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spartansaver

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patience_and_focus Collaborator

patience_and_focus

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It's an interesting article, making a pretty compelling case for reopening the world except for large gatherings.  I'm curious what an epidemiologist would think of it.

 

No its not. It relies on the first and second points at the end of the article heavily for it to work.

 

1. TEST the population extensively to isolate asymptomatic carriers.

2. TRACE contacts and maintain quarantine for those who have tested positive.

 

None of these were done anywhere properly except in Singapore, Hong Kong and to some extent in South Korea, as the article states. Then the article goes on to say that "better late than never" and proposes to open up the society simultaneously with scaling up (1) & (2). The problem is that with epidemics is all about outpacing the virus and what works in the beginning stop working later until we get ahead of the virus. Since (1) and (2) were not done earlier in US (utter failures), one has to slow down the spread of virus to buy time for testing and tracing to catch-up the otherwise exponential spread. Only when the testing and tracing has been established to be efficient, we can slowly open up. Nobody is arguing that we should not open up, but it would be foolish to do it when we cannot outpace the virus spread with test and trace. We are nowhere close.

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cobafdek Newbie

cobafdek

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Anthony Fauci MD.  And war criminal, behind the War Criminal.  Fauci has effectively joined the campaign to re-elect the President.

 

"Fauci said that the 'first and only time' that he and coronavirus response coordinator Dr. Deborah Birx talked to Trump about 'shutdown'-like mitigation policies, 'the president listened to the recommendation and went to the mitigation.'”

 

"When Fauci and Birx went to Trump a second time advising him to extend the White House’s social-distancing guidelines through the end of April, Trump 'went with the health recommendations,' Fauci said."

 

https://www.cnbc.com/2020/04/13/coronavirus-anthony-fauci-clarifies-comments-that-sparked-firing-fears.html

 

Anyone surprised that Fauci's statements (above) were left out of the Washington Post's account of today's briefing?:

 

https://www.washingtonpost.com/politics/trump-calls-fauci-a-wonderful-guy-the-day-after-promoting-a-tweet-that-called-for-him-to-be-fired/2020/04/13/4f450d2a-7d9d-11ea-9040-68981f488eed_story.html

RichardGibbons Rising Star

RichardGibbons

Posted
Posted

 

No its not. It relies on the first and second points at the end of the article heavily for it to work.

 

1. TEST the population extensively to isolate asymptomatic carriers.

2. TRACE contacts and maintain quarantine for those who have tested positive.

 

None of these were done anywhere properly except in Singapore, Hong Kong and to some extent in South Korea, as the article states. Then the article goes on to say that "better late than never" and proposes to open up the society simultaneously with scaling up (1) & (2). The problem is that with epidemics is all about outpacing the virus and what works in the beginning stop working later until we get ahead of the virus. Since (1) and (2) were not done earlier in US (utter failures), one has to slow down the spread of virus to buy time for testing and tracing to catch-up the otherwise exponential spread. Only when the testing and tracing has been established to be efficient, we can slowly open up. Nobody is arguing that we should not open up, but it would be foolish to do it when we cannot outpace the virus spread with test and trace. We are nowhere close.

 

Yeah, obviously it requires test and trace. But it doesn't make much sense to say, "we haven't done this well in the past, therefore this article sucks because it suggests we do it in the future."

 

Like, no kidding that the USA screwed up early and that it isn't capable of doing test and trace today. While you claim he's saying to open the country today and simultaneously scale up test and trace, the author doesn't say that. In fact, he implies the opposite. Test and trace are two of the Ten Commandments. Commandments because those two things are super important to do, because they're not just irrelevant details that we can ignore if we don't have the capability today.

 

The reason the article's interesting and compelling is because it lays out what needs to be in place to start opening things up, including a effective test and trace strategy.  So if you're looking to see if we're ready to open up, one criteria might be whether you've got the resources to do test and trace on the expected number of new infections.

 

I agree with everyone else though--saying that it's OK to open schools because kids don't die doesn't make much sense, and doesn't fit with his "avoid events where people mix with a lot of different people" reasoning.

Spekulatius Grand Master

Spekulatius

Posted
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Do we actually still do trace and test here anymore? Seems like we have pretty much given up on tracing.

