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Remdesivir preliminary data from two of the many clinical trials going on -

 

https://www.statnews.com/2020/04/29/gilead-says-critical-study-of-covid-19-drug-shows-patients-are-responding-to-treatment/

 

Some highlights -

 

Study conducted by National Institute of Allergy and Infectious Diseases (head to head with placebo) -

"The preliminary data showed that the time to recovery was 11 days on remdesivir compared to 15 days for placebo, a 31% decrease. The mortality rate for the remdesivir group was 8%, compared to 11.6% for the placebo group; that mortality difference was not statistically significant."

 

Study conducted by China (head to head with placebo). Very similar findings to the above study -

"In the China study, also published Wednesday in the Lancet, investigators found that remdesivir did not significantly improve the time to clinical improvement, mortality, or time to clearance of virus in patients with serious COVID-19 compared with placebo. There was a 23% improvement in time to clinical improvement for remdesivir compared to placebo, but the difference was not statistically significant. "

 

And the stock market went up!

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Sweden

 

It seems a bit harsh to constantly review Sweden on the number of deaths compared to their neighbours as their policy was never aimed at less corona death in the first place and they were upfront about this. If someone wants to compare, you have to look at the broader picture (economic growth, quality of life), which you cannot do until much later. Despite what many predicted, their IC capacity seems to be holding.

 

I think it's useful to look at what this approach does vs different approach. I don't see anything harsh or unfair here.

 

I also saw some numbers somewhere that it's not because things arent officially closed that they aren't basically closed.. saw numbers on Swedish restaurants and theaters being basically zero, but don't remember where. Probably same for any big events, travel, etc.

 

I think the main argument from the Swedes is that they can keep doing what they have been doing for long time, unlike those nations that are doing a lockdown. The opening of the US in some states where they still don’t really have falling infection rates strikes me as risky, but I guess we will have to see. I think the interesting part will be how we manage to open the schools for the next school year (I assume the current school years is going to be all remote, at least where I live)

 

The state I live in (MA)  still has persistently high infection and death rates (in fact. today may have been a record for latter  ) which means that our very leaky shutdown probably persists for a while.

https://www.mass.gov/doc/covid-19-dashboard-april-29-2020/download

 

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Remdesivir preliminary data from two of the many clinical trials going on -

 

https://www.statnews.com/2020/04/29/gilead-says-critical-study-of-covid-19-drug-shows-patients-are-responding-to-treatment/

 

Some highlights -

 

Study conducted by National Institute of Allergy and Infectious Diseases (head to head with placebo) -

"The preliminary data showed that the time to recovery was 11 days on remdesivir compared to 15 days for placebo, a 31% decrease. The mortality rate for the remdesivir group was 8%, compared to 11.6% for the placebo group; that mortality difference was not statistically significant."

 

Study conducted by China (head to head with placebo). Very similar findings to the above study -

"In the China study, also published Wednesday in the Lancet, investigators found that remdesivir did not significantly improve the time to clinical improvement, mortality, or time to clearance of virus in patients with serious COVID-19 compared with placebo. There was a 23% improvement in time to clinical improvement for remdesivir compared to placebo, but the difference was not statistically significant. "

 

And the stock market went up!

 

The China study did not show statistical significance and it was in patients with severe disease.

 

The NIAD ACTT study (Not necessarily in as "severe" patients, but hospitalized ones who have imaging findings or need supplemental O2 or a few other criteria) did not show statistical significance in mortality, but did show reduction in time to recovery that was statistically significant. Unfortunately does not seem to be a game changer based on the NIAD press release (study hasn't been published yet), but so far Remdesivir is the only drug that has been shown to do something in a RCT in Covid (unlike Hydroxychloroquine/Azithro), so it's something I guess.

 

So the ACTT shows that it works in patients, but not necessarily severe ones (per inclusion criteria at https://clinicaltrials.gov/ct2/show/NCT04280705). This may indicate that Remdesivir works if administered earlier, before the disease becomes severe. The problem with this is that Gilead has indicated that it takes a lot of resources and time to manufacture doses of this medication (I believe their estimates are to have enough for hundreds of thousands of rounds of treatment this year) and if we are not restricting Remdesivir to only severe patients but giving it to everyone hospitalized, we may not have enough of the drug because that is a fairly large number of patients...

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Sweden

 

It seems a bit harsh to constantly review Sweden on the number of deaths compared to their neighbours as their policy was never aimed at less corona death in the first place and they were upfront about this. If someone wants to compare, you have to look at the broader picture (economic growth, quality of life), which you cannot do until much later. Despite what many predicted, their IC capacity seems to be holding.

