Coronavirus

[Liberty]

https://www.cnbc.com/2020/04/27/mccourt-trumps-coronavirus-leadership-awful-for-us-and-the-world.html

 

 

[Read the Footnotes]

Another simulator from MGH, Harvard, and Georgia Tech

 

https://www.covid19sim.org/

[Dalal.Holdings]

A lesson in not celebrating too soon:

 

https://www.bloomberg.com/news/articles/2020-04-26/singapore-reports-931-more-virus-cases-total-exceeds-13-600

 

Singapore -- which has one of Asia’s smallest populations -- is emerging with the region’s highest number of coronavirus cases after the world’s two most populous countries.

 

The island-nation reported 931 new cases on Sunday, with the total number of infections exceeding 13,000, overtaking Japan. Only China and India have more cases in Asia.

 

Interestingly, they have heat and humidity in abundance. They also have density though (migrant dorms, public transit, etc).

 

Only 12 deaths which means 1) they are testing like crazy and/or 2) the deaths will grow as these relatively new cases run their course (likely a combination of the two).

 

One other interesting thing to think about—is the disease less severe in hot/humid climates?

 

It is well known that some of the innate immune defenses of the lung such as mucociliary clearance work better in warmer, humid environments.

 

Lungs may actually be better protected if you catch this in warm & humid climates...the optimist in me wants to believe it, but we’ll have to see how mortality in Singapore evolves...

 

However we should note that Singapore, like S Korea (and unlike neighbor Malaysia) is aggressively testing and contact tracing since early days—this reduces mortality too.

[Cigarbutt]

Random thoughts:

 

-The Singapore experience is telling in the sense that it gives an indication of the potential costs involved for the various exit strategies, wherever one stands in the containment-mitigation spectrum (measures, time frame etc). CV is highly contagious, spreads (mostly) quietly and silently and has the potential to find the weakest links. With a starting population having low immunity..

 

-Testing healthcare providers and workers is a double-edged sword. Confidence requires testing but testing can reveal (based on on-the-ground experience in hospitals and chronic care homes as well as various hot spot reports) an extent of spread that requires massive quarantine. This can result in many people simply not showing up for work, in decimated supply chains of care and sometimes simply desertion of personnel during peak times (in my jurisdiction, for some chronic care homes, it has been necessary to call for and hire people not ready or trained to do the job and the army was even summoned in a few cases). This is certainly an area where non-linear changes can occur at certain levels.

 

-Somebody below discusses the delicate issue of "years lost". Compared to the 1918 flu episode, the age profile is markedly different. In the US, for COVID-19, 3.2% of deaths occur in the 15-44 age bracket, 19.2% in 45-64 and 77.6% in the 65+ category (versus 16.0% of the population). The 1918 episode affected all age groups proportionally and the COVID-19 raises a delicate redistribution question. In a related way (clearly true in my jurisdiction but also corroborated elsewhere), because of confinement? and economic pressures?, domestic violence is on the rise while youth protection signaling is down at a time when it should be rising and this is likely due to a critical missing link when schools are closed.

https://www.forbes.com/sites/richkarlgaard/2020/04/25/living-days-stolen--a-smarter-way-to-measure-covid-19-deaths/#7a1ed9d76184

 

[Guest cherzeca]

this Manhattan project-like group looks promising...no epidemiologists.  only real scientists:  https://www.wsj.com/articles/the-secret-group-of-scientists-and-billionaires-pushing-trump-on-a-covid-19-plan-11587998993?mod=hp_lead_pos5

[Investor20]

That is absolutely wrong. I can give a lot of references to asymptomatic before April 2nd.  But here are four examples:

 

Did you actually read any of these "reports"? (WHO means published research studies not popular press clippings. Posting multiple articles that discuss the same case doesn't bolster your argument.)

 

Referencing a Chinese case (edit: this is actually the same case as the german case below):

Interviews with the Chinese patient at the center of the case revealed she may have actually had mild, nonspecific symptoms.

