COVID-19

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IlliniDave
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Re: COVID-19

Post by IlliniDave »

ertyu wrote:
Mon Mar 30, 2020 7:40 am
costs money to switch from whatever they were making originally then switch back. they don't want to - they lobbied trump not to invoke the wartime act that forces them because "muh profits." trump is an idiot who cares about whether CEOs approve of him and not about the good of his country. So he sucked at invoking that act to the full extent and in a timely fashion - just like he sucked at everything else when it comes to this epidemic
Cheap, good, fast. Pick any two.

And that's before the regulatory stuff kicks in, which prohibits "fast". Probably takes years normally to get a medical device like a ventilator approved for use in an ICU from starting at the drawing board. Non-medical device companies don't have the right infrastructure to deal with that regulatory bureaucracy.

That's one of the unseen problems of mammoth regulation. You narrow the field of suppliers to almost nil. Small companies can't afford the regulatory overhead, few others want to eat the cost of entry to such a market. Even with streamlining that's been done over the last month, my understanding is that the barrier is intimidating.

Asking companies that are seeing their revenue strangled to bear the entire startup cost is another issue. Even among large corporations relatively few are sitting on a significant hoard of cash.

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Bankai
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Re: COVID-19

Post by Bankai »

The first sign of times to come? It's all good to be self-isolating as working from home introvert with a massive war chest. It's a completely different world for many others out there on no income/savings. You can't just shut a society for months and expect everyone to obey - this is aginst human nature.
Police with batons and guns have moved in to protect supermarkets on the Italian island of Sicily after reports of looting by locals who could no longer afford food.
https://www.gulf-times.com/story/659546 ... on-looting

ZAFCorrection
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Re: COVID-19

Post by ZAFCorrection »

Manufacturing tools have have usually been very specifically designed and hacked to within an inch of their life to optimize for producing exactly one kind of part. Same goes for every process. To get from widgets to ventilators, you're probably better off just moving the engineers to a warehouse with generic parts and tools standing by. The original factory is not going to get you anywhere faster unless there is a lucky coincidence.

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Bankai
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Re: COVID-19

Post by Bankai »

The moral debate is not lives vs money. It is lives vs lives. It will take months, perhaps years, if ever, before we can assess the wider implications of what we are doing. The damage to children’s education, the excess suicides, the increase in mental health problems, the taking away of resources from other health problems that we were dealing with effectively. Those who need medical help now but won’t seek it, or might not be offered it. And what about the effects on food production and global commerce, that will have unquantifiable consequences for people of all ages, perhaps especially in developing economies?

Governments everywhere say they are responding to the science. The policies in the UK are not the government’s fault. They are trying to act responsibly based on the scientific advice given. But governments must remember that rushed science is almost always bad science. We have decided on policies of extraordinary magnitude without concrete evidence of excess harm already occurring, and without proper scrutiny of the science used to justify them.
https://www.spectator.co.uk/article/The ... s-we-think

den18
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Re: COVID-19

Post by den18 »

An interesting question was asked in the other group I am part of, does viral load affect the severity of this virus? Has there been any information on this, even anecdotally? Influenza severity, for example, has been shown to be affected by viral load.

I don't think much can be done to prevent the majority of people from getting this virus. You can not keep everything shutdown for months. Certainly not when most people were living paycheck to paycheck. Even the measures being taken are to "flatten the curve", not actually prevent people from getting it. I am also unclear on if herd immunity will be a thing if we are already seeing multiple strains.

My understanding is, before modern medicine, there was a practice of getting a extremely mild form of infection by limiting viral load (touching what an infected person has touched for example). The person would then get infected with a mild form of the illness, rather then possibly a severe form. This may be a strategy to consider if things continue the way they are.

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jennypenny
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Re: COVID-19

Post by jennypenny »

DS's college has been using the 3D printers available in different departments to make masks for local hospitals. Faculty and students are working together on it and producing about 50 masks/day. I think we'll see some interesting solutions springing up like that one.

----

While I can appreciate the concern for mental health challenges and the overall burden an economic shutdown places on the average person, I'm a little skeptical of the dire predictions of what will happen to society in a prolonged shutdown.

First, there is always the possibility that one can recover from any financial, educational, or work-related setback. There is no recovering from death, whether your own or that of someone you care about. IMO, it's important to distinguish between fatal and non-fatal risks (listen to El-Erian discuss 'least catastrophical mistakes').

