Coronavirus

[KJP]

I'm also interested in orthopa's point:  For those who believe the US response was "too little, too late" to avoid overloading hospitals a la Italy, by what date (or range of dates) should we start to see overloaded ICUs in the apparently most troubled areas, e.g., Seattle and NYC? 

 

Approx every week cases double, and it takes about a week until people are hospitalized, so once you reach a large enough threshold of cases, each week gets progressively worse.  Going from 1 case to 100 takes around the same amount of time as going from 100 to 100,000 (unmitigated), and the problems become much large in that 100 > 100,000 progression.

 

If the estimates I've seen hold, that threshold is hitting right about now with around 20,000 estimated US cases as of a few days ago. Clusters will become large enough to impact large city health systems once you have a few thousand cases in the area, and I'd expect in less than 7 days you'll start seeing a crush of patients in Seattle and NYC, and the situation will likely get worse each week from there.

 

Thanks for the quick and precise response.  What contrary data over the next 7-21 days would cause you to change your opinion?

 

Note that I'm using ICU overload in an attempt to find an objective measure in light of the lack of testing in the US (though I understand that an ICU visit could be 14-28 days days after infection, so if you see ICU overload, then you likely have even bigger problems in the near future unless significant containment measures were instituted weeks earlier.)

 

If we don't start seeing deaths spike soon, I'd be surprised and would re-assess.  Every country hit has been following similar trajectories, so it's within my 90% confidence interval that we will start to see an increase of cases along that trajectory (which is likely a significant undercount), and because the most serious cases will be the ones identified, I'd expect to see a high mortality rate.

 

Thanks for the response.  I suspect that for anyone following this debate it would be useful to write down now and as precisely as possible the data that would cause you to start to change your opinion so you can avoid thesis creep in the future.  (A bit of Tetlock's methodology.)

[minten]

Unfortunately, seasonality is likely overstated. The real benefit is that though COVID-19 will increase through the summer, cold and flu season will decrease and offset some of the demand from COVID-19.

 

https://ccdd.hsph.harvard.edu/will-covid-19-go-away-on-its-own-in-warmer-weather/

 

Seasonality was definitely overstated by the likes of Trump who suggested previously to just do nothing and let the weather fix it. But if by then the numbers are down (which seems very likely), it definitely won't hurt.

 

Anyway, daily update on Italy:

 

New cases:

 

11-03: 2313

12-03: 2651

13-03: 2547

14-03: 3497

15-03: 3590

16-03: 3233

 

Nope, no endless compounding here.

 

 

[alwaysdrawing]

Thanks for the response.  I suspect that for anyone following this debate it would be useful to write down now and as precisely as possible the data that would cause you to start to change your opinion so you can avoid thesis creep in the future.  (A bit of Tetlock's methodology.)

 

How about if we just write about the positions we take and discuss how the market isn't factoring in the appropriate data and place our bets in the market?

 

I don't want there to be deaths, and I don't want to be right about the mistakes that the US has made.  I hope the change in weather will kill the virus, but I see the evidence that it won't from places that are already warmer than it will get here in the US.

 

At the end of the day, I'm terrified of what's coming, I still think the market has wildly UNDER-reacted, and I have tried to help people see what's available.

[StevieV]

Testing on coronavirus vaccines has begun in the US - https://abcnews.go.com/Business/wireStory/coronavirus-vaccine-test-opens-us-volunteer-1st-shot-69624041

 

Unprecedented speed.  Hopefully we'll get some good results for this or another vaccine.

 

Testing doesn't mean close to roll-out or even effective, but better than nothing.

[DCG]

Testing on coronavirus vaccines has begun in the US - https://abcnews.go.com/Business/wireStory/coronavirus-vaccine-test-opens-us-volunteer-1st-shot-69624041

 

Unprecedented speed.  Hopefully we'll get some good results for this or another vaccine.

 

Testing doesn't mean close to roll-out or even effective, but better than nothing.

 

 

"Even if the research goes well, a vaccine wouldn’t be available for widespread use for 12 to 18 months, said Dr. Anthony Fauci of the U.S. National Institutes of Health."

[Read the Footnotes]

Canada is building a wall and they're going to make America pay for it.

