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spartansaver

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Trump: Nobody told me about the pandemic I warned you about. If the economy is bad, it's the governors' fault, but if you don't get sick, credit me. I have all the authority and none of the responsibility.

 

When Trump is wrong, he simply spins 180 and lies about what he said yesterday. This is what his years of constant lying have set the stage for. "The truth is what I say today." But you cannot bluff a virus.

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thanks for the control group info.  clearly if a patient can select between the GILD anti-viral and plaq/z-pack, then I wouldn't see any ethical issue.

Obviously, you're entitled to your own ethical opinions.

A problem that is often seen is that drug companies find placebo control (no real treatment, sugar pill etc) to be a pain when trying to establish superior performance (to nothing) because, very often, a significant number of patients report better outcomes (!) and also higher incidence of side effects (!) in the placebo arm of the investigation. Sometimes, it's not what's real that counts, it's what you believe in. :)

 

Speaking of placebo effects in the investing world, they happen all the time. The most impressive manifestation (from my humble perspective) was when accounting rules were relaxed for financial institutions' mark-to-market accounting in March 2009. The symbolic move really 'helped' from the proprietary data perspective i was looking at. The most impressive part is that the financial institutions (most of them anyway) most exposed to MBS and NPLs showed the most spectacular improvement in the market perception of risk for these entities. Eventually, it was discovered that most would have been fine anyhow but their stay in the ICU was shortened considerably. I've always had mixed feelings about placebo effects.

https://www.medrxiv.org/content/10.1101/2020.04.14.20062463v1

another antibody test study: " Under the three scenarios for test performance characteristics, the population prevalence of COVID-19 in Santa Clara ranged from 2.49% (95CI 1.80-3.17%) to 4.16% (2.58-5.70%). "

Interesting but (the contrarian side keeps manifesting) they explain well how their results should be interpreted with caution for example when discussing their (major) assumption about specificity:

"We consider our estimate to represent the best available current evidence, but recognize that new information, especially about the test kit performance, could result in updated estimates. For example, if new estimates indicate test specificity to be less than 97.9%, our SARS-CoV-2 prevalence estimate would change from 2.8% to less than 1%, and the lower uncertainty bound of our estimate would include zero." (my bold)

The wording about caution reminds me of the present discussion about AMC. Some see it (the equity) coming through unscathed and some see the fulcrum security way down.

One of the big problems with the false positive results is that a low but still significant positive antibody response may be related to other kinds (the old and common kinds) of CV. Those antibodies may or may not provide protection against the new CV and, obviously, would terribly reduce the value of the published 'random' prevalence data about the recent outbreak.

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https://seekingalpha.com/news/3561767-stanford-study-points-to-far-higher-rate-of-covidminus-19-infection\

 

EDIT: looks like this was already posted above, but maybe you are all interested in the seeking alpha comments section :)

 

This is my quick take from the full text:

https://www.medrxiv.org/content/10.1101/2020.04.14.20062463v1.full.pdf

 

The unadjusted prevalence of antibodies to SARS-CoV-2 in Santa Clara County was 1.5%

 

1) Completely disproves the "this infection has been widespread for months thesis". It wasn't even widespread by April 3 in this CA county.

 

2) Pretty much makes herd immunity unfeasible due to #1

 

3) Their estimated mortality rate is very low--like close to Flu level low. Note how they recruited volunteers: they used facebook ads. From the Dutch bloodbank study, we say that younger folk have this in much higher numbers asymptomatically. So their estimate of asymptomatic infections may skew higher due to Facebook ads as the method of recruiting. There are some other caveats to their estimates that cigarbutt pointed out.

 

And note:

We did not account for age imbalance in our sample

 

But anyway, let's say this is the case and it is just as deadly as the Flu. How does one explain Italy, parts of WA, and NYC getting a surge of ICU/vented patients? Is it just as deadly as the Flu, but much more contagious so we see a sudden surge of critically ill patients? If that is the case, then why should we declare "this is nothing to worry about"?

 

You have two choices here:

1) Occam's razor: every country that saw this didn't overreact for a reason--this is something to take seriously and Wuhan, Italy, NYC show that clearly.

 

2) Everyone is wrong and this is no different than the Flu.

