Coronavirus

[meiroy]

 

I now know multiple CoB&F board members who have it and/or their families have it. These are fantastic contributors to the board. I won't reveal who, but you would want to help them. The list will grow.

 

It won't happen to all of us at the same time and some of us will live in areas that get lucky. A lot of us are going to be at home for months.

 

While we are cooped up, let's use our skills to benefit each other and society.

 

Strongly agree.

 

20,000-60,000 die in the US every flu season.  61 deaths so far from covid-19 (25 from a single life care facility in wash). and we are shutting down the nation.

 

ignorance is bliss.

 

It's simply unbelievable that people still write things like this.

 

1. The flu is indeed serious and you should get vaccinated yearly.

2. Current numbers of Covid-19 in the USA do not represent the actual situation for obvious reasons.

3. It's not the current numbers but the *potential exponential growth* which has been seen in other locations.  Surely people that post on CoBF have the required mathematical skills to understand this.

4. Covid-19 IS NOT the Flu.

5. etc. seriously.

 

 

 

 

 

 

[tede02]

 

I now know multiple CoB&F board members who have it and/or their families have it. These are fantastic contributors to the board. I won't reveal who, but you would want to help them. The list will grow.

 

It won't happen to all of us at the same time and some of us will live in areas that get lucky. A lot of us are going to be at home for months.

 

While we are cooped up, let's use our skills to benefit each other and society.

 

Strongly agree.

 

20,000-60,000 die in the US every flu season.  61 deaths so far from covid-19 (25 from a single life care facility in wash). and we are shutting down the nation.

 

ignorance is bliss.

 

The problem with this is the consensus is the disease is many multiples more deadly than the seasonal flu. If you're a healthy adult under 50, perhaps your risk of death is very low. But if you catch the disease and spread it, others are put at risk. If this thing infects nursing homes around the country, the toll could be terrible. I keep hearing people make comments to the effect of, "This is nothing more than the common cold so who cares." I'm worried that the situation is going to be way worse in the western world because people aren't taking it seriously. In Asia, they had the SARS situation which apparently was quite bad from a human and economic perspective. Countries like Taiwan and Singapore learned those lessons and, from what read, have aggressively moved to mitigate this thing and it's working.

[no_free_lunch]

I keep thinking about South Korea. Somehow they managed to control it. The case counts have been static there for the past week and in total they are at 71 deaths. Remember that they were the first flash point outside of China.  Is it possible it will peak soon in Italy as well?

[TwoCitiesCapital]

I keep thinking about South Korea. Somehow they managed to control it. The case counts have been static there for the past week and in total they are at 71 deaths. Remember that they were the first flash point outside of China.  Is it possible it will peak soon in Italy as well?

 

This is largely because South Korea was VERY quick to contain the spread. Italy and the rest of the Western works have not been. Containment is likely no longer an option - now we're onto mitigation.

[Guest cherzeca]

@cherzeca check out where Italy was a few weeks back. The fear is we’ll have the same exploding growth, though I am cautiously optimistic that measures taken last few days will help us avoid the Italy nightmare scenario

 

we need to protect elderly with very stringent precautionary measures for them.  until recently, anyone could walk into a nursing facility. 

 

for the rest of us, all full steam ahead.

[Ice77]

I keep thinking about South Korea. Somehow they managed to control it. The case counts have been static there for the past week and in total they are at 71 deaths. Remember that they were the first flash point outside of China.  Is it possible it will peak soon in Italy as well?

 

This is largely because South Korea was VERY quick to contain the spread. Italy and the rest of the Western works have not been. Containment is likely no longer an option - now we're onto mitigation.

 

South Korea aggressively tested the 20-29 age group which has a much higher proportion of asymptomatic spreaders. The testing by age group data between the two countries (SK vs Italy) is very stark in that age group. Instead of waiting for symptoms to test, you slow the spread at its root by testing and restricting the younger spreaders who are more asymptomatic and stay so longer for some reason (perhaps stronger immunity?).

[no_free_lunch]

Thanks for the feedback  If it is a matter if control At this point Italy has country wide isolation. That should be more effective than SK measures.  So it seems likely you see a peak in mortality, perhaps very soon.

