COVID-19

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Ego
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Re: COVID-19

Post by Ego »

Jin+Guice wrote:
Sat Mar 28, 2020 12:03 pm
He says the "worst case scenario" is 2.2 million Americans die ~0.66%.
Hum. Correct me if I am wrong but I believe that is the same worst case scenario number that appeared in the Imperial College report that caused the US and UK to lockdown. That report has since been revised down significantly.

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Re: COVID-19

Post by jacob »

@Ego - Apologies for hammering this [very important point], but the downward revision is because action was subsequently taken relative to the underlying "do nothing" assumptions of the first model (with the 2.2M estimate). This lead to a new and much lower death toll in the second model---thus indicating that the adopted measures would be effective. If those measures are lifted in order to return to BAU, the first model will hold again.

Jin+Guice
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Re: COVID-19

Post by Jin+Guice »

@Ego: O.k. I didn't know that. Looks like I need to take my rage posting down a notch because this is not the grotesque abuse of mathematification that I thought it was.

From the Imperial College report: "The higher peak in mortality in GB is due to the smaller size of the country and its older population compared with the US. In total, in an unmitigated epidemic, we would predict approximately 510,000 deaths in GB and 2.2 million in the US, not accounting for the potential negative effects of health systems being overwhelmed on mortality.

For an uncontrolled epidemic, we predict critical care bed capacity would be exceeded as early as the
second week in April, with an eventual peak in ICU or critical care bed demand that is over 30 times
greater than the maximum supply in both countries.
"

Whoops, looks like the Imperial College acknowledges that their own "worst case scenario" doesn't account for something they predict to happen. Assuming I have the right paper (https://www.imperial.ac.uk/media/imperi ... 3-2020.pdf), their central point is not to present a worst case scenario, but to outline strategies that would not overwhelm ICU capacity in the U.S. and U.K. I admit that I thought Kennon made up the numbers based on his own model without stating assumptions, which is why I was so mad. He instead abuses other peoples numbers, the advantage here is that assumptions can be examined.

The point of Kennon's article is that we need to look at the trade off between the economic costs and loss of life. These are big decisions and brashley making comparisons based on incorrect assumptions and incomplete models is not doing anyone any favors nor does it help us examine trade offs.


@Augustus: Thanks for the compliment, but don't confuse the fact that I work in a hospital with me having actual medical training. I was trained solely for my job and honestly being an audio technician for years prepared me more for my specific job than any of the shallow medical knowledge I acquired during "training." My job has nothing to do with the part of medicine that's important for this pandemic. I am actually out of work because surgeries are largely cancelled and my skills are non-transferable. Even trained medical professionals such as doctors or nurses, who have a depth of general medical knowledge (which again, I do not), are still highly specialized. As usual, the crowd here is different and I think the medical professionals here have made conservative and accurate statements where they acknowledge their level of expertise and how it relates to this issue.

J_
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Re: COVID-19

Post by J_ »

Today, 28 of March, Austria, little mountain village, friends of me on walking distance, a family of four, parents about 40+ children 13 and 11y. Mother became infected, became explicit ill on 20 of March, later all tested positive. Before: one parent healthy, other parent healthy but with a long standing muscle illness can hardly walk, children healthy. All isolated in their own home. Neighbors delivering groceries. First days, woman felt very fatigued, difficulty breathing, hardly appetite, man quickly tired. Now slightly improving health. I brought some things to them today (left it on their doorstep) and spoke from 7 yards with the children and mother. Children are hardly noticing it (only their confiness) parents feel slowly return of their strength. Not heard of any medicine.
For me it meant a relief, not only that my friends will overcome, but a real proof that healthy, fit people can withstand this virus.
A thing I like to share with you all.

George the original one
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Re: COVID-19

Post by George the original one »

George the original one wrote:
Fri Mar 27, 2020 3:27 pm
Oregon Health Authority as of 9:30a Fri, Mar 27
- 414 Positives
- 8510 Negatives
- 12 Deaths

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

Cases by Age Group
- 9 19 or younger
- 32 20-29
- 48 30-39
- 81 40-49
- 78 50-59
- 84 60- 69
- 47 70-79
- 35 80 and over
- 0 Not available

Hospitalized by Age Group
- 0 19 or younger
- 3 20-29
- 6 30-39
- 17 40-49
- 15 50-59
- 29 60- 69
- 21 70-79
- 11 80 and over
- 0 Not available

Hospitalized
- 102 Yes
- 218 No
- 94 Not provided

Sex
- 222 Male
- 187 Male
- 5 Not available

Hospital Capacity
- 360 Available ICU beds
- 2294 Available non-ICU beds
- 715 Available ventilators
- 91 COVID-19 admissions
- 31 COVID-19 patients on ventilators
65 new cases including a third case in my county. A change in how available beds are reported, now separating adult-size from child-size.

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

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Re: COVID-19

Post by 7Wannabe5 »

@slowtraveler:

I wasn’t doubting Kennon’s ability to perform calculations. I was attempting to point out his handwaving regarding life expectancy. In the U.S. the annual death rate for men does not hit 15% until age 89.