 

Referencing a German case:

But the researchers had not spoken with the woman, who had in fact experienced mild symptoms at the time of transmission.

 

Referencing a Taiwan case:

What was curious, Ho said, is that the woman did not start showing symptoms until Jan. 25, while the husband started showing symptoms just a day later, on Jan. 26

 

So most of the cases mentioned were actually mildly symptomatic or presymptomatic, not "truly asymptomatic".

 

In that bulletin, WHO clearly stated that presymptomatic and asymptomatic transmission was possible.

No, I did not read each study.  But I read several news articles.

 

February 13, 2020

https://nypost.com/2020/02/13/coronavirus-can-be-spread-by-people-who-dont-show-symptoms-cdc-warns/

 

Coronavirus can be spread through people who aren’t exhibiting symptoms of the illness, the director of the Centers for Disease and Control and Prevention said Thursday.

 

 

[KCLarkin]

February 13, 2020

https://nypost.com/2020/02/13/coronavirus-can-be-spread-by-people-who-dont-show-symptoms-cdc-warns/

 

Coronavirus can be spread through people who aren’t exhibiting symptoms of the illness, the director of the Centers for Disease and Control and Prevention said Thursday.

 

Wow! Who knew? No, I mean literally WHO knew. Here is video from a WHO briefing on February 4th discussing asymptomatic transmission:

 

Can I suggest you save your efforts to scapegoat WHO for your Facebook friends? You do realize that WHO has the budget of one large U.S. hospital? It is a small group of underfunded bureaucrats not a wealthy gang of super-villians?

[Liberty]

https://www.nytimes.com/interactive/2020/04/26/us/politics/trump-coronavirus-briefings-analyzed.html?smtyp=cur&smid=tw-nytimes

 

The New York Times analyzed every word President Trump has spoken at his White House briefings and other presidential remarks on the coronavirus — more than 260,000 words — from March 9 through mid-April.

 

Here are 6 things we learned.

 

First, President Trump's words — enough to fill a 700-page book — reveal a display of presidential hubris and self-pity unlike anything historians say they have seen before

 

Second, by far the most recurring utterances from President Trump are self-congratulations — roughly 600 of them, often based on exaggerations and falsehoods, according to our analysis

 

Third, in President Trump's self-congratulatory comments — we found at least 130 examples — he's always the hero, even as the way he describes his role changes over time. He has been writing his own history of the coronavirus — one that's favorable to him.

 

Fourth, President Trump blamed others for inadequacies in the state and federal coronavirus response more than 110 times.

 

His targets shifted over time — from the Obama administration to China to the WHO — as he's struggled to focus attention elsewhere.

 

Fifth, President Trump's attempts to display empathy or appeal to national unity — about 160 instances — amount to only a quarter of the number of times he complimented himself or a top member of his team

 

And sixth: President Trump has mentioned the growing number of Americans affected by the coronavirus — nearly 50,000 dead as of April 26, hundreds of thousands of others sick — only fleetingly.

[Viking]

We will start to learn more about the impact of the virus on companies and industries. Pretty sobering stuff. Impacts existing shareholders, bond holders, creditors. Also instructive to read their outlook of what the next 24 months will look like.

 

Norwegian Proposes Debt Restructuring That Will Wipe Out Owners

- https://www.bloomberg.com/news/articles/2020-04-27/norwegian-proposes-debt-restructuring-that-will-wipe-out-owners

 

...Norwegian is asking the holders of three bonds to convert about $350 million into equity, while aircraft lessors would swap at least $500 million of the 33.3 billion kroner ($3.1 billion) they are owed. The proposal would leave existing owners of the stock with 5.2% of the company -- and that’s before a 400 million-krone equity issue that would dilute them further.

 

...As part of the new business plan, the carrier plans to only operate 7 airplanes in the Scandinavian region until April 2021 to minimize its cash burn, and then gradually resume long-haul and European flights. Norwegian only expects normal operations in 2022. Even then, it expects to operate fewer aircraft and focus on profitable routes.