 

Choose wisely. Or unwisely. The choice is yours.

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Guest cherzeca

thanks for the control group info.  clearly if a patient can select between the GILD anti-viral and plaq/z-pack, then I wouldn't see any ethical issue.

 

I'm assuming this is a typo. But obviously if a patient can select between two experimental drugs, it isn't a blind or random study!

 

Plaq/z-pack isn't standard of care, so it wouldn't be the control.

 

The patient enrols in trial knowing they get 50/50 chance at Remdisivir. This is informed consent. Any clinical trial needs to be approved by multiple ethics boards, so don't waste too much time thinking about the ethics.

 

why cant the data collector/analyzer not be told which group is which?  again, if you are denying patient care/choice when the patient is critically ill (as I understand these studies are focusing on...some or all on respirators) then you have an ethical issue.  since reasonable people can disagree with respect to ethics, no problem if you disagree, as we will agree to disagree

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Just finished doing a session of healthcare workers in the NYC/CT relating their own and their family's experiences with COVID (entirely anecdotal stuff coming up)...

 

A lot of the time the entire household was infected, except for kids under 10

It was very hard to get testing unless you were very sick or fought tooth and nail (remember these are healthcare workers, still could not get tested easily in the beginning - later guidance started to include them in testing prioritization)

Hospital staff capacity was at breaking points consistently, with it being difficult for those admitted to even get food to eat within a couple of hours of schedule - due to staff out sick, expanded capacity, and proning of ICU patients taking a lot of time

It is a nightmare to communicate with someone admitted to the hospital - very limited, it is extremely lonely and isolating for both those in the hospital and their families outside the hospital

 

I'm trying to make meaning out of these anecdotes - likely there are a lot more infected than testing indicates (we all know that by now). This excess number includes those who are mildly ill but never got tested, and then double that total to include those who were infected could have been asymptomatic. So multiply case counts by 2-5x. This is how we are getting to 0.6-15% total infected population in different geographies that have released data so far.

 

While CFR may be lower, the people who did get to the front of the queue and got tested is testimony to the fact how many moderate to seriously ill patients are out there. This is not a virus to mess with. The hospitalization rate and critical illness rates are quite staggering as well. This explains why hospitals are so overwhelmed. Nothing much except COVID care is going on in most hospitals in our region for the last month.

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https://www.bloomberg.com/news/articles/2020-04-17/trump-tells-three-democratic-states-to-liberate-themselves

 

Trump tweet:

 

LIBERATE VIRGINIA, and save your great 2nd Amendment. It is under siege!

 

A sorry excuse for a leader.

 

So is the Governor of Virginia. You know, the guy who can't follow the Constitution, likes to dress up in blackface, and would kill babies after birth. Is he a great leader in your opinion?

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While CFR may be lower, the people who did get to the front of the queue and got tested is testimony to the fact how many moderate to seriously ill patients are out there. This is not a virus to mess with. The hospitalization rate and critical illness rates are quite staggering as well. This explains why hospitals are so overwhelmed. Nothing much except COVID care is going on in most hospitals in our region for the last month.

 

On point.

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why cant the data collector/analyzer not be told which group is which?  again, if you are denying patient care/choice when the patient is critically ill (as I understand these studies are focusing on...some or all on respirators) then you have an ethical issue.  since reasonable people can disagree with respect to ethics, no problem if you disagree, as we will agree to disagree

 

I'm married to a clinical trials manager, so I am biased to actual medical ethics rather than Cherzeca's personal code of ethics.

 

The point of a clinical trial is to see if a medical intervention is safe and effective. The best way to do that is through a double-blind, randomized, placebo-controlled study. If you use anecdotal studies (like the infamous French plaq study), you can only ever have low confidence that an intervention is safe or effective. The blinding is to remove bias from the study.

 

Cherzeca's code of ethics is wrong in this specific instance because there are no known safe and effective treatments for COVID-19. Patient care/choice comes when they choose to enroll or not enroll in the study. If a doctor/patient thinks Plaq is safe and effective, they can prescribe it off label. If a doctor/patient wants to use an experimental drug (Remdisivir), they can apply for compassionate use. No need to taint the study to meet a doctor or patient's personal biases.

