Coronavirus

[StubbleJumper]

There appears to be several points that are being debated, so I’m putting this down as much for me to clear my thinking as much as anything else.  My thinking has evolved so I appreciate those who have contributed to the topic (sometimes in a passionate way). 

 

Points of agreement (I believe):

1) Initial R0 and CFR are significantly higher for COVID19 vs. “normal” flu

2) CFR significantly higher for older / immune compromised individuals

3) The dormant period for the virus is potentially up to two weeks or more

4) There are no cures or vaccines

 

 

Points of debate:

1) Is testing useful?  If so, when?  If not, why not?

2) What methods could stop or slow down the spread of the virus, and their effectiveness & cost?

3) What resources do we have to cope with the disease?

4) What are the economic implications, and indirectly the impact on security prices?

 

On the points of debate:

1) I think there’s probably a stage when testing would have been helpful.  I’m increasingly coming around to the view that that time has passed.  Regardless if you think there are 5mm people infected in the US or 50k or 5k, it seems like there are more than enough cases out there given the dormant period to start the epidemic.  All the data is backward looking, and we won’t know the number of cases anyway since we didn’t test, so if you disagree with this conclusion, could you outline why you disagree? 

 

2) So far it looks like several methods are being advocated for, and nobody is disagreeing on the what could be done (e.g., hygiene, social distancing, etc.), but rather what is practical.  For example, could travel be limited in a country like US?  It’s possible, but we’d have to get way worse before we see that.  However, if everyone worked from home (I think a non-controversial method to deal with the spread) a large swath of the economy goes into a tailspin.  Google is already asking everyone North America to work from home for a month. 

 

a. I’m also coming around to the view that we will all get this at some point.  The Singapore resurgence example is instructive.  If there are sufficient carriers in the wild, I don’t think containment is going to work.  So the question then becomes how long can we spread out the transmission and “bending the curve” vs. eliminating the virus forever. 

b. Also, buying time allows for potential defenses like vaccines to be developed and commercialized.

 

3) I was under the impression that there was potentially more to be done for folks who are sick from the disease (and flu), but from the conversation here it appears that after a certain point, those who are older / immune compromised will have a hard time recovering period.  However, some could be treated, and the question then goes back to how do we maximize the resources available for the largest amount of people (e.g., spreading out the transmission over a longer period.

 

4) As far as the economic impact my opinion is worth just as much as the next guy’s, and I’m not even sure so who knows…

 

Did I misinterpret or misrepresent anything here?

 

 

 

Has everybody in this discussion actually concocted a model for this?  Seriously, 15 minutes with a spreadsheet can be quite instructive.  You soon learn that the potential of flattening the curve is driven largely by your assumptions of 1) How many people seek medical help and are instructed by physicians to self isolate, vs how many have mild symptoms and just continue with day-to-day life; and 2) What is the effective R0 for those who self-isolate vs the R0 of those who have mild cases and just continue on with business as usual. 

 

If you are in the camp that there is a large group that is not destined to self-isolate, there's not much that can be done to flatten the curve.

 

Seriously, if people haven't already done so, go ahead and model it.  And by the way, if somebody disagrees with your modelling assumptions, don't accuse him of not understanding math or being stupid.

 

 

SJ

[Dalal.Holdings]

There appears to be several points that are being debated, so I’m putting this down as much for me to clear my thinking as much as anything else.  My thinking has evolved so I appreciate those who have contributed to the topic (sometimes in a passionate way). 

 

Points of agreement (I believe):

1) Initial R0 and CFR are significantly higher for COVID19 vs. “normal” flu

2) CFR significantly higher for older / immune compromised individuals

3) The dormant period for the virus is potentially up to two weeks or more

4) There are no cures or vaccines

 

 

Points of debate:

1) Is testing useful?  If so, when?  If not, why not?

2) What methods could stop or slow down the spread of the virus, and their effectiveness & cost?

3) What resources do we have to cope with the disease?

4) What are the economic implications, and indirectly the impact on security prices?

 

On the points of debate:

1) I think there’s probably a stage when testing would have been helpful.  I’m increasingly coming around to the view that that time has passed.  Regardless if you think there are 5mm people infected in the US or 50k or 5k, it seems like there are more than enough cases out there given the dormant period to start the epidemic.  All the data is backward looking, and we won’t know the number of cases anyway since we didn’t test, so if you disagree with this conclusion, could you outline why you disagree? 

 

2) So far it looks like several methods are being advocated for, and nobody is disagreeing on the what could be done (e.g., hygiene, social distancing, etc.), but rather what is practical.  For example, could travel be limited in a country like US?  It’s possible, but we’d have to get way worse before we see that.  However, if everyone worked from home (I think a non-controversial method to deal with the spread) a large swath of the economy goes into a tailspin.  Google is already asking everyone North America to work from home for a month. 

 

a. I’m also coming around to the view that we will all get this at some point.  The Singapore resurgence example is instructive.  If there are sufficient carriers in the wild, I don’t think containment is going to work.  So the question then becomes how long can we spread out the transmission and “bending the curve” vs. eliminating the virus forever. 

b. Also, buying time allows for potential defenses like vaccines to be developed and commercialized.