 

...Norwegian plans an “optimizing of fleet size, including disposal of aircraft no longer needed,” and only plans to operate 110 to 120 jets onces it returns to normal operations, compared with 168 aircraft before the pandemic, it said in the presentation.

[Liberty]

 

Perspective (and zoom lenses).

[Liberty]

 

Asia is scanning people in to and out of every building, and treating their airports like infectious disease laboratories. Meanwhile we are reopening states like “have a go at it, but please be careful, if you feel like it, throw a mask on”. Trends in ~10 days will be insightful

[Spekulatius]

Another simulator from MGH, Harvard, and Georgia Tech

 

https://www.covid19sim.org/

 

Pretty interesting simulator. If this is correct and we lift restriction too early, than we have to pay the piper roughly 2 month later.

 

Personally, I see ourself going down the path of herd immunity and I guess they simulation shows this too. I don’t see a way that we avoid going having the virus go though most of the population, with the current level or testing and tracing in place, with the obvious consequence for IFR rate and duration of the epidemic. I guess we will find out.

 

We know we lifted the shutdowns too were too early, if we get runaway outbreaks in late summer/fall. Perhaps we can manage the outbreaks and keep R0 close to one in which case will still have the virus going though most of the population, but without runaway outbreaks.

 

It will be interesting to see how the different states do in this situation ,as they deploy different strategies with different durations as far as restriction are concerned.

[samwise]

Perhaps we can manage the outbreaks and keep R0 close to one in which case will still have the virus going though most of the population, but without runaway outbreaks.

 

It will be Iger weint to see how the different states do in this situation ,as they deploy different strategies with different durations as far as restriction are concerned.

 

This is NY's strategy. Cuomo was mentioning aiming for R_t in [0.8,1.2]. One hand on the valve of social contact, and eyes on the 3 dials of new cases, hospitalizations, and something else I forgot (ICU?). It'll be interesting to see how finely that valve can be turned.

 

Agree with clutch that the end-state here is similar deaths (area under curve), unless a cure or vaccine is found soon as Dalal hopes.

 

Sweden seems to be managing about ok, with daily cases between 500-750 per day since march end. Although it looks like the peak is rising above 750 now. Thats the risk with trying to control R_t around 1. A bit above 1 and cases will compound again.

 

edit: Sweden data https://www.worldometers.info/coronavirus/country/sweden/ daily new cases chart

[clutch]

Glad to see that more people are recognizing what the "flatten the curve" exactly entails. It's not to eliminate/control the virus, but to stretch out the number of cases/deaths over time. There is always a danger of 2nd or 3rd spike even if you control it now (e.g., look at Singapore). Hence, the modeling papers such as the Imperial College's work recommend doing the intervention measures for 18 months or more, until the vaccine is found. I'm not sure those who religiously support the "flatten the curve" approach understands this! And I don't understand why some people would like to consider discovering a vaccine as a "black swan" event that could happen in the short term. All the EXPERTS agree that it will take about 18 months. Shouldn't we take their words?

 

Anyways, the problem I see is that the general public does not understand what the strategy entails. They are mostly left in the blind having to trust the government and their experts. Only after you read the actual modeling papers or run simulation yourself, you really understand the consequences and what's ahead of us with this strategy. And it's not just Trump in the US who is not communicating this, but the same in other countries as well.

 

I honestly don't know which measure will work out the best in the end...The future is impossible to predict. I'm not sure why many value investors suddenly believe anyone can model and predict the future... We used to laugh at so-called financial or economic "experts" who try to model and predict the market... It's not much different in the epidemiology world where the system you are trying to model is extremely complex and dynamic.

 

[Guest cherzeca]

https://nypost.com/2020/04/27/ive-worked-the-coronavirus-front-line-and-i-say-its-time-to-start-opening-up/

 

Daniel G. Murphy, MD, is chairman of the Department of Emergency Medicine at St. Barnabas Hospital in The Bronx:  time to end lockdown

 

 

[matjone]

Has anyone seen what the hospitalization rate was for working age people in Italy?  It seems like if that is low enough it's possible to work out something for the older folks to stay home and allow everyone else back to work for a partial reopening?