Second, even with the talk of increased suicides, I don't think the lessons of the 08-09 financial crash apply. I see this situation as more akin to a war effort than a financial crisis. It's a moment of solidarity with opportunities for people to rise to the occasion. That was not true in 08-09. If you've read Tribe, you know that people are mentally healthier when they feel a part of something, whether the 'something' is good or bad. I believe that applies here.

Third, during the financial crash and its aftermath, I think the negativity came from people feeling forgotten or displaced. They felt invisible. The popularity of Sanders and Trump shows how many people felt the system had failed them. Or worse, ignored them. This time, everyone is being asked to do their part — everyone’s participation matters. People are also finding ways to help, both big and small. The quarantine has forced people into acting locally because it’s all they can do. People are (re)connecting with their neighbors and communities.

Fourth, young people will have a shared experience to unify them. I know that younger people are particularly hard hit if they are missing out of graduations, job opportunities, rites of passage, sports seasons that may have produced college scholarships, etc. But they are *all* missing out on those things. That’s what is different here. It’s a unifying event, not one with winners and losers. After 08-09, some missed out while others got lucky, intensifying income disparity. This time, no one is safe from the virus. I think that fact, combined with the Tribe-like feelings and rediscovery of community, will help younger folks weather this storm much better than Millennials did during the financial crisis. ('pandemmials'?)

I’m not trying to sugar coat the devastating consequences that may come from a prolonged shutdown. I’m only pointing out that there may be benefits as well, and those might offset some consequences and make people more resilient overall. To put it another way, things will get painful, but possibly in a strengthening kind of way instead of a debilitating one.

ertyu
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Re: COVID-19

Post by ertyu »

den18 wrote:
Mon Mar 30, 2020 11:38 am
An interesting question was asked in the other group I am part of, does viral load affect the severity of this virus?
Yes. Viral load on infection (and as you fight off the infection) does impact severity. It also depends on how you get infected: severity is different if you breathe it in deep in your lungs vs. if it just sticks to your throat (most people with mild to no symptoms have tons of it in their throat). You are best off if you breathe in only a little of it, or if it gets into your throat down your sinuses from your eyes. This is also consistent with other diseases. For instance, with bubonic plague, if you get it via fleas you've got a chance with antibiotic treatment. Pneumonic plague, however, is 100% lethal (if you get infected by breathing it into your lungs).

Have no source. Have picked this stuff up from "somewhere on the internet"

IlliniDave
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Re: COVID-19

Post by IlliniDave »

jennypenny wrote:
Mon Mar 30, 2020 11:41 am
DS's college has been using the 3D printers available in different departments to make masks for local hospitals. Faculty and students are working together on it and producing about 50 masks/day. I think we'll see some interesting solutions springing up like that one.
There is a group I know of here, a network of young engineering types that attended a local university looking to do the same thing except with face shields instead of masks.

It's one thing as a volunteer group to do this and donate. It gets a little more difficult to get corporate backing because of liability (or at least how corporations perceive the liability). Looks like they might get some corporate donations, but so far none have got their employer interested in taking over the fabrication.

You're right that especially in the short term it's likely to come primarily from local non-commercial entities making small quantities and donating to local medical facilities.

Pretty much agree with he rest of your post as well. I'm walking around with two strikes against me, so some of that is a selfish outlook.

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Re: COVID-19

Post by jacob »


jacob
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Re: COVID-19

Post by jacob »

Denmark: The country-wide social interventions mandated (and mostly followed) early on in the epidemic has reduced R0 from 2.6 (herd immunity at 62%) to 1.4 (herd immunity at 29%). The general belief is that because of this the curve has been sufficiently flattened and health care system will not be overwhelmed. With R0>1 the curve has not been broken yet though. As a side-effect, regular flu (BAU R0 slightly over ~1) has pretty much been eliminated from the country.

white belt
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Re: COVID-19

Post by white belt »

CS wrote:
Sun Mar 29, 2020 10:04 pm
That is definitely war wages. I think oncology is going to take a bit hit over the next 12-18 months unless they can get some mandatory testing in place - it is by definition a department of high risk people.
I’m not sure which wars you are familiar with, but in my experience $5k week net is at least 5x what most medical professionals are making even in actual war zones. Well maybe some contractors make more like $2k a week, but government employees and military are making less than that usually.