 

3) I was under the impression that there was potentially more to be done for folks who are sick from the disease (and flu), but from the conversation here it appears that after a certain point, those who are older / immune compromised will have a hard time recovering period.  However, some could be treated, and the question then goes back to how do we maximize the resources available for the largest amount of people (e.g., spreading out the transmission over a longer period.

 

4) As far as the economic impact my opinion is worth just as much as the next guy’s, and I’m not even sure so who knows…

 

Did I misinterpret or misrepresent anything here?

 

 

 

Has everybody in this discussion actually concocted a model for this?  Seriously, 15 minutes with a spreadsheet can be quite instructive.  You soon learn that the potential of flattening the curve is driven largely by your assumptions of 1) How many people seek medical help and are instructed by physicians to self isolate, vs how many have mild symptoms and just continue with day-to-day life; and 2) What is the effective R0 for those who self-isolate vs the R0 of those who have mild cases and just continue on with business as usual. 

 

If you are in the camp that there is a large group that is not destined to self-isolate, there's not much that can be done to flatten the curve.

 

Seriously, if people haven't already done so, go ahead and model it.  And by the way, if somebody disagrees with your modelling assumptions, don't accuse him of not understanding math or being stupid.

 

 

SJ

 

Spreadsheets and models are for geeks who wear thick framed glasses! And apparently so is the precautionary principle!

[Read the Footnotes]

https://newyork.cbslocal.com/2020/03/09/coronavirus-update-new-jersey-patient-speaks-out/

 

"Cuomo also made a surprise announcement. One of the latest cases is a top transportation official in charge of the airports: Rick Cotton, executive director of the Port Authority. Cotton is in his mid-70s and is asymptomatic."

 

 

“He’ll be working from home and the senior team that work with Rick will also be tested,” Cuomo said.

 

Maybe its just in Singapore and New Jersey there are asymptomatic people? No way it could be in Ontairo like KC said. They tested all 3000 people.

 

Your shedding the disease regardless, even if less. Still no bueno, and undetected, untested.

 

I believe everyone accepts that there are infected people who are asymptomatic. In Kings County, WA medical personal interviewed by local media reported that asymptomatic people in the LTC facilities progressed from asymptomatic to dead within one hour in multiple cases.

 

The problem is that Ontario, and China's research in combination with the most commonly expected vectors of disease transmission indicate that asymptomatic transmission is luckily not a major factor and that NPI's are effective and still worthwhile.

 

We WILL see in the future on a regional basis and with varying levels of leadership and effectiveness efforts efforts made at containment and eventually to mitigation once containment no longer makes sense for that geographic area.

 

The dominoes will fall one at a time, not all at once. Then they will be put back up again and they will likely fall a few more times before this is over.

[StubbleJumper]

There appears to be several points that are being debated, so I’m putting this down as much for me to clear my thinking as much as anything else.  My thinking has evolved so I appreciate those who have contributed to the topic (sometimes in a passionate way). 

 

Points of agreement (I believe):

1) Initial R0 and CFR are significantly higher for COVID19 vs. “normal” flu

2) CFR significantly higher for older / immune compromised individuals

3) The dormant period for the virus is potentially up to two weeks or more

4) There are no cures or vaccines

 

 

Points of debate:

1) Is testing useful?  If so, when?  If not, why not?

2) What methods could stop or slow down the spread of the virus, and their effectiveness & cost?

3) What resources do we have to cope with the disease?

4) What are the economic implications, and indirectly the impact on security prices?

 

On the points of debate:

1) I think there’s probably a stage when testing would have been helpful.  I’m increasingly coming around to the view that that time has passed.  Regardless if you think there are 5mm people infected in the US or 50k or 5k, it seems like there are more than enough cases out there given the dormant period to start the epidemic.  All the data is backward looking, and we won’t know the number of cases anyway since we didn’t test, so if you disagree with this conclusion, could you outline why you disagree? 

 

2) So far it looks like several methods are being advocated for, and nobody is disagreeing on the what could be done (e.g., hygiene, social distancing, etc.), but rather what is practical.  For example, could travel be limited in a country like US?  It’s possible, but we’d have to get way worse before we see that.  However, if everyone worked from home (I think a non-controversial method to deal with the spread) a large swath of the economy goes into a tailspin.  Google is already asking everyone North America to work from home for a month. 

 

a. I’m also coming around to the view that we will all get this at some point.  The Singapore resurgence example is instructive.  If there are sufficient carriers in the wild, I don’t think containment is going to work.  So the question then becomes how long can we spread out the transmission and “bending the curve” vs. eliminating the virus forever. 

b. Also, buying time allows for potential defenses like vaccines to be developed and commercialized.

 

3) I was under the impression that there was potentially more to be done for folks who are sick from the disease (and flu), but from the conversation here it appears that after a certain point, those who are older / immune compromised will have a hard time recovering period.  However, some could be treated, and the question then goes back to how do we maximize the resources available for the largest amount of people (e.g., spreading out the transmission over a longer period.

 

4) As far as the economic impact my opinion is worth just as much as the next guy’s, and I’m not even sure so who knows…

 

Did I misinterpret or misrepresent anything here?

