COVID-19

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Jin+Guice
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Re: COVID-19

Post by Jin+Guice »

@Ego: The argument is framed by the "worst case scenario" which is presumably caused by BAU.

Actually, in Kennon's article it's framed by a genie offering us a choice between saving 2.15 million American lives or causing a global economic catastrophe "equal to or worse than the Great Depression."


Claiming the worst case scenario is 2.2 million Americans dead, based on a projection that admits it's not the actual worst case scenario and then offering:
Kennon wrote:We’re talking about condemning nearly the entirety of the world to a generational black hole. We’re talking about tens of millions of children being homeless. Starvation. Endemic poverty with the multi-generational scars that result including addiction, depression, anxiety, heart attack, and suicide. The net harms, and ultimate deaths, are so much worse for humanity than what we are facing from COVID-19, to go down this route would be one of the greatest unforced errors in global history. It would be unbridled madness. I struggle to even wrap my head around the level of narcissism or sociopathy required to suggest such a thing; how a person could be so wicked and monstrous that they would destroy the entirety of Earth, including the lives of their own children, grandchildren, great-grandchildren, nieces, nephews, friends, co-workers, and neighbors, not only here in the United States but in Europe, Asia, and Africa.

is inaccurate framing.

Which he uses to infer:
Kennon wrote:Make no mistake that if someone claims to support such an action, what they are really saying is, “I would rather have few extra months or years myself, or with my grandma, even if it means I have to kill other people, destroy their lives for the next few decades, and condemn their children to hunger, homelessness, and endless struggle.” Don’t pretend that it’s anything less craven than that. It’s a deeply immoral, selfish position that is cloaking itself in false piousness. I find it disgusting.
Based on this brilliant analysis he informs us that he will not "support an indefinite shut-down lasting for twelve or sixteen weeks that sent us into a Great Depression." He does support closing the schools for at least six months, mandatorily increasing paid time off, massive bailouts to hospitals, massive spending for medical supplies and temporary hospitals and unionizing doctors (because nurses apparently have it to easy)... We are left to presume he's performed the same rigorous analysis on these sweeping economic and societal changes and that they would not "send us into a Great Depression."

Our society is facing a difficult decision where trade offs must be made. The decision would be difficult if we knew what the outcomes were, but it is vastly more difficult in the face of uncertainty. Framing the problem as bounded by two wildly inaccurate payoff schemes and then issuing off-the-cuff policy suggestions isn't helping the situation, it's only adding to the confusion.


Edit: Jacob's above post addresses this in a much more thoughtful, intelligent and interesting way. I'm leaving my post because I enjoy being an asshole to people who write shitty essays on the internet.

One add:
jacob wrote:
Sat Mar 28, 2020 5:27 pm
Following this "algorithm" does not require any knowledge or appreciation of the exponential features. Indeed---this is important---it will work too as long as there's no overshoot(*) built into the problem. (Of course, presuming that data are accurate :-P )
This is what's actually important and what we should actually be talking about. Is this method a good choice in the face of uncertainty? In what cases is it robust and what is it fragile too and are we willing to accept that?

steveo73
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Re: COVID-19

Post by steveo73 »

Jin+Guice wrote:
Sat Mar 28, 2020 5:54 pm
Our society is facing a difficult decision where trade offs must be made. The decision would be difficult if we knew what the outcomes were, but it is vastly more difficult in the face of uncertainty. Framing the problem as bounded by two wildly inaccurate payoff schemes and then issuing off-the-cuff policy suggestions isn't helping the situation, it's only adding to the confusion.
Exactly. We need to make the best possible decisions with a massive amount of uncertainty. We then need to adjust to the situation as it evolves.

If you look at the situation through that lens I'm amazed that governments across the world appear to be doing a pretty reasonable job. I'm amazed that a lot of companies are responding by putting the social outcomes ahead of profit. I'm amazed how arrogant and self-entitled a lot of people are who seem to have the inability to practice social distancing but then again we like staying at home.

I'm also amazed at how unprepared society is at dealing with incidents of this scale or maybe better put how poorly we manage these risks. This is a free market problem but it's also a societal and specifically a governmental problem. We just haven't saved enough for a significant economic downturn or prepared for a pandemic scenario when we clearly should have.

jacob
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Re: COVID-19

Post by jacob »

Concerning the hospitalization rate in an overloaded system, this is more of a medical doctor-question, but what would happen to those who are hospitalized but do not need to into intensive care insofar hospitals are overloaded and they can't get in in the first place.