 

I have to think we will learn about procedures to control thus thing and gradually WD will adapt and life will return to normal.

 

My "concern" as an investor is the market could swing back very quickly as soon as there is any evidence of a peak.

[RichardGibbons]

Yeah, basically one of several reasons South Korea had fewer problems was because the did a bunch of testing early on, basically the stuff some people were saying was a waste of time (which probably is a waste of time now).

 

That said, the most fascinating thing of this thread today is that a professed MD on an investing board seems to believe there's little difference between cases doubling in 3 days versus 6 days.  If we're talking 55 days since the first case, that's the difference between 2^9 = 512 cases and 2^18 = 262,000 cases.

 

Is it really possible to become and MD without a basic understanding of exponential growth and no understanding of statistics/sampling theory?  (This is a serious question, not rhetorical, because I don't know the answer and I'm curious if such big holes are normal in doctors' education.)

 

(Cobafdek: this is why I'm at the 2% rather than the 70% number for orthopa's theory.  If someone doesn't understanding even the most basic concepts of exponential growth or statistics--ideas you'd learn in your first year courses--them, when it comes to a pandemic, their hypotheses about the meaning of anything they observe are likely to be worthless.)

 

 

[hardincap]

@cherzeca check out where Italy was a few weeks back. The fear is we’ll have the same exploding growth, though I am cautiously optimistic that measures taken last few days will help us avoid the Italy nightmare scenario

 

we need to protect elderly with very stringent precautionary measures for them.  until recently, anyone could walk into a nursing facility. 

 

for the rest of us, all full steam ahead.

 

i suspect its logistically impossible to selectively quarantine older folks, while very doable to shut down everything for two weeks or so. china showed this works. italy mandated shutdowns pretty late in the game but it seems we're doing it early enough to avert disaster

[SnarkyPuppy]

 

I now know multiple CoB&F board members who have it and/or their families have it. These are fantastic contributors to the board. I won't reveal who, but you would want to help them. The list will grow.

 

It won't happen to all of us at the same time and some of us will live in areas that get lucky. A lot of us are going to be at home for months.

 

While we are cooped up, let's use our skills to benefit each other and society.

 

Strongly agree.

 

20,000-60,000 die in the US every flu season.  61 deaths so far from covid-19 (25 from a single life care facility in wash). and we are shutting down the nation.

 

ignorance is bliss.

 

Disgusting.

[Viking]

Thanks for the feedback  If it is a matter if control At this point Italy has country wide isolation. That should be more effective than SK measures.  So it seems likely you see a peak in mortality, perhaps very soon.

 

I have to think we will learn about procedures to control thus thing and gradually WD will adapt and life will return to normal.

 

My "concern" as an investor is the market could swing back very quickly as soon as there is any evidence of a peak.

 

We are not seeing China getting back to normal yet. It looks like L shaped recovery, with hope it will become U in time. September is not very far away and it could be back, mutated and meaner than ever. So much we still do not understand.

[spartansaver]

Thanks for the feedback  If it is a matter if control At this point Italy has country wide isolation. That should be more effective than SK measures.  So it seems likely you see a peak in mortality, perhaps very soon.

 

I have to think we will learn about procedures to control thus thing and gradually WD will adapt and life will return to normal.

 

My "concern" as an investor is the market could swing back very quickly as soon as there is any evidence of a peak.

 

We are not seeing China getting back to normal yet. It looks like L shaped recovery, with hope it will become U in time. September is not very far away and it could be back, mutated and meaner than ever. So much we still do not understand.

 

What if it becomes a W shaped recovery?

[Guest cherzeca]

@cherzeca check out where Italy was a few weeks back. The fear is we’ll have the same exploding growth, though I am cautiously optimistic that measures taken last few days will help us avoid the Italy nightmare scenario

 

we need to protect elderly with very stringent precautionary measures for them.  until recently, anyone could walk into a nursing facility. 

 

for the rest of us, all full steam ahead.

