, 2020 Posted April 23, 2020 https://quillette.com/2020/04/23/covid-19-superspreader-events-in-28-countries-critical-patterns-and-lessons/
Liberty Posted April 23, 2020 Posted April 23, 2020 https://www.thenewatlantis.com/publications/not-like-the-flu-not-like-car-crashes-not-like
Liberty Posted April 23, 2020 Posted April 23, 2020 Bill Gates memo: https://www.seattletimes.com/nation-world/it-is-impossible-to-overstate-the-pain-fight-against-coronavirus-will-define-our-era-bill-gates-says/ “This is like a world war, except in this case, we’re all on the same side,” he writes. [...] In the coming months, the drop-off in new infections will be precipitous in places where social distancing has slashed the rate of transmission, he says. “A lot of people will be stunned that in many places we will go from hospitals being overloaded in April to having lots of empty beds in July,” Gates writes. “The whiplash will be confusing, but it is inevitable from the exponential nature of infection.”
minten Posted April 23, 2020 Posted April 23, 2020 A humanitarian reason for opening up the economies around the world: "Coronavirus pandemic will cause global famines of 'biblical proportions,' UN warns"\ "While dealing with a Covid-19 pandemic, we are also on the brink of a hunger pandemic," David Beasley told the UN's security council. "There is also a real danger that more people could potentially die from the economic impact of Covid-19 than from the virus itself." https://www.cnn.com/2020/04/22/africa/coronavirus-famine-un-warning-intl/index.html Yes, it is from CNN, not Fox. We all know we won't care because it won't be us. It's a point i've been trying to make since the start.
minten Posted April 23, 2020 Posted April 23, 2020 Preliminary NY sttudy says 21.2% of NYC has antibodies.
Cigarbutt Posted April 23, 2020 Posted April 23, 2020 Have there been any studies on the virus's ability to spread via HVAC systems in office/multi-family buildings? This is no time for definitive answers and there is potential airborne transmission over long distances. The critical variables are virus load, proximity and one's susceptibility. Unlike other infections (example: Legionella bacteria, Legionnaires' disease) which thrives in ventilation systems and transmits this way), CV does not appear to transmit through ventilation systems. But do you own work. References below. Don't hesitate to ask more questions even if answers cannot be provided. :) https://www.nature.com/articles/d41586-020-00974-w https://msystems.asm.org/content/msys/5/2/e00245-20.full.pdf Personal note: spending time on this will invariably cause you to focus on your environment and to the realization that microbes are terribly ubiquitous. Killing people passively is far easier to take than killing them aggressively. People were going to die here, regardless. Which is why everyone was in between a rock and a hard place. Its why many countries delayed, because the choice was not easy. But it seems many took the gutless approach...passively via economic suicide, akin to tossing a living person off a boat without a life raft in the middle of the ocean and driving away while they are still alive, vs, dealing with the repercussions of "you didn't lock down the economy and a bunch of old people died as a result of getting the virus"... we are continuing to see that the elder and at risk will die regardless, but now the economy is hitting hard all people, from infant to elder in its effects. Why do you limit your choices to only two extreme outcomes? Isn't it possible to get the boat going while simultaneously devising rescue units. As a society, we take these decisions all the time. What's different here is the suddenness, uncertainty and complexity of the issue but aren't there a lot of intelligent people on this boat? In general, i think a high value belongs to individualism and would normally rather live in the US versus Singapore but wonder if the balance may require temporary adjustments to deal with abnormal transitions. Take a look (if short on time 10:16 to 10:26): "Therefore, it is critical that we go into this eyes open,with strong leadership and good government, united and determined, to see this through."
Guest Schwab711 Posted April 23, 2020 Posted April 23, 2020 Gottlieb said 10x - 20x undercounting https://seekingalpha.com/news/3562760-coronavirus-cases-10x-20x-higher-reported-former-fda-commish In 2009, undercounting was found to be 17x. Cuomo says 14% of NYC residents have had COVID https://www.cnbc.com/2020/04/23/new-york-antibody-study-estimates-13point9percent-of-residents-have-had-the-coronavirus-cuomo-says.html Given the ~140k NYC confirmed cases, this again supports 10x - 20x undercounting. A lot of data supports closer to 20x (or potentially a little above it) in places with less testing and closer to 10x in NYC (which seems like where it is right now). That helps a lot to hone in on what we are dealing with! The obvious question is true hospitalization rate/CFR: https://www1.nyc.gov/site/doh/covid/covid-19-data.page This implies a hospitalization rate of 1.2% - 2.5% CFR of 0.5% - 1.0% (probably closer to middle or bottom of the range here since we have estimates of uncounted deaths not confirmed - there's some overcounting and early deaths are unlikely to fully offset any overcounting given the more accurate estimate of unconfirmed COVID deaths in NYC [versus other areas]). This fits with what data looked like early. 0.5% - 1.0% CFR and highly contagious. If anyone has hospitalization/CFR by age bracket in NYC, please post! I'm not sure using the national age brackets makes sense yet. That's too much extrapolation imo, but a 15x - 20x scalar will probably give a reasonable range.
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