Coronavirus

[Guest Schwab711]

 

Did I misinterpret or misrepresent anything here?

 

I think you have an excellent understanding of this at this point, and apparently able to put it down on paper better then me.

 

Thanks.  Just trying to make sure I fully understand the various perspectives.  Again, apologies again for the comment before re: the profession you've chosen.  It meant no disrepect.

 

I do want to ask you - if you were to take a step back and think about your position, where could you be wrong?

 

I could be wrong by how much of a hit this will be to the ICU/need for respirator, ie breakdown of health system. I can only think back to working during the H1N1 outbreak and the 17-18 flu season and that volume load which was ~15 million cases if I recall correctly. The system was stretched, but did not collapse, My opinion is the virus has been here for 6 weeks/months and cases are vastly under reported. So in my mind we are currently in an environment of where many think we will be from documented patient 1 say 4-6 weeks from now, already!  Its in this mind frame I have a hard time rectifying a wickedly high death rate and medical system collapse if we are operating in this environment currently.

 

I certainly could be wrong on this, I hope I'm right of course. We will see. The fact of the matter is if the cases are severely under estimated and we are handling it now maybe we are further along on the curve then we think, and handling it fine.

 

Again, hope Im not wrong. We will see I guess....

 

Here's a question. I am no medical professional so maybe this is a silly question:

 

Let's assume you are correct - coronavirus in some form has been in N America, say since January or early Feb.

 

Therefore people have been experiencing flu-like symptoms and/or perhaps slightly more elevated symptoms than a normal flu.

 

And some must have been going to a doctor or perhaps hospital. Doctors perform a flu test which would presumably come back negative.

 

Would there have been some communication that doctors/hospitals are noticing a pretty decent amount of patients with flu-like or slightly elevated flu-like symptoms but testing negative for the flu? An amount of patient records to corroborate this?

 

I am not saying it's impossible - frankly it may very well be true, and is therefore worth exploring - so would there some records to prove/disprove this?

 

This is what has been happening for weeks, and weeks.  There has been communication between myself, others, and regional ERs regarding this exact subject. In all reality knowing whether or not these people had corona would not have changed the symptoms. How do I know already? NO ONE HAS DIED AND ICUS ARE NOT FULL!

 

You could retrospectively go back and look at the data but who would you convince? Look at the media/social media. They want closure, NOW! They will only accept a positive results. How would we know? Antibody testing via blood! Would show all of those recovered.

 

Question I have for those constantly citing Italy as a reason for very high concern. The virus is in what? 170 countries now?  All over the god damn world.  Why is Italy the rule and not the exception?

 

What is the implied Ro for the scenario where there are currently millions of active cases in the US (and similar spread outside the US)? That Ro contradicts everyone's reporting.

 

The severe / moderate / mild case percentages you imply contradict everyone.

 

The lowest CFR estimated contradicts your assumptions.

 

You have yet to mention that CV progresses slowly, showing symptoms after several days and first deaths have come after ~25 days. So although there's almost certainly some case undercounting, there's also expected to be a longer lag between transmission and death.

 

We saw a large spike in daily ER visits for flu and respiratory symptom in NYC

 

https://a816-health.nyc.gov/hdi/epiquery/visualizations?PageType=ps&PopulationSource=Syndromic

 

Your theory continually relies on no explanation of the disease, it's symptoms, how it progresses, and so on. You just say it's millions because it's been here since January (you make no effort to timeline where China was with cases at that time or estimate how many imported cases that would imply to get to millions of cases in 6 weeks). Your theory becomes further unlikely given the number of negative tests in many regions. WHO guidance that CV spreads slower than the flu. All you have is intuition, a few out of context quotes from various non-experts, and heavy fist pounding on the table. I can find doctors that predict the end of times, mid-single digit % death throughout the world, and other terrible things. That they are doctors doesn't make them right because their nonsense doesn't fit triangulated facts. Same with you. Your nonsense theory doesn't fit with triangulated facts from hundreds of sources.

 

Your theory around no spike in admissions and no deaths is also consistent with all the triangulated facts that the disease has spread considerably in the last several days and symptoms are only starting to be shown. Similar to NYC's uptick.

 

Trump is saying that this is bad and promoting social distancing. Every major country throughout the world has had some sort of shut down. Do you really think this is all somehow a MSM or Democratic plot, in coordination with every country in the world?!?