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https://www.bloomberg.com/news/articles/2020-04-17/trump-tells-three-democratic-states-to-liberate-themselves

 

Trump tweet:

 

LIBERATE VIRGINIA, and save your great 2nd Amendment. It is under siege!

 

A sorry excuse for a leader.

 

 

 

So is the Governor of Virginia. You know, the guy who can't follow the Constitution, likes to dress up in blackface, and would kill babies after birth. Is he a great leader in your opinion?

 

I want to hold my tongue here, so instead of saying that's a pretty ignorant thing to say, I will say hmmm... you think so. That is an interesting opinion. To paraphrase the late Daniel Moynihan you are entitled to your own opinions, but not your own facts.

 

To wit, I don't think anything you said about the gov Northam is really true.

 

re Northam:

  • One could argue rightfully that he doesn't have the same interpretation of the constitution that you do.
  • As to the black face, there is constitutional statute of limitation for one's college stupidities, (Eighth Amendment if memory serves)  ;) (sortof fact)
     
  • And the baby killing statement is a willful misinterpretation. For the record he was talking about non-viable fetuses. Look, he's a doctor and the nuance on his statements on this was lost in the brouhaha. So no he is not a 'baby-killer'.

 

Trump, on the other hand, is never nuanced. He seems to be quite challenged by the constitution. He is a paragon nothing save narcissistic socio-pathy.  He is a mentally ill man with no morals who is utterly out of his depth generally and this crisis is telling.

 

Back to the prez and coronavirus:

Sadly, people have (and will) die because of Trump, plain and simple.

 

 

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https://www.bloomberg.com/news/articles/2020-04-17/trump-tells-three-democratic-states-to-liberate-themselves

 

Trump tweet:

 

LIBERATE VIRGINIA, and save your great 2nd Amendment. It is under siege!

 

A sorry excuse for a leader.

 

 

 

So is the Governor of Virginia. You know, the guy who can't follow the Constitution, likes to dress up in blackface, and would kill babies after birth. Is he a great leader in your opinion?

 

I want to hold my tongue here, so instead of saying that's a pretty ignorant thing to say, I will say hmmm... you think so. That is an interesting opinion. To paraphrase the late Daniel Moynihan you are entitled to your own opinions, but not your own facts.

 

To wit, I don't think anything you said about the gov Northam is really true.

 

re Northam:

  • One could argue rightfully that he doesn't have the same interpretation of the constitution that you do.
  • As to the black face, there is constitutional statute of limitation for one's college stupidities, (Eighth Amendment if memory serves)  ;) (sortof fact)
     
  • And the baby killing statement is a willful misinterpretation. For the record he was talking about non-viable fetuses. Look, he's a doctor and the nuance on his statements on this was lost in the brouhaha. So no he is not a 'baby-killer'.

 

Trump, on the other hand, is never nuanced. He seems to be quite challenged by the constitution. He is a paragon nothing save narcissistic socio-pathy.  He is a mentally ill man with no morals who is utterly out of his depth generally and this crisis is telling.

 

Back to the prez and coronavirus:

Sadly, people have (and will) die because of Trump, plain and simple.

 

I didn't say Trump was a good leader. In fact his track record with 2A is worse than Obama. I have been plenty critical of him on this forum.

 

I find it amusing that you are able to use mental gymnastics to look past his blackface era. "College shenanigans"

 

2A rights don't come from the BofR. They are affirmed by it, meaning those rights exist with or without it. It's merely a declaration that the govt supports the natural rights of its citizens. So interpretation is moot.

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https://seekingalpha.com/news/3561767-stanford-study-points-to-far-higher-rate-of-covidminus-19-infection\

 

EDIT: looks like this was already posted above, but maybe you are all interested in the seeking alpha comments section :)

 

This is my quick take from the full text:

https://www.medrxiv.org/content/10.1101/2020.04.14.20062463v1.full.pdf

 

The unadjusted prevalence of antibodies to SARS-CoV-2 in Santa Clara County was 1.5%

 

1) Completely disproves the "this infection has been widespread for months thesis". It wasn't even widespread by April 3 in this CA county.