 

 

 

Has everybody in this discussion actually concocted a model for this?  Seriously, 15 minutes with a spreadsheet can be quite instructive.  You soon learn that the potential of flattening the curve is driven largely by your assumptions of 1) How many people seek medical help and are instructed by physicians to self isolate, vs how many have mild symptoms and just continue with day-to-day life; and 2) What is the effective R0 for those who self-isolate vs the R0 of those who have mild cases and just continue on with business as usual. 

 

If you are in the camp that there is a large group that is not destined to self-isolate, there's not much that can be done to flatten the curve.

 

Seriously, if people haven't already done so, go ahead and model it.  And by the way, if somebody disagrees with your modelling assumptions, don't accuse him of not understanding math or being stupid.

 

 

SJ

 

Spreadsheets and models are for geeks who wear thick framed glasses! And apparently so is the precautionary principle!

 

 

Do you have some sort of obligatory quota which demands that you issue at least one insult or an otherwise denigrating comment per post?

 

SJ

[Dalal.Holdings]

There appears to be several points that are being debated, so I’m putting this down as much for me to clear my thinking as much as anything else.  My thinking has evolved so I appreciate those who have contributed to the topic (sometimes in a passionate way). 

 

Points of agreement (I believe):

1) Initial R0 and CFR are significantly higher for COVID19 vs. “normal” flu

2) CFR significantly higher for older / immune compromised individuals

3) The dormant period for the virus is potentially up to two weeks or more

4) There are no cures or vaccines

 

 

Points of debate:

1) Is testing useful?  If so, when?  If not, why not?

2) What methods could stop or slow down the spread of the virus, and their effectiveness & cost?

3) What resources do we have to cope with the disease?

4) What are the economic implications, and indirectly the impact on security prices?

 

On the points of debate:

1) I think there’s probably a stage when testing would have been helpful.  I’m increasingly coming around to the view that that time has passed.  Regardless if you think there are 5mm people infected in the US or 50k or 5k, it seems like there are more than enough cases out there given the dormant period to start the epidemic.  All the data is backward looking, and we won’t know the number of cases anyway since we didn’t test, so if you disagree with this conclusion, could you outline why you disagree? 

 

2) So far it looks like several methods are being advocated for, and nobody is disagreeing on the what could be done (e.g., hygiene, social distancing, etc.), but rather what is practical.  For example, could travel be limited in a country like US?  It’s possible, but we’d have to get way worse before we see that.  However, if everyone worked from home (I think a non-controversial method to deal with the spread) a large swath of the economy goes into a tailspin.  Google is already asking everyone North America to work from home for a month. 

 

a. I’m also coming around to the view that we will all get this at some point.  The Singapore resurgence example is instructive.  If there are sufficient carriers in the wild, I don’t think containment is going to work.  So the question then becomes how long can we spread out the transmission and “bending the curve” vs. eliminating the virus forever. 

b. Also, buying time allows for potential defenses like vaccines to be developed and commercialized.

 

3) I was under the impression that there was potentially more to be done for folks who are sick from the disease (and flu), but from the conversation here it appears that after a certain point, those who are older / immune compromised will have a hard time recovering period.  However, some could be treated, and the question then goes back to how do we maximize the resources available for the largest amount of people (e.g., spreading out the transmission over a longer period.

 

4) As far as the economic impact my opinion is worth just as much as the next guy’s, and I’m not even sure so who knows…

 

Did I misinterpret or misrepresent anything here?

 

 

 

Has everybody in this discussion actually concocted a model for this?  Seriously, 15 minutes with a spreadsheet can be quite instructive.  You soon learn that the potential of flattening the curve is driven largely by your assumptions of 1) How many people seek medical help and are instructed by physicians to self isolate, vs how many have mild symptoms and just continue with day-to-day life; and 2) What is the effective R0 for those who self-isolate vs the R0 of those who have mild cases and just continue on with business as usual. 

 

If you are in the camp that there is a large group that is not destined to self-isolate, there's not much that can be done to flatten the curve.

 

Seriously, if people haven't already done so, go ahead and model it.  And by the way, if somebody disagrees with your modelling assumptions, don't accuse him of not understanding math or being stupid.

 

 

SJ

 

Spreadsheets and models are for geeks who wear thick framed glasses! And apparently so is the precautionary principle!

 

 

Do you have some sort of obligatory quota which demands that you issue at least one insult or an otherwise denigrating comment per post?

 

SJ

 

Yes, especially when others are put at risk.

[orthopa]

11. The number of cases are vastly under reported, probably numbering in the millions by now in the US.

 

Everything you are saying is based on this assumption, which has no proof! Obviously the lack of testing in the US means this could be true. But extremely unlikely based on what we are seeing in other countries.

 

In Ontario, we have tested just under 3000 people and 36 were positive. That is just over 1% positive from people deemed high risk of the virus. This is not a virus that has been silently going around for months.

 

You are just wrong on this. And repeating it 50 times does not add value.

 

 

https://www.latimes.com/science/story/2020-03-10/us-coronavirus-cases-far-above-official-tally-scientists

 

"An analysis of the novel coronavirus’ spread inside the United States suggests that thousands of Americans are already infected, dimming the prospects for stomping out the outbreak in its earliest stages."