[John Hjorth]

Tweet by Ravi Nagarajan.

[Guest Schwab711]

So at this point you have two options as an investor:

 

1) Trust some guesses/major assumptions based solely on anecdotes from people that millions in U.S. have been silently infected for months now

 

2) Go by what is being witnessed in other countries at this very moment and acknowledge that the United States is merely a couple of weeks behind (relatively early in the course of epidemic)

 

The more probabilistically likely scenario is obvious to me. A majority may show mild/flu like symptoms but even if a minority get very sick, we would certainly have seen a spike in unexplained ARDS cases across U.S. if millions were infected months ago...

 

Inversion tells me #1 is most likely wrong.

 

Your right. 2 options.

 

Do you think Cuomo is going on record saying that thousands likely had the virus, recovered, and didn't know it if it was highly unlikely? In this climate? At this time? Thats pretty ballsy isnt it?

 

Maybe he was joking?

 

Q for u: if millions caught this month ago and it is only 2-3x deadlier than the flu (an underestimate based on our current data), how many people would have died without a formal diagnosis (since we wouldn't have been able to diagnose) in the past 2 mo? How many ICU patients with ARDS would we have had?

 

In order for your theory to work, you must be arguing that COVID19 is much much LESS deadlier than the flu <<< 0.1%. That is a bold statement to be making now and I know what I think of the odds of that being even remotely true.

 

I think you just typed out the answer. Why aren't we seeing more dead people/ARDS? You cant say this virus spreads rapidly in one breath and will kill everyone and on the same hand keep saying, its coming, its coming, its coming.

 

How can you use current data? S. Korea has 51 million people but tested 140,000. Thats .27% of the population. How can you honestly use that data? Your going to extrapolate that for the other 99.63% of the population? Really?

 

Secondly I want an honest opinion about Cuomo. Why would he come out and say that? In NYC. During a pandemic with massive panic in society?

 

There was a shortage of tests in SK. They tested the people they did because government's have been tracking every case they can. That's why folks are mad at Italy and then the US's response. They stopped monitoring everyone adjacent to the virus.

 

It's frustrating you're a doctor and won't read about this. WHO said its 5-6 day doubling vs ~3 days for some other viruses. Even if you start with 10 people one month ago, by month end we would project to have 320-640 cases. This is a 12-18 month problem.

 

https://graphics.reuters.com/CHINA-HEALTH-SOUTHKOREA-CLUSTERS/0100B5G33SB/index.html

[orthopa]

 

Did I misinterpret or misrepresent anything here?

 

I think you have an excellent understanding of this at this point, and apparently able to put it down on paper better then me.

 

Thanks.  Just trying to make sure I fully understand the various perspectives.  Again, apologies again for the comment before re: the profession you've chosen.  It meant no disrepect.

 

I do want to ask you - if you were to take a step back and think about your position, where could you be wrong?

 

I could be wrong by how much of a hit this will be to the ICU/need for respirator, ie breakdown of health system. I can only think back to working during the H1N1 outbreak and the 17-18 flu season and that volume load which was ~15 million cases if I recall correctly. The system was stretched, but did not collapse, My opinion is the virus has been here for 6 weeks/months and cases are vastly under reported. So in my mind we are currently in an environment of where many think we will be from documented patient 1 say 4-6 weeks from now, already!  Its in this mind frame I have a hard time rectifying a wickedly high death rate and medical system collapse if we are operating in this environment currently.

 

I certainly could be wrong on this, I hope I'm right of course. We will see. The fact of the matter is if the cases are severely under estimated and we are handling it now maybe we are further along on the curve then we think, and handling it fine.

 

Again, hope Im not wrong. We will see I guess....

 

Here's a question. I am no medical professional so maybe this is a silly question:

 

Let's assume you are correct - coronavirus in some form has been in N America, say since January or early Feb.

 

Therefore people have been experiencing flu-like symptoms and/or perhaps slightly more elevated symptoms than a normal flu.

 

And some must have been going to a doctor or perhaps hospital. Doctors perform a flu test which would presumably come back negative.

 

Would there have been some communication that doctors/hospitals are noticing a pretty decent amount of patients with flu-like or slightly elevated flu-like symptoms but testing negative for the flu? An amount of patient records to corroborate this?