Imagine you are 89 and you attend a reunion of the 100 remaining members of your Korean conflict division. Prior to Covid you would expect only 85 in attendance next year. The assumption that 50% penetration of Covid will just pick off 7 or 8 of the 15 guys who would have died anyways implies that even given Covid there will still be expectation of 85 in attendance at your next reunion! Obviously, this is patently ridiculous, because even at the age of 89, contingency or what used to be referred to as the “cussedness” of life applies.

Approximately 14% of the U.S. population is over age 65. If we hypothetically assign all Covid deaths to this “aged” contingent, then 5% death rate due to Covid within this cohort results even if overall death rate of those who contract Covid is dubious low assumption of only .7%. There simply aren’t enough people over 80 “who would have died anyway”( at 3.3% of population) to take the hit without large loss (greater than 5 years) of life expectancy.

George the original one
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Re: COVID-19

Post by George the original one »

BEST GRAPHING TOOL SO FAR
"Are we winning yet?"

This interactive charts the new confirmed cases of COVID-19 in the past week vs. the total confirmed cases to date. When plotted in this way, exponential growth is represented as a straight line that slopes upwards. Notice that almost all countries follow a very similar path of exponential growth.

https://aatishb.com/covidtrends/

For those wishing a more visual explanation, particularly those who are not fond of math, here is an explanatory video: https://www.youtube.com/watch?v=54XLXg4fYsc

Lastly, my editorial comment is that since the graph uses weekly data, there will be a lag as far as trajectory. In other words if a country is successful, the turn won't conclusively show up until next week. (Sure wish there was a USA states version; I'm certainly too lazy to make one)

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Ego
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Re: COVID-19

Post by Ego »

jacob wrote:
Sat Mar 28, 2020 1:55 pm
If those measures are lifted in order to return to BAU, the first model will hold again.
@Jacob & @J&G...Straw man. No one is suggesting returning to business as usual. We are surging hospital capacity at incredible rates. We are testing a wide variety of medications against the virus. We are working on antibody treatments. We are finally getting around to do extensive testing. We have come up with a dozen makeshift solutions to the ventilator problem. We have now hammered home to the vulnerable populations how important it is that they quarantine like both @JP & @7W have responsibly done. We are doing a thousand things that were not considered in the worst case model. They are costly and alone would push us into a recession. They are worth it.

With each proposed action (or refraining from action) we ought to consider not only the benefits but also the costs. To ignore the cost side is disingenuous at best.

We've turned the page so I will quote the link that @slowtraveler posted and encourage everyone to read it.

thrifty++
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Re: COVID-19

Post by thrifty++ »

J_ wrote:
Sat Mar 28, 2020 2:58 pm
Today, 28 of March, Austria, little mountain village, friends of me on walking distance, a family of four, parents about 40+ children 13 and 11y. Mother became infected, became explicit ill on 20 of March, later all tested positive. Before: one parent healthy, other parent healthy but with a long standing muscle illness can hardly walk, children healthy. All isolated in their own home. Neighbors delivering groceries. First days, woman felt very fatigued, difficulty breathing, hardly appetite, man quickly tired. Now slightly improving health. I brought some things to them today (left it on their doorstep) and spoke from 7 yards with the children and mother. Children are hardly noticing it (only their confiness) parents feel slowly return of their strength. Not heard of any medicine.
For me it meant a relief, not only that my friends will overcome, but a real proof that healthy, fit people can withstand this virus.
A thing I like to share with you all.
Thanks for sharing this good news.

steveo73
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Re: COVID-19

Post by steveo73 »

Ego wrote:
Sat Mar 28, 2020 4:36 pm
We are doing a thousand things that were not considered in the worst case model. They are costly and alone would push us into a recession. They are worth it.

With each proposed action (or refraining from action) we ought to consider not only the benefits but also the costs. To ignore the cost side is disingenuous at best.
I agree. We have to look at this situation rationally and factually. I'm a fan of a small period total lockdown so I'm probably more on the extreme side of the actions to take but we cannot lose focus of the big picture here. This can be a catastrophic event if the health system cannot meet the increased demand from COVID-19 cases. There will be a massive economic impact.

I think we need to manage the health problem first but we need to realize that there are costs to the actions we are taking now and we should be looking to minimize those costs as much as possible. We shouldn't be basing our decisions on data that is limited in it's value to the situation that is evolving right now. We should not be giving models that are not reliable some sort of enhanced status of reliability that they don't have.

I work with data and I have for basically my whole career. You need to be very careful when using statistical models to predict processes that evolve/change in real time and you have poor data. This is exactly the situation that we are in right now.

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Re: COVID-19

Post by jacob »

@Ego - I read the Kennon piece. I agree with others that he's missing a crucial aspect, so a straw man this is not. If the hospital system is overloaded, it's not just corona deaths, we counting, every other death rate will go up to unless we simply refuse treatment to anyone infected over the age of 65 or 40 or whatever the cutoff needs to be. The second aspect is that the world is not geared towards burying that many dead, alternatively dealing with so many estates ... or in general resolving the death of 5-10% of the population over 65 within the space of a few months.