 

i suspect its logistically impossible to selectively quarantine older folks, while very doable to shut down everything for two weeks or so. china showed this works. italy mandated shutdowns pretty late in the game but it seems we're doing it early enough to avert disaster

 

BREAKING

 

AP--New York:  In a dramatic new development in the effort for New York City to deal the Coronavirus a crushing blow, Mayor de Blasio has declared that all New York City residents must commit suicide within the next two weeks.

 

"There may be thousands of deaths of New York City residents during this pandemic, and to prevent this, I have decided to implement a fail safe procedure that will enable 20 million people to save the lives of some two thousand vulnerable New York City residents.  You do the math," said Mayor de Blasio.

 

New York City residents will be called to special suicide centers built by the National Guard by order of party affiliation, with conservatives first, republicans second, liberals third and progressives maybe never.

 

"Corona cleansing will be the motto of my administration," said Mayor de Blasio.  In order to implement the procedure, the Mayor will be exempt from the suicide protocol.

[undervalued]

I wonder if cases are spiking high in Italy because the way they greet each other there?

[cobafdek]

Is it really possible to become and MD without a basic understanding of exponential growth and no understanding of statistics/sampling theory? (This is a serious question, not rhetorical, because I don't know the answer and I'm curious if such big holes are normal in doctors' education.)

 

Since I'm an MD, I can answer your question.  The answer is yes.  Probability/statistics is hard.  Furthermore, it's probably the worst taught class in medical school, with the least interest for most med students, who are understandably more interested in anatomy, physiology, biochemistry, pathology, etc.  The average doctor is no more proficient in formal probability and statistical concepts than the average layman, i.e., CoBF member.

 

That said, and in defense of us MDs, ordinary clinical decisions are based on intuitive probability judgments that are made implicitly, and without the need for any tricky mathematics.  Mathematical probability comes into play only on those rare occasions when the right answer turns out to be counterintuitive.  It's not really relevant in everyday clinical practice.

 

After completing my residency, I did a research fellowship which involved getting an MPH degree in biostatistics.  But even if an MD has a good understanding of statistics, a medical opinion is nearly useless in this current coronavirus situation.  Clinical decision making is based on statistical inference, whether it's explicit or intuitive.  Statistical inference is based on well-designed experiments, clean data, and a well-understood scenario, none of which characterize this pandemic.  Statistical thinking is retrospective, based on past data.  With coronovirus, we have a whopping 4 months of chaotic short-term data.

 

Probability judgments are prospective.  They can be based on relative frequencies over time, relative frequencies in an actual group of patients, relative frequencies in an imaginary group of patients, or they can be subjective belief.  Most of the speculation in this thread is based on the latter two.  We're all guessing.  Orthopa is clear on that.  He is also self-aware because he admits he may be subject to the anchoring bias, having committed to a relatively controversial opinion.

 

My local experience parallels Orthopa's so far (except for no cases of positive coronovirus tests yet, which is because there has been hardly any testing done around here as of this weekend).  I'm in Orange County, California.  My hospital's ER has a tent outside for overflow cases.  It went up last week and hasn't been utilized.  The hospital and ICU census is the usual at this time of year. (I know it's early.)  My flow of office patients has actually slowed in the past week, possibly because patients are now thinking twice about coming to the doctor or hospital.  (I know it's early.)

 

(Cobafdek: this is why I'm at the 2% rather than the 70% number for orthopa's theory.  If someone doesn't understanding even the most basic concepts of exponential growth or statistics--ideas you'd learn in your first year courses--them, when it comes to a pandemic, their hypotheses about the meaning of anything they observe are likely to be worthless.)

 

My opinion that Orthopa's theory has a 70% probability of being correct is pure subjective belief, partly based on my local anecdotal scene.  It's just a feeling.  I don't think it's any more or less valid than any of the counter-opinions in this thread.  We're all fooled by randomness.  And I have not expressed my opinion in my community because I think people would misinterpret it and not do the right thing, which is to use the precautionary principle. 

 

In fact, I think it is a major mistake and dangerous to think that heavy speculative computation - seen on this thread - is at all helpful in these cases.  For unknown unknowns like this novel coronovirus, the worst case scenario is bad enough.  Put down the calculator and run like hell.