 

I am not saying it's impossible - frankly it may very well be true, and is therefore worth exploring - so would there some records to prove/disprove this?

 

This is what has been happening for weeks, and weeks.  There has been communication between myself, others, and regional ERs regarding this exact subject. In all reality knowing whether or not these people had corona would not have changed the symptoms. How do I know already? NO ONE HAS DIED AND ICUS ARE NOT FULL!

 

You could retrospectively go back and look at the data but who would you convince? Look at the media/social media. They want closure, NOW! They will only accept a positive results. How would we know? Antibody testing via blood! Would show all of those recovered.

 

Question I have for those constantly citing Italy as a reason for very high concern. The virus is in what? 170 countries now?  All over the god damn world.  Why is Italy the rule and not the exception?

 

What is the implied Ro for the scenario where there are currently millions of active cases in the US (and similar spread outside the US)? That Ro contradicts everyone's reporting.

 

The severe / moderate / mild case percentages you imply contradict everyone.

 

The lowest CFR estimated contradicts your assumptions.

 

You have yet to mention that CV progresses slowly, showing symptoms after several days and first deaths have come after ~25 days. So although there's almost certainly some case undercounting, there's also expected to be a longer lag between transmission and death.

 

We saw a large spike in daily ER visits for flu and respiratory symptom in NYC

 

https://a816-health.nyc.gov/hdi/epiquery/visualizations?PageType=ps&PopulationSource=Syndromic

 

Your theory continually relies on no explanation of the disease, it's symptoms, how it progresses, and so on. You just say it's millions because it's been here since January (you make no effort to timeline where China was with cases at that time or estimate how many imported cases that would imply to get to millions of cases in 6 weeks). Your theory becomes further unlikely given the number of negative tests in many regions. WHO guidance that CV spreads slower than the flu. All you have is intuition, a few out of context quotes from various non-experts, and heavy fist pounding on the table. I can find doctors that predict the end of times, mid-single digit % death throughout the world, and other terrible things. That they are doctors doesn't make them right because their nonsense doesn't fit triangulated facts. Same with you. Your nonsense theory doesn't fit with triangulated facts from hundreds of sources.

 

Your theory around no spike in admissions and no deaths is also consistent with all the triangulated facts that the disease has spread considerably in the last several days and symptoms are only starting to be shown. Similar to NYC's uptick.

 

Trump is saying that this is bad and promoting social distancing. Every major country throughout the world has had some sort of shut down. Do you really think this is all somehow a MSM or Democratic plot, in coordination with every country in the world?!?

 

I never said the shut down was a plot. Did I say something I wasn't aware of?

 

Your right, its only, me a little ER, a network of ~50 urgent cares across NYS state seeing ~50 pts a week for a month, so 75k pts a month. Very small sample and data, except for all of the negative flus and viral syndrome diagnoses. Ill keep you guys updated!  Oh so now it progresses, very, very slowly. Ok. A week ago we were talking about exponential growth. Now its progressing slowly and just got here.

 

I have seen 23 people over the last 2 days with fever, ST, body aches, mild temp and negative flu. All went home, no breathing issues. Still waiting for testing in my area. Maybe its something else? :o

 

I never said my data was official or inclusive and your right I just keep posting links/verbage that reinforces my opinion. But at the same time I can't help it. It just keeps coming out. Just following like you guys!

 

 

[orthopa]

So at this point you have two options as an investor:

 

1) Trust some guesses/major assumptions based solely on anecdotes from people that millions in U.S. have been silently infected for months now

 

2) Go by what is being witnessed in other countries at this very moment and acknowledge that the United States is merely a couple of weeks behind (relatively early in the course of epidemic)

 

The more probabilistically likely scenario is obvious to me. A majority may show mild/flu like symptoms but even if a minority get very sick, we would certainly have seen a spike in unexplained ARDS cases across U.S. if millions were infected months ago...

 

Inversion tells me #1 is most likely wrong.

 

Your right. 2 options.

 

Do you think Cuomo is going on record saying that thousands likely had the virus, recovered, and didn't know it if it was highly unlikely? In this climate? At this time? Thats pretty ballsy isnt it?

 

Maybe he was joking?

 

Q for u: if millions caught this month ago and it is only 2-3x deadlier than the flu (an underestimate based on our current data), how many people would have died without a formal diagnosis (since we wouldn't have been able to diagnose) in the past 2 mo? How many ICU patients with ARDS would we have had?