 

"Released into a country of about 330 million, each of these travelers was assumed to have passed the virus to 2 to 2.5 people, each of whom in turn infected another 2 to 2.5 people, and so on. Tote up the nodes on this rapidly branching network of contacts and the number of victims balloons quickly, the researchers wrote."

 

"That only accounts for U.S. residents whose infections originated with people carrying the virus directly from Wuhan, the epicenter of the outbreak in China. In reality, many more people likely have brought the virus here from other hot spots, including Italy, South Korea and the rest of Asia. Each virus carrier who arrived from those places would set off his or her own cascade of infections"

 

"But estimates of the coronavirus’ reproductive rate in circumstances where it is spreading undetected has ranged between 5 and 6, so the researchers may have greatly underestimated the number of infections in the United States, Burke said.

 

“The overall conclusion is, it’s very likely there’s a significant burden of disease we have yet to uncover,” Chowell said.

 

Some of that will likely show up as testing for the disease becomes more commonplace, he said. But much of the outbreak’s unseen underside may never be counted."

 

https://www.washingtonpost.com/health/coronavirus-may-have-spread-undetected-for-weeks-in-washington-state/2020/03/01/0f292336-5bcc-11ea-9055-5fa12981bbbf_story.html

 

Its been in the country for months. Maybe you believe it, if you read online instead? ???

 

[Castanza]

For some reason I have it in my head you are an engineer. Recall the concept of load factor. In theory, it is what you say, a planned amount that is certain to be overwhelmed in situations like this. In practice, pop-up hospitals/clinics/designated testing areas can absorb certain types of healthcare traffic that provide additional capacity. The military is capable of providing healthcare that is highly scalable and I'm sure they have procedures the broader population could copy. We can already see the pop-up additional capacity concept being used in WA.

 

So yes, there is some threshold that I can't rigorously define for you (and probably isn't definable). However, there's a larger gray area than I believe you are considering. Similar with containment area size. Containing MSAs and advising limited inter-state (or inter-community) travel greatly reduces node-to-node contact (from the higher-level POV of community nodes, not individual people). At any point, governments could feasibly shut down highways. Similar to Orthopa, just because we can imagine a way someone can escape quarantine/testing/containment doesn't mean we throw the solution out entirely. Back to engineering, every system has a planned failure rate and that's fine.

 

You just need that R0 rate to fall below 1. If it does, you can see the light at the end of the tunnel. If not, the tunnel is still dark.

 

Thanks for sharing, FWIW I appreciate your logical approach to most topics on this forum. I agree that scalability is certainly possible in the US. But it will most likely take military precautions as you've mentioned.

 

The thing I struggle with is what are the secondary effects of this thing. I can see similar effects with both "letting it run its course" and "lets shut everything down". But both of these have a common input which is uncertain (severity). Until the severity question is answered I have a hard time saying lets preemptively lock down the whole US economy. I guess I'm in the boat of "take personal precautions, and encourage businesses to take precautions as well."

 

Either way I smell massive taxpayer funded bailouts on the horizon.

 

[Kaegi2011]

 

Has everybody in this discussion actually concocted a model for this?  Seriously, 15 minutes with a spreadsheet can be quite instructive.  You soon learn that the potential of flattening the curve is driven largely by your assumptions of 1) How many people seek medical help and are instructed by physicians to self isolate, vs how many have mild symptoms and just continue with day-to-day life; and 2) What is the effective R0 for those who self-isolate vs the R0 of those who have mild cases and just continue on with business as usual. 

 

If you are in the camp that there is a large group that is not destined to self-isolate, there's not much that can be done to flatten the curve.

 

Seriously, if people haven't already done so, go ahead and model it.  And by the way, if somebody disagrees with your modelling assumptions, don't accuse him of not understanding math or being stupid.

 

 

SJ

 

If you have a model done already I'd appreciate you sharing it.  I don't have a clue on the variables at play here, and quite frankly I don't want to get to false precision. 

 

What you're saying makes sense, but my question is if one has no symptoms or mild symptoms how would they know to self isolate?  There's the example above of the NJNY Port Authority person who is asymptomatic - if he wasn't who he was I'm sure he wouldn't have been tested. 

 

Lastly, I don't know if hte last comment was meant for me, but I don't think it's constructive to the conversation...

[StubbleJumper]

There appears to be several points that are being debated, so I’m putting this down as much for me to clear my thinking as much as anything else.  My thinking has evolved so I appreciate those who have contributed to the topic (sometimes in a passionate way). 

 

Points of agreement (I believe):

1) Initial R0 and CFR are significantly higher for COVID19 vs. “normal” flu

2) CFR significantly higher for older / immune compromised individuals

3) The dormant period for the virus is potentially up to two weeks or more

4) There are no cures or vaccines

 

 

Points of debate:

1) Is testing useful?  If so, when?  If not, why not?

2) What methods could stop or slow down the spread of the virus, and their effectiveness & cost?

3) What resources do we have to cope with the disease?

4) What are the economic implications, and indirectly the impact on security prices?