 

https://nationalpost.com/news/canada/trudeau-travel-restrictions-ban-coronavirus-covid19-canada

 

=>Canada closes borders to non-citizens.

[Liberty]

Interactive infection model (can teak various parameters and see what happens):

 

https://meltingasphalt.com/interactive/outbreak/

[StevieV]

Testing on coronavirus vaccines has begun in the US - https://abcnews.go.com/Business/wireStory/coronavirus-vaccine-test-opens-us-volunteer-1st-shot-69624041

 

Unprecedented speed.  Hopefully we'll get some good results for this or another vaccine.

 

Testing doesn't mean close to roll-out or even effective, but better than nothing.

 

 

"Even if the research goes well, a vaccine wouldn’t be available for widespread use for 12 to 18 months, said Dr. Anthony Fauci of the U.S. National Institutes of Health."

 

Well, that's why I said - "Testing doesn't mean close to roll-out or even effective, but better than nothing."

 

12-months would be way better than 18-months which would be way better than never.  Earlier testing starts and the more number of trials, the better chances of closer to 12 rather than later.

 

[chrispy]

I am quite surprised the greater Seattle area is just now shutting down restaurants and bars.  They were considered one of the first hotspots in the US yet several other locations were hours or days earlier in making these tough decisions.

[minten]

At the end of the day, I'm terrified of what's coming, I still think the market has wildly UNDER-reacted, and I have tried to help people see what's available.

 

if that's not too personal, what exactly are you so terified of?  catching the disease?  a society in temporary lock-down?  something else?

[alwaysdrawing]

At the end of the day, I'm terrified of what's coming, I still think the market has wildly UNDER-reacted, and I have tried to help people see what's available.

 

if that's not too personal, what exactly are you so terified of?  catching the disease?  a society in temporary lock-down?  something else?

 

Terrified of my family, friends and loved ones catching a horrible disease that kills people by depriving them of oxygen.  Terrified of millions of global deaths.

Terrified of a depression hitting the economy as bad as 1929.  Terrified that the economic instability around the world brings war.

[mcliu]

Don't forget potential for zombie apocalypse.

[CorpRaider]

Man, I think I might have this thing.  Started with stomach pain and "discomfort" for like 24 hours then horrible, worst in my life, stomach flu symptoms, high fever nasty chills and aches for like 24 hours, now I've still got some stomach "issues" but with a little cough and mild tightness in the chest, no fever.  Hopefully, it gets better from here.  I read that a small percentage of people have experienced severed nausea etc then the cough and respiratory stuff...with corona.  If I could do the drive thru google test, I would, but I'm not going to go contaminate the hospital unless it gets a lot worse.

[LC]

Man, I think I might have this thing.  Started with stomach pain and "discomfort" for like 24 hours then horrible, worst in my life, stomach flu symptoms, high fever nasty chills and aches for like 24 hours, now I've still got some stomach "issues" but with a little cough and mild tightness in the chest, no fever.  Hopefully, it gets better from here.  I read that a small percentage of people have experienced severed nausea etc then the cough and respiratory stuff...with corona.  If I could do the drive thru google test, I would, but I'm not going to go contaminate the hospital unless it gets a lot worse.

 

One of my wife's friends "had it" (or so she/we think) - cough, intense fever for a day or two, then a lingering cough. My wife had a terrible cough and body aches back in January.

 

Hope you feel better...drink warm liquids and get enough rest!

[Read the Footnotes]

Man, I think I might have this thing.  Started with stomach pain and "discomfort" for like 24 hours then horrible, worst in my life, stomach flu symptoms, high fever nasty chills and aches for like 24 hours, now I've still got some stomach "issues" but with a little cough and mild tightness in the chest, no fever.  Hopefully, it gets better from here.  I read that a small percentage of people have experienced severed nausea etc then the cough and respiratory stuff...with corona.  If I could do the drive thru google test, I would, but I'm not going to go contaminate the hospital unless it gets a lot worse.

 

Sorry to hear you may have it. It certainly sounds possible. Today's task force made it clear that PPE/containment is very difficult. Study up on the way it normally evolves, because it tends to evolve over time and you want to make sure you know what to look for.