Some best/good estimate numbers which are reasonable correct: 0.7% (or 1.2%) die (IFR). Half who go into critical die. 15-20% of hospitalizations go into critical. The percentage that gets hospitalized is thus 0.007*2/0.15 ~ 9%. In summary:

death rate: 0.7%
critical rate: 1.4%
hospitalization rate: 9%

Feel free to multiply 9% by whatever (R0-1)/R0, like 60% or 20%...

Can IV and nose-oxygen be supplied on an outpatient basis?

thrifty++
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Re: COVID-19

Post by thrifty++ »

First death in NZ. A woman in her 70s.

63 new cases. Bringing the total to 514 confirmed or probable cases.

There is 1 remaining person in critical condition. The other person was the woman who died.

56 people have recovered.

The number of tests being done keeps increasing. With the average tests now 1,786 per day.

NZ may well provide a good indicator of the mortality rate, being lucky enough to start aggressively testing people before the deaths and critical cases started, Using these numbers a mortality rate of only 0.19% and the number of cases that are serious or critical of only 0.39%. Im really hoping that these sorts of numbers bear out as we continue.

The hospitals in NZ have turned into ghost towns apparently. All non urgent surgeries have been postponed, and also most people don't want to go there anyway. I think the General Practice clinics are the same. Certainly mine was when I went to get a flu shot. I was the only patient there. A friend who runs a GP practice said the same to me. GP's are doing all consultations by web or phone unless it is not possible to do so - eg obviously not possible for a flu injection. Someone in a hazmat suit comes out to greet you and asks you questions related to Covid19 risks and then if you have them im not sure what they do, either send you to the hospital or prepare the doctor to suit up and see you in one specific cordoned off area.

I think what is happening is that most places heavily affected have substantially more cases than reported so the stats are skewed by the most serious ones. Its hard to believe for example that NZ has more cases than Iraq, where 42 people are recorded as having died.
Last edited by thrifty++ on Sat Mar 28, 2020 8:36 pm, edited 1 time in total.

George the original one
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Re: COVID-19

Post by George the original one »

jacob wrote:
Sat Mar 28, 2020 6:26 pm
Can IV and nose-oxygen be supplied on an outpatient basis?
Oxygen, yes but... need infrastructure to deliver & refill tanks -or- manufacturing to deliver the portable generator/pumps. Dad had a tank at home after his heart attacks. Somewhere I've seen the portable generator/pump; maybe my dad eventually had one of those. Hospital rooms are plumbed with the oxygen, so for short needs where observation is desired that is preferred.

I've never seen IVs at home without medical supervision.

classical_Liberal
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Re: COVID-19

Post by classical_Liberal »

jacob wrote:
Sat Mar 28, 2020 6:26 pm
Can IV and nose-oxygen be supplied on an outpatient basis?
Nasal Canula O2 can be administered pretty easily outpt, many folks with choric lung conditions have home condensers. I'm not sure how the supply for those look? The problem with COVID is that patient's respiratory status rapidly deteriorates, like, more quickly than many have ever seen. So someone needing supplemental O2 has a large enough chance of crashing, that they need regular monitoring. In normal times I would say no way this would happen due to concern for patient wellbeing and potential legal issues. However, these are not normal times. Not sure what you mean by IV? just fluids? It's possible, but much more difficult to do correctly than supplemental O2. People self administer IV antibiotics at home if needed long term under very specific circumstances. Again if IVF are really needed, not being in the hospital setting for monitoring is generally a bad idea.

I think its much more likely we would see the auditorium type, temporary triage hospital centers than prescribed home use of this stuff. At least there would be some professionals around to monitor, although not as closely as normal, so outcomes would suffer, yet still be much better than unobserved at home.

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fiby41
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Re: COVID-19

Post by fiby41 »

They've started advertising testing online. Costs about ~$15 /person. Buses were arranged in the capital to take stranded migrant labourers to their hometowns. Ten-fifteen thousand people showed up at bus depots disregarding shelter-in-place. :cry:

At current rate we'll run out of hospital beds by May end. Scenarios: https://www.livemint.com/news/india/whi ... 73227.html

PM-Cares charitable fund was set up with the PM apologizing for the hardships caused to the poor due to the virus. The two epics were alluded to:
Lakshman rekha: The fence chalked by Lakshmana around their residence to safeguard Sita while he went in search for his older brother Ram who had sent a distress signal which was actually a subterfuge when they were in forest exile.
Mahabharata War: The war at the site of Kurukshetra was fought for 18 days while the war against the virus is being fought for 21 days.