 

In order for your theory to work, you must be arguing that COVID19 is much much LESS deadlier than the flu <<< 0.1%. That is a bold statement to be making now and I know what I think of the odds of that being even remotely true.

 

I think you just typed out the answer. Why aren't we seeing more dead people/ARDS? You cant say this virus spreads rapidly in one breath and will kill everyone and on the same hand keep saying, its coming, its coming, its coming.

 

How can you use current data? S. Korea has 51 million people but tested 140,000. Thats .27% of the population. How can you honestly use that data? Your going to extrapolate that for the other 99.63% of the population? Really?

 

Secondly I want an honest opinion about Cuomo. Why would he come out and say that? In NYC. During a pandemic with massive panic in society?

 

There was a shortage of tests in SK. They tested the people they did because government's have been tracking every case they can. That's why folks are mad at Italy and then the US's response. They stopped monitoring everyone adjacent to the virus.

 

It's frustrating you're a doctor and won't read about this. WHO said its 5-6 day doubling vs ~3 days for some other viruses. Even if you start with 10 people one month ago, by month end we would project to have 320-640 cases. This is a 12-18 month problem.

 

https://graphics.reuters.com/CHINA-HEALTH-SOUTHKOREA-CLUSTERS/0100B5G33SB/index.html

 

I have read about it thanks. That wasn't my question. My question was a simple one. Im not looking for context. Again, do you trust data for .27% of the population for anything?

 

You seem to like medicine/data. Would you trust data that said we tested .27% of the US population for Diabetes and 95% were found to have it. The testing was done after the scientists put out an ad for people to come in if they had symptoms of diabetes. Would you trust that data?

[Guest Schwab711]

 

I never said the shut down was a plot. Did I say something I wasn't aware of?

 

Your right, its only, me a little ER, a network of ~50 urgent cares across NYS state seeing ~50 pts a week for a month, so 75k pts a month. Very small sample and data, except for all of the negative flus and viral syndrome diagnoses. Ill keep you guys updated!  Oh so now it progresses, very, very slowly. Ok. A week ago we were talking about exponential growth. Now its progressing slowly and just got here.

 

I have seen 23 people over the last 2 days with fever, ST, body aches, mild temp and negative flu. All went home, no breathing issues. Still waiting for testing in my area. Maybe its something else? :o

 

I never said my data was official or inclusive and your right I just keep posting links/verbage that reinforces my opinion. But at the same time I can't help it. It just keeps coming out. Just following like you guys!

 

This seems more fair. Hopefully I didn't jump the gun but the deniers are ridiculous at this point.

 

For one, there's been every suggestion under the sun for the virus, so there is some changing of prior assumptions as a society. Growth can be exponential (double in 5-6 days) and symptoms be slow to progress. I think the fear is it's a few days no symptoms, several days of symptoms you describe, and they either peak at that (mild) or progress to hypoxia-like cases (moderate/severe). Don't quote me though, just finding overlap on what I've read.

 

Didn't mean to jump the gun but those downplaying it are frustrating because it makes it worse for everyone. I think there's undercounting but not drastically.

 

 

[whiskybravo]

Orthopa,  thank you for your time and contribution to the board. 

 

Just to clarify are you an ER medical doctor or an orthopedic physician assistant?

[orthopa]

So at this point you have two options as an investor:

 

1) Trust some guesses/major assumptions based solely on anecdotes from people that millions in U.S. have been silently infected for months now

 

2) Go by what is being witnessed in other countries at this very moment and acknowledge that the United States is merely a couple of weeks behind (relatively early in the course of epidemic)

 

The more probabilistically likely scenario is obvious to me. A majority may show mild/flu like symptoms but even if a minority get very sick, we would certainly have seen a spike in unexplained ARDS cases across U.S. if millions were infected months ago...

 

Inversion tells me #1 is most likely wrong.

 

Your right. 2 options.

 

Do you think Cuomo is going on record saying that thousands likely had the virus, recovered, and didn't know it if it was highly unlikely? In this climate? At this time? Thats pretty ballsy isnt it?

 

Maybe he was joking?

 

Q for u: if millions caught this month ago and it is only 2-3x deadlier than the flu (an underestimate based on our current data), how many people would have died without a formal diagnosis (since we wouldn't have been able to diagnose) in the past 2 mo? How many ICU patients with ARDS would we have had?

