Dalal.Holdings Posted March 15, 2020 Posted March 15, 2020 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. There's a simple explanation: reliance on anecdotes over objective data, narrative fallacy, etc. Happens to a lot of clinicians because they see patients and extrapolate from those handful of clinical encounters to the larger population. Anyway--the rule is that if lots of people's lives are on the line, you should err on the side of caution ("prepare for the worst"), not assume "everything is going to be fine". Ie. board up your house even if it is 98% likely to be out of the hurricane's direct path. That's the precautionary principle in a nutshell.
KCLarkin Posted March 15, 2020 Posted March 15, 2020 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, Real quarantine is essential. Self-isolation means you will just infect family and close contacts.
Dalal.Holdings Posted March 15, 2020 Posted March 15, 2020 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, Real quarantine is essential. Self-isolation means you will just infect family and close contacts. South Korea did not have to impose lockdown as strict as Wuhan and Northern Italy. People self quarantined once they knew they were positive to reduce further spread. With or without self-isolation, the chance you infect people in your household is already very very high (after all, you are going to end up at home at the end of the day). The thing about testing people and letting them know they are positive is they can quarantine themselves from other people outside their household. The household catching it is a foregone conclusion, but reducing spread to new households is what we should be after.
Cigarbutt Posted March 15, 2020 Posted March 15, 2020 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. Elective surgeries will be affected but it's hard to see to what extent. Under the worst-cases scenarios, both Canada (socialized medicine) and the US (hybrid system) will follow a similar scarcity curve. Transforming operating rooms into ICU beds is unlikely for a long time. A more likely scenario is that elective surgeries that require ICU beds after (heart and other major operations) will be selectively postponed. Cancer surgeries that don't require ICU stays are the last elective cases to be cancelled. Good luck
StubbleJumper Posted March 15, 2020 Posted March 15, 2020 Quarantine the elderly and other vulnerable groups and just let the virus run its course through the healthy population: https://nationalpost.com/opinion/why-draconian-measures-may-not-work-two-experts-say-we-should-prioritize-those-at-risk-from-covid-19-than-to-try-to-contain-the-uncontainable
LC Posted March 15, 2020 Posted March 15, 2020 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. I think it's much higher than 2%. The reality is many people are sick and not dying of pneumonia - I would assume a portion of posters on this very thread are experiencing symptoms as well as the rest of the population, or had experienced symptoms in Jan/Feb and recovered. The first reported US case was January 21. This is an incredibly fast transmitting virus. The odds are, cases existed prior to Jan 21. And further, the odds are that the spread of this virus across the US was much faster than official reports claim. This is due to lack of testing i.e. lack of timely, accurate information. But ultimately, I agree w/ the principle of: better safe than sorry. For the obvious reason, and for the secondary reason as it provides a "trial-run" on a global basis for future pandemics. I am about 20% cash btw. If I didn't suffer from biases like anchoring and all that stuff I would think about 1/3 cash is the ideal amount right now.
Dalal.Holdings Posted March 15, 2020 Posted March 15, 2020 This is great visualization: https://www.washingtonpost.com/graphics/2020/world/corona-simulator/ Want to re-emphasize this great post. Stochastic simulation is a powerful way to understand what measures you can take to curb this disease progression. Anyone who says "I know what will work!" without running real simulations or consulting data from other countries with N>1000s is poking around in the dark. We cannot afford to listen to such people. This shows that social distancing (even with 25% of people not compliant) works even better than quarantines. If you combine social distancing with mass testing and quarantining of known positives (until they are "recovered"), it is likely to work even better.
orthopa Posted March 15, 2020 Posted March 15, 2020 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. Registered username as an orthopedic PA while in PA to DO accelerated program. Then ER training. Currently working in ER and Urgent care.