Lemon
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Re: COVID-19

Post by Lemon »

jacob wrote:
Sat Mar 28, 2020 6:26 pm
Can IV and nose-oxygen be supplied on an outpatient basis?
Yes. But there are several issues.

First with Oxygen the issue George mentioned is the main one of logistics - What you have now done is move from shipping large quantities of oxygen to one place to small amounts all over the place. Also even hospitals are strained for oxygen because patients with COVID us vastly more than the 'average' hospital patient they are replacing (all those elective/semi elective patients without respiratory issues). This isn't actually the patients on ventilators which as a closed system are pretty oxygen efficient but those on open circuit oxygen at high flow rates which can get through masses of the stuff. There is the other issue of COVID patients tend to be 'fine' and then rapidly 'not fine'. It also isn't currently isn't easy/obvious to predict who is going to progress. That can't be managed at home.

With IVs same thing. You need someone trained to make up whatever you are giving to the patient (doing it wrong can go really bad). SO you now have a nurse running around the community giving IVs - far less efficient than keeping people in one place and moving them too the nurse. As the thing that becomes rate limiting in every healthcare system is going to be staff this is a really bad idea. You can produce everything but staff relatively quickly and you are going to lose staff to the illness too. China could ship people in form elsewhere because it was massive. No other country can do this as the pandemic is no longer local.

As for not getting hospitalised. If you need oxygen and you don't get it...probably not going to end well. But just oxygen is doable provided you have a supply with a lower skill mix than a standard hospital. So field hospitals, the UK is building these now.

CS
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Re: COVID-19

Post by CS »

Study on using plasma:
https://jamanetwork.com/journals/jama/f ... le/2763983
Results All 5 patients (age range, 36-65 years; 2 women) were receiving mechanical ventilation at the time of treatment and all had received antiviral agents and methylprednisolone. Following plasma transfusion, body temperature normalized within 3 days in 4 of 5 patients, the SOFA score decreased, and Pao2/Fio2 increased within 12 days (range, 172-276 before and 284-366 after). Viral loads also decreased and became negative within 12 days after the transfusion, and SARS-CoV-2–specific ELISA and neutralizing antibody titers increased following the transfusion (range, 40-60 before and 80-320 on day 7). ARDS resolved in 4 patients at 12 days after transfusion, and 3 patients were weaned from mechanical ventilation within 2 weeks of treatment. Of the 5 patients, 3 have been discharged from the hospital (length of stay: 53, 51, and 55 days), and 2 are in stable condition at 37 days after transfusion.

Five minute test (similar to strep) getting rolled out next week. Someone said 70% accuracy, which might have been for the strep version, because I didn't see that mentioned in the announcement.
https://www.marketwatch.com/story/abbot ... 2020-03-27


Another test from the German company Bosch. 2.5 hours, No lab needed (but you have to buy their unit for low five figures), each test a reasonable cost. The reddit page has a link to the original article in German.
https://www.reddit.com/r/Coronavirus/co ... oduces_95/


Data about what social restriction were used with 1918 flu pandemic and the results for different cities in the US. As expected, Philadelphia was a mess. RIP Great Grandpa and family. The original article from the National Geographic is linked within. It is free with a signup (or perhaps an cloaked browser connection).
https://twitter.com/JoyceWhiteVance/sta ... 95264?s=20


CDC mask recommendations might change, from someone who might know.
https://twitter.com/DrMattMcCarthy/stat ... 19841?s=20


A hepa filter mask from your vacuum bag (cross posted)
https://youtu.be/W6d3twpHwis


There is speculation the virus could make young men sterile.
https://www.scmp.com/news/china/science ... t-male-sex
https://www.medrxiv.org/content/10.1101 ... 1.full.pdf
In a paper published on the preprint research platform medRxiv.org, the researchers – from Zhongnan Hospital of Wuhan University and the Hubei Clinical Research Centre for Prenatal Diagnosis and Birth Health – said they analysed blood samples from 81 men aged 20 to 54 who tested positive for the coronavirus and were hospitalised in January.
The median age of the participants was 38 and roughly 90 per cent of them had only mild symptoms. The samples were collected in the last days of their stay in hospital.
Using the samples, the team looked at the ratio of testosterone to luteinising hormone (T/LH). A low T/LH ratio can be a sign of hypogonadism, which in men is a malfunction of the testicles that could lead to lower sex hormone production.
The average ratio for the Covid-19 patients was 0.74, about half the normal level.