 

In order for your theory to work, you must be arguing that COVID19 is much much LESS deadlier than the flu <<< 0.1%. That is a bold statement to be making now and I know what I think of the odds of that being even remotely true.

 

I think you just typed out the answer. Why aren't we seeing more dead people/ARDS? You cant say this virus spreads rapidly in one breath and will kill everyone and on the same hand keep saying, its coming, its coming, its coming.

 

How can you use current data? S. Korea has 51 million people but tested 140,000. Thats .27% of the population. How can you honestly use that data? Your going to extrapolate that for the other 99.63% of the population? Really?

 

Secondly I want an honest opinion about Cuomo. Why would he come out and say that? In NYC. During a pandemic with massive panic in society?

 

I don't look to elected officials to form objective opinions about reality, leaving aside the fact that it is in their interest that people in their area take crises seriously. The financial markets are offering you many opportunities to get rich beyond your wildest dreams right now if you are really as confident as you seem about this.

 

Your right he must be speaking off the cuff and sticking his neck out during a pandemic/crisis and not talking to the medical professionals/epidemiologists, etc.

[Spekulatius]

Tweet by Ravi Nagarajan.

 

Irrresponsible and Unbelievable.

 

I just talked with my brother in Germany. Germany is in a virtual lockdown. Some places area till open but practice social distancing and patrons at the coffee house sit a table apart. many places aren’t even open any more.

 

His daughter has the final test (Abitur) next week Tuesday supposedly, but she isn’t even sure it’s going to take place or may be rescheduled. This brings life on hold , because  without this Abitur exam passed, you can’t apply at the university. Rules are being made up as we go.

 

Another interesting tidbit from my brother, who sells wood/lumber wholesale is that the Chinese are back in the market with huge orders. He can’t make sense of it, but heard from other folks in different trades that they apparently restarting their factories so there are orders for other stuff as well. Wood is dirt cheap so maybe they are taking advantage of the low prices or there is more stimulus? No idea, but interesting nevertheless.

[Pondside47]

A conversation facilitated by Li Lu.

 

One model predicted Shanghai would see 800,000 cases, but through their extraordinary early efforts to limit travel, end larger gatherings, and immediately implement social distancing and testing, they limited cases to just 300 .And Dr. Zhang and his team have cured 95% of their COVID-19 patients in his hospital.

 

https://podcasts.apple.com/us/podcast/43-special-coronavirus-episode-dr-wenhong-zhang-lessons/id1472376956?i=1000468366901

 

I couldn't help but notice how this doctor is not laying it on thick on Xi as some of the US officials are doing to Trump.

[minten]

but through their extraordinary early efforts to limit travel, end larger gatherings, and immediately implement social distancing and testing, they limited cases to just 300

 

Which to a more or less extent is what every Chinese city did, what Hong Kong did, what Taiwan did, what Japan did, what South Korea did, what Singapore did, all had or are having great success. It's also what Italy did (a week ago), what almost every European country did or is doing (last few days to today), and what surely the US will do early next week. A couple of weeks of not eating out, a sharp short recession and a sharp bounce of demand after that, better treatment options to be available in the fall, and we should all be good to go.

[alwaysdrawing]

NYC is going to have a bad time.  This link plots the incidence of ED visits per day for Influenza Like Illness (ILI).

 

https://weinbergerlab.shinyapps.io/NYC_syndromic/

 

Most likely normal seasonal cold and flu season was responsible for the large jump in cases in Nov-March, however the current large spike is most likely related to coronavirus.

 

We shall see--if orthopa starts seeing deaths from URI/LRI patients, then that would fit with coronavirus, and his previous experience would fit with normal seasonal cold and flu season (with no deaths).

 

If you look online, you can see pictures of full bars and restaurants in NY, so it's clear social distancing isn't being done on a widespread scale.  From OpenTable data, you can see major cities have had reductions in restaurant reservations of around 40% from 1-2 months ago, and over 60% in Boston/NYC/Seattle.  That's just the beginning--many many small businesses will fail when the death counts start growing in the US and people pull back more.

 

https://docs.google.com/spreadsheets/d/e/2PACX-1vRbPuAyJy74UmbF6kLXFGXDk2eX3N6zvRLzxPamG8FAA3E-SVqMOMSIht-eYEF_4qrNGOJuPbDjTsPD/pubhtml#

 

We are likely 1 week away from large clusters in NYC and Seattle starting to hit hospitalization, which will be followed by other cities as clusters grow.