 

On the points of debate:

1) I think there’s probably a stage when testing would have been helpful.  I’m increasingly coming around to the view that that time has passed.  Regardless if you think there are 5mm people infected in the US or 50k or 5k, it seems like there are more than enough cases out there given the dormant period to start the epidemic.  All the data is backward looking, and we won’t know the number of cases anyway since we didn’t test, so if you disagree with this conclusion, could you outline why you disagree? 

 

2) So far it looks like several methods are being advocated for, and nobody is disagreeing on the what could be done (e.g., hygiene, social distancing, etc.), but rather what is practical.  For example, could travel be limited in a country like US?  It’s possible, but we’d have to get way worse before we see that.  However, if everyone worked from home (I think a non-controversial method to deal with the spread) a large swath of the economy goes into a tailspin.  Google is already asking everyone North America to work from home for a month. 

 

a. I’m also coming around to the view that we will all get this at some point.  The Singapore resurgence example is instructive.  If there are sufficient carriers in the wild, I don’t think containment is going to work.  So the question then becomes how long can we spread out the transmission and “bending the curve” vs. eliminating the virus forever. 

b. Also, buying time allows for potential defenses like vaccines to be developed and commercialized.

 

3) I was under the impression that there was potentially more to be done for folks who are sick from the disease (and flu), but from the conversation here it appears that after a certain point, those who are older / immune compromised will have a hard time recovering period.  However, some could be treated, and the question then goes back to how do we maximize the resources available for the largest amount of people (e.g., spreading out the transmission over a longer period.

 

4) As far as the economic impact my opinion is worth just as much as the next guy’s, and I’m not even sure so who knows…

 

Did I misinterpret or misrepresent anything here?

 

 

 

Has everybody in this discussion actually concocted a model for this?  Seriously, 15 minutes with a spreadsheet can be quite instructive.  You soon learn that the potential of flattening the curve is driven largely by your assumptions of 1) How many people seek medical help and are instructed by physicians to self isolate, vs how many have mild symptoms and just continue with day-to-day life; and 2) What is the effective R0 for those who self-isolate vs the R0 of those who have mild cases and just continue on with business as usual. 

 

If you are in the camp that there is a large group that is not destined to self-isolate, there's not much that can be done to flatten the curve.

 

Seriously, if people haven't already done so, go ahead and model it.  And by the way, if somebody disagrees with your modelling assumptions, don't accuse him of not understanding math or being stupid.

 

 

SJ

 

Spreadsheets and models are for geeks who wear thick framed glasses! And apparently so is the precautionary principle!

 

 

Do you have some sort of obligatory quota which demands that you issue at least one insult or an otherwise denigrating comment per post?

 

SJ

 

Yes, especially when others are put at risk.

 

 

You should consider changing strategies.  People will tune you out if all you can offer is insults.

 

SJ

[alwaysdrawing]

WASHINGTON (Reuters) - The White House has ordered federal health officials to treat top-level coronavirus meetings as classified, an unusual step that has restricted information and hampered the U.S. government’s response to the contagion, according to four Trump administration officials.

 

This is scary--top officials need to communicate honestly and openly.

 

This will be worse than even I think....we are not ready for what's coming.

[orthopa]

There appears to be several points that are being debated, so I’m putting this down as much for me to clear my thinking as much as anything else.  My thinking has evolved so I appreciate those who have contributed to the topic (sometimes in a passionate way). 

 

Points of agreement (I believe):

1) Initial R0 and CFR are significantly higher for COVID19 vs. “normal” flu

2) CFR significantly higher for older / immune compromised individuals

3) The dormant period for the virus is potentially up to two weeks or more

4) There are no cures or vaccines

 

 

Points of debate:

1) Is testing useful?  If so, when?  If not, why not?

2) What methods could stop or slow down the spread of the virus, and their effectiveness & cost?

3) What resources do we have to cope with the disease?

4) What are the economic implications, and indirectly the impact on security prices?

 

On the points of debate:

1) I think there’s probably a stage when testing would have been helpful.  I’m increasingly coming around to the view that that time has passed.  Regardless if you think there are 5mm people infected in the US or 50k or 5k, it seems like there are more than enough cases out there given the dormant period to start the epidemic.  All the data is backward looking, and we won’t know the number of cases anyway since we didn’t test, so if you disagree with this conclusion, could you outline why you disagree? 

 

2) So far it looks like several methods are being advocated for, and nobody is disagreeing on the what could be done (e.g., hygiene, social distancing, etc.), but rather what is practical.  For example, could travel be limited in a country like US?  It’s possible, but we’d have to get way worse before we see that.  However, if everyone worked from home (I think a non-controversial method to deal with the spread) a large swath of the economy goes into a tailspin.  Google is already asking everyone North America to work from home for a month. 

 

a. I’m also coming around to the view that we will all get this at some point.  The Singapore resurgence example is instructive.  If there are sufficient carriers in the wild, I don’t think containment is going to work.  So the question then becomes how long can we spread out the transmission and “bending the curve” vs. eliminating the virus forever. 

b. Also, buying time allows for potential defenses like vaccines to be developed and commercialized.