More on the underreporting going on
https://www.buzzfeednews.com/article/ni ... -hospitals
Doctors and nurses working in several hospitals around the country, who spoke with BuzzFeed News on the condition of not being named out of fear of repercussions, said that the official counts of COVID-19 related deaths are not comprehensive for three main reasons: a lack of tests and protective equipment means not everyone who contracted or dies of COVID-19 is diagnosed; overwhelmed hospitals may be running behind on reporting the numbers to state and county authorities; and some hospitals reporting their totals on a daily basis say they’re not being reflected promptly in county and state reports.
I would posit another reason - if they knowingly allow a ncovid patient in to get the treatment dollars then they could be liable. (I'm looking at you, radiation oncology)


Asymptomatic patients (apologies if I got this from this forum, I can't remember anymore)
https://twitter.com/fascinatorfun/statu ... 14887?s=20
https://www.wired.com/story/a-south-kor ... for-trump/
“In Daegu, we had more than 10k members of Shincheonji. When we tested those who were symptomatic, 87.5 % turned out to be positive. When we tested a sample of people who weren’t symptomatic, it was 74.4%”

An existing TB vaccine might help. Germany is rolling out study using healthcare workers. I thought I remembered reading the UK was doing a similar study but that might have been something else.
https://m.medicalxpress.com/news/2020-0 ... virus.html


In other news, my data sharing addiction is still going strong and I have 20k words to write in 7 days. Happy Sunday, everyone.

CS

CS
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Re: COVID-19

Post by CS »

More cool stuff for data geeks - Visualizing the History of Pandemics
Apparent the first graphic is updated regularly
https://www.visualcapitalist.com/histor ... deadliest/

Edit - it also has that excellent R0 graphic showing just how contagious measles is.

jacob
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Re: COVID-19

Post by jacob »

http://covid19.healthdata.org/

US state by state projections of the first wave including hospital, icu, and vent shortages. Also expected fatalities, peak dates, etc.

EdithKeeler
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Re: COVID-19

Post by EdithKeeler »

“On The Media” this morning was very good—talked about the various articles coming out of about the virus and peer reviews, “armchair epidemiologists,” coverage by the media, etc. Worth a listen.
https://www.wnycstudios.org/podcasts/ot ... g-the-hero

Jason

Re: COVID-19

Post by Jason »

I was listening to an interview with a highly credentialized scientist on the matter. One of the first people to handle an AIDS patient. Was honest in that his expertise in this corona is three months old. His macro picture was concerning. Essentially, this has been a Northern Hemisphere event. It's inevitable entry into the Southern Hemisphere (Spring/Summer) will be cataclysmic due to fragile infrastructure. It will then recirculate to the North (Fall/Winter).

ertyu
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Re: COVID-19

Post by ertyu »

The only silver lining here would be if the temporary pause over the summer lets hospitals and gvts catch up on preparedness. Shit's not looking good, though - someone elsewhere on the internet was talking about hospital stocks tanking because of corona patients who are low margin displacing patients with more lucrative diseases to treat. Hospital mgt thus incentivised to skimp on ppe and not purchase equipment that will not be required past the duration of the epidemic.

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Seppia
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Re: COVID-19

Post by Seppia »

ertyu wrote:
Sun Mar 29, 2020 12:03 pm
Hospital mgt thus incentivised to skimp on ppe and not purchase equipment that will not be required past the duration of the epidemic.
Another great side effect of a privatized healthcare system

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 3:23 pm
Oregon Health Authority as of 9:30a Sat, Mar 28
- 479 Positives
- 9693 Negatives
- 13 Deaths

Cases by County
- 8 Benton (Corvallis) - Note two are actually in Washington state, though they're residents of Benton County.
- 36 Clackamas (Oregon City)
- 3 Clatsop (Astoria)
- 1 Columbia (St. Helens)
- 20 Deschutes (Bend)
- 4 Douglas (Roseburg)
- 1 Grant (Canyon City)
- 1 Hood River (Hood River)
- 8 Jackson (Medford)
- 5 Josephine (Grants Pass)
- 2 Klamath (Klamath Falls)
- 9 Lane (Eugene)
- 1 Lincoln (Newport)
- 32 Linn (Albany)
- 94 Marion (Salem)
- 1 Morrow (Heppner)
- 81 Multnomah (Portland)
- 11 Polk (Dallas)
- 1 Tillamook (Tillamook)
- 4 Umatilla (Pendleton)
- 1 Union (La Grande)
- 2 Wasco (The Dalles)
- 140 Washington (Hillsboro)
- 13 Yamhill (McMinnville)