[clutch]

Has anyone seen what the hospitalization rate was for working age people in Italy?  It seems like if that is low enough it's possible to work out something for the older folks to stay home and allow everyone else back to work for a partial reopening?

 

https://jamanetwork.com/journals/jama/fullarticle/2763667

 

I think you could infer from the case fatality rates for the working age groups, which seem to be very low considering the infected fatality rate is probably is an order of magnitude lower than that.

[tng]

And I don't understand why some people would like to consider discovering a vaccine as a "black swan" event that could happen in the short term. All the EXPERTS agree that it will take about 18 months. Shouldn't we take their words?

 

 

I have a feeling that this vaccine will be a lot more tricky than people think, because of how this affects different groups of people. For people under 20, it basically doesn't affect them. It affects very few people from ages 20-30. Then starts ramping up as people get older. So if we do come up with a vaccine, are we really going to inject it into all the kids and risk the unknown long term side effects? Most kids would probably prefer getting the actual virus than rolling the dice on an unknown drug. Would you inject it into your toddler? If COVID-19 is as deadly as Ebola, people would be lining up to take an experimental vaccine because that gives better odds for survival. But since it affects certain groups more than others, people in the safer groups are not going to want to take the mystery vaccine or it simply won't be approved for that reason.

 

There are something like 100 vaccines in trials already. One or more of them will likely be the vaccine that we will use in 2 years. But we are not going to accelerate the studies because this virus isn't deadly enough to risk potential unknown side effects. The more realistic black swan on the positive side is a treatment that decreases death rate and speeds up recovery time.

[Spekulatius]

And I don't understand why some people would like to consider discovering a vaccine as a "black swan" event that could happen in the short term. All the EXPERTS agree that it will take about 18 months. Shouldn't we take their words?

 

 

I have a feeling that this vaccine will be a lot more tricky than people think, because of how this affects different groups of people. For people under 20, it basically doesn't affect them. It affects very few people from ages 20-30. Then starts ramping up as people get older. So if we do come up with a vaccine, are we really going to inject it into all the kids and risk the unknown long term side effects? Most kids would probably prefer getting the actual virus than rolling the dice on an unknown drug. Would you inject it into your toddler? If COVID-19 is as deadly as Ebola, people would be lining up to take an experimental vaccine because that gives better odds for survival. But since it affects certain groups more than others, people in the safer groups are not going to want to take the mystery vaccine or it simply won't be approved for that reason.

 

There are something like 100 vaccines in trials already. One or more of them will likely be the vaccine that we will use in 2 years. But we are not going to accelerate the studies because this virus isn't deadly enough to risk potential unknown side effects. The more realistic black swan on the positive side is a treatment that decreases death rate and speeds up recovery time.

 

I agree - the immunity via vaccine eventually or one has been infected already and shows antibody isn’t really binary , it is more a probability question. I am sure they having been infected already provides some infection , as will a vaccine. The probability of a reinfection in both cases is unknown. Some vaccines work very well, in terms of preventing reinfection, other are imperfect, like the flu vaccine. The flu vaccine for example works best in you get people who least need it and not so well in older people unfortunately. It is possible that we run into the same problem with COVID-19 too, but it is not knowable yet.

[Read the Footnotes]

Glad to see that more people are recognizing what the "flatten the curve" exactly entails. It's not to eliminate/control the virus, but to stretch out the number of cases/deaths over time. There is always a danger of 2nd or 3rd spike even if you control it now (e.g., look at Singapore). Hence, the modeling papers such as the Imperial College's work recommend doing the intervention measures for 18 months or more, until the vaccine is found. I'm not sure those who religiously support the "flatten the curve" approach understands this! And I don't understand why some people would like to consider discovering a vaccine as a "black swan" event that could happen in the short term. All the EXPERTS agree that it will take about 18 months. Shouldn't we take their words?

