Coronavirus

[jeffsreng]

You will never know the real numbers.  The rich Chinese who got it will never disclose it and flew over to US to get help.

They would isolate themselves unlike others.

[mcliu]

Chinese # probably off by 10x. If you can read Chinese, go through archived social media (most posts deleted), it is much more widespread and covered up.

[alwaysdrawing]

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.

 

The willful ignorance, and people ignoring the data is wild.  Italy has taken drastic steps to contain the virus, and even so, much of the spread is "baked in" from before the draconian measures were taken.

 

The US must take similar actions ASAP, as Italy's course is increasingly "baked in" to our next few weeks, and without mitigation, it will be even worse.

 

The pictures of hundreds of people at spring break in Florida, over-crowded airports, and filling bars for St. Paddy's celebrations in NYC, Boston, Chicago, and cities around the country are evidence that many people just don't get it. 

 

There are signs of promise though, as schools around the country start to shut down, more companies restrict travel and implement work-from-home, and individuals start to socially distance.

 

Here is a map of school closures around the US: 

https://www.edweek.org/ew/section/multimedia/map-coronavirus-and-school-closures.html

 

That map indicates progress is being made, although more needs to be done.

 

We will start seeing the effects of strain on hospitals in the hardest hit areas (likely Seattle, NYC, and Boston) in the coming week or two weeks, as many more cases progress to serious levels.

 

The stats show 80% mild cases, 15% hospitalizations, and 5% ICU.  For those patients who need hospitalization and supplemental oxygen, it's vital to keep hospitals below capacity.  For those who need ICU level care, it's even more vital, as we've seen in Italy how triaging ventilators can cause the mortality rate to rise precipitously.

[orthopa]

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.

 

Thanks, but I wasnt asking about Berkshire Hathaway.

 

Can anyone else help on this?

[JRM]

None of my doctor friends think this is an issue.  It's hard to get across that, based on China's numbers, only 1% of Wuhan's population was infected.  They built two temporary hospitals and three others in the region.  They locked down 60M people and restricted travel for almost 1 billion people. That's an incredible response to "only" 1% of the population (of one city) ultimately being infected.  Can you imagine if they didn't take the nuclear option?

 

On to the rest of the world.  Rest of world "confirmed" infected should surpass total infected in China sometime early this week.  We should hit 1 million infected worldwide sometime in the next month.  Absolutely incredible for such a short period of time. 

 

Andrew Cuomo is asking for military support.  He's earned a lot of respect from me for his intense testing and responses to this, politics aside.

 

This is a first of its kind disease, so don't expect much concern from any medical professional who's not taken the time to observe Wuhan or Lombardy.  With that said, I pray for the doctors and nurses for what is likely coming.  I don't blame them. The ones I know are too busy dealing with day to day issues.

[Dalal.Holdings]

None of my doctor friends think this is an issue.  It's hard to get across that, based on China's numbers, only 1% of Wuhan's population was infected.  They built two temporary hospitals and three others in the region.  They locked down 60M people and restricted travel for almost 1 billion people. That's an incredible response to "only" 1% of the population (of one city) ultimately being infected.  Can you imagine if they didn't take the nuclear option?

 

On to the rest of the world.  Rest of world "confirmed" infected should surpass total infected in China sometime early this week.  We should hit 1 million infected worldwide sometime in the next month.  Absolutely incredible for such a short period of time. 

 

Andrew Cuomo is asking for military support.  He's earned a lot of respect from me for his intense testing and responses to this, politics aside.

 

This is a first of its kind disease, so don't expect much concern from any medical professional who's not taken the time to observe Wuhan or Lombardy.  With that said, I pray for the doctors and nurses for what is likely coming.  I don't blame them. The ones I know are too busy dealing with day to day issues.

 

ROW confirmed infected just surpassed mainland China today. See attached chart.

[alwaysdrawing]

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?

 

Trevor Bedford has put together an excellent thread to estimate the current number of cases (not confirmed testing, but a model of where actual cases might be).