Read the Footnotes Posted March 15, 2020 Posted March 15, 2020 This is great visualization: https://www.washingtonpost.com/graphics/2020/world/corona-simulator/ Want to re-emphasize this great post. Stochastic simulation is a powerful way to understand what measures you can take to curb this disease progression. Anyone who says "I know what will work!" without running real simulations or consulting data from other countries with N>1000s is poking around in the dark. We cannot afford to listen to such people. This shows that social distancing (even with 25% of people not compliant) works even better than quarantines. If you combine social distancing with mass testing and quarantining of known positives (until they are "recovered"), it is likely to work even better. Simulations with 10,000 iterations or more is 100% the correct way to really understand the issues here. On the other hand if you have the experience of having built a ton of similar models and run simulations in the past, you really don't need to build one in this case to know that this is not just a cold. It's so glaringly easy to see.
KCLarkin Posted March 15, 2020 Posted March 15, 2020 This shows that social distancing (even with 25% of people not compliant) works even better than quarantines. If you combine social distancing with mass testing and quarantining of known positives (until they are "recovered"), it is likely to work even better. I was referring to mandatory quarantines of known positives. This is impossible where testing is being rationed.
jeffsreng Posted March 15, 2020 Posted March 15, 2020 FYI: https://asecondopinionpodcast.com/china-covid19-special/
orthopa Posted March 15, 2020 Posted March 15, 2020 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. I told you earlier maybe I was anchored right? We will see, not only that told you I was willing to eat crow if wrong! Like I have anything to gain arguing with you guys about this. ::)
Liberty Posted March 15, 2020 Posted March 15, 2020 https://www.nytimes.com/interactive/2020/03/15/business/economy/coronavirus-worker-risk.html Nice chart showing proximity to diseases and proximity to others by profession. Dentists, be careful out there.
Dalal.Holdings Posted March 15, 2020 Posted March 15, 2020 Found it.. The village where it all started in Italy (and which has been in lockdown by far the longest) has been infection free for the last two days. In the Piedmont region the contagion curve is decreasing, seems like past actions taken are proving to be effective not only in Asia, but in Italy as well, as long as you account for the delay between measures being taken and actual cases going down.. Considering the fact Italy's new cases and number of deaths (despite terrible on a micro-level, don't get me wrong) have not been growing exponentially at all (like in many of the doomsday models) even before the lockdown kicks in in the stats, it sounds like we're a number of days, maybe a week away, from the lockdown of the entire country having its effect and new cases should decrease. Incorrect. OK, sure. Let's exchange data Italy new cases: March 11: 2313 March 12: 2651 March 13: 2547 March 14: 3497 Italy deaths: March 11: 196 March 12: 189 March 13: 250 March 14: 175 What's yours? Don't get bogged down in the weeds. Updated statistics for Italy March 15 (which is not over): Italy New Cases: March 15: +3590 Italy Deaths: March 15: +368 :-\
orthopa Posted March 15, 2020 Posted March 15, 2020 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. I think it's much higher than 2%. The reality is many people are sick and not dying of pneumonia - I would assume a portion of posters on this very thread are experiencing symptoms as well as the rest of the population, or had experienced symptoms in Jan/Feb and recovered. The first reported US case was January 21. This is an incredibly fast transmitting virus. The odds are, cases existed prior to Jan 21. And further, the odds are that the spread of this virus across the US was much faster than official reports claim. This is due to lack of testing i.e. lack of timely, accurate information. But ultimately, I agree w/ the principle of: better safe than sorry. For the obvious reason, and for the secondary reason as it provides a "trial-run" on a global basis for future pandemics. I am about 20% cash btw. If I didn't suffer from biases like anchoring and all that stuff I would think about 1/3 cash is the ideal amount right now. https://www.nejm.org/doi/full/10.1056/NEJMoa2001191 Question for you guys as I havent seem to be making any friends swimming against the tide! Above is the NEJM article on first case of corona virus. This is what I don't understand. First US case was January 20st, with 4 days of symptoms and as I have read this is a very fast transmitting virus. Some have said this is very fast, some fast, symptoms take a while to show up, agree. Please reconcile this for me. It has been exactly 2 months since this gentleman returned to the US from wuhan China. Is it out of the way to assume that there was community spread with this gentleman? 4 days of cough, fever, flew on a plane? Lets just work on that premise. Now I have become lost with all of the projections, graphs, charts, etc. Pick whatever model you want. My question is this: Its been 2 months since that virus was officially detected in a known area. I'm not aware of this so please help. Is there overload in the area where this gentleman was? Are there people dying? What does it look like? Are they running out of ICU beds? How is california? They were not far behind and have a HUGE population! I know there can be a delay in symptoms but isnt 2 months long enough for this virus to really get going, especially with lockdown, social distancing just happening now?