 

There are some threads we have started to help investors:

 

https://www.cornerofberkshireandfairfax.ca/forum/general-discussion/hygiene-tips-for-coronavirus/

 

https://www.cornerofberkshireandfairfax.ca/forum/general-discussion/how-to-prepare-for-coronavirus/

 

The forecast that we will see more CoB&F members having the virus in the coming days seems true. Let's keep contributing to these threads that might help people!

[Guest]

We might just be heading into a recession...probably Obama's fault.  :o

 

https://www.usatoday.com/story/news/politics/2020/03/16/coronavirus-task-force-hold-briefing-live-updates/5057442002/

[rukawa]

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.)

 

Exponential growth and compounding are studied in high school. I don't remember even covering this in university (mine education was in engineering) except in passing....it was just assumed you obviously knew it.

 

Proper statistics and sampling I learned much later. However I've never believed anyone really has a grasp on how to do anything reliable with statistics...the field has been filled with pseudoscience and bullshit from day one especially in the soft sciences. The only people who were able to use it effectively were physicists and they used it in a fashion very different than almost every other field...they tend to use it deductively instead of inductively. A physicist will start with a model which may have a probabilistic feature to it and reason from the assumptions of the model to statistical conclusions. They almost never reason the opposite way from data to models....they never do things like linear regressions. 

 

Its the reasoning inductively that ends up being a mess generally. Its really shocking to me how prescient Keynes was and how correct he was about the problem inductive problems in statistics (Tinbergen debate and Keynes book on Probability theory). I think it will be another 150 years before we really figure out how to properly reason with statistics if ever.

[Guest]

Take this for what it's worth (just a rumor).

 

My brother (who is pretty reliable) said he heard from 2 different people that Ohio is looking at using the National Guard to close down the borders. We live in a different city than my brother but my wife heard the same thing at her workplace. I find it hard to believe but we'll see.

[mcliu]

What’s a good source for case data by state to track progress?

[minten]

https://science.sciencemag.org/content/early/2020/03/13/science.abb3221

 

Interesting study about the outbreak in China.  Estimates (among others) a high infection rate from people walking around with no to little symptoms.

[meiroy]

Theorizing about sunshine-hours in various locations and lethality (based on little data, but interesting line of thought since Vitamin D supplementation is inexpensive and not-risky, so very asymmetric): https://simonsarris.com/sunlight

 

Vitamin D deficiency has also long been theorized as one of the factors causing influenza seasonality.  See, for example, this paper:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2870528/

https://news.harvard.edu/gazette/story/2017/02/study-confirms-vitamin-d-protects-against-cold-and-flu/

 

On the other hand, some studies have suggested that Vitamin D supplementation doesn't do much to present viral respiratory tract infections:  https://www.ncbi.nlm.nih.gov/pubmed/28719693

https://www.ncbi.nlm.nih.gov/pubmed/26951286

 

As you note, Vitamin D is very cheap.  You can also google to find recent evidence regarding the levels of supplementation that might lead to toxicity (tl;dr -- there appears to be plenty of room to supplement without causing any significant problems).

 

Based on this research, I've been supplementing with Vitamin D since last fall with good results re common cold symptoms (which are an issue with two small children in the house).  Of course, n=1 doesn't provide much evidence of anything.

 

Just FYI, there is some evidence that very high doses of Vitamin D can cause/contribute to kidney stones:

 

http://www.vitamindsupplement.com/vitamin-d-and-kidney-stones/

 

So, don't overdo it, don't mega dose thinking it can't have negative effects.

 

(Anecdotally, I've had kidney stone symptoms that seemed to be correlated with high Vitamin D doses. YMMV.)

 

What was the "high dose" that you were taking?

 

I've read that natural exposure to the sun during summer can often give you an equivalent dose to 15-20k UIs, the body seems pretty good at dealing with higher doses (better than lower doses).

 

It certainly depends where you live, but here in Canada, for someone who's inside the house most of the day, I'm probably getting little naturally so supplementation makes a lot of sense. I've been doing mostly 5k uis during summer and 8-10k uis during winter, probably for about 15 years.

 

The body would produce only the required amount, whereas with supplementing one could overdose, supposedly causing calcium concentrations in soft tissues.  Hence the recommendation to take it with Vitamin K2 MK-7. That's what I'm doing anyhow.