 

 

Some relevant quotes:

 

Outbreaks that we're seeing across the US now are likely the result of sparks that landed in mid-Jan to mid-Feb that through exponential growth have become localized "fires".

 

I believe that a 5-6 day doubling is an accurate model for growth, so that sparks that landed in mid-Jan may have grown to ~2000 infections at this point and sparks that arrived in mid-Feb may have grown to ~50 infections at this point.

 

The seeming sudden appearance of outbreaks across the US are not due to a sudden influx of cases. Instead, transmission chains have been percolating for 4-8 weeks now and we're just now starting to see exponential growth pick up steam.

 

Thus, a rough guess would be a ~20 sparks that caught between Jan 15 and Feb 15 and have resulted in growing outbreaks, each of which on average will be around ~1000 infections, some bigger than others. This would be an extremely rough ~20k infections in the USA.

 

I could easily be off 2-fold in either direction, but my best guess is that we're currently in the 10,000 to 40,000 range nationally. (Ed. NOTE: This is from 3/13/2020, so not current through today)

 

The full thread is worthwhile, and his posts are generally helpful.

 

I believe the cases you were seeing in the ED during January and February were normal cold and flu, not COVID19.

[orthopa]

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.

 

Wait a second. Wasn't I just getting filleted for this last week?

[Spekulatius]

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.

 

Thanks, but I wasnt asking about Berkshire Hathaway.

 

Can anyone else help on this?

Orthopa, I am not an expert, but it is impossible to predict what happens when a single person gets infected. It’s jut random walk static’s, maybe that person is asocial and doesn’t have many contact and might remain the only person. Maybe this person is a social butterfly and gets into contact with a lot of people that are vulnerable and it spread like wildfire and he becomes the infamous patient zero. Just about could happen.

 

The way statistics works it is easier to predict what happens when a larger number of people get infect (100 is probably a reasonable number) since the law of large numbers makes random fluctuations less important. I also think that 100 infections (based in some articles I read)  in a cluster is the point of no return when an infection most likely can’t be contained any more because these 100 people generally have so many interactions during their incubation period that it is basically untraceable . Again, am not in the medical field or an epidemiologist, but just from a basic understanding of statistics, I think what I wrote is directionally correct.

 

I also think Dallal is correct that the way exponential growth works, it takes time until the number is in the 100,000 or millions when it become really a factor in a country with the US population. If 1 million people are infected, chances are that each of us will know someone who is infected, if it’s just 10k, chances are that few of us are in the same situation.

[orthopa]

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.

 

Ok so we will say it doubles every 3 days, so its been 2 months. Thats 20 doubles? So your comfortable with saying there reasonable suspicion there are 1,048,576 infections in the area  alone where this gentleman is with no apparent stress on the healthcare system. And that being said there is still the rest of the state to be counted and so far 60 deaths?

 

 

[Guest Schwab711]

WHO says 5-6 day doubling (3/6/20 sit rpt)

 

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports

 

It is not right to assume all additional cases are local and all non-local additional cases are from a separate contagion tree.

 

There's no proper way to answer your last post because it's not 3 day doubling, not all transmissions stay local, and death rate can only be compared to estimated cases 25+ days before.

 

Spek has a good high-level explanation.

[DocSnowball]

None of my doctor friends think this is an issue. 

 

 

 

 

This is a first of its kind disease, so don't expect much concern from any medical professional who's not taken the time to observe Wuhan or Lombardy.  With that said, I pray for the doctors and nurses for what is likely coming.  I don't blame them. The ones I know are too busy dealing with day to day issues.

 

Every physician I know in real life is taking it very very seriously. None is taking a step back from the challenge ahead. Multiple have had transmission in their hospitals to healthcare workers already, and are tackling incompetent administrators who still want to continue "business as usual" but are buckling over one by one to move non-urgent visits to phone or televisits to prevent further transmission from presymptomatic patients. Respect for healthcare workers in this time of crisis. 