 

The Washington Post has a helpful simulator on how various levels of social distancing help with flattening the curve:

https://www.washingtonpost.com/graphics/2020/world/corona-simulator/?itid=hp_hp-top-table-main_virus-simulator

[EliG]

Clarifying, yes, turning ORs into ICUs is a big deal. However, in case of pandemic the most urgent have to be taken care of first. Elective surgery may be cancelled for many reasons including the fact that they don't want people coming in for elective surgery to get infected with the coronavirus. So outpatient procedures may continue, but procedures requiring hospital stay may be cancelled. We are not there yet.

 

Cancer surgeries are elective surgeries, aren't they? Turning ORs into ICUs will effectively prioritize covid-19 cases over cancer surgeries, regardless of patients' age and odds of survival. My wife (52yo) is doing pre-operative chemo. She is supposed to have a curative surgery in early May. If the system is overwhelmed by then, she is a walking dead.

 

Canada is uniquely ill-prepared to deal with this because our system runs at/over capacity at the best of times.

 

 

 

My point is that Canada is doing an excellent job of trying to be prepared and flattening the curve. So far so good.

 

Disagree. Our borders remain wide open. All twits below are from yesterday or today.

 

 

I’m completely baffled by the many accounts of people returning to Canada not being explicitly told about the self-isolation expectations. Surely there are people who genuinely have no idea that’s what they’re supposed to do.

 

 

My cousin returned from Japan this morning via YVR. No screening, no info on starting 14 day self isolation (which he immediately observed on his own volition). Tomorrow will be a heavy travel day with many returning home. This needs to be fixed tonight.

 

 

Hearing this from a lot of people coming through YVR...no screening, no questions, no info about #COVIDー19 or need to quarantine. If the rest of us are doing our part, they better get it together at the airport.

 

 

Just landed at Toronto Pearson an hour ago. I was asked (by a computer) if I’d been to Italy, Iran or China. I clicked no. I was waved in. I only know I’m supposed to self-isolate because I read it on the news.

 

 

[alwaysdrawing]

NYC is going to have a bad time.  This link plots the incidence of ED visits per day for Influenza Like Illness (ILI).

 

https://weinbergerlab.shinyapps.io/NYC_syndromic/

 

Most likely normal seasonal cold and flu season was responsible for the large jump in cases in Nov-March, however the current large spike is most likely related to coronavirus.

 

We shall see--if orthopa starts seeing deaths from URI/LRI patients, then that would fit with coronavirus, and his previous experience would fit with normal seasonal cold and flu season (with no deaths).

 

If you look online, you can see pictures of full bars and restaurants in NY, so it's clear social distancing isn't being done on a widespread scale.  From OpenTable data, you can see major cities have had reductions in restaurant reservations of around 40% from 1-2 months ago, and over 60% in Boston/NYC/Seattle.  That's just the beginning--many many small businesses will fail when the death counts start growing in the US and people pull back more.

 

https://docs.google.com/spreadsheets/d/e/2PACX-1vRbPuAyJy74UmbF6kLXFGXDk2eX3N6zvRLzxPamG8FAA3E-SVqMOMSIht-eYEF_4qrNGOJuPbDjTsPD/pubhtml#

 

We are likely 1 week away from large clusters in NYC and Seattle starting to hit hospitalization, which will be followed by other cities as clusters grow.

 

The Washington Post has a helpful simulator on how various levels of social distancing help with flattening the curve:

https://www.washingtonpost.com/graphics/2020/world/corona-simulator/?itid=hp_hp-top-table-main_virus-simulator

 

Here is a Medium post where a data scientist models when NYC hospitals will likely be overwhelmed.  Approx 8-10 days from now:

https://medium.com/@donnellymjd/covid-19-new-york-will-be-the-next-italy-but-doesnt-have-to-be-54a5c8137d42

[Dalal.Holdings]

 

Your right he must be speaking off the cuff and sticking his neck out during a pandemic/crisis and not talking to the medical professionals/epidemiologists, etc.

 

Another Q: Usually when there is an impending crisis like a cat 5 hurricane about to hit your state, is it in the governor’s interest to get people in their state overly concerned or under concerned? Don’t know where you live, but New Yorkers are hard people to get concerned about things.