 

 

[Guest oakwood42]

At the end of the day, I'm terrified of what's coming, I still think the market has wildly UNDER-reacted, and I have tried to help people see what's available.

 

if that's not too personal, what exactly are you so terified of?  catching the disease?  a society in temporary lock-down?  something else?

 

 

Terrified of my family, friends and loved ones catching a horrible disease that kills people by depriving them of oxygen.  Terrified of millions of global deaths.

Terrified of a depression hitting the economy as bad as 1929.  Terrified that the economic instability around the world brings war.

 

wow - take it easy, turn the news off for a couple hours.

[Viking]

Posted Sunday night: Calculated Risk blog just called recession for US. That was fast.

 

https://www.calculatedriskblog.com/2020/03/sunday-night-futures-limit-down.html

 

First, from Goldman Sachs today:

 

“[W]e now expect real GDP growth of 0% in Q1 (from +0.7%), -5% in Q2 (from 0%), +3% in Q3 (from +1%), and +4% in Q4 (from +2¼%), with further strong gains in early 2021. This takes our 2020 GDP forecast down to +0.4% (from 1.2%).”

 

Goldman Sachs currently thinks the recovery will be in Q3 and be fairly rapid.  I think the timing is unknown, and the recovery will probably be tepid at first - and then pickup.

 

With the sudden economic stop, and with many states  shutting down by closing down schools, bars and restaurants - combined with the sluggish government response, both on testing and fiscal stimulus - my view is the US economy in now in a recession (started in March 2020), and GDP will decline sharply in Q2 (as Goldman Sachs is forecasting). The length of the recession will depend on the course of the pandemic, and that is unknown at this time. Unfortunately the usual leading indicators aren't useful with this type of event.

[AssetOrLiabilty]

Man, I think I might have this thing.  Started with stomach pain and "discomfort" for like 24 hours then horrible, worst in my life, stomach flu symptoms, high fever nasty chills and aches for like 24 hours, now I've still got some stomach "issues" but with a little cough and mild tightness in the chest, no fever.  Hopefully, it gets better from here.  I read that a small percentage of people have experienced severed nausea etc then the cough and respiratory stuff...with corona.  If I could do the drive thru google test, I would, but I'm not going to go contaminate the hospital unless it gets a lot worse.

 

Lurker for years, my first post on this forum.

 

I had the sae thing in late January. Extreme stomach discomfort that started quite suddenly leading to bouts of vomiting. I couldn't even drive myself back home without puking into a bag. The stomach discomfort got better in 24 hours (mild fever also went away). Then the coughing started which later days. I'd wake up at nights to cough for few minutes each time. Chest tightness also began. I'm a lot better now, but my chest tightness isn't fully gone. If I fully relax my body I can feel a tiny bit of resistance to talking in a whole breath of air. I also have asthma and using my inhaler helped!

 

CorpRaider, keep hope and stay happy. Positivity helps the immune system. Thank God for Netflix. I watched a ton of comedy when I was going through the bug, whatever it was. Stay hydrated!!

 

I never considered Corona seriously but it does look like the symptoms are correlated. Now if there was community transmission in late January, just imagine how off we are with the denominator. I've been thinking about this a lot lately. The hard thing with exponentials is that it's easy to be way off if we are even slightly off in any parameter. What if we are wrong on the start date by a couple of weeks or so?

 

Orthopa's anecdotes and line of thought seems reasonable to me.

[minten]

https://science.sciencemag.org/content/early/2020/03/13/science.abb3221

 

Interesting study about the outbreak in China.  Estimates (among others) a high infection rate from people walking around with no to little symptoms.

 

just some further thoughts:  altough this study doesn't state it explicitly, it does suggest there were way more undocumented cases out there in China at the time. It also explains why the "just stay at home when you're sick"-policy didn't work at all; as apparently many had it but never were sick. Policy only starts having effect when you limit the movements of * everybody *, as the tricky thing about this virus is apparently having no symptoms tells us nothing.

 

This also kind of confirms the train of thought others are having on this board. The bad news of this it could be more widespread than we think it is, and it will be almost impossible to eradicate. The good news being the number of people that get infected but never notice should be vastly understated, very much pushing down the percentage of people that ends up in the hospital/death.  Anyway, one study like this is not enough to draw conclusions but it does add to the evidence.