I have a buddy in Germany who told me some of his relatives tested positive and they did trace down contacts during the last two weeks prior to the positive test results. So at least in Germany, they still attempt tracing.

Guest cherzeca

Guest cherzeca

Posted
Posted

Do we actually still do trace and test here anymore? Seems like we have pretty much given up on tracing.

I have a buddy in Germany who told me some of his relatives tested positive and they did trace down contacts during the last two weeks prior to the positive test results. So at least in Germany, they still attempt tracing.

 

the trains also run on time in Germany

Liberty Contributor

Liberty

Posted
Posted

 

"When somebody is the president of the United States, the authority is total and that's the way it's got to be. It's total, and the governors know that,"

 

Herr Dictator announced: "The beatings will continue until morale improves."

 

Trump, Feb. 28: "The press is in hysteria mode" over coronavirus.

 

Trump video, April 13: "The media minimized the risk from the start."

 

Dalal.Holdings Grand Master

Dalal.Holdings

Posted
Posted

 

"When somebody is the president of the United States, the authority is total and that's the way it's got to be. It's total, and the governors know that,"

 

Herr Dictator announced: "The beatings will continue until morale improves."

 

Lol...this is fine tho. I am more worried about the government telling me I have to shutter my business during a pandemic out of concern for “public safety” and the infringement on my liberties than I am of a demagogue making some clear power grabs.

 

This guy only runs the Presidency like a family biz—wut could go wrong ? Someone call that savant Kushner, I need some professional medical/epidemiological/economic advice.

ERICOPOLY Mentor

ERICOPOLY

Posted
Posted

 

"When somebody is the president of the United States, the authority is total and that's the way it's got to be. It's total, and the governors know that,"

 

Herr Dictator announced: "The beatings will continue until morale improves."

 

Trump, Feb. 28: "The press is in hysteria mode" over coronavirus.

 

Trump video, April 13: "The media minimized the risk from the start."

 

 

Yay!  I love opposites day!

Dalal.Holdings Grand Master

Dalal.Holdings

Posted
Posted

 

"When somebody is the president of the United States, the authority is total and that's the way it's got to be. It's total, and the governors know that,"

 

Herr Dictator announced: "The beatings will continue until morale improves."

 

Trump, Feb. 28: "The press is in hysteria mode" over coronavirus.

 

Trump video, April 13: "The media minimized the risk from the start."

 

 

First it was a “hoax” exaggerated by the lame stream media, now it was minimized too much by the media. Which is it derp?

 

Maybe when he means “minimized by the media”, he is exclusively referring to the leaders of his fan club Hannity and Limbaugh...let’s not forget his own minimizing just weeks ago...

Liberty Contributor

Liberty

Posted
Posted

Thread:

 

There's a growing body of data to strongly suggest #COVID19 predisposes to both venous and arterial thromboembolism due to excessive inflammation, hypoxia, immobilization and diffuse intravascular coagulation. This may explain some of rapid decline patients experience 1/n

 

Provider urgently need good data to guide practice. Reports on incidence of thrombotic complications are limited. Doctors weren't routinely doing pulmonary embolism studies or echocardiograms, in part because protocols were to limit patient contact as a way to control spread. 2/n

 

One new study looked at 184 ICU patients with proven #COVID19 pneumonia of whom 23 died (13%), 22 were discharged alive (12%), 139 (76%) were still on ICU on April 5th. It found 31% incidence of thrombotic complications in ICU patients. Remarkably high 3/n

 

https://www.sciencedirect.com/science/article/pii/S0049384820301201

 

Other analysis from China describe cardiomyopathy. There's limited reporting on the cases. Growing awareness of thrombotic events raise question of whether some of the incidence of heart strain in setting of hypoxia could be result of pulmonary emboli? 4/n

 

https://www.nejm.org/doi/full/10.1056/NEJMoa2002032

 

One etiology may be #COVID19-associated coagulopathy (CAC). Patients with severe COVID-19 infection can develop clotting events meeting criteria for DIC criteria with fulminant activation of coagulation, resulting in widespread microvascular thrombosis 5/n

 

https://www.hematology.org/covid-19/covid-19-and-coagulopathy

 