Conversely, when it comes to the economy, I note that factories and businesses are still standing. What's being messed up right now is that our financial system relies part on the stock of money but also its flow. Much like a nuclear reactor, is NOT a system designed to be shut down just like that. The stock (savings) is still there but the flow (payments) is being cut off. This is where the government is uniquely capable of helicoptering in money to keep the flow on life support(*) There is of course lots of ideological opposition to this, but insofar people can wrap their minds around the factor that it's just account numbers on a computer screen largely guiding people around, perhaps it's not necessary to change people's behavior the hard way by letting ~1% of the population die.

(*) @bsog had a recent post with a great metaphor describing the economy as a car engine w/o a battery that must be kept running.

In "Marxist" terms, this whole debate basically seems to be similar to the one between labor and capital. It's not surprising that interested parties tend to stand where they usually sit as well. Those who have a lot of money/savings are willing to take greater risks with people's lives than those who have less. Perhaps especially those who rely on other people (their old friends?) for support instead of their dividends or 401k savings? One can definitely put a price on a human life... the question is how high? I calculated it in an earlier post: A complete shutdown was something like $175,000 per casualty. If old people are worth less than that, then the rational choice is to let the epidemic burn through.

Usually "respect for all individuals" (even the old and weak) ranks pretty high up there in terms of what we value which is also why most countries have opted for killing their economies over killing their old, although there are certainly voices, typically free market advocates, who value the economy over almost everything else. And technically, letting the old die sooner would solve a lot of other economic problems, like underfunded pensions and medic* systems, ... but where do we stop if we go down that path? Logan's run? These are some very hard ethical questions to answer.

Regardless of the debate, the thing is we are where we are ... and we have a system that we're not making major changes too (because it's almost impossible to change a complex system). There has to be a here->there solution.

It would appear that most countries are indeed slow-walking the measures doing the trade-off between not-overloading-the-healthcare-system and letting-the-economy-run-as-much-and-as-long-as-possible. Indeed, countries seemingly choose to lock things down a bit (rarely completely) just ahead of the deadline of "if you don't act now, you're fucked"-cliff. This has the effect of pushing the deadline out a bit to "if you don't act somewhat more, you're fucked again"-cliff. This is a fine line to walk and some countries have indeed falling over the cliff.

Regardless, this is how most leaders and most people are choosing to #flattenthecurve, basically iteratively playing it right up to the next crisis level. 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 )

The strategy being followed by almost all countries in the world can be thus summarized as "lets enact just enough restrictions to avoid overloading our health care system but no more as the cost to the economy would be too high".

(*) With that algorithm, humanity is extremely lucky that the incubation time is not substantially longer than the doubling time (cf. HIV which has this problem ... fortunately, it's "only" an STD, so R0 is low and controllable) because that would allow the overshoot to build up before the consequences are felt. With COVID19, we see the consequences of our choices within two weeks or so.

PS: Sweden actually is going in the direction of minimum economic interference in the virus's path because they think killing the economy is a bigger deal than killing the old. It'll be interesting to see who is right.

George the original one
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Re: COVID-19

Post by George the original one »

George the original one wrote:
Fri Mar 27, 2020 5:57 pm
State of Washington published count as of 3:30p Fri 27 Mar
- 3207 Positives
- 49015 Negatives
- 175 deaths

Cases by County (County seats)
- 5 Adams (Ritzville)
- 42 Benton (Prosser)
- 13 Chelan (Wenatchee)
- 5 Clallam (Port Angeles)
- 76 Clark (Vancouver)
- 1 Columbia (Dayton)
- 7 Cowlitz (Kelso)
- 5 Douglas (Waterville)
- 1 Ferry (Republic)
- 12 Franklin (Pasco)
- 42 Grant (Ephrata)
- 1 Grays Harbor (Montesano)
- 79 Island (Coupeville)
- 11 Jefferson (Port Townsend)
- 1760 King (Seattle)
- 42 Kitsap (Port Orchard)
- 8 Kittitas (Ellensburg)
- 7 Klickatat (Goldendale)
- 7 Lewis (Chehalis)
- 1 Lincoln (Davenport)
- 2 Mason (Shelton)
- 2 Okanogan (Okanogan)
- 231 Pierce (Tacoma)
- 3 San Juan (Friday Harbor)
- 91 Skagit (Mount Vernon)
- 1 Skamania (Stevenson)
- 913 Snohomish (Everett)
- 86 Spokane (Spokane)
- 3 Stevens (Colville)
- 27 Thurston (Olympia)
- 2 Walla Walla (Walla Walla)
- 92 Whatcom (Bellingham)
- 5 Whitman (Colfax)
- 72 Yakima (Yakima)
- 45 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
- 13% 70-79
- 13% 80+

Cases by Sex at Birth
- 51% Female
- 46% Male
- 3% Unknown
1093 new cases.

The data in this report is reflective of all cases received as of 11:59 PM 3/27/2020. A small percentage of lab reports (<1%) have yet to be reviewed and are currently counted as negatives*.

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

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.

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