 

I think it's useful to look at what this approach does vs different approach. I don't see anything harsh or unfair here.

 

I also saw some numbers somewhere that it's not because things arent officially closed that they aren't basically closed.. saw numbers on Swedish restaurants and theaters being basically zero, but don't remember where. Probably same for any big events, travel, etc.

 

Regarding Sweden -- here is an answer from their former state epidemiologist.

 

"I think we should wait a year when comparing the deaths in different countries."

 

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Sweden

 

It seems a bit harsh to constantly review Sweden on the number of deaths compared to their neighbours as their policy was never aimed at less corona death in the first place and they were upfront about this. If someone wants to compare, you have to look at the broader picture (economic growth, quality of life), which you cannot do until much later. Despite what many predicted, their IC capacity seems to be holding.

 

I think it's useful to look at what this approach does vs different approach. I don't see anything harsh or unfair here.

 

I also saw some numbers somewhere that it's not because things arent officially closed that they aren't basically closed.. saw numbers on Swedish restaurants and theaters being basically zero, but don't remember where. Probably same for any big events, travel, etc.

 

Regarding Sweden -- here is an answer from their former state epidemiologist.

 

"I think we should wait a year when comparing the deaths in different countries."

 

 

The same epidemiologist said in another interview that compared to their neighbors Sweden has a lot more old people living in nursing homes, which have been locked down but nonetheless seem to be petri dishes for the virus to spread. And I think well more than half of COVID-related deaths in Sweden so far have come from nursing homes.

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Remdesivir preliminary data from two of the many clinical trials going on -

 

https://www.statnews.com/2020/04/29/gilead-says-critical-study-of-covid-19-drug-shows-patients-are-responding-to-treatment/

 

Some highlights -

 

Study conducted by National Institute of Allergy and Infectious Diseases (head to head with placebo) -

"The preliminary data showed that the time to recovery was 11 days on remdesivir compared to 15 days for placebo, a 31% decrease. The mortality rate for the remdesivir group was 8%, compared to 11.6% for the placebo group; that mortality difference was not statistically significant."

 

Study conducted by China (head to head with placebo). Very similar findings to the above study -

"In the China study, also published Wednesday in the Lancet, investigators found that remdesivir did not significantly improve the time to clinical improvement, mortality, or time to clearance of virus in patients with serious COVID-19 compared with placebo. There was a 23% improvement in time to clinical improvement for remdesivir compared to placebo, but the difference was not statistically significant. "

 

And the stock market went up!

 

The China study did not show statistical significance and it was in patients with severe disease.

 

The NIAD ACTT study (Not necessarily in as "severe" patients, but hospitalized ones who have imaging findings or need supplemental O2 or a few other criteria) did not show statistical significance in mortality, but did show reduction in time to recovery that was statistically significant. Unfortunately does not seem to be a game changer based on the NIAD press release (study hasn't been published yet), but so far Remdesivir is the only drug that has been shown to do something in a RCT in Covid (unlike Hydroxychloroquine/Azithro), so it's something I guess.

 

So the ACTT shows that it works in patients, but not necessarily severe ones (per inclusion criteria at https://clinicaltrials.gov/ct2/show/NCT04280705). This may indicate that Remdesivir works if administered earlier, before the disease becomes severe. The problem with this is that Gilead has indicated that it takes a lot of resources and time to manufacture doses of this medication (I believe their estimates are to have enough for hundreds of thousands of rounds of treatment this year) and if we are not restricting Remdesivir to only severe patients but giving it to everyone hospitalized, we may not have enough of the drug because that is a fairly large number of patients...

 

The problem that I see with Remdesivir application early on is that it is administered intravenously in 10 dosages. So it is only something that can be done in a hospital setting (or equivalent ) and not very conducive to early intervention.

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The same epidemiologist said in another interview that compared to their neighbors Sweden has a lot more old people living in nursing homes, which have been locked down but nonetheless seem to be petri dishes for the virus to spread. And I think well more than half of COVID-related deaths in Sweden so far have come from nursing homes.

 

[Omitting the embedded posts by Liberty, minten & clutch, but respectfully not ignoring them, - just to avoid dense quoting.]

 

frank,

 

It's actually true - and very striking :

 

Public Health Agency of Sweden (Folkhälsomyndigheten) - Confirmed cases of COVID-19 in Sweden (Antal fall av covid-19 i Sverige).