Data previously published by hematologists from Wuhan, China indicated that abnormal coagulation parameters can be a useful predictor of prognosis in pneumonia due to #COVID19 (Tang et al, 2020). 6/n

 

https://b-s-h.org.uk/media/18151/dic-score-in-covid-19-pneumonia_19-03-2020.pdf

 

This clotting phenomenon may, in certain cases, explain rapid decompensation some doctors describe, where patients will become acutely hypoxic and require urgent intubation. Providers tell me they are now more routinely doing studies for pulmonary emboli in these settings. 7/n

 

This should be subject of urgent follow up by @CDCGov. We should be aggregating, making available in @CDCMMWR, detailed clinical experience with U.S. patients. With almost 600,000 diagnosed cases, we greatly need more data on collected American clinical experience with #COVID19.

 

Also: https://www.vox.com/2020/4/14/21219021/scott-gottlieb-coronavirus-covid-19-social-distancing-economy-recession

 

Also: https://nypost.com/2020/04/13/virginia-pastor-who-held-packed-church-service-dies-of-coronavirus/

Dalal.Holdings Grand Master

Dalal.Holdings

Posted
Posted

https://twitter.com/realDonaldTrump/status/1250063051182747651

 

Cuomo’s been calling daily, even hourly, begging for everything, most of which should have been the state’s responsibility, such as new hospitals, beds, ventilators, etc. I got it all done for him, and everyone else, and now he seems to want Independence! That won’t happen!

 

Presidential--with a capital 'P'.

 

Somebody jelly of President Cuomo, wants to capture the political upside of Cuomo's stellar management (but "takes no responsibility" for any of the downside--Mr. 'Zero skin in the game' Trump!).

John Hjorth Grand Master

John Hjorth

Posted
Posted

https://twitter.com/realDonaldTrump/status/1250063051182747651

 

Cuomo’s been calling daily, even hourly, begging for everything, most of which should have been the state’s responsibility, such as new hospitals, beds, ventilators, etc. I got it all done for him, and everyone else, and now he seems to want Independence! That won’t happen!

 

Presidential--with a capital 'P'.

 

Somebody jelly of President Cuomo, wants to capture the political upside of Cuomo's stellar management (but "takes no responsibility" for any of the downside--Mr. 'Zero skin in the game' Trump!).

 

Somehow, this reminds me about americans saying the EU and Euro being built with inherent flaws.

minten Newbie

minten

Posted
Posted

In all the talk about the contact tracing apps nobody seems to want to get into how it will work in practice.    If I go out running, and run past someone who is infected, how will the system evaluate risk. How will the system know if and in what way I interacted with this person?  If you set the filter too loose, it won't work. If you set it too tight, your whole society will be in quarantine in days and everybody will de-install it within a week. Also, if I sit in locked up my apartment all day, and my infected neighbour will sit 1 meter away for hours in his apartment, but with a wall between us, will the app know there's a wall?  I can think of countless more questions like this.

 

 

RichardGibbons Rising Star

RichardGibbons

Posted
Posted

In all the talk about the contact tracing apps nobody seems to want to get into how it will work in practice.    If I go out running, and run past someone who is infected, how will the system evaluate risk. How will the system know if and in what way I interacted with this person?  If you set the filter too loose, it won't work. If you set it too tight, your whole society will be in quarantine in days and everybody will de-install it within a week. Also, if I sit in locked up my apartment all day, and my infected neighbour will sit 1 meter away for hours in his apartment, but with a wall between us, will the app know there's a wall?  I can think of countless more questions like this.

 

Yeah, any solution won't be perfect. It's nice, however, that everyone involved recognizes that the perfect is the enemy of the good. I imagine that the epidemiologists' understanding of exponential growth will allow them to see that a solution that reduces the R0 by 70% is worthwhile even if it doesn't reduce it by 100%.

brianr27 Newbie

brianr27

Posted
Posted

My guess is that contact testing will require widespread testing. Anyone flagged as at risk via contact tracing to be required to self-quarantine until they can provide a test result showing that they are not infectious. Ideally, the person would take an at home test and submit the results but that could be open to tampering. A less ideal option would be that the person would go to a drive through, show an ID and be certified non-infectious.

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