However, in the hardest hit areas I believe the number of deaths a hospital will see from COVID will exceed the number of deaths a combat hospital has seen even through any of the deadliest months of combat operations since the Vietnam War (for US military). Now maybe there is a different psychological strain on a medical professional seeing an 80 year old woman die on a ventilator compared to seeing a 20 year old man bleeding out from severe gun shot or shrapnel wounds. Either way, these are challenging days for medical professionals.

My heart goes out to the military medical folks assisting who are likely not getting any extra pay or overtime pay.

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Bankai
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Re: COVID-19

Post by Bankai »

This doctor modeled how much COVID-19 costs vs. typical treatment approved by NHS and even the scenario with maximum benefit has the cost more than 3x over the usual cut-off (£97k for each extra year of life vs. the usual cut-off of £30k). And that's without considering the other side, i.e. all the negative consequences of the current policy i.e. suicides, other treatments postponed, etc.

https://drmalcolmkendrick.org/2020/03/2 ... -covid-19/

The government also brought 20k doctors and nurses back from retirement to fight the virus. Today at a press conference the government confirmed it expects daily infections to grow slightly from current levels before stabilizing in 2-3 weeks. I'm looking at both sets of numbers directly from the government and they just don't add up - is there really a need for 20k extra staff on top of 200k current staff to deal with 2.5k cases per day? Consider the vast majority of everything else is canceled/postponed including cancer ops.

Is there a good source of worldwide or by country data on weekly/monthly deaths compared to previous years? It would be interesting to know if overall deaths are actually up or not.

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C40
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Re: COVID-19

Post by C40 »

Bankai wrote:
Mon Mar 30, 2020 12:35 pm
Is there a good source of worldwide or by country data on weekly/monthly deaths compared to previous years? It would be interesting to know if overall deaths are actually up or not.
That is an interesting question. I believe about 60 million people die per year, or 5 million per month. (based on 2015 data).. Thus far there have been ~36,000 reported Coronavirus deaths worldwide. Even if the actual number is 100,000, it's little compared to normal total deaths.

I imagine that so far, total deaths this YTD might actually be lower than normal, due to having so many people not working, and not driving to work/school, and thus a reduction in deaths due to work accidents and car crashes. (there are about 100,000 auto crash deaths per month worldwide.. about 3,000 of those in the U.S.)

Of course, most of the Covid-related deaths are still to come, and total deaths for the year could be way higher than normal, because:
- More Covid deaths
- Other health issues not getting normal care because of hospital overload
- A large rise of deaths in less developed nations.. Due to economic hardship causing starvation, and other large interruptions to normal life causing various type of deaths

7Wannabe5
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Re: COVID-19

Post by 7Wannabe5 »

The change in deaths as reflected by obituaries in Bergamo newspaper.

https://news.sky.com/video/obituaries-o ... o-11957768

Also consider how many large metropolitan areas there are in the world vs. how many have been through their (first) curve. Also frontline medical staff have indicated that it is not difficult to distinguish Covid cases from the flu. Also one could note that we were as likely due for a recession as a 65 year old Covid victim was due to die. Ergo any economic fallout was bound to happen anyways once the over inflated /debt-leveraged market got its long deserved come-uppance.

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Re: COVID-19

Post by jacob »

What you want is a death rate table.

Death rates are usually given in per 100,000 per year. For example, the death rate in the US for murders is about 5 translating into a 0.005% chance of getting murdered in any given year.

https://www.cdc.gov/nchs/fastats/deaths.htm

The total death rate in the US is 863.8 (2015) (so 0.8638%) for all causes. This means 0.86% of the total population dies every year. In contrast, the US birth rate is about 1200.

The death rate for influenza and pneumonia is 25.7. It's 183.9 for cancer and 14.5 for suicide. The estimated death rate for COVID19 is 700-1100, whereas it was 30,000-60,000 for the black death. Hopefully, this gives some perspective.

PS: Keep in mind that death rates would not be additive in an overloaded health care system. It's conceivable that someone who would otherwise have survived a gunshot wound in ICU might not if that space is already occupied by a COVID19 patient.