 

Translation help :

 

Tidsserie: Sjukdomsfall per dag -> Time series : Confirmed cases per day,

Sjukdomsfall per åldersgrupp -> Confirmed cases per age group, &

Avlitna per åldersgrupp -> Deaths per age group [in the context here : COVID-19 related].

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^^^

Long term care / nursing home deaths seem to be a significant problem in almost every country where there is significant community transmission. And it seems to be irrespective of whether the country imposed a severe lockdown or not. It's just the perfect combination of density + old age, the condition at which this virus is most lethal. In hindsight, not having foreseen this problem could be the most serious mistake made by the governments / health officials around the world.

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I’m actually worrying more about long term damage to the economy from overreaction. Closing outdoor spaces (beaches and parks) makes very little sense for something that spreads via respiratory droplets. Keep those outdoor venues open and force 6 ft distancing...these journo photos that shame beach goers is not helping and is ridiculous.

 

Lockdowns have served a useful purpose. We did not run out of vents and icu beds in hard hit regions and people throughout the country have changed their behavior. It’s time to reopen because I do not think the benefit for further lockdowns outweigh the costs...

 

Trump on Sweden:

https://twitter.com/realdonaldtrump/status/1255825648448348161?s=21

 

Despite reports to the contrary, Sweden is paying heavily for its decision not to lockdown. As of today, 2462 people have died there, a much higher number than the neighboring countries of Norway (207), Finland (206) or Denmark (443). The United States made the correct decision!

 

Guess he supported the lockdowns all along.

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Sweden

 

It seems a bit harsh to constantly review Sweden on the number of deaths compared to their neighbours as their policy was never aimed at less corona death in the first place and they were upfront about this. If someone wants to compare, you have to look at the broader picture (economic growth, quality of life), which you cannot do until much later. Despite what many predicted, their IC capacity seems to be holding.

 

I think it's useful to look at what this approach does vs different approach. I don't see anything harsh or unfair here.

 

I also saw some numbers somewhere that it's not because things arent officially closed that they aren't basically closed.. saw numbers on Swedish restaurants and theaters being basically zero, but don't remember where. Probably same for any big events, travel, etc.

 

Regarding Sweden -- here is an answer from their former state epidemiologist.

 

"I think we should wait a year when comparing the deaths in different countries."

 

 

Why not wait 10 years and then we'll really have perspective?

 

This is about real-time decision-making under uncertainty to try to balance various pros and cons to do as well as possible through a crisis..

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The same epidemiologist said in another interview that compared to their neighbors Sweden has a lot more old people living in nursing homes, which have been locked down but nonetheless seem to be petri dishes for the virus to spread. And I think well more than half of COVID-related deaths in Sweden so far have come from nursing homes.

 

Nursing homes are getting infected with a large number of deaths in a lot of countries.

 

And yeah, they are locked down across countries, but medical personnel and staff are contact points that carry the infection inside.

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Sweden

 

It seems a bit harsh to constantly review Sweden on the number of deaths compared to their neighbours as their policy was never aimed at less corona death in the first place and they were upfront about this. If someone wants to compare, you have to look at the broader picture (economic growth, quality of life), which you cannot do until much later. Despite what many predicted, their IC capacity seems to be holding.

 

I think it's useful to look at what this approach does vs different approach. I don't see anything harsh or unfair here.

 

I also saw some numbers somewhere that it's not because things arent officially closed that they aren't basically closed.. saw numbers on Swedish restaurants and theaters being basically zero, but don't remember where. Probably same for any big events, travel, etc.

 

Regarding Sweden -- here is an answer from their former state epidemiologist.

 

"I think we should wait a year when comparing the deaths in different countries."

 

 

Why not wait 10 years and then we'll really have perspective?

 

This is about real-time decision-making under uncertainty to try to balance various pros and cons to do as well as possible through a crisis..

 

I have answered this before but the 1 year - 18 months timeline is what a lot of modeling work is based on -- when they anticipate that a vaccine will be available.

 

The Swedish argument is that you can't keep the lockdown for 18 months and as soon as any country lifts the lockdown, the number of cases/deaths will peak again -- as the modeling work also predicts. Therefore, if you sum up all the deaths over that period most countries would have suffered a similar number of deaths.

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I have answered this before but the 1 year - 18 months timeline is what a lot of modeling work is based on -- when they anticipate that a vaccine will be available.

 

The Swedish argument is that you can't keep the lockdown for 18 months and as soon as any country lifts the lockdown, the number of cases/deaths will peak again -- as the modeling work also predicts. Therefore, if you sum up all the deaths over that period most countries would have suffered a similar number of deaths.