 

3) I was under the impression that there was potentially more to be done for folks who are sick from the disease (and flu), but from the conversation here it appears that after a certain point, those who are older / immune compromised will have a hard time recovering period.  However, some could be treated, and the question then goes back to how do we maximize the resources available for the largest amount of people (e.g., spreading out the transmission over a longer period.

 

4) As far as the economic impact my opinion is worth just as much as the next guy’s, and I’m not even sure so who knows…

 

Did I misinterpret or misrepresent anything here?

 

 

 

Has everybody in this discussion actually concocted a model for this?  Seriously, 15 minutes with a spreadsheet can be quite instructive.  You soon learn that the potential of flattening the curve is driven largely by your assumptions of 1) How many people seek medical help and are instructed by physicians to self isolate, vs how many have mild symptoms and just continue with day-to-day life; and 2) What is the effective R0 for those who self-isolate vs the R0 of those who have mild cases and just continue on with business as usual. 

 

If you are in the camp that there is a large group that is not destined to self-isolate, there's not much that can be done to flatten the curve.

 

Seriously, if people haven't already done so, go ahead and model it.  And by the way, if somebody disagrees with your modelling assumptions, don't accuse him of not understanding math or being stupid.

 

 

SJ

 

BINGO!!

[Read the Footnotes]

Spreadsheets and models are for geeks who wear thick framed glasses! And apparently so is the precautionary principle!

Do you have some sort of obligatory quota which demands that you issue at least one insult or an otherwise denigrating comment per post?

SJ

SJ, I think he was joking.

DH, Next time try one of these  ;) so people will know you were joking.

 

For me all it took was a piece of paper, a calculator and less than three minutes to scare the crap out of me, but of course I know a bit about healthcare and I've done enough bootstrap modeling in the past that I didn't think building a statistical model was worth the time. I could see it in my head.

[opihiman2]

This thread is the perfect example of why I stopped perusing this board a long time ago.  Just idiotic assumptions being made by Internet randos and drawing wild conclusions from them: SHLD, SD, CHK, etc... and now the coronavirus.  It seems that most of you guys have all of a sudden turned into infectious disease experts and epidemiologists. 

[orthopa]

 

 

Did I misinterpret or misrepresent anything here?

 

I think you have an excellent understanding of this at this point, and apparently able to put it down on paper better then me.

[Kaegi2011]

Spreadsheets and models are for geeks who wear thick framed glasses! And apparently so is the precautionary principle!

Do you have some sort of obligatory quota which demands that you issue at least one insult or an otherwise denigrating comment per post?

SJ

SJ, I think he was joking.

DH, Next time try one of these  ;) so people will know you were joking.

 

For me all it took was a piece of paper, a calculator and less than three minutes to scare the crap out of me, but of course I know a bit about healthcare and I've done enough bootstrap modeling in the past that I didn't think building a statistical model was worth the time. I could see it in my head.

 

Could you share the logic please to those who are less informed?  :)

[Read the Footnotes]

A while back, I wrote up one very simple way to create point estimates of the capacity tipping points.

 

No one listened or paid any attention then. :(

[Kaegi2011]

 

Did I misinterpret or misrepresent anything here?

 

I think you have an excellent understanding of this at this point, and apparently able to put it down on paper better then me.

 

Thanks.  Just trying to make sure I fully understand the various perspectives.  Again, apologies again for the comment before re: the profession you've chosen.  It meant no disrepect.

 

I do want to ask you - if you were to take a step back and think about your position, where could you be wrong? 

[Gregmal]

This thread is the perfect example of why I stopped perusing this board a long time ago.  Just idiotic assumptions being made by Internet randos and drawing wild conclusions from them: SHLD, SD, CHK, etc... and now the coronavirus.  It seems that most of you guys have all of a sudden turned into infectious disease experts and epidemiologists.

 

LOL yup. That and the hysteria, along with its mouthpieces, tend to let the day to day volatility, inspire their confidence. Kind of the antithesis of investing. But hey, are you ready for extinction?

[orthopa]

So your ok with catching 50 for every 50 that run free? Looks like your in cahoots with those in charge in Singapore.

 

You obviously aren't going to change your opinion because you've made it clear where you stand (at last for today), so this is as far as we go. I've posted citations I think are worth readers' time. I can understand all sorts of opinions in life, but this is one I think is plainly ignorant. You may have a lot of healthcare experience, but most every doctor and organization with on-the-ground experience or oversight of this disease contradicts you. You want people on this board to respect your experience but you refuse to acknowledge the more relevant experience of others saying you are wrong. It's hubris.

Where are my "this is concerning, and we are watching developments with caution" folks?

 

And be thought a fool by everyone with a strong opinion? Better to remain silent.  ;)

 

 

 

 

@orthopa

I think what folks are saying when saying testing is important is that identifying as many spreaders as possible is key to containment. You can't catch them all. Don't let perfect be the enemy of the good. Some folks spread to 1 person. Some spread disease to dozens. You want to eliminate as many spreaders as possible so that the disease population can't reach escape velocity. Basically to the point above about the number sick at any given time being semi-controllable.

 

 

 

Whats your plan for asymptomatic people/kids who don't seem to be affected and dont go to the doctor?