 

[meiroy]

"My life has been a product of compound interest exponential growth." Warren Buffett

 

“The first rule of compoundingexponential growth: Never interrupt it unnecessarily.” Charlie Munger

 

“The elementary mathematics of compound interest exponential growth is one of the most important models there is on earth.” Charlie Munger

 

"The joys of compounding exponential growth are there if you keep your stake growing, but all you need have is one year in which you give back half, and your program, at the same growth rate, must stretch out years and years longer." Adam Smith

 

(Disclaimer: 1. simplified on purpose 2. no, they didnt.)

 

You're welcome.

 

[minten]

Yesterday someone posted here it's criminal to underestimate this issue.  I'd argue at this stage it's equally criminal to overestimate it.  My twitter feed is completely filled with doomsday-message after doomsday-message. "This is the worst adversary the world has ever faced", "the Dow is going 90% down", etc etc, goes on and on and on.  And retweeted, and retweeted.  Made-up doctors tweet from made-up ER's, retweeted 1000's of times, it's hard to keep track of it.

 

Fact: in Italy, everybody's nightmare, 0.04% of the population has contracted this virus. 1800 deaths.  Did you know malaria kills 3000 CHILDREN (!) a day, and nobody gives a fuck? Least of all, the economy?

 

Fear is out of proportion. This isn't at a stage yet where it's a serious threat to the world population, and it's now clear it will never reach that stage. You still have a bigger chance of getting hit by a bus while walking back with groceries from your cleaned out supermarket then actually dying from corona  (well, maybe not, with public transportation severely limited in many places, but you get my point).

 

This could have only eventually become a threat on a scale that it's big enough for people to justifyably get worried when it keeps compounding and compounding. By now, based on what we've seen in Asia even in countries where measures were not really that strict in the first place, it's pretty clear it won't, every country on earth has taken measures in the last week or so.  For this to ever become a serious threat it would need to double and then double and then double and then double and then double some more.

 

Italy's numbers will start coming down end of the week or in the weekend, there's no way they won't.  I hope the scaremongering will stop at that point. But it's amazing to me how the human mind is so unable to properly evaluate risk and threats, and is unable to process small numbers in relation to large numbers.  Can't we just say to eachother:  yes, this is something we need to take seriously. yes, it's best not to eat out for a few weeks and work at home whenever possible.  no, this is not something we need to panic or scaremonger over?

 

[JRM]

Yesterday someone posted here it's criminal to underestimate this issue.  I'd argue at this stage it's equally criminal to overestimate it.  My twitter feed is completely filled with doomsday-message after doomsday-message. "This is the worst adversary the world has ever faced", "the Dow is going 90% down", etc etc, goes on and on and on.  And retweeted, and retweeted.  Made-up doctors tweet from made-up ER's, retweeted 1000's of times, it's hard to keep track of it.

 

Fact: in Italy, everybody's nightmare, 0.04% of the population has contracted this virus. 1800 deaths.  Did you know malaria kills 3000 CHILDREN (!) a day, and nobody gives a fuck? Least of all, the economy?

 

Fear is out of proportion. This isn't at a stage yet where it's a serious threat to the world population, and it's now clear it will never reach that stage. You still have a bigger chance of getting hit by a bus while walking back with groceries from your cleaned out supermarket then actually dying from corona  (well, maybe not, with public transportation severely limited in many places, but you get my point).

 

This could have only eventually become a threat on a scale that it's big enough for people to justifyably get worried when it keeps compounding and compounding. By now, based on what we've seen in Asia even in countries where measures were not really that strict in the first place, it's pretty clear it won't, every country on earth has taken measures in the last week or so.  For this to ever become a serious threat it would need to double and then double and then double and then double and then double some more.

 

Italy's numbers will start coming down end of the week or in the weekend, there's no way they won't.  I hope the scaremongering will stop at that point. But it's amazing to me how the human mind is so unable to properly evaluate risk and threats, and is unable to process small numbers in relation to large numbers.  Can't we just say to eachother:  yes, this is something we need to take seriously. yes, it's best not to eat out for a few weeks and work at home whenever possible.  no, this is not something we need to panic or scaremonger over?