 

The flaw with that thinking is that we're learning and working on things that could be here before the vaccine, and the timeline for the vaccine is unknown (could be sooner than we think too), and there's limited healthcare capacity. So if in 2-3 months we have some more therapies/drugs and best practices (proning?) to helps save people who get sick, it's better to be infected later rather than sooner and to keep the curve flat rather than have a high peak early on.

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I have answered this before but the 1 year - 18 months timeline is what a lot of modeling work is based on -- when they anticipate that a vaccine will be available.

 

The Swedish argument is that you can't keep the lockdown for 18 months and as soon as any country lifts the lockdown, the number of cases/deaths will peak again -- as the modeling work also predicts. Therefore, if you sum up all the deaths over that period most countries would have suffered a similar number of deaths.

 

The flaw with that thinking is that we're learning and working on things that could be here before the vaccine, and the timeline for the vaccine is unknown (could be sooner than we think too), and there's limited healthcare capacity. So if in 2-3 months we have some more therapies/drugs and best practices (proning?) to helps save people who get sick, it's better to be infected later rather than sooner and to keep the curve flat rather than have a high peak early on.

 

Vaccine -- I think it'd be the same as relying on a miracle when every expert says it would take at least 18 months.

 

Healthcare capacity -- Good point, but it seems Sweden has avoided overflows. At least I haven't seen any news regarding this. This was obviously a problem in NYC or Italy but might have been overestimated in many countries. As you may know, it's quite the opposite in Ontario where cardiac patients are dying due to delayed surgeries while hospital beds are empty. So a lockdown can directly cause deaths, too.

 

Treatment -- I think the Swedish thinking is that reaching the herd immunity quickly is the best "treatment". This is how a pandemic was overcome throughout our history. It does sound cruel but seems like that's what they believe in.

 

What I'm saying is you can't judge their action unless this pandemic has played out. Especially it was their plan to intentionally go through the peak. You can judge that from a moral/ethical standpoint, but you can't judge whether it's working or not -- yet.

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After seeing what's happening in China, I am more bearish now. Here is what I think

1. The virus is not going away. Repeated outbreaks happen over and over in various cities in China right now, though the Chinese CDC kept reporting 0-2 cases each day. Harbin is on 2nd lockdown and Xi'an just had a big outbreak.

2. The Gilead drug helps a little but not a game changer.

3. With social distancing enforced, restaurants and all other serivces would at most run at 50% capacity. If you run a restaurant and have 100 seats, with 6ft distancing, you can only do 30-50 customers at once, depending on your seating locations. This will continue to create a drag.

4. Vaccine is not as easy as people thought. Some vaccines can even cause certain subtypes of the virus to infect even faster because the antibody for the other subtypes act as the key to the door.

 

Of course, the Chinese government wants you to think otherwise. It is now blaming all additional outbreaks on irresponsible foreigners spreading virus in China. I see that in all kinds of social media in China.

 

On top of that, we have Buffet and Munger not buying anything after the big market drop. Has this ever happened before? At the same time, we also have all kinds of 0 experience "investors" taking out their credit card, taking mortgage forebearance etc. to trade in the market. I've personally been contacted by a few college classmates who have never traded stocks now wanting to catch this opportunity of a decade to make money.

I have to wonder if Buffet and Munger are smarter or these 0 experience day traders.

 

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I have answered this before but the 1 year - 18 months timeline is what a lot of modeling work is based on -- when they anticipate that a vaccine will be available.

 

The Swedish argument is that you can't keep the lockdown for 18 months and as soon as any country lifts the lockdown, the number of cases/deaths will peak again -- as the modeling work also predicts. Therefore, if you sum up all the deaths over that period most countries would have suffered a similar number of deaths.

 

The flaw with that thinking is that we're learning and working on things that could be here before the vaccine, and the timeline for the vaccine is unknown (could be sooner than we think too), and there's limited healthcare capacity. So if in 2-3 months we have some more therapies/drugs and best practices (proning?) to helps save people who get sick, it's better to be infected later rather than sooner and to keep the curve flat rather than have a high peak early on.

 

Here is an example of what Liberty is talking about, related to the discussion in this topic about what's going on in the Scandinavian countries :

 

Fyens.dk [April 29th 2020] : Ulla has found the solution: Smart "Conversation box" makes it possible to visit family on nursing home.