[Dalal.Holdings]

You are wrong. If you truly think the whole world is wrong and you are right, you should probably figure out what you are missing instead of using larger font and bolded letters.

 

Better answer for him: "If you truly think the whole world is wrong and you are right, the futures market opens at 6 pm EST"

[John Hjorth]

WHO says 5-6 day doubling (3/6/20 sit rpt)

 

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports. ...

 

Schwab,

 

What are you specifically referring to when you mention "5-6 days doubling"?

[orthopa]

You are wrong. If you truly think the whole world is wrong and you are right, you should probably figure out what you are missing instead of using larger font and bolded letters.

 

Better answer for him: "If you truly think the whole world is wrong and you are right, the futures market opens at 6 pm EST"

 

Come on Dalal! What do you think my question regarding the numbers and deaths. Your a numbers guy right?

 

I cant keep up. First its doubling fast, then slow, and there is exponential growth, but we still have to wait.

 

Im waiting for the futures to open just like you!!!

[orthopa]

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?

 

Trevor Bedford has put together an excellent thread to estimate the current number of cases (not confirmed testing, but a model of where actual cases might be).

 

 

Some relevant quotes:

 

Outbreaks that we're seeing across the US now are likely the result of sparks that landed in mid-Jan to mid-Feb that through exponential growth have become localized "fires".

 

I believe that a 5-6 day doubling is an accurate model for growth, so that sparks that landed in mid-Jan may have grown to ~2000 infections at this point and sparks that arrived in mid-Feb may have grown to ~50 infections at this point.

 

The seeming sudden appearance of outbreaks across the US are not due to a sudden influx of cases. Instead, transmission chains have been percolating for 4-8 weeks now and we're just now starting to see exponential growth pick up steam.

 

Thus, a rough guess would be a ~20 sparks that caught between Jan 15 and Feb 15 and have resulted in growing outbreaks, each of which on average will be around ~1000 infections, some bigger than others. This would be an extremely rough ~20k infections in the USA.

 

I could easily be off 2-fold in either direction, but my best guess is that we're currently in the 10,000 to 40,000 range nationally. (Ed. NOTE: This is from 3/13/2020, so not current through today)

 

The full thread is worthwhile, and his posts are generally helpful.

 

I believe the cases you were seeing in the ED during January and February were normal cold and flu, not COVID19.

 

You must mean colds sir. Their flu's were negative. So I had a whole bunch of colds (they were presenting differently too) come in while a novel virus was erupting across the world with daily direct airplane travel, no vaccine, no cure, a 4-6 week head start and no travel restriction for weeks?

[Guest Schwab711]

WHO says 5-6 day doubling (3/6/20 sit rpt)

 

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports. ...

 

Schwab,

 

What are you specifically referring to when you mention "5-6 days doubling"?

 

2nd page 2nd question 1st paragraph of 3/6/20 report

 

Q - How are COVID-19 and influenza viruses different?

The speed of transmission is an important point of difference between the two viruses. Influenza has a shorter

median incubation period (the time from infection to appearance of symptoms) and a shorter serial interval (the

time between successive cases) than COVID-19 virus. The serial interval for COVID-19 virus is estimated to be 5-6

days, while for influenza virus, the serial interval is 3 days. This means that influenza can spread faster than COVID-

19.

[cobafdek]

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.

 

I'd put the chance that Orthopa is right at greater than 70%.  (I believe if the entire population were tested, the base rate of Covid-19 is very high, and therefore the CFR is very low).  I also think that his and my probability assessment of this rare pandemic event is irrelevant for deciding what to do:  "panic" precautionary behavior is required.

 

It's like Taleb being asked whether he was bullish or bearish on the stock market.  He said he was bullish, meaning 70% chance the market was going up.  Yet, he had a very large short position on SP500 futures (the TV interviewer was dumbfounded).

 

There is no contradiction here.