 

2) Pretty much makes herd immunity unfeasible due to #1

 

3) Their estimated mortality rate is very low--like close to Flu level low. Note how they recruited volunteers: they used facebook ads. From the Dutch bloodbank study, we say that younger folk have this in much higher numbers asymptomatically. So their estimate of asymptomatic infections may skew higher due to Facebook ads as the method of recruiting. There are some other caveats to their estimates that cigarbutt pointed out.

 

And note:

We did not account for age imbalance in our sample

 

But anyway, let's say this is the case and it is just as deadly as the Flu. How does one explain Italy, parts of WA, and NYC getting a surge of ICU/vented patients? Is it just as deadly as the Flu, but much more contagious so we see a sudden surge of critically ill patients? If that is the case, then why should we declare "this is nothing to worry about"?

 

You have two choices here:

1) Occam's razor: every country that saw this didn't overreact for a reason--this is something to take seriously and Wuhan, Italy, NYC show that clearly.

 

2) Everyone is wrong and this is no different than the Flu.

 

Choose wisely. Or unwisely. The choice is yours.

 

Not looking for an argument here just clarification of my thoughts and others who have consistently said I was wrong. Im not looking for a victory lap here or looking to be ridiculed. Im just looking for a little clarification of thoughts vs what I hypothesized on or about March 15th since you continue to allude to it, case in point your 1.

 

What exactly is wide spread to you? 50x suspected cases is not wide spread? Jesus Christ.

 

My framework of thought was on around March 11-15th there were hundreds of thousands if not millions of people that had the corona virus. I was not able to project a specific number and the observation was completely anectotal. I get that. I also never suggested herd immunity.

 

So now that this latest antibody test comes out and its projected 50-80k people in one county in California in early April may have had the virus is it really that big of a stretch to think 100s of thousands/millions had it across the US in Mid March?  If it was 500-1000 people in the Standford study I would raise the white flag. If this study is to be taken even at face value the number infected was easily over a millon one month ago. Using that nationwide against confirmed studies we get 34 million in US infected that is too simple of a projection but gives a frame of refence. Even now is this not possible?

 

How much more evidence do we need? We have the German study....flawed bc area was hard hit so too high at 15%. Pregnant woman...flawed not random. Homeless study...flawed not random. Dutch study, people too young. Italian article on 60% of people had antibodies...area was hard hit, doesnt count. This study...flawed...they advertised on Facebook so people who may have had the virus more likely to participate even though we take our CFR from only the people we test who show up and are in a window to test positive via PCR.

 

I think many who have tracked this maybe pretty anchored on their theory and again that is up for debate. But so far we have 5 antibody studies all non perfect true. But all point to an infection rate way above what is confirmed and thus the CFR drops significantly as a result. Early in this pandemic looking even at the recent Gilead study these studies are not perfect but we are looking for any early data points we can get. But all the antibody studies as imperfect as each is points to way more spread then shown by confirmed tests and way lower CFR.  Is there an antibody study that has shown just the opposite?

 

Many of the critics of this antibody studies immediately point to the sensitivity/specificity of the tests used to find this data suggesting they cannot not be relied on to say this is "like the flu". Yet many including RichardGibbons advocate for heavy testing and say this is a necessary metric and should be used extensively. If you dont use it you are dangerous, we must test!!. So which is it?  ??? When the data fits we love em and when it doesn't we hate em?

 

 

 

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https://www.clickorlando.com/news/florida/2020/04/17/north-florida-beaches-among-first-to-reopen-since-coronavirus-closures/

 

Florida was one of the last to shut down,  only shut down for 16 days, and has one the lowest deaths per thousand in the entire country and a top 5 population.

 

Makes you wonder if heat/population spread>then a statewide lockdown. Texas and California would suggest the same.

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I'm trying to ask this uncontroversially mostly medical professionals here: assuming a gradual relaxation of the lockdown with no vaccine, no treatment, and no (or minimal) testing/tracking. Would you say going out is acceptable or too risky? Let's assume a medium-high risk state like MA. Let's assume not super vulnerable person.

If we want to talk concrete "going out" categories, let's say going to parks, general shopping, meeting friends/family, going to office/work, going to a restaurant (I tried to order this from least risk to most risk).

Outcome of "severe" infection sounds very scary. That has to be balanced with infection risks though.

I know this is a bit theoretical and uncertain, but since there's a talk of "relaxation" even in NY state, maybe this could be useful.