 

Point taken.  Its difficult to sift the signal through the noise.  A lot of viral experts coming out of the woodwork.  I also suspect that for some experts this is their 15 minutes of fame, and they don't want to let a good panic go to waste.

 

A quick google search for malaria deaths per year, and a few seconds reading the WHO's own website, it looks like less than 800 deaths per day due to malaria vs 3000.  Still a lot.

 

Why are world leaders predicting that 60-70% of the world population will contract this eventually?  What is 1% of 70% of 7.8B?  Are they full of crap?  Will we have a vaccine soon?  Hopefully you are correct; but if you are it will likely be for the wrong reasons.

[thowed]

I am curious as to how different things are between large metropolises and the countryside.  I imagine things are much more normal in the latter.

 

In London, one of the larger metropolises, things are continuing to slow down in the centre.  Offices are starting to effectively close down, cafes are very quiet.  I know someone who flew back to Europe yesterday in a plane with just 20 other passengers.

 

To go right back to basics: cash-flows cash-flows cash-flows.

 

I don't see what governments can do to get people spending money (apart from online) if they're too scared to go places.

 

My guess is that there are some big 'unknown unknowns' to come.  At present it's hard to imagine a stockmarket recovery until the virus is contained and people are going out again.  But no doubt governments will make some big moves before that, and some of them will take, either permanently or temporarily.

 

[Guest]

DeWine is not messing around:

 

https://wtov9.com/news/local/gov-mike-dewine-looking-at-closing-ohio-bars-restaurants

[Read the Footnotes]

I keep thinking about South Korea. Somehow they managed to control it. The case counts have been static there for the past week and in total they are at 71 deaths. Remember that they were the first flash point outside of China.  Is it possible it will peak soon in Italy as well?

 

This is largely because South Korea was VERY quick to contain the spread. Italy and the rest of the Western works have not been. Containment is likely no longer an option - now we're onto mitigation.

 

South Korea aggressively tested the 20-29 age group which has a much higher proportion of asymptomatic spreaders. The testing by age group data between the two countries (SK vs Italy) is very stark in that age group. Instead of waiting for symptoms to test, you slow the spread at its root by testing and restricting the younger spreaders who are more asymptomatic and stay so longer for some reason (perhaps stronger immunity?).

 

Devil's Shadow, do you have citations you could share? This seems a VERY important insight. Asymptomatic young people could easily be responsible for infecting far more than their proportionate share of the infected population.

 

This population could do a huge amount of damage. I had already suspected this see my previous posts about college students saying that they could not be prevented from coming to class sick. That they had a right to come to class if they wanted to. I've pasted a couple of quotes I found in a Forbes article, but I'd be interested in seeing what more CoB&F can turn up.

 

https://www.forbes.com/sites/sciencebiz/2020/03/15/covid-19-who-is-infectious/#6ba8504d8961

 

Evidence from South Korea and Italy is reinforcing how our testing strategy can lead us astray. Italy, like the United States, has focused on testing people who are ill. South Korea has taken a more national surveillance approach, making testing widely available. In Italy the distribution of people testing positive is skewed toward older age. This distribution makes us think that mostly the older population is infected. But in South Korea, the distribution is quite different, with a skew toward younger people and a peak around 20-29-year olds, the groups that may be socializing the most. Even many children were testing positive at much higher rates than Italy. The implication is that there are a lot of people out and about who are positive, but not overtly sick – and are vectors for spread.

 

In an article published in medRxiv, a preprint server that posts studies before peer review, scientists from Europe using public data, estimated that about half the cases or more in Singapore and Tianjin, China are from transmission from people without symptoms.

 

If this is true, that the 20-29 year olds are the superspreaders, then we should help get the word out on that.

[orthopa]

Yeah, basically one of several reasons South Korea had fewer problems was because the did a bunch of testing early on, basically the stuff some people were saying was a waste of time (which probably is a waste of time now).