[Dalal.Holdings]

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.

 

Ok so we will say it doubles every 3 days, so its been 2 months. Thats 20 doubles? So your comfortable with saying there reasonable suspicion there are 1,048,576 infections in the area  alone where this gentleman is with no apparent stress on the healthcare system. And that being said there is still the rest of the state to be counted and so far 60 deaths?

 

Yes the power of doubling time is a sight to behold, ain't it! You're right if it were 3 days (which is a very aggressive estimate), it would be ~250k right now (not 1M) since first case Jan 20. In reality the doubling time is longer. And your original claim was that millions have had this for months was it not?

 

The real world is quite messy--esp when dealing with small numbers. For example, what if those initial few cases back in January were mostly hermits who stayed indoors and played video games all day? The doubling time would be much longer than if they were instead yoga instructors. With exponential processes like this, there is a lot of randomness earlier in the course because there are fewer individuals involved. Once you get a critical mass, the trend gets smoother. But obviously you don't care about thinking about compounding on a higher level like you don't care about the Berkshire example. Your experience and that of the healthcare professionals you are in communication with trumps this kind of low level analytical thinking. Futures open in less than 40 min!

[mcliu]

@orthopa, what is your assessment of what went wrong in Italy? Why the high # of deaths and probability that occurs in the US?

[Kaegi2011]

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.

 

Sorry but can you answer the question on the data above?  If the uptick that the data is pointing to is related to Covid19 it would suggest something is happening, even if we don't know for sure 100% due to the lack of testing. 

[Viking]

As expected...

 

Federal Reserve slashes rates to zero, restarts QE

- https://finance.yahoo.com/news/federal-reserve-cuts-rates-to-zero-restarts-quantitative-easing-qe-210001968.html

 

The Federal Reserve made an emergency announcement Sunday afternoon by announcing that it would be cutting interest rates to zero for the first time since the financial crisis.

 

The central bank said it will use its “full range of tools” to battle the economic impacts of the novel coronavirus and announced quantitative easing in the form of at least $700 billion of asset purchases. It also encouraged banks to provide credit to the economy by eliminating reserve requirements and allowing the financial firms to tap into capital and liquidity buffers.

 

In a global effort, the Fed also announced standing U.S. dollar liquidity swap line arrangements in coordination with the Bank of Canada, the Bank of England, the Bank of Japan, the European Central Bank, and the Swiss National Bank.

[orthopa]

@orthopa, what is your assessment of what went wrong in Italy? Why the high # of deaths and probability that occurs in the US?

 

I posted this earlier in the thread. I do not claim to be an expert on this. Just brainstorming like you guys.

 

 

 

Thats a good question, and I think this is alot of the reason for concern that it will spiral out of control in US. To be honest I don't know why Italy when to shit so fast. I have never worked there, don't know their facilities, protocols, patient populations, medications available,  etc.

 

Stuff that I would throw at a wall to see if it sticks?

 

1. Older population or population centers where disease has hit, we know it affects older people more, like nursing home in Washington.

2. More smokers? Covid 19 would be murder on someone with COPD, severe asthma, smoker etc.

3. Lower admission threshold? I dont know their protocols but medicine and treatment is not universal town to town, state to state, and certainly not country to country

 

I would argue it has nothing to do with testing vs Korea though why?

 

Latest updates are Italy 12462 positive, 827 deaths, Korea 7869 positive 66 deaths. How do you explain the difference?

 

Again there is no cure for Covid 19 so its not like Korea is curing people and Italy isnt. Again whether you are tested or not if you are to the point that you need a respirator (think dying) you will go in and be treated. Even if you test positive on day 1 you can do down hill quick if your old and immuno compromised so drive through testing would be great but your ass would still be in the ICU if you body couldn't handle the disease. Is it the case that S. Koreans are healthier? Maybe. Less lung disease? Maybe

 

So to summarize testing is not a cure, its a diagnosis, a label. Treatment for those positive is fluids, rest, tylenol for fever, steriods/breathing treatments for breathing issues. If you go down hill, its happening regardless of your test results as there is nothing to decrease the viral load.  My assumption is S. Koreas actually hands on treatment isnt much better in this day and age then Italy's so that leaves the pts.