 

I already answered. You can't catch everyone. Any additional you do catch early can moderate the number sick at any given time. You might not be able to control total number to get sick, but spreading that number out over a longer period leads to far better outcomes in aggregate. That's why people are testing.

 

Further, WHO says adult to child transmission is more common than reverse, as opposed to seasonal flu.

 

To the "it's been here for 1+ month" comment, viruses compound when no one has immunity.

 

I don't disagree with this point on spreading it out, but what exactly is the threshold (number of patients a hospital can hold)?

 

Healthcare capacity is derived and constructed off of averages and then scaled according to population. A pandemic by nature is already over-capacity right?

 

If I had to guess the threshold is quite low and I'm doubtful any solutions will be effective. The US is especially difficult to contain and isolate due to its size, efficiency and reliance on individual travel (interstate) compared to small countries like Germany (who funny enough just announced 3/4 of their citizens are likely to be infected).

 

If small countries that heavily rely on public transit can barely contain this thing how can a vast country like the US contain it? I guess scale could make quarantining sections of the country possible, but with the reliance on individual transit it feels like a bucket full of holes trying to carry water.

 

For some reason I have it in my head you are an engineer. Recall the concept of load factor. In theory, it is what you say, a planned amount that is certain to be overwhelmed in situations like this. In practice, pop-up hospitals/clinics/designated testing areas can absorb certain types of healthcare traffic that provide additional capacity. The military is capable of providing healthcare that is highly scalable and I'm sure they have procedures the broader population could copy. We can already see the pop-up additional capacity concept being used in WA.

 

 

 

Nope Im a physican that works in the ER/Urgent care. Im the "ignorant" fuck adding no value that would walk in to see if you went to the hospital with these symptoms.

[KCLarkin]

"An analysis of the novel coronavirus’ spread inside the United States suggests that thousands of Americans are already infected, dimming the prospects for stomping out the outbreak in its earliest stages."

 

I agree with the above. I disagree with your estimates:

 

11. The number of cases are vastly under reported, probably numbering in the millions by now in the US.

 

That is a factor of 1000x which makes a massive difference when you are trying to estimate how dangerous this virus is. You are welcome to your opinion that millions of people in the US are infected with this virus and happily walking around asymptomatic. But please understand that your opinion is not based on facts.

 

[StubbleJumper]

 

Has everybody in this discussion actually concocted a model for this?  Seriously, 15 minutes with a spreadsheet can be quite instructive.  You soon learn that the potential of flattening the curve is driven largely by your assumptions of 1) How many people seek medical help and are instructed by physicians to self isolate, vs how many have mild symptoms and just continue with day-to-day life; and 2) What is the effective R0 for those who self-isolate vs the R0 of those who have mild cases and just continue on with business as usual. 

 

If you are in the camp that there is a large group that is not destined to self-isolate, there's not much that can be done to flatten the curve.

 

Seriously, if people haven't already done so, go ahead and model it.  And by the way, if somebody disagrees with your modelling assumptions, don't accuse him of not understanding math or being stupid.

 

 

SJ

 

If you have a model done already I'd appreciate you sharing it.  I don't have a clue on the variables at play here, and quite frankly I don't want to get to false precision. 

 

What you're saying makes sense, but my question is if one has no symptoms or mild symptoms how would they know to self isolate?  There's the example above of the NJNY Port Authority person who is asymptomatic - if he wasn't who he was I'm sure he wouldn't have been tested. 

 

Lastly, I don't know if hte last comment was meant for me, but I don't think it's constructive to the conversation...

 

 

Well, I would say that understanding is best obtained if you build it out yourself.  A quick and easy one:

 

-create a column for each of two groups, one which has been diagnosed with Covid and has self isolated, and one which is either asymptomatic or has such mild symptoms that they haven't gone to the doctor for treatment

-select an R-naught for each of those groups.  The undiagnosed group might have R0=3, and the confirmed group might have R0=1.5

-build out a simulation by using 30 or 40 rows representing discrete "rounds" where the virus propogates.  Your new cases are driven by your two different assumed R-naughts, and you can then once again apply your assumption of how many of those new cases will self-isolate and how many will just go on with day to day life.

-you now have a multi-stage, 3 parameter, discrete time model that you've concocted in 15 minutes.  Play around with your two assumed R-naughts and play around with your split between the percentage of people who self-isolate and those who do not.  See how the evolution of the epidemic changes when you play with those parameters.

 

 

Pretty much everybody on this board spent some portion of their life as a spreadsheet jockey, so this type of exercise is pretty basic.

 

The last comment was not directed at you.  There are 3 or 4 posters who have a view of this pandemic which might or might not be correct.  Their view is underpinned by a few key assumptions (just like the model you could build).  Other people do not share those key assumptions and parameterize their model differently, as should be expected in a situation characterized by uncertainty.  But, the disagreement about how to best parameterize your model ought not degenerate into accusations of innumeracy or stupidity.

 

 

SJ

[orthopa]

 

Did I misinterpret or misrepresent anything here?

 

I think you have an excellent understanding of this at this point, and apparently able to put it down on paper better then me.