Kaegi2011 Posted March 15, 2020 Posted March 15, 2020 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. I told you earlier maybe I was anchored right? We will see, not only that told you I was willing to eat crow if wrong! Like I have anything to gain arguing with you guys about this. ::) Orthopa - do you have any thoughts on this data? Seems to be in your region. I’m also hearing a lot of people (docs) on Twitter say that they’re seeing the uptick in similar symptoms but without testing they just send people home. So is it possible that people are sick and dying but without tests we don’t know the “cause” definitively?
Dalal.Holdings Posted March 15, 2020 Posted March 15, 2020 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. I think it's much higher than 2%. The reality is many people are sick and not dying of pneumonia - I would assume a portion of posters on this very thread are experiencing symptoms as well as the rest of the population, or had experienced symptoms in Jan/Feb and recovered. The first reported US case was January 21. This is an incredibly fast transmitting virus. The odds are, cases existed prior to Jan 21. And further, the odds are that the spread of this virus across the US was much faster than official reports claim. This is due to lack of testing i.e. lack of timely, accurate information. But ultimately, I agree w/ the principle of: better safe than sorry. For the obvious reason, and for the secondary reason as it provides a "trial-run" on a global basis for future pandemics. I am about 20% cash btw. If I didn't suffer from biases like anchoring and all that stuff I would think about 1/3 cash is the ideal amount right now. https://www.nejm.org/doi/full/10.1056/NEJMoa2001191 Question for you guys as I havent seem to be making any friends swimming against the tide! Above is the NEJM article on first case of corona virus. This is what I don't understand. First US case was January 20st, with 4 days of symptoms and as I have read this is a very fast transmitting virus. Some have said this is very fast, some fast, symptoms take a while to show up, agree. Please reconcile this for me. It has been exactly 2 months since this gentleman returned to the US from wuhan China. Is it out of the way to assume that there was community spread with this gentleman? 4 days of cough, fever, flew on a plane? Lets just work on that premise. Now I have become lost with all of the projections, graphs, charts, etc. Pick whatever model you want. My question is this: Its been 2 months since that virus was officially detected in a known area. I'm not aware of this so please help. Is there overload in the area where this gentleman was? Are there people dying? What does it look like? Are they running out of ICU beds? How is california? They were not far behind and have a HUGE population! I know there can be a delay in symptoms but isnt 2 months long enough for this virus to really get going, especially with lockdown, social distancing just happening now? The consensus for the origination of coronavirus is late November in Wuhan. It did not become a big deal until 2 months later. The way exponential growth works is that when you start with small numbers, it takes time for them to snowball into significant numbers. Once significant numbers are attained, then the growth becomes impactful and felt in a very real way. Berkshire Hathaway was a company not on too many people's radars in the 1960s and 1970s. Eventually it became impossible to ignore.
alwaysdrawing Posted March 15, 2020 Posted March 15, 2020 Taleb on Why you are harming others by not "overreacting" https://t.co/iSDperUx8g?amp=1
KCLarkin Posted March 15, 2020 Posted March 15, 2020 I know there can be a delay in symptoms but isnt 2 months long enough for this virus to really get going, especially with lockdown, social distancing just happening now? Exactly. The virus is really getting going and there is a lag of, say 6 weeks, until you see the deaths. There is widespread, undetected, uncontained community spread in the US. Canada is seeing that when we test people coming from the US. Major parts of the US will look like Italy shortly. Canada is probably a week or two behind the US.
jeffsreng Posted March 15, 2020 Posted March 15, 2020 Remember virus can change and mutate and get stronger. Worse they stay dormant and erupt later.