 

Anyways, the problem I see is that the general public does not understand what the strategy entails. They are mostly left in the blind having to trust the government and their experts. Only after you read the actual modeling papers or run simulation yourself, you really understand the consequences and what's ahead of us with this strategy. And it's not just Trump in the US who is not communicating this, but the same in other countries as well.

 

I honestly don't know which measure will work out the best in the end...The future is impossible to predict. I'm not sure why many value investors suddenly believe anyone can model and predict the future... We used to laugh at so-called financial or economic "experts" who try to model and predict the market... It's not much different in the epidemiology world where the system you are trying to model is extremely complex and dynamic.

You seem to have left out one of the other principal reasons for flattening the curve in the first wave, which is simply to buy time. The hope is that we will have more tools available than simply hand washing and physical distancing, the same tools we we had hundreds of years ago.

 

A good analogy is to think of it as putting a patient in to a medically induced coma briefly in hopes that treatment will improve in the interim. The number of interventions large and small that can be developed in three months is often also underestimated buy those who oppose flattening the first wave.

[clutch]

Glad to see that more people are recognizing what the "flatten the curve" exactly entails. It's not to eliminate/control the virus, but to stretch out the number of cases/deaths over time. There is always a danger of 2nd or 3rd spike even if you control it now (e.g., look at Singapore). Hence, the modeling papers such as the Imperial College's work recommend doing the intervention measures for 18 months or more, until the vaccine is found. I'm not sure those who religiously support the "flatten the curve" approach understands this! And I don't understand why some people would like to consider discovering a vaccine as a "black swan" event that could happen in the short term. All the EXPERTS agree that it will take about 18 months. Shouldn't we take their words?

 

Anyways, the problem I see is that the general public does not understand what the strategy entails. They are mostly left in the blind having to trust the government and their experts. Only after you read the actual modeling papers or run simulation yourself, you really understand the consequences and what's ahead of us with this strategy. And it's not just Trump in the US who is not communicating this, but the same in other countries as well.

 

I honestly don't know which measure will work out the best in the end...The future is impossible to predict. I'm not sure why many value investors suddenly believe anyone can model and predict the future... We used to laugh at so-called financial or economic "experts" who try to model and predict the market... It's not much different in the epidemiology world where the system you are trying to model is extremely complex and dynamic.

You seem to have left out one of the other principal reasons for flattening the curve in the first wave, which is simply to buy time. The hope is that we will have more tools available than simply hand washing and physical distancing, the same tools we we had hundreds of years ago.

 

A good analogy is to think of it as putting a patient in to a medically induced coma briefly in hopes that treatment will improve in the interim. The number of interventions large and small that can be developed in three months is often also underestimated buy those who oppose flattening the first wave.

 

Those are all fair points. I'm just not sure if the public is aware of this as the main reason. Perhaps the message would be too grim if they were told, "we are just buying time, hoping to find a cure...and it could take over a year".

[ERICOPOLY]

Millions of lives could be saved from flu deaths over the next decade if everyone would stop eating meat and dairy.  Is that statement correct?  My understanding is that the flu comes from livestock (pigs and chickens) via wild ducks.

 

Anyways, back to shutting down the world in order to save the same numbers from something else, and doing nothing as simple as a healthier diet for eradicating the flu...

[Read the Footnotes]

Glad to see that more people are recognizing what the "flatten the curve" exactly entails. It's not to eliminate/control the virus, but to stretch out the number of cases/deaths over time. There is always a danger of 2nd or 3rd spike even if you control it now (e.g., look at Singapore). Hence, the modeling papers such as the Imperial College's work recommend doing the intervention measures for 18 months or more, until the vaccine is found. I'm not sure those who religiously support the "flatten the curve" approach understands this! And I don't understand why some people would like to consider discovering a vaccine as a "black swan" event that could happen in the short term. All the EXPERTS agree that it will take about 18 months. Shouldn't we take their words?

 

Anyways, the problem I see is that the general public does not understand what the strategy entails. They are mostly left in the blind having to trust the government and their experts. Only after you read the actual modeling papers or run simulation yourself, you really understand the consequences and what's ahead of us with this strategy. And it's not just Trump in the US who is not communicating this, but the same in other countries as well.