 

Thanks.  Just trying to make sure I fully understand the various perspectives.  Again, apologies again for the comment before re: the profession you've chosen.  It meant no disrepect.

 

I do want to ask you - if you were to take a step back and think about your position, where could you be wrong?

 

I could be wrong by how much of a hit this will be to the ICU/need for respirator, ie breakdown of health system. I can only think back to working during the H1N1 outbreak and the 17-18 flu season and that volume load which was ~15 million cases if I recall correctly. The system was stretched, but did not collapse, My opinion is the virus has been here for 6 weeks/months and cases are vastly under reported. So in my mind we are currently in an environment of where many think we will be from documented patient 1 say 4-6 weeks from now, already!  Its in this mind frame I have a hard time rectifying a wickedly high death rate and medical system collapse if we are operating in this environment currently.

 

I certainly could be wrong on this, I hope I'm right of course. We will see. The fact of the matter is if the cases are severely under estimated and we are handling it now maybe we are further along on the curve then we think, and handling it fine.

[Read the Footnotes]

11. The number of cases are vastly under reported, probably numbering in the millions by now in the US.

 

Everything you are saying is based on this assumption, which has no proof! Obviously the lack of testing in the US means this could be true. But extremely unlikely based on what we are seeing in other countries.

 

In Ontario, we have tested just under 3000 people and 36 were positive. That is just over 1% positive from people deemed high risk of the virus. This is not a virus that has been silently going around for months.

 

You are just wrong on this. And repeating it 50 times does not add value.

 

 

https://www.latimes.com/science/story/2020-03-10/us-coronavirus-cases-far-above-official-tally-scientists

 

"An analysis of the novel coronavirus’ spread inside the United States suggests that thousands of Americans are already infected, dimming the prospects for stomping out the outbreak in its earliest stages."

 

"Released into a country of about 330 million, each of these travelers was assumed to have passed the virus to 2 to 2.5 people, each of whom in turn infected another 2 to 2.5 people, and so on. Tote up the nodes on this rapidly branching network of contacts and the number of victims balloons quickly, the researchers wrote."

 

"That only accounts for U.S. residents whose infections originated with people carrying the virus directly from Wuhan, the epicenter of the outbreak in China. In reality, many more people likely have brought the virus here from other hot spots, including Italy, South Korea and the rest of Asia. Each virus carrier who arrived from those places would set off his or her own cascade of infections"

 

"But estimates of the coronavirus’ reproductive rate in circumstances where it is spreading undetected has ranged between 5 and 6, so the researchers may have greatly underestimated the number of infections in the United States, Burke said.

 

“The overall conclusion is, it’s very likely there’s a significant burden of disease we have yet to uncover,” Chowell said.

 

Some of that will likely show up as testing for the disease becomes more commonplace, he said. But much of the outbreak’s unseen underside may never be counted."

 

https://www.washingtonpost.com/health/coronavirus-may-have-spread-undetected-for-weeks-in-washington-state/2020/03/01/0f292336-5bcc-11ea-9055-5fa12981bbbf_story.html

 

Its been in the country for months. Maybe you believe it, if you read online instead? ???

 

Orthopa has an important point here. Please read this article:

 

https://www.boston.com/news/health/2020/03/11/coronavirus-testing-delays

 

The outbreak in Kings County, WA was only discovered because the flu project funded by Bill Gates broke the law and multiple times ignored the direction of the federal government. I think the story told in this article is a real window in to how we got to where we are and is important for understanding our future.

 

Some of the "Influenza" pressure on the US healthcare system was undoubtedly COVID-19. Even Kings County LTC victims who died after the discovery of the outbreak were classified as victims of the flu and only diagnosed as COVID-19 through testing after death, and after a different finding of cause of death on the death certificate.

 

Deaths from COVID-19 in China are similarly understated. In China, for decades the practice has been you can only have one cause of death and it must be the most immediate cause of death. So if you had COVID-19 which caused a heart attack, the cause of death would be recorded as "heart attack" not COVID-19. That plus the fog of war led to under reporting. Please keep your tin hats safely stowed away. They aren't even needed in this case.

[Spekulatius]

In case you want some real stories:

My relative who was cured 3 weeks ago now has the symptoms again and CT shows lung infections. My mom’s neighbor was recently cured and discharged from hospital and died the next night.

 

sorry to hear that. Do you know their ages?

Both in the 50s.

 

@Muscleman , very very sorry to hear. Reoccurring infections have been reported in China (my wife told me about it) and so far seem inexplicable and scary. Probably different strains of the Virus ( solely my conjecture).

[Read the Footnotes]

In case you want some real stories:

My relative who was cured 3 weeks ago now has the symptoms again and CT shows lung infections. My mom’s neighbor was recently cured and discharged from hospital and died the next night.

 

sorry to hear that. Do you know their ages?

Both in the 50s.

 

@Muscleman , very very sorry to hear. Reoccurring infections have been reported in China (my wife told me about it) and so far seem inexplicable and scary. Probably different strains of the Virus ( solely my conjecture).

Thank you for contributing, Muscleman and sorry for your continued loss due to this terrible illness.

 

Stories of reinfection, and stories of lung damage are very concerning and are probably not factored in to most people's mental models.