 

I have read some believe S. Korea have been giving super super high doses of vitamin C IV with success. Maybe they are having success and never picked up the phone to call Lombardy. Idk.

 

Many people have cited Italy as a concern which is very valid. I think a good thought to ponder is why is Italy the rule and not the exception?  This has hit 180? countries by now. How is medicine and access to healthcare in the third world?What the hell is going on there?

[orthopa]

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.

 

Sorry but can you answer the question on the data above?  If the uptick that the data is pointing to is related to Covid19 it would suggest something is happening, even if we don't know for sure 100% due to the lack of testing.

 

Well it looks like data is presenting with flu symptoms. Does not mention deaths. I would hope to god if people died they were tested for covid19. Dead people get just as much of a right to a test as living plus in this day and age a requirement I would imagine. I would imagine the data is due to.

 

1. Covid19 of course, it has flu like symptoms

2. Worries individuals/paranoid.

 

Otherwise how do you fake flu symptoms?

 

 

 

 

"Katie S

@scoville_katie

Replying to

@chrislhayes

I noticed about a month ago that we were treating a lot of patients for the flu that had negative flu tests. My mind goes back to that and I just wonder if we missed the bus even before we thought we did."

 

Maybe I work where Katie works LOL! jk. Worth a read of her thread!

[Guest Schwab711]

@orthopa, what is your assessment of what went wrong in Italy? Why the high # of deaths and probability that occurs in the US?

 

I posted this earlier in the thread. I do not claim to be an expert on this. Just brainstorming like you guys.

 

 

 

Thats a good question, and I think this is alot of the reason for concern that it will spiral out of control in US. To be honest I don't know why Italy when to shit so fast. I have never worked there, don't know their facilities, protocols, patient populations, medications available,  etc.

 

Stuff that I would throw at a wall to see if it sticks?

 

1. Older population or population centers where disease has hit, we know it affects older people more, like nursing home in Washington.

2. More smokers? Covid 19 would be murder on someone with COPD, severe asthma, smoker etc.

3. Lower admission threshold? I dont know their protocols but medicine and treatment is not universal town to town, state to state, and certainly not country to country

 

I would argue it has nothing to do with testing vs Korea though why?

 

Latest updates are Italy 12462 positive, 827 deaths, Korea 7869 positive 66 deaths. How do you explain the difference?

 

Again there is no cure for Covid 19 so its not like Korea is curing people and Italy isnt. Again whether you are tested or not if you are to the point that you need a respirator (think dying) you will go in and be treated. Even if you test positive on day 1 you can do down hill quick if your old and immuno compromised so drive through testing would be great but your ass would still be in the ICU if you body couldn't handle the disease. Is it the case that S. Koreans are healthier? Maybe. Less lung disease? Maybe

 

So to summarize testing is not a cure, its a diagnosis, a label. Treatment for those positive is fluids, rest, tylenol for fever, steriods/breathing treatments for breathing issues. If you go down hill, its happening regardless of your test results as there is nothing to decrease the viral load.  My assumption is S. Koreas actually hands on treatment isnt much better in this day and age then Italy's so that leaves the pts.

 

I have read some believe S. Korea have been giving super super high doses of vitamin C IV with success. Maybe they are having success and never picked up the phone to call Lombardy. Idk.

 

Many people have cited Italy as a concern which is very valid. I think a good thought to ponder is why is Italy the rule and not the exception?  This has hit 180? countries by now. How is medicine and access to healthcare in the third world?What the hell is going on there?

 

The first patients in South Korea were young.

 

The first patients in Italy were older.

 

South Korea and Italy have nearly identical death rates by age bucket.

 

It's ok to just say I don't know.