 

I honestly don't know which measure will work out the best in the end...The future is impossible to predict. I'm not sure why many value investors suddenly believe anyone can model and predict the future... We used to laugh at so-called financial or economic "experts" who try to model and predict the market... It's not much different in the epidemiology world where the system you are trying to model is extremely complex and dynamic.

You seem to have left out one of the other principal reasons for flattening the curve in the first wave, which is simply to buy time. The hope is that we will have more tools available than simply hand washing and physical distancing, the same tools we we had hundreds of years ago.

 

A good analogy is to think of it as putting a patient in to a medically induced coma briefly in hopes that treatment will improve in the interim. The number of interventions large and small that can be developed in three months is often also underestimated buy those who oppose flattening the first wave.

 

Those are all fair points. I'm just not sure if the public is aware of this as the main reason. Perhaps the message would be too grim if they were told, "we are just buying time, hoping to find a cure...and it could take over a year".

By "cure" I assume you mean a vaccine, which will likely take a year at a minimum. There are people trying to compress the timeline, but it is a Manhattan Project level effort to improve on the best case timelines.

 

Treatments are much more likely to be available on an expedited schedule such by the end of the summer. Chloroquine was Forsythia all along, but Remdesivir continues to show progress and there are about six other candidates that some analysts feel are even more promising than Remdesivir. Plus there is convalescent plasma which though there are many uncertainties at least has the highest probability of providing a benefit.

 

But there are many smaller interventions that depend upon the supply chain or are simply information based. For example, the US CDC just added six new symptoms for the public to watch for, indicating that we have a long way to go both in understanding the virus and the disease and in communicating best practices to the public. Plus some of those best practices will be dependent upon the supply chain. Two months ago it would not have done that much good to admit that everyone should have been wearing facial coverings because there weren't enough available with on a national public health level would not have had much value.

 

Pharmaceuticals and vaccines are going to be very important, but you also should not underestimate how much the standard of care has likely already improved. Outcomes have varied significantly from one hospital to another. Information sharing regarding best practices can likely continue to improve outcomes. Also, there have been so many reports from China that were dismissed as being incorrect that have proven to be true. It is unfortunate that time was wasted, but now that some unusual features of CV/COVID-19 have been validated in our own populations, and even more discovered, treatment protocols will likely continue to evolve and improve. To a large extent this is based upon observation, research and information sharing, and can be achieved more quickly that some of the other processes that are more dependent upon prolonged period limited science and biology or limitation imposed by the supply chain.

[Guest cherzeca]

regarding getting back to work, there should be enough data to indicate that almost all children and young adults and a significant majority of healthy (no underlying conditions) can get back to school and work. serology testing should be enhanced and monitored, to see how strong the immunity is. 

 

elderly and adults with underlying conditions should continue with mitigation or get back to work under a monitored process.  as someone who respects personal autonomy and liberty, I would have people self assess themselves into these categories and self monitor.

 

so rifle not shotgun approach, simply because covid's deathly impact is to aggravate other conditions though lowering oxygen blood levels, triggering lung inflammation etc.

 

real simple. no big brother governors on power trips

 

edit:  in other words, to the question, is it safe to return, the answer is yes for some, maybe for some and no for some.  so those that can should, maybes should be monitored, and many who are no will want to get a vaccine.  no one size fits all.

[Dalal.Holdings]

I am of the opinion we should reopen strategically and those who choose to be careful can continue to be careful and those who don’t won’t. Federal gov’t has not developed enough testing/contact tracing to do this in the safest way, but there is little hope they will if given more time due to overall incompetence.

 

We’ll get back to our lives, but the world won’t be like it was before—certainly not for some time. I think certain healthcare sites will just have to have covid units for the considerable future.

 

We have changed certain aspects of our behavior that will protect more individuals, but I do believe unfortunately that large portions of the population will continue to be high risk. At this point, it looks like it will be endemic in many countries for some time. And no, herd immunity is not coming anytime soon.