IlliniDave
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Re: COVID-19

Post by IlliniDave »

I saw some weekly data from England that shows weekly deaths have declined since mid-January and are running below averages for the past 5 years.

https://www.ons.gov.uk/peoplepopulation ... ndandwales

Saw some similar data for the US, the explanation being that all the anti-covid measures are dropping overall death rates. I see if I can locate that when I can get to my other computer.

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Bankai
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Re: COVID-19

Post by Bankai »

jacob wrote:
Mon Mar 30, 2020 1:25 pm
The estimated death rate for COVID19 is 700-1100
I wonder why some countries report numbers indicating a much lower rate than this.

Iceland (in theory, the best data since they a) did the most tests per capita & b) have the highest %age of the population infected), has 1086 cases and 2 deaths i.e. "it's just flu" 0.2% CFR. Translating this into the death rate would give c. 0.13% (or 130 per 100k) assuming 2/3 of the population gets infected? Iceland also reported that half of all positive cases are asymptomatic.

Germany - 64k cases vs 560 deaths or 0.9% CFR. Add the asymptomatic half and it goes down to .45% (assuming they were not captured in positives since there would be no reason to test them). In reality, even less since there are also mild cases never tested on top of asymptomatic ones. So the death rate of c. <300 per 100k assuming 2/3 of the population infected?

Now, clearly calculation like this only makes sense once cases are resolved which is not the case. However, the current rate is so much different than in other countries that it's impossible not to ask why? Is the rest of the world recording each death that tested positive as COVID-19 even if the person was critically ill already?

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Re: COVID-19

Post by jacob »

@Bankai - Either they have a small population sample (Iceland) that was contained early; or they've recently expanded testing rapidly (US is a case in point, Germany likely too). Recall, that it takes about ~12 days between a positive test result and eventual death. If the doubling time is 3 days and your test capacity is very high, that means that there are 2^(12/3) = 16 times as many people to test than have died yet. There's your factor for 10x+ hiding in plain sight. To get accurate ratios, the counts need to be backdated. The number of dead must be divided by the case number as it was N days ago, where N is a couple of weeks.

Add: For example, Iceland has 1086 positives, 2 deaths, but 25 still in critical. Using the usual 50% survival rate for critical patients, we get an IFR of (2+12.5)/1086=1.3%, in line with the other "contained" examples.

Good data requires: enough deaths to pass the t-test; testing everybody in the population (in which the outbreak was contained, e.g. everyone on the plague ship); and enough time for everybody to who will die to die. South Korea has the best data fulfilling all these criteria. The Plague Ship is also good. Vo is not great because they only had 1 death (that would fail the t). These include a direct measure of the asymptotic cases.

Reporting is obviously not perfect. E.g. someone falls dead on the street with a heart attack and posthumously tests positive: They may or may not be reported as a covid death. Someone dying at home of pneumonia w/o ever making it to a hospital to get tested might not get reported. There's some noise being made by doctors in WA about people dying of C19 but not making it into the official stats.

PS: I'm not buying the argument that a large number of asymptotic cases already means we're close to herd immunity. If that was the case, there wouldn't be so many tests (about 83% of all tests given in the US) that come back negative when people test for other reasons (cold, flu, ...). @cL made that point earlier. @7wb5 made the point that we should follow the principle of parsimony in that if we have two competing theories and one is simpler than the other, we should go with the simpler one. That's the one that doesn't presume the existence of a dark number of asymptomatic cases.

George the original one
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Re: COVID-19

Post by George the original one »

George the original one wrote:
Sat Mar 28, 2020 5:46 pm
State of Washington published count as of 3:30p Sat 28 Mar
- 4300 Positives
- 54896 Negatives
- 175 deaths

Cases by County (County seats)
- 5 Adams (Ritzville)
- 56 Benton (Prosser)
- 13 Chelan (Wenatchee)
- 5 Clallam (Port Angeles)
- 82 Clark (Vancouver)
- 1 Columbia (Dayton)
- 10 Cowlitz (Kelso)
- 5 Douglas (Waterville)
- 1 Ferry (Republic)
- 16 Franklin (Pasco)
- 44 Grant (Ephrata)
- 1 Grays Harbor (Montesano)
- 92 Island (Coupeville)
- 13 Jefferson (Port Townsend)
- 2077 King (Seattle)
- 49 Kitsap (Port Orchard)
- 8 Kittitas (Ellensburg)
- 7 Klickatat (Goldendale)
- 7 Lewis (Chehalis)
- 1 Lincoln (Davenport)
- 2 Mason (Shelton)
- 3 Okanogan (Okanogan)
- 282 Pierce (Tacoma)
- 4 San Juan (Friday Harbor)
- 97 Skagit (Mount Vernon)
- 1 Skamania (Stevenson)
- 912 Snohomish (Everett)
- 108 Spokane (Spokane)
- 3 Stevens (Colville)
- 33 Thurston (Olympia)
- 4 Walla Walla (Walla Walla)
- 102 Whatcom (Bellingham)
- 6 Whitman (Colfax)
- 100 Yakima (Yakima)
- 160 Unassigned (labs are having trouble keeping up and Dept of Health is working to determine the proper county)