Dalal.Holdings Posted March 15, 2020 Posted March 15, 2020 I know there can be a delay in symptoms but isnt 2 months long enough for this virus to really get going, especially with lockdown, social distancing just happening now? Exactly. The virus is really getting going and there is a lag of, say 6 weeks, until you see the deaths. There is widespread, undetected, uncontained community spread in the US. Canada is seeing that when we test people coming from the US. Major parts of the US will look like Italy shortly. Canada is probably a week or two behind the US. Q: if you start with 1 case and it doubles every 3 days, how long until we actually notice it? It will take many doublings until we feel it and news picks up. Furthermore if mortality is in single digits, it will take even longer for us to notice it. This has been here since January but exponential growth starts slowly with small numbers until they snowball and you can no longer ignore it. See my Berkshire example. To think that just because there were a few cases in Jan implies there were millions in the U.S. at that time is a major major stretch.
jeffsreng Posted March 15, 2020 Posted March 15, 2020 I have to disagree. Virus has been in LA since December.
Dalal.Holdings Posted March 15, 2020 Posted March 15, 2020 I have to disagree. Virus has been in LA since December. That bat must've flown all the way from Wuhan to LA. If cases double every 3 days, it will take 18-21 days just to go from 1 case to 100 cases. It doesn't matter when the virus was "first here". It was first in China in November 2019 but hardly noticed until January because snowballing takes time.
orthopa Posted March 15, 2020 Posted March 15, 2020 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. I told you earlier maybe I was anchored right? We will see, not only that told you I was willing to eat crow if wrong! Like I have anything to gain arguing with you guys about this. ::) Orthopa - do you have any thoughts on this data? Seems to be in your region. I’m also hearing a lot of people (docs) on Twitter say that they’re seeing the uptick in similar symptoms but without testing they just send people home. So is it possible that people are sick and dying but without tests we don’t know the “cause” definitively? I can give you our update recommendations that just came through from local DOH on fax 5 minutes ago. If pt has suspected Covid19 with mild symptoms pt is to go HOME and self quarantine for 14 days. If pt has high suspicion of Covid19 infection we are supposed to call the local DOH and speak to an epidemiologist, the criteria are: 1. A person who has been in close contact with someone who has covid-19 2. A person who traveled to area with high incidence. 3. Person who has tested negative for flu/RSV A joint decision is then made regarding need for testing. Anyone with life threatening symptoms is to go by ER.
minten Posted March 15, 2020 Posted March 15, 2020 Found it.. The village where it all started in Italy (and which has been in lockdown by far the longest) has been infection free for the last two days. In the Piedmont region the contagion curve is decreasing, seems like past actions taken are proving to be effective not only in Asia, but in Italy as well, as long as you account for the delay between measures being taken and actual cases going down.. Considering the fact Italy's new cases and number of deaths (despite terrible on a micro-level, don't get me wrong) have not been growing exponentially at all (like in many of the doomsday models) even before the lockdown kicks in in the stats, it sounds like we're a number of days, maybe a week away, from the lockdown of the entire country having its effect and new cases should decrease. Incorrect. OK, sure. Let's exchange data Italy new cases: March 11: 2313 March 12: 2651 March 13: 2547 March 14: 3497 Italy deaths: March 11: 196 March 12: 189 March 13: 250 March 14: 175 What's yours? Don't get bogged down in the weeds. Updated statistics for Italy March 15 (which is not over): Italy New Cases: March 15: +3590 Italy Deaths: March 15: +368 :-\ These statistics are always for a 24 hour period when reported, so yes, the "day" is in fact over. I argued numbers aren't growing exponentially, they clearly aren't, don't know else what to say. Nevertheless, a lot of death unfortunately. It should get better in a few days (or a week) when the lockdown finally kicks in. Some say there's a 10 day lag to new cases, others a 14 day lag, we will see I guess, we're at 6 days now.
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