stevenkesslar

I'm adding this WSJ article, to put this discussion in another context: Questioning the Clampdown Will people lose faith when they find out they are expected to get the virus anyway? By Holman W. Jenkins, Jr. Wall Street Journal The cost to Americans of the economic shutdown is vast. What are they getting for their money? Essentially less excess demand for respiratory ventilators and other emergency care than can currently be supplied. Some number of respiratory deaths will be avoided (really delayed since we all die) but we’ll be spending a lot more than we’ve ever been willing to spend before to avoid flu deaths. Eighty-three percent of our economy will be suppressed to relieve pressure on the 17% represented by health care. This will have to last months, not weeks, to modulate the rate at which a critical mass of 330 million get infected and acquire natural immunity. Will people put up with it once they realize they are still expected to get the virus? Wouldn’t it make more sense to pour resources into isolating the vulnerable rather than isolating everyone? Basically aren’t we really just praying that summer will naturally suppress transmission and get us off the hook of an untenable policy? The U.S. may or may not be a test case of a large continental country where hot spots of contagion shock other places into buttoning up and hunkering down, curbing excess local demand for intensive-care beds. But the cost will be astronomical. Essentially we are killing other sectors indefinitely to manage the load on the health-care sector. Understandably, politicians believe faith in government requires avoiding Italy-like scenes. But turned on its head here is the 50-year-old “QALY” revolution: the idea of measuring the burden of disease and benefit of health care based on “quality-adjusted life year,” typically valued at $50,000 to $150,000. In the present instance, the cost isn’t just medical intervention (e.g., ventilator use) but the cost of an economywide shutdown to limit the number of candidates for ventilation at any one time. I don’t know what the figure is, but the QALY value we are placing on avoiding Italy-like deaths is surely a high multiple of any figure previously considered realistic. A British estimate is that 12 people have the virus for every one found by testing. In any case, testing becomes a tad mootish now if the goal is to isolate even young and healthy people. That's probably the best example of the case for why this is all just a big overreaction. And it does get into all these arguments you have to get into, that nobody really wants to think about. What is a 50 year old life worth? The implicit assumption is that a certain additional numbers of older and sicker people dying is better than screwing up the economy for everybody else. The unstated assumption is that "everybody else" doesn't include the people who work in the health care sector, who will ensure a year of torture. Of the people who get really sick, or survive but with permanent lung impairments. Or the occasional 18 year old who had the misfortune of vaping or having some pre-existing condition. What's obvious is that no country really wants to go through this hell. That said, the Wall Street Journal has some very good points that we haven't even begun to answer. If we do suppress this virus, how do we keep it suppressed when we try to get back to business? Can we do this for 6 month? 12 months? 18 months? The WSJ is not wrong to question whether this is an "untenable policy". The part of their argument that seems inhumane is that people all over the world obviously don't want to let nature run its course and make this their country like Italy, or five times worse, or ten times worse. The part of their argument that makes sense is that to have an economy, someone has to work. And if this goes on for 6 months or 12 months are 18 months, the cost just keeps mounting. They are also right to ask: if I'm going to get this virus, anyway, why not just get it out of the way, so I can go back to work? I think there's two conclusions that seem like certainties. First, if the goal is suppression, we're going to have to be all in, like China and South Korea and Singapore are. When the lock down ends, and until we have a vaccine, "test, trace, treat" has to be everyone's mantra. Second, someone has to work while this virus is running amok. And they will be taking a risk by doing so -whether they work in hospitals, or for Amazon. So we ought to be thinking about what it means to have their back. Or to make sure their employers have their back. I haven't seen the study that says 12 young and healthy people have the virus for every one found in testing. That article the OP posted of the 25 year old who went to Florida suggests that even the young and healthy can get very sick. So that is going to remain a mystery until we have more testing. The testing in South Korea does suggest that a significant number of young adults and children get this virus and don't even know they have it. They simply may help spread it. Unless we really do want to have a Great Depression, we can't just give the entire global economy a year off with sick pay. Or however long it takes until we have a vaccine, or the virus just dies out. I don't agree with the WSJ. But I do agree with the idea that we have to figure out how to create a safe worker environment, sooner rather than later. And for a year or so, until there is a vaccine, we may have to find ways to isolate the vulnerable rather than isolating everyone else. We actually have to do that anyway, now. If it's true that lots of college students who work in the dining rooms of nursing homes can be carrying this virus without knowing it, that alone is a good reason to think about how to do a better job of isolating those seniors from a killer virus. There's one other reason that suppression may make sense, which goes back to the idea of a more virulent mutation. I'm not a scientist. But everything I've read suggests a more deadly mutation is unlikely. That said, such a mutation would be a random ticket in the biological lottery. And the more people that get infected, the more random lottery tickets COVID-19 gets. If we give it 1 billion lottery tickets, it has a far better shot of developing an even more deadly mutation than if we limit it to only 1 million people's bodies. So far, we're at 343,421 lottery tickets and counting.

Thanks for the clarification. We agree. Estimated Influenza Illnesses, Medical visits, Hospitalizations, and Deaths in the United States — 2017–2018 influenza season If you click on the link, there's a great example there of your point. Dr. Fauci is estimating 1 % of the people who get COVID-19 will die. So if you say that, by comparison, 0.1 % of the people who get the flu die, that sounds a lot less deadly. If you say that 0.01 % of people aged 5-17 who get the flu die, that sounds like almost nobody. And those are the actual numbers for 2017-2018 flu season. If you say 528 kids aged 5-17 died, that doesn't sound very good. You could say that sounds very scary. But that is how many died of flu in 2017-2018. And some are arguing that we didn't shut down the global economy over that. Age of Coronavirus Deaths That's from the WHO-China Joint Mission Data. I think it includes data from the front of the outbreak, when a lot higher percentage died because nobody knew what this was. So the numbers may be overestimates. But whether you look at it as a percentage, or as real people who died, it is scary. For children under 17, the death rate for the flu in 2017-2018 was 0.01 %, as I said above. For COVID-19, it's 0.2 