 

Like I said, put your money where your mouth is and make some bets if you feel so confident.

[Dalal.Holdings]

Orthopa,  thank you for your time and contribution to the board. 

 

Just to clarify are you an ER medical doctor or an orthopedic physician assistant?

 

Important to clarify given the contradiction between the username and claims made on here.

[BG2008]

Guys,

 

Does anyone have information/procedure if you have family member who are infected?  Testing?  Go to ER, PCP, not go?  My brother has had a fever for an almost a week now.  We are in NYC.  Thank you.  I see that NYC has a drive through testing in New Rochelle. 

[no_free_lunch]

Clarifying, yes, turning ORs into ICUs is a big deal. However, in case of pandemic the most urgent have to be taken care of first. Elective surgery may be cancelled for many reasons including the fact that they don't want people coming in for elective surgery to get infected with the coronavirus. So outpatient procedures may continue, but procedures requiring hospital stay may be cancelled. We are not there yet.

 

Cancer surgeries are elective surgeries, aren't they? Turning ORs into ICUs will effectively prioritize covid-19 cases over cancer surgeries, regardless of patients' age and odds of survival. My wife (52yo) is doing pre-operative chemo. She is supposed to have a curative surgery in early May. If the system is overwhelmed by then, she is a walking dead.

 

Canada is uniquely ill-prepared to deal with this because our system runs at/over capacity at the best of times.

 

 

 

My point is that Canada is doing an excellent job of trying to be prepared and flattening the curve. So far so good.

 

Disagree. Our borders remain wide open. All twits below are from yesterday or today.

 

 

I’m completely baffled by the many accounts of people returning to Canada not being explicitly told about the self-isolation expectations. Surely there are people who genuinely have no idea that’s what they’re supposed to do.

 

 

My cousin returned from Japan this morning via YVR. No screening, no info on starting 14 day self isolation (which he immediately observed on his own volition). Tomorrow will be a heavy travel day with many returning home. This needs to be fixed tonight.

 

 

Hearing this from a lot of people coming through YVR...no screening, no questions, no info about #COVIDー19 or need to quarantine. If the rest of us are doing our part, they better get it together at the airport.

 

 

Just landed at Toronto Pearson an hour ago. I was asked (by a computer) if I’d been to Italy, Iran or China. I clicked no. I was waved in. I only know I’m supposed to self-isolate because I read it on the news.

 

Thank you Eli.

 

I will add to your posts that medical staff are not being provided with protective equipment such as masks unless dealing with known coronavirus patients. I am concerned what will happen if this starts to spread in the hospitals. There is all this talk of bed capacity and that is an important statistic but Canadians should be aware they can barely staff the existing beds pre corona virus. We should be taking all precautions to keep our medical system intact.

[no_free_lunch]

Guys,

 

Does anyone have information/procedure if you have family member who are infected?  Testing?  Go to ER, PCP, not go?  My brother has had a fever for an almost a week now.  We are in NYC.  Thank you.  I see that NYC has a drive through testing in New Rochelle.

 

I'm not a doctor but what are they going to do at a hospital. You just help to overwhelm the system if you go in.  I am getting sick too now and I plan to stay at home unless I actually feel critically ill.  There is no cure, what are they going to do?

 

Consider too that if you don't have it you might get it going to the hospital.

 

There are some things he can do like eat healthy, vitamin C, lots of warm water, get as much fresh air as possible, keep exercising.  Focus on that, hopefully just body takes care of it.

 

Just echoing my own procedures. .

[Guest Schwab711]

Guys,

 

Does anyone have information/procedure if you have family member who are infected?  Testing?  Go to ER, PCP, not go?  My brother has had a fever for an almost a week now.  We are in NYC.  Thank you.  I see that NYC has a drive through testing in New Rochelle.

 

https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html

 

https://www.health.harvard.edu/diseases-and-conditions/coronavirus-resource-center#Sick

 

Please read for yourself but generally stay home and keep track of days and symptoms. It might get a little scary but 80%-85% of cases with symptoms are bad flu-like and can be recovered from at home. Should only last 7-10 days. I imagine that's scary but it'll get better.

 

Call your doctor and urgent care/hospital emergency room before going so they can prepare.