Cases by Age
- 2% 0-19
- 10% 20-29
- 15% 30-39
- 14% 40-49
- 18% 50-59
- 16% 60-69
- 12% 70-79
- 12% 80+

Cases by Sex at Birth
- 51% Female
- 46% Male
- 3% Unknown
596 new cases. Reporting format changed and I was about to quit reporting when I noticed a button for tabular format <whew>. I notice case counts sometimes going down for a county; I believe these are presumptive cases that did not confirm in testing rather than removal due to illness ending.

State of Washington published count as of midnight, Sat 28 Mar
- 4896 Positives
- 54896 Negatives
- 195 deaths

Cases by County (County seats)
- 7 Adams (Ritzville)
- 101 Benton (Prosser)
- 14 Chelan (Wenatchee)
- 6 Clallam (Port Angeles)
- 68 Clark (Vancouver)
- 1 Columbia (Dayton)
- 13 Cowlitz (Kelso)
- 5 Douglas (Waterville)
- 1 Ferry (Republic)
- 32 Franklin (Pasco)
- 50 Grant (Ephrata)
- 1 Grays Harbor (Montesano)
- 95 Island (Coupeville)
- 14 Jefferson (Port Townsend)
- 2161 King (Seattle)
- 56 Kitsap (Port Orchard)
- 7 Kittitas (Ellensburg)
- 7 Klickatat (Goldendale)
- 10 Lewis (Chehalis)
- 1 Lincoln (Davenport)
- 2 Mason (Shelton)
- 3 Okanogan (Okanogan)
- 288 Pierce (Tacoma)
- 3 San Juan (Friday Harbor)
- 101 Skagit (Mount Vernon)
- 1 Skamania (Stevenson)
- 1068 Snohomish (Everett)
- 136 Spokane (Spokane)
- 3 Stevens (Colville)
- 36 Thurston (Olympia)
- 6 Walla Walla (Walla Walla)
- 111 Whatcom (Bellingham)
- 6 Whitman (Colfax)
- 95 Yakima (Yakima)
- 387 Unassigned (labs are having trouble keeping up and Dept of Health is working to determine the proper county)

Cases by Age
- 2% 0-19
- 25% 20-39
- 33% 40-59
- 28% 60-79
- 12% 80+

Deaths by Age
- 0% 0-19
- 1% 20-39
- 6% 40-59
- 39% 60-79
- 54% 80+


Cases by Sex at Birth
- 51% Female
- 45% Male
- 4% Unknown

Jin+Guice
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Re: COVID-19

Post by Jin+Guice »

Dr. Malcom Kendrick wrote: Number who may die:

The 500,000 figure for possible deaths, that I used in the calculation above, is the absolute upper range of the numbers that have been proposed, and it comes from modelling that was developed by the Imperial College in London. Their modelling has been since used around the world to guide Government responses.

This report uses an ifr of 0.9% and assumes hospitals are not overrun. The purpose of the shut down is to attempt to ensure the hospitals aren't overrun. Modeling what happens if the hospitals don't fail without addressing what has actually happened in Italy and Spain and is on the verge of happening in New York City, France and Switzerland, but calling this the "absolute upper bound" is dishonest.

I don't know if lockdown is the right thing. There is too much uncertainty, too many second order effects and too many inflection points to run a cost-benefit analysis. I'm not saying that the cost is worth the benefit, because no one can possibly know. Before mitigation efforts, hospitals in Italy & Spain were collapsing. This isn't based on a model. It doesn't prove that the benefits are worth the costs. But if you want to discuss costs and benefits, address the actual worst case scenario that happened with 100% certainty, rather than hiding behind models based on false assumptions.

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