I could open a new topic... but probably not worth it.

Thanks

Complement to Cobafdek, in the middle of the (tribal) fight.

Your question is difficult to answer (it feels like: What's the risk of shorting Tesla stock?) and it includes the evaluation of tail risk.

Since my background has some relevance and since i need to address this question now, here's a tentative answer.

 

It seems that the opening will be gradual and the rate of opening will be inversely proportional to virus resurgence. So you'll need to adjust your risk management for your area and with the evolving picture. I work with a scenario of localized and limited resurgence activity during the opening with no second or third wave although this could become low-grade seasonal. I'd say testing will be useful for certain areas of concern but it's hard to see how testing at large will be useful for local decisions. I would also add that herd immunity is not a black or white concept. Relative herd immunity may be much lower than the often 60-70% quoted.

 

1st risk: risk that you become a spreader without being sick

This is a population-level risk but also an individual risk as you may bring the disease to loved ones who may be susceptible (known risk factors or even rarely idiosyncratic).

Then, your cumulative (i share DocSnowball's realism about molecules and timeline) individual risk is likely lowish (and will evolve over a fairly long time), especially if you take basic precautions (basic distance, washing hands, and avoiding social contacts with older (or frail) friends or family members). The concept of position sizing (extent of your social participation along the activity risk spectrum you describe) could be applied as a degree of conviction that your area is safe (from publicly announced statistics, hospital activity level etc).

 

2nd risk: risk that you become significantly sick

Apart from idiosyncratic risk, which is very low, your risk will be proportional to risk factors (age, lung disease, obesity, diabetes etc) with individual risk factors being likely more than additive and serious event risk going up exponentially with the overall level of frailty. Assuming not super vulnerable means no major risk factors, it seems that your risk of becoming significantly sick is very low (do your own work  :) ).

 

What you do as an individual is also tied to your risk personality. If you used to go for the flu vaccine every year versus not even worrying about becoming sick will have an influence on future behavior vs CV. It's possible CV becomes old news very rapidly especially if other events take eyeballs off the bug (and its consequences).

 

@Jurgis: personally I wait for one incubation period to start to trust the data - cases in your state have gone down and stayed down for 14 days; and for two incubation periods for giving the all clear - cases are in single digits or zero in your state for 28 days. Try to phase your return back towards activities in that way. The most essential activities come first, and the lowest risk will be where you're not within 3-6 feet of others and are outdoors. The highest risk will be going to healthcare facilities and crowded indoor gatherings. One thing I've learned is this virus is 2 SD beyond what I've expected of it in spreading, so better to be safe than sorry. The fact that it spreads so easily in healthcare facilities (10k healthcare workers infected in the US!!! cities with public transport really hit hard) tells me there is effective transmission beyond droplets, perhaps it lives well on surfaces + asymptomatic/presymptomatic people spread it early on...(you fill in your thoughts)

 

Maybe a smart idea to build a checklist of do's and don't to follow before, during and after going out and test-drive/refine it when you start going out. I'll try to get it started.

 

Is this activity essential?

What is the risk in this activity? How can it be substituted or minimized?

Hand sanitizer - check. Wipes - check. Mask - check.

Keeping social distance, minimizing touches, minimizing time spent/risk incurred in the activity

Sanitize when done, dispose mask and take footwear off safely on return

Hand washing when home

Dispose clothes for washing later, hand washing again

 

These are good suggestions. Thanks.

 

This checklist is gold!  thanks

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https://www.bloomberg.com/news/articles/2020-04-17/trump-tells-three-democratic-states-to-liberate-themselves

 

Trump tweet:

 

LIBERATE VIRGINIA, and save your great 2nd Amendment. It is under siege!

 

A sorry excuse for a leader.

 

The virus is coming for your guns! Buy more guns and shoot it! That's the only way to make sure.

 

My in vitro study shows that guns kill viruses (you try for yourself and see what happens when you put a bullet thru a test tube). Let's open up the gun shops as essential businesses.  ;D

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""In order to insert an HIV sequence into this genome, molecular tools are needed, and that can only be done in a laboratory," he added."