 

Drink lots of fluids and read about the French warning on taking aspirin. It sounds like it may be better to take Tylenol but please research for yourself.

 

Good luck and I'm hoping for the best for you and your family!

[Dalal.Holdings]

Guys,

 

Does anyone have information/procedure if you have family member who are infected?  Testing?  Go to ER, PCP, not go?  My brother has had a fever for an almost a week now.  We are in NYC.  Thank you.  I see that NYC has a drive through testing in New Rochelle.

 

What I would recommend to a family member in your situation (take it with a grain of salt and follow your brother's own doctors' advice):

 

1 week of fever is nothing to dismiss without at least consulting a PCP. I would consider using acetaminophen to quell it if no contraindications and reach out to PCP if other symptoms (respiratory, etc) not as severe. If things are bad then urgent care/ED. I would give where ever you were going the heads up that corona may be an issue so they can give you precise instructions on how to arrive without potentially infecting others. The drive through testing is to be operational this week, but not sure how efficient it will be and your brother may have to wait in a car for a while in line if it is packed.

[alwaysdrawing]

By the way, I would guess cancer surgeries will continue for some time unless things get really bad at the local hospital.

 

Elective surgeries, which I would expect to start cancelling soon, would be stuff like hernias, tubal ligations, and cosmetic surgeries.  While cancer surgeries are semi-elective in that they are non-urgent, and they might be able to safely be delayed, I think many would still happen unless the hospital is truly overrun.  I think it would be up to the surgeon and patient to figure out the risks and benefits, as well as hospital policy.

 

This is from the American College of Surgeons two days ago:

https://www.facs.org/about-acs/covid-19/information-for-surgeons

 

Each hospital, health system, and surgeon should thoughtfully review all scheduled elective procedures with a plan to minimize, postpone, or cancel electively scheduled operations, endoscopies, or other invasive procedures until we have passed the predicted inflection point in the exposure graph and can be confident that our health care infrastructure can support a potentially rapid and overwhelming uptick in critical patient care needs.

 

Immediately minimize use of essential items needed to care for patients, including but not limited to, ICU beds, personal protective equipment, terminal cleaning supplies, and ventilators. There are many asymptomatic patients who are, nevertheless, shedding virus and are unwittingly exposing other inpatients, outpatients, and health care providers to the risk of contracting COVID-19.

 

Source:  my wife is an OB/Gyn that performs surgeries every week.

[Dalal.Holdings]

Another (useless) graph for the "there's nothing we can do anyway" crowd.

 

FYI South Korea achieved this WITHOUT A LOCKDOWN, but merely extensive TESTING. And South Korea's population is similar to Italy's.

 

Source:

[RichardGibbons]

I'd put the chance that Orthopa is right at less than 2%.  But I've been continuing to mull the issue, since it's an interesting thought experiment--how can Orthopa's data point be reconciled with the 100 data points that contradict his claims?

 

One way it could be true is if the area around Orthopa previously had a coronavirus that infected people and gave them some sort of heightened immunity compared to everywhere else.  Or, maybe the COVID-19 came early to his region, but was a mutated version that happens to have a much lower rate of serious consequences.

 

That said, I think both of these cases are super low probability, that it's much more likely that multitude of experts saying "this is a big deal" are right, and Orthopa isn't. 

 

In fact, in my case, I view the evidence Orthopa's brought to support his argument as weakening his argument since it's showing that he's confidently making large, unwarranted leaps to support his thesis. To me, this increases the chance that he's a guy who's comfortable squeezing evidence into odd shapes in order to support his conclusions.  (e.g. a few days ago, 2 cases was enough for him to extrapolate conclusions about 100,000 people infected. Today, he's saying that 140,000 tests isn't enough to extrapolate anything.)

 

At this point, I'm curious whether he's a troll or just completely locked into an incorrect mental model.  I still lean toward the latter.

[Liberty]

Another (useless) graph for the "there's nothing we can do anyway" crowd.

 

FYI South Korea achieved this WITHOUT A LOCKDOWN, but merely extensive TESTING. And South Korea's population is similar to Italy's.

 

Source:

 

South Korea's approach was very similar to Wuhan's from what I heard. Lots and lots and lots of testing and temperature taking everywhere, separating family members who are infected rather than at-home quarantine, etc. It wasnt just extensive testing, there was a lot of shutting down of things and shutdowns too,