TV2.dk [April 29th 2020] : Daugther invents "Conversation Box" so she can speak with her mother [inside, John] at nursing home.

 

This is a story of a civil engineer called Ulla employed at Novo Nordisk A/S, where she [obviously] is working with work environment on the Novo Nordisk factories, likely with speciality in keeping the air clean, and she has been thinking about how to do something about what everybody is talking about, while nobody trying to do something about it. So she just did it, based on that "... this is not rocket science".

 

- - - o 0 o - - -

 

Decomposition, analysis & solution of a tiny part of an extremely complex issue at hand in totality, and taking a focused stab at that tiny part. Every tiny contribution helps over time, if solutions are shared with the world.

 

- - - o 0 o - - -

 

Anecdotal : This story is from the nursing home here in Odense where my dad lives.

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On top of that, we have Buffet and Munger not buying anything after the big market drop. Has this ever happened before? At the same time, we also have all kinds of 0 experience "investors" taking out their credit card, taking mortgage forebearance etc. to trade in the market. I've personally been contacted by a few college classmates who have never traded stocks now wanting to catch this opportunity of a decade to make money.

I have to wonder if Buffet and Munger are smarter or these 0 experience day traders.

 

The market has provided ample opportunity for those who missed this in March to cash out with the S&P now where it was in October 2019. There should be no valid excuse for these people if they lose their shirts.

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After seeing what's happening in China, I am more bearish now. Here is what I think

1. The virus is not going away. Repeated outbreaks happen over and over in various cities in China right now, though the Chinese CDC kept reporting 0-2 cases each day. Harbin is on 2nd lockdown and Xi'an just had a big outbreak.

2. The Gilead drug helps a little but not a game changer.

3. With social distancing enforced, restaurants and all other serivces would at most run at 50% capacity. If you run a restaurant and have 100 seats, with 6ft distancing, you can only do 30-50 customers at once, depending on your seating locations. This will continue to create a drag.

4. Vaccine is not as easy as people thought. Some vaccines can even cause certain subtypes of the virus to infect even faster because the antibody for the other subtypes act as the key to the door.

Of course, the Chinese government wants you to think otherwise. It is now blaming all additional outbreaks on irresponsible foreigners spreading virus in China. I see that in all kinds of social media in China.

 

On top of that, we have Buffet and Munger not buying anything after the big market drop. Has this ever happened before? At the same time, we also have all kinds of 0 experience "investors" taking out their credit card, taking mortgage forebearance etc. to trade in the market. I've personally been contacted by a few college classmates who have never traded stocks now wanting to catch this opportunity of a decade to make money.

I have to wonder if Buffet and Munger are smarter or these 0 experience day traders.

 

+1 to all the points above. Particularly #4 (it is called antibody dependent enhancement). I think people have no understanding of what kind of hurdles we may run into. Although as far as I know animal studies to date have not shown this effect for SAR-CoV2.

 

I also think outbreaks that kill so many people will have negative psychological effect on everyone (even though the mortality will be highest in older people). It will be a drag for larger parts of the economy for some time to come (retail, hospitality, tourism and travel, restaurants, energy).

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On top of that, we have Buffet and Munger not buying anything after the big market drop. Has this ever happened before? At the same time, we also have all kinds of 0 experience "investors" taking out their credit card, taking mortgage forebearance etc. to trade in the market. I've personally been contacted by a few college classmates who have never traded stocks now wanting to catch this opportunity of a decade to make money.

I have to wonder if Buffet and Munger are smarter or these 0 experience day traders.

 

The market has provided ample opportunity for those who missed this in March to cash out with the S&P now where it was in October 2019. There should be no valid excuse for these people if they lose their shirts.

 

https://www.wsj.com/articles/coronavirus-turmoil-free-trades-draw-newbies-into-stock-market-11588158001

 

“I feel like everything that I buy, I watch pretty closely and if it’s something that’s not doing well, I’ll generally try to put [that money] into something that is doing well instead,”

 

https://www.bloomberg.com/news/articles/2020-04-29/firemen-and-romance-writers-faces-of-a-fierce-rebound-in-stocks

 

“I’m a complete noob when it comes to stocks,” the mother of high school senior twin boys said while sheltering at home. “It’s not thousands and thousands of dollars that I invested, but it’s a start. We’ll see what happens. I hate to say it, but it’s like gambling, isn’t it?”

 

More accounts were opened and dollars invested at E*Trade in the first quarter than in any prior full-year period, according to a company statement. The brokerage added 329,000 retail accounts and over $18 billion in net retail assets.

 

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