 

That said, the most fascinating thing of this thread today is that a professed MD on an investing board seems to believe there's little difference between cases doubling in 3 days versus 6 days.  If we're talking 55 days since the first case, that's the difference between 2^9 = 512 cases and 2^18 = 262,000 cases.

 

Is it really possible to become and MD without a basic understanding of exponential growth and no understanding of statistics/sampling theory?  (This is a serious question, not rhetorical, because I don't know the answer and I'm curious if such big holes are normal in doctors' education.)

 

(Cobafdek: this is why I'm at the 2% rather than the 70% number for orthopa's theory.  If someone doesn't understanding even the most basic concepts of exponential growth or statistics--ideas you'd learn in your first year courses--them, when it comes to a pandemic, their hypotheses about the meaning of anything they observe are likely to be worthless.)

 

You said I didnt think I was ignorant. Liar! I like you how strictly adhere to statistics though! That takes a lot of confidence in medicine! I would never want to operate on you. Imagine going through the complication rates with you. Whoo!

 

Maybe you can reconcile this questions for me since you guys are way better at the crunching the numbers then I am.

 

Can we all agree Italy is a shit show right? Many have used it as an example of worst case scenario.

 

1. First case in Washington Jan 20th, First case in Italy Jan 31st. Cant argue that right?

 

2. Italy has 1809 deaths I think? Washington State 50, ~27 from infirmed elderly.

 

3. You guys have pounded the table about exponential growth. I clearly don't get it or calculate it. As as many have said for days, it is coming. No doubt, it is coming.

 

4. You guys are data driven guys. Whats up here?

 

Also FWIW I dont believe your name is Richard Gibbons. Who would name their kid Dick Gibbons? j/k ;)

[orthopa]

 

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!

 

But this is where I'm trying to reconcile.  You're saying that you're not seeing it.  But evidence suggest that flue like cases are increasing significantly, but we don't know due to what.  So I'm wondering if this is just a precursor of things to come, and you might not have seen it first hand. 

 

And I can't imagine that we are testing dead people for the virus - I would definitely save the testing capacity for those alive and potentially contained at this moment... 

 

So if that's the case, then are we undercounting BOTH deaths and people infected??

 

I never said I'm not seeing it. I currently don't have testing avail other then the protocol I just said came over from DOH. How can I diagnose someone without a positive Covid-19 test? I am seeing what you posted in that tweet. High increase in flu like symptoms with negative flu. I have made that clear I think multiple times haven't I?

 

No they are not testing bodies at the morgue. You asked about testing people who come in with flu like symptoms. I don't believe I have heard of any cases of DOA(have you?) covid-19. Today, if you have someone on life support/ventilator anywhere in America I would hope to god its known whether or not they have Covid19.

 

I don't mean to put words into your mouth, but I think you have said that a lot of people are infected and we're not seeing the deaths, so the conclusion is that CFR is lower than what's out there.  So I'm asking - is the disconnect with what other countries are seeing that both infected and deaths are undercounted (vs. just denominator being undercounted)?

 

Just another thought on this. That tweet said flu like illness spiked March 1st right? Assuming those were all new cases we are now 15 days out. If your only self quarantined for 14 days then it could be broadly assumed that your chance of dying is high in 14 days right?

 

That being said is it reasonable to assume there should have been a HUGE spike in deaths? Its been 15 days right? How many in NYC 3?

[Liberty]

Cloroquine: https://docs.google.com/document/d/e/2PACX-1vTi-g18ftNZUMRAj2SwRPodtscFio7bJ7GdNgbJAGbdfF67WuRJB3ZsidgpidB2eocFHAVjIL-7deJ7/pub

 

Also: https://apnews.com/ce014d94b64e98b7203b873e56f80e9a

[Cigarbutt]

I find the following to be a helpful guide for practical individual down-to-earth applications and as an input to understand better the difficult decisions that policymakers have to make:

https://www.thinkglobalhealth.org/article/could-coronavirus-kill-million-americans

They need to channel a diverse source of expert and non-expert info that is often contradictory. It must be hard to lead in times of uncertainty.