Cases by Age Group
- 10 19 or younger
- 39 20-29
- 60 30-39
- 95 40-49
- 91 50-59
- 92 60- 69
- 49 70-79
- 42 80 and over
- 1 Not available

Hospitalized by Age Group
- 0 19 or younger
- 3 20-29
- 5 30-39
- 21 40-49
- 16 50-59
- 33 60- 69
- 23 70-79
- 16 80 and over
- 0 Not available

Hospitalized
- 117 Yes
- 266 No
- 96 Not provided

Sex
- 260 Male
- 214 Male
- 5 Not available

Hospital Capacity
- 283 Available adult ICU beds
- 2099 Available adult non-ICU beds
- 189 Available pediatric beds
- 68 Available pediatric ICU beds
- 746 Available ventilators
- 107 COVID-19 admissions
- 31 COVID-19 patients on ventilators
69 new cases. Bit of a surge in Jackson County (Medford).

Oregon Health Authority as of 8:00a Sun, Mar 29
- 548 Positives
- 10878 Negatives
- 13 Deaths

Cases by County
- 8 Benton (Corvallis) - Note two are actually in Washington state, though they're residents of Benton County.
- 39 Clackamas (Oregon City)
- 3 Clatsop (Astoria)
- 1 Columbia (St. Helens)
- 23 Deschutes (Bend)
- 4 Douglas (Roseburg)
- 1 Grant (Canyon City)
- 2 Hood River (Hood River)
- 19 Jackson (Medford)
- 6 Josephine (Grants Pass)
- 4 Klamath (Klamath Falls)
- 10 Lane (Eugene)
- 1 Lincoln (Newport)
- 36 Linn (Albany)
- 109 Marion (Salem)
- 1 Morrow (Heppner)
- 91 Multnomah (Portland)
- 13 Polk (Dallas)
- 2 Tillamook (Tillamook)
- 4 Umatilla (Pendleton)
- 1 Union (La Grande)
- 3 Wasco (The Dalles)
- 154 Washington (Hillsboro)
- 13 Yamhill (McMinnville)

Cases by Age Group
- 10 19 or younger
- 49 20-29
- 70 30-39
- 103 40-49
- 109 50-59
- 101 60- 69
- 59 70-79
- 45 80 and over
- 2 Not available

Hospitalized by Age Group
- 0 19 or younger
- 4 20-29
- 6 30-39
- 25 40-49
- 17 50-59
- 34 60- 69
- 25 70-79
- 18 80 and over
- 0 Not available

Hospitalized
- 129 Yes
- 316 No
- 103 Not provided

Sex
- 306 Female
- 236 Male
- 6 Not available

Hospital Capacity
- 285 Available adult ICU beds
- 2010 Available adult non-ICU beds
- 193 Available pediatric beds
- 66 Available pediatric ICU beds
- 767 Available ventilators
- 142 COVID-19 admissions
- 37 COVID-19 patients on ventilators

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Ego
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Re: COVID-19

Post by Ego »

Seppia wrote:
Sun Mar 29, 2020 12:06 pm
Another great side effect of a privatized healthcare system
Just spoke with a nurse friend who is at a hospital with 20 Covid positives. He in oncology and they are still treating regular oncology patients. They have not yet shifted them to a temporary facility.

He has been contacted by several headhunters offering $5500 per week plus housing to relocate to Seattle.

thrifty++
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Re: COVID-19

Post by thrifty++ »

Is anyone on here in New Caledonia? I feel like that is the place I would most want to be right now. Provided borders are closed to France. Are they? It looks barely unaffected by covid19. And it doesn't ever get cold there which will be nice with southern hemisphere winter on its way. How are things in New Caledonia now?

George the original one
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Re: COVID-19

Post by George the original one »

Can anyone explain the logic of the UK lockdown leaving dry cleaners open?!?

Also, I didn't pay enough attention to Australian states going to stage 2. Did they all do it at once and when? Australia is definitely an interesting case because of the extreme population distribution.

chenda
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Re: COVID-19

Post by chenda »

George the original one wrote:
Sun Mar 29, 2020 3:54 pm
Can anyone explain the logic of the UK lockdown leaving dry cleaners open?!?
I assume its considered neccessary to sterilise towels and clothes and things, and the premises I think fall under the same use class as laundrettes.

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