 

https://www.zerohedge.com/geopolitical/us-launches-full-scale-investigation-wuhan-lab

 

Pentagon suggests otherwise:

https://futurism.com/neoscope/us-military-unlikely-covid-19-created-lab-bioweapon

 

It’s a big enough disaster to investigate closely and maybe even go down some rabbit holes, but the way the virus got started as well as Occam’s razor and existing genetic evidence suggests that this virus got its start in nature.

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Anyone has an opinion to use an Ozone generator for desinfection? I felt it’s worth a shot and bought a~$100 unit and put it in the garage. My wife leaves her scrub, shoes there and The car doors open and we let this run for half an hour. I do the same coming home.

Likewise we keep everything going in he house ( grocery, mail ) and expose it for 1/2  hour plus risk time.

 

Subjectively the ozone smell is pretty strong and lingers for a couple hours when the unit is done.

 

I have read some Chinese papers that seem indicate that ozone disinfection works well viruses ( small particles = large surface to volume ratio) but nothing definitive.

 

You definitely want to be careful running this in the house because ozone can create respiratory issues, but running in the garage should be ok.

 

Any input welcome. I looked at UV desinfection but determined that what obenan buy noncommercially most likely doesn’t have enough power to do much.

 

Yeah be careful with ozone--O3 is highly reactive and can damage tissues, can be carcinogenic. And it may not be necessary--if you leave your garage open on a sunny day (or leave contaminated items in a car with windows that don't block UV/windows rolled down, that's probably enough UV light to do the job.

 

The primary way of catching this is likely inhalation of droplets from someone nearby who has it, not from touching fomites anyway.

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""In order to insert an HIV sequence into this genome, molecular tools are needed, and that can only be done in a laboratory," he added."

https://www.zerohedge.com/geopolitical/us-launches-full-scale-investigation-wuhan-lab

Pentagon suggests otherwise:

https://futurism.com/neoscope/us-military-unlikely-covid-19-created-lab-bioweapon

It’s a big enough disaster to investigate closely and maybe even go down some rabbit holes, but the way the virus got started as well as Occam’s razor and existing genetic evidence suggests that this virus got its start in nature.

It's hard to disprove theories which can be unfortunate for alleged conspiracies of various sorts.

1st step: evidence

Most of the genomic work that came out suggests that the mutations were natural (although not 100% sure).

A good example (quite 'scientific' but included as some may be interested; i know Gregmal for instance has an interest in advanced genomics):

https://www.nature.com/articles/s41591-020-0820-9

2nd step: source

The main source, Mr Luc Montagnier, after the work that led to the Nobel prize, has become REALLY bizarre. He has postulated about the use of antibiotics for autism, DNA "teleportation" and especially about the "memory" of water. (bad-taste joke removed here)

 

 

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Anyone has an opinion to use an Ozone generator for desinfection? I felt it’s worth a shot and bought a~$100 unit and put it in the garage. My wife leaves her scrub, shoes there and The car doors open and we let this run for half an hour. I do the same coming home.

Likewise we keep everything going in he house ( grocery, mail ) and expose it for 1/2  hour plus risk time.

 

Subjectively the ozone smell is pretty strong and lingers for a couple hours when the unit is done.

 

I have read some Chinese papers that seem indicate that ozone disinfection works well viruses ( small particles = large surface to volume ratio) but nothing definitive.

 

You definitely want to be careful running this in the house because ozone can create respiratory issues, but running in the garage should be ok.

 

Any input welcome. I looked at UV desinfection but determined that what obenan buy noncommercially most likely doesn’t have enough power to do much.

 

Yeah be careful with ozone--O3 is highly reactive and can damage tissues, can be carcinogenic. And it may not be necessary--if you leave your garage open on a sunny day (or leave contaminated items in a car with windows that don't block UV/windows rolled down, that's probably enough UV light to do the job.

 

The primary way of catching this is likely inhalation of droplets from someone nearby who has it, not from touching fomites anyway.

 

Thanks, didn’t know that O3 can be carcinogenic. The problem with leaving outside is that sun is not always there in New England. Also, my wife often comes home at night, so no sun then. We will keep that in mind and minimize our exposure. the ozone smell is gone in the morning if the let it run for 20 min in the evening after coming home. I am a assuming it will kill the Virus long before it kills us.

 

Thanks for the input.

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