Coronavirus

[orthopa]

 

If you dont understand WHY mayors and governors exist, and WHY they bear certain responsibilities, rather than the Federal government, then theres no point in having a discussion until you revisit 3rd grade social studies.

 

Perfect bully move here..Fair enough, I will revisit Third Grade - what will you revisit?

 

Here is a tweet from your Governor.

 

 

 

"People will die if we get cocky about reopening. To those who are upset about our careful approach — don't blame your local official. Blame me."

 

Things were moving quickly back in March and still are to some degree but Cuomo didnt think a shelter in place would work on 3/20/2020. A couple days later he did and now says it can't be lifted unless certain measures are taken even though now it seems the shelter in place may responsible for the majority of all continued infections in NYC.  In reality all involved have blame.

 

https://www.ksla.com/2020/03/20/california-becomes-first-state-order-lockdown/

 

 

In New York, where coronavirus has killed 32 people, Gov. Andrew Cuomo said he has no plans to impose a statewide mandate.

 

“My job is to make sure that the state has a coordinated plan and it works everywhere,” he said this week. “I don’t think shelter-in-place really works.”

[arcube]

 

Not saying Trump is smart or has added value.  The political side

of this isn’t super interesting.

 

The trust thing is real. 

When it it widely declared that we are flattening the curve to keep hospitals from being overrun, and the hospitals are empty and firing people.... how do you not at that point update the model to relax social distancing.  You can change the narrative (“actually we aren’t worried about hospitals we just want to minimize total death count”) but then you have a trust issue because people can remember what the argument was from a couple months ago, the argument used to garner compliance and convince people to sacrifice their economic livelihood.  Maybe making that sacrifice for  a demographic they aren’t part of (elderly and ill) wasn’t sufficient motivation so the ante was upped by saying no this is everyone’s issue of the hospitals are fucked.  But here we are and if we try to change the argument now it just makes it seem like the old argument was manipulative. If we don’t change the argument then we should be relaxing social measuring in areas with minimal hospital resource usage. You sort of have to pick one.

 

Appreciate your comment about the politics of this. I do agree it is useless but I think in an election year politics became so much a part of it and in fact drove it unfortunately.

 

I do believe that they are updating the models in real time. I believe that NY folks can schedule any elective surgeries now. This is collateral damage but these are not the perfect of times. I also think CA will start easing early May and in fact some people tell me that it might be the first week. I just wish we had real testing scale. A lot could be flushed out easily. The fact that we have no coordination as a country will set us back. Thanks again. 

[Guest cherzeca]

@orthopa

"how can the hospitalization rate/positive rate be so high..."

 

I have heard from several NYC doctors I know that when admits are presumed covid based upon symptoms, and then there is a "confirmatory" test which is negative, hospital just treats it as a false negative and doesnt change record, and proceeds with oxygen, IV and monitoring 

[arcube]

 

If you dont understand WHY mayors and governors exist, and WHY they bear certain responsibilities, rather than the Federal government, then theres no point in having a discussion until you revisit 3rd grade social studies.

 

Perfect bully move here..Fair enough, I will revisit Third Grade - what will you revisit?

 

Here is a tweet from your Governor.

 

 

 

"People will die if we get cocky about reopening. To those who are upset about our careful approach — don't blame your local official. Blame me."

 

Things were moving quickly back in March and still are to some degree but Cuomo didnt think a shelter in place would work on 3/20/2020. A couple days later he did and now says it can't be lifted unless certain measures are taken even though now it seems the shelter in place may responsible for the majority of all continued infections in NYC.  In reality all involved have blame.

 

https://www.ksla.com/2020/03/20/california-becomes-first-state-order-lockdown/

 

 

In New York, where coronavirus has killed 32 people, Gov. Andrew Cuomo said he has no plans to impose a statewide mandate.

 

“My job is to make sure that the state has a coordinated plan and it works everywhere,” he said this week. “I don’t think shelter-in-place really works.”

 

I am sure information changed and he recalculated. Also the CA decisions were bold at that time and that might have helped change the response.

 

Would you say that the guy is atleast trying his best to manage the damn curveball that this disease is?

[orthopa]

 

Trust has been lost.

The scientists got on their soap box, pointed to their models, and made their predictions of doom and gloom.  Nowhere in the 1-2million death model stated “If we shelter in place” then we will see the outcome that we have seen (empty hospitals, death toll 10-20 times less than expected).  They are definitely saying that now, but it feels like an after-the-fact revision.  And now there is a doubling down .... it will be later.

 

You blame the lack of trust developing on scientists and media when everyday your boy gets on his own soapboax and starts lying and yelling. Has no medical experience yet does not take medical community seriously. What is his record here as an executive. He may be winning but in the end the con game helps no one, not even his own supporters.

 

I live in a community with 450,000 people. We’ve been shut down for 6 weeks.  We’ve had 3 deaths ... a prisoner, a homeless person, an elderly person, all with extremely bad health prior.  The hospitals are empty and the community is getting obliterated.

Greg is right that New York is a special case as is anywhere with a high population density or public transportation.  To apply a one size fits all model is like when homeland security gave funding to small towns in the Midwest to fight terrorism.

 

So the community is getting obliterated because peoples lives were saved at a huge inconvenience?

 

Rather than accept that the models were flawed, or even just need to be revised, updated and more nuanced, it seems the scientific community and media is still doubling down on the terror and denying any error.  The problem with this is that they are squandering the little trust left.  You only get one shot at this.  It’s like the boy who cried wolf.  As more time passes and the predictions and models and hysteria stay diverged from reality, people lose faith in those leaders and in the models.  Then, when they are right later, and say no really now it’s gonna happen .... no one will listen. Once we open up, if there’s a new alarm bell, people will shrug and say “well you say that before.”

 

Wow you talk about admission. How about the Big Daddy admits he fked up on this royally! Playing the Cohen book, he will never admit to anything. How he thought the geometric progression will work in the reverse direction as long as he is blustering.

 

 

Not saying Trump is smart or has added value.  The political side

of this isn’t super interesting.

 

The trust thing is real. 

When it it widely declared that we are flattening the curve to keep hospitals from being overrun, and the hospitals are empty and firing people.... how do you not at that point update the model to relax social distancing.  You can change the narrative (“actually we aren’t worried about hospitals we just want to minimize total death count”) but then you have a trust issue because people can remember what the argument was from a couple months ago, the argument used to garner compliance and convince people to sacrifice their economic livelihood.  Maybe making that sacrifice for  a demographic they aren’t part of (elderly and ill) wasn’t sufficient motivation so the ante was upped by saying no this is everyone’s issue of the hospitals are fucked.  But here we are and if we try to change the argument now it just makes it seem like the old argument was manipulative. If we don’t change the argument then we should be relaxing social measuring in areas with minimal hospital resource usage. You sort of have to pick one.

 

Somehow the argument has also gone from we have to bend the curve knowing a large portion of the populatoin will get infected and we have to spread it out....To now we cant re open because people WILL get infected and are being put at risk.

 

When did we ever believe that a large portion of the population was not going to be exposed? I have read many that think the early to open states are foolish and "crazy". Did people really think they were going to out run this virus forever?

 

Just like after 911 those that went to flying planes were foolish, didnt know the risks, were naive, "must have wanted to die". Same thing we are seeing now.

[Guest Schwab711]

NY never issued a shelter in place order statewide. If it exists, it's local/voluntary. We have a stay at home order which allows essential businesses to continue. There's obviously debate about what those essential businesses are.

 

https://thehill.com/blogs/blog-briefing-room/490562-surgeon-general-coronavirus-guidelines-represent-national-stay-at-home-order

[Guest Schwab711]

We are at the point where we are just arguing how you think other people are thinking/acting. If you assume the other person is irrational then you will conclude they are irrational.

[orthopa]

 

If you dont understand WHY mayors and governors exist, and WHY they bear certain responsibilities, rather than the Federal government, then theres no point in having a discussion until you revisit 3rd grade social studies.

 

Perfect bully move here..Fair enough, I will revisit Third Grade - what will you revisit?

 

Here is a tweet from your Governor.

 

 

 

"People will die if we get cocky about reopening. To those who are upset about our careful approach — don't blame your local official. Blame me."

 

Things were moving quickly back in March and still are to some degree but Cuomo didnt think a shelter in place would work on 3/20/2020. A couple days later he did and now says it can't be lifted unless certain measures are taken even though now it seems the shelter in place may responsible for the majority of all continued infections in NYC.  In reality all involved have blame.

 

https://www.ksla.com/2020/03/20/california-becomes-first-state-order-lockdown/

 

 

In New York, where coronavirus has killed 32 people, Gov. Andrew Cuomo said he has no plans to impose a statewide mandate.

 

“My job is to make sure that the state has a coordinated plan and it works everywhere,” he said this week. “I don’t think shelter-in-place really works.”

 

I am sure information changed and he recalculated. Also the CA decisions were bold at that time and that might have helped change the response.

 

Would you say that the guy is atleast trying his best to manage the damn curveball that this disease is?

 

I think everyone involved is trying to. But since everyone alive in the US is dealing with a pandemic like this for the first time, all involved have been wrong and right at the same time. Trump, Fauci, Cuomo, pick anyone here.  Everyone is guessing and the guesses change daily. Its impossible to be in charge in any position and have perfect record in managing this. We all have horrible predictive capabilities, we are human. No different then investing, ha! ;D

[orthopa]

NY never issued a shelter in place order statewide. If it exists, it's local/voluntary. We have a stay at home order which allows essential businesses to continue. There's obviously debate about what those essential businesses are.

 

https://thehill.com/blogs/blog-briefing-room/490562-surgeon-general-coronavirus-guidelines-represent-national-stay-at-home-order

 

True, whats going on in NYS if not shelter in place is a close cousin as people do seem to actually be listening.

[Guest Schwab711]

NY never issued a shelter in place order statewide. If it exists, it's local/voluntary. We have a stay at home order which allows essential businesses to continue. There's obviously debate about what those essential businesses are.

 

https://thehill.com/blogs/blog-briefing-room/490562-surgeon-general-coronavirus-guidelines-represent-national-stay-at-home-order

 

True, whats going on in NYS if not shelter in place is a close cousin as people do seem to actually be listening.

 

I was reading something that the efficacy of 'social distancing' is far surpassing any expectations researchers had coming in. Early models looked at 70%, 80%, and 90% efficacy. The US model assumed 50%.

 

A key factor driving the large estimate was a crucial assumption, discussed internally by task force officials, that only 50% of Americans would observe the government's stringent social distancing guidelines, the source said. That calculation was not shared widely. In reality, a much larger number -- 90% -- is observing the government's guidelines, US Surgeon General Dr. Jerome Adams said in several interviews this week

 

https://www.cnn.com/2020/04/07/politics/white-house-coronavirus-death-projections/index.html

 

That's been a huge factor in making the models look bad. No one expected Americans to listen to authorities  8)

[rb]

Now we're talking state bankruptcies. That's surely gonna work out well for the economy.

 

https://www.reuters.com/article/us-health-coronavirus-usa-states/mcconnell-says-he-favors-state-bankruptcy-over-more-federal-aid-idUSKCN2242U7

[Dalal.Holdings]

Now we're talking state bankruptcies. That's surely gonna work out well for the economy.

 

https://www.reuters.com/article/us-health-coronavirus-usa-states/mcconnell-says-he-favors-state-bankruptcy-over-more-federal-aid-idUSKCN2242U7

 

Especially considering that the Fed now probably holds a good chunk of these bonds...

[patience_and_focus]

While we are talking about how this virus is a curveball and we keep learning new things, here is another one -

 

Alarmed as COVID patients' blood thickened, New York doctors try new treatments

https://www.reuters.com/article/us-health-coronavirus-usa-blood/alarmed-as-covid-patients-blood-thickened-new-york-doctors-try-new-treatments-idUSKCN22421Z

 

In many subjects showing up in hospitals, no typical symptoms of covid-19 but stroke or kidney complications.

 

"At Mount Sinai, nephrologists noticed kidney dialysis catheters getting plugged with clots. Pulmonologists monitoring COVID-19 patients on mechanical ventilators could see portions of lungs were oddly bloodless. Neurosurgeons confronted a surge in their usual caseload of strokes due to blood clots, the age of victims skewing younger, with at least half testing positive for the virus."

 

“I’ve never seen any other viruses causing that,” Jabbour said.

 

 

 

[clutch]

Just to share the potential backfire of relying on prediction models...

 

In Ontario, Canada, the health experts had "projected just under 1,600 COVID-19 deaths, 80,000 cases by end of April."

 

They had expected the hospitals to become full and ramped up the capacities, preparing for the surge.

 

As of April 22, 12,245 cases have been reported, significantly lower than the predicted number. Hospital beds are empty, and plenty of ICUs and ventilators are available.

 

Meanwhile, deaths are relatively still high, at 659 as of April 22. This is because long-term care facilities have become epicenters of the outbreak. Half of the deaths have come from long-term care facilities. They are now relocating the staffing and resources from hospitals to long-term care homes. Maybe the government should have focused on protecting the most vulnerable from the get-go (old age + living in shared housing).

 

These prediction models are not crystal balls. Yet, we seem to be relying more and more on them to make decisions that could lead to this kind of negative, unexpected consequences.

[RichardGibbons]

These prediction models are not crystal balls. Yet, we seem to be relying more and more on them to make decisions that could have this kind of negative consequences.

 

Yeah, models aren't perfect, but I don't really see an alternative. Is there one?

[samwise]

These prediction models are not crystal balls. Yet, we seem to be relying more and more on them to make decisions that could have this kind of negative consequences.

 

Yeah, models aren't perfect, but I don't really see an alternative. Is there one?

 

An alternative is feedback from experience. If we find there is a lot of capacity, then we can open up a bit. If they start trending towards overload, reduce social contacts a bit.

 

The risk is the feedback takes a couple of weeks to show in the data, so probably still a good idea to keep refining the models and have some foresight. Another risk is if the population can be controlled with that granularity.

 

One path through the epidemic is to keep hospitals just below full capacity. Assuming the only concern we have is higher death rate with healthcare overload.

[arcube]

The doctor who led the federal agency involved in developing a coronavirus vaccine said on Wednesday that he was removed from his post after he pressed for a rigorous vetting of a coronavirus treatment embraced by President Trump. The doctor said that science, not “politics and cronyism” must lead the way.

Dr. Rick Bright was abruptly dismissed this week as the director of the Department of Health and Human Services’ Biomedical Advanced Research and Development Authority, or BARDA, and as the deputy assistant secretary for preparedness and response.

Instead, he was given a narrower job at the National Institutes of Health. “I believe this transfer was in response to my insistence that the government invest the billions of dollars allocated by Congress to address the Covid-19 pandemic into safe and scientifically vetted solutions, and not in drugs, vaccines and other technologies that lack scientific merit,” he said in a statement to The Times’s Maggie Haberman.

“I am speaking out because to combat this deadly virus, science — not politics or cronyism — has to lead the way,” he said.

 

 

The White House declined to comment. A spokeswoman for Alex Azar, the health and human services secretary, did not immediately respond to an email seeking comment. The medical publication Stat reported on Tuesday that Dr. Bright had clashed with Bob Kadlec, the assistant health secretary for preparedness and response.

Dr. Bright, who noted that his entire career had been spent in vaccine development both in and outside of government, has led BARDA since 2016.

In the statement, he said: “My professional background has prepared me for a moment like this — to confront and defeat a deadly virus that threatens Americans and people around the globe. To this point, I have led the government’s efforts to invest in the best science available to combat the Covid-19 pandemic.

“Unfortunately, this resulted in clashes with H.H.S. political leadership, including criticism for my proactive efforts to invest early into vaccines and supplies critical to saving American lives. I also resisted efforts to fund potentially dangerous drugs promoted by those with political connections,”

 

Dr. Bright, who is a career official and not a political appointee, pointed specifically to the initial efforts to make chloroquine and hydroxychloroquine widely available before it was scientifically tested for efficacy with the coronavirus.

“Specifically, and contrary to misguided directives, I limited the broad use of chloroquine and hydroxychloroquine, promoted by the administration as a panacea, but which clearly lack scientific merit,” he said.

 

“While I am prepared to look at all options and to think ‘outside the box’ for effective treatments, I rightly resisted efforts to provide an unproven drug on demand to the American public,” Dr. Bright said, describing what ultimately happened: “I insisted that these drugs be provided only to hospitalized patients with confirmed Covid-19 while under the supervision of a physician.

 

“These drugs have potentially serious risks associated with them, including increased mortality observed in some recent studies in patients with Covid-19.

[Guest cherzeca]

"The number of U.S. coronavirus-linked deaths in long-term care facilities including nursing homes has eclipsed 10,000, as facility owners said they are still struggling to access the testing they need to detect and curb outbreaks."  https://www.wsj.com/articles/coronavirus-deaths-in-u-s-nursing-long-term-care-facilities-top-10-000-11587586237?mod=hp_lead_pos1

 

this is gross negligence.  shutting down access to nursing homes and focusing all mitigation resources on the elderly rather than ordering sheltering in place for non-elderly would have been common sense.  dont look to Fauci and birx for common sense. 

[clutch]

These prediction models are not crystal balls. Yet, we seem to be relying more and more on them to make decisions that could have this kind of negative consequences.

 

Yeah, models aren't perfect, but I don't really see an alternative. Is there one?

 

Make decisions based on the most pertinent observations? E.g., the fact that COVID-19 has significantly higher death rates in older people.

 

In general, scientists should inform decision-makers primarily based on observations/experiments, not prediction models. People are getting delusional regarding these models... thinking that they can accurately predict the future if the models are built by scientists.

[John Hjorth]

These prediction models are not crystal balls. Yet, we seem to be relying more and more on them to make decisions that could have this kind of negative consequences.

 

Yeah, models aren't perfect, but I don't really see an alternative. Is there one?

 

Make decisions based on the most pertinent observations? E.g., the fact that COVID-19 has significantly higher death rates in older people.

 

In general, scientists should inform decision-makers primarily based on observations/experiments, not prediction models.

 

Easy to say, when the matter at hand is basically unknown from the beginning of the situation.

[clutch]

These prediction models are not crystal balls. Yet, we seem to be relying more and more on them to make decisions that could have this kind of negative consequences.

 

Yeah, models aren't perfect, but I don't really see an alternative. Is there one?

 

Make decisions based on the most pertinent observations? E.g., the fact that COVID-19 has significantly higher death rates in older people.

 

In general, scientists should inform decision-makers primarily based on observations/experiments, not prediction models.

 

Easy to say, when the matter at hand is basically unknown from the beginning of the situation.

 

It was well-known for this particular case, which was at the end of March.

[Guest cherzeca]

These prediction models are not crystal balls. Yet, we seem to be relying more and more on them to make decisions that could have this kind of negative consequences.

 

Yeah, models aren't perfect, but I don't really see an alternative. Is there one?

 

Make decisions based on the most pertinent observations? E.g., the fact that COVID-19 has significantly higher death rates in older people.

 

In general, scientists should inform decision-makers primarily based on observations/experiments, not prediction models.

 

Easy to say, when the matter at hand is basically unknown from the beginning of the situation.

 

this is BS Hj.  the early data from china was definitive on excessive impact on elderly.  and we knew the genomics of this virus very early on.  we were not operating in the dark, we were just operating stupidly.

[patience_and_focus]

These prediction models are not crystal balls. Yet, we seem to be relying more and more on them to make decisions that could have this kind of negative consequences.

 

Yeah, models aren't perfect, but I don't really see an alternative. Is there one?

 

Make decisions based on the most pertinent observations? E.g., the fact that COVID-19 has significantly higher death rates in older people.

 

In general, scientists should inform decision-makers primarily based on observations/experiments, not prediction models. People are getting delusional regarding these models... thinking that they can accurately predict the future if the models are built by scientists.

 

The only thing that is delusional is to believe that people who have spent all their lives in this area (doctors in the area of infectious diseases, diagnostic, vaccine and drug development experts, and yes, epidemiologist) make decisions solely based on models and not update their hypothesis based on hard data on the ground.

[clutch]

These prediction models are not crystal balls. Yet, we seem to be relying more and more on them to make decisions that could have this kind of negative consequences.

 

Yeah, models aren't perfect, but I don't really see an alternative. Is there one?

 

Make decisions based on the most pertinent observations? E.g., the fact that COVID-19 has significantly higher death rates in older people.

 

In general, scientists should inform decision-makers primarily based on observations/experiments, not prediction models. People are getting delusional regarding these models... thinking that they can accurately predict the future if the models are built by scientists.

 

The only thing that is delusional is to believe that people who have spent all their lives in this area (doctors in the area of infectious diseases, diagnostic, vaccine and drug development experts, and yes, epidemiologist) make decisions solely based on models and not update their hypothesis based on hard data on the ground.

 

Fair point -- if you assume that these scientists were all rational, just like how economists would assume.  ;)

[SnarkyPuppy]

@orthopa

"how can the hospitalization rate/positive rate be so high..."

 

I have heard from several NYC doctors I know that when admits are presumed covid based upon symptoms, and then there is a "confirmatory" test which is negative, hospital just treats it as a false negative and doesnt change record, and proceeds with oxygen, IV and monitoring

 

Accepts anecdotal data in direction that confirms preconceived bias.  Ignores anecdotal data in opposite direction

 

https://www.sfgate.com/bayarea/article/Santa-Clara-county-coronavirus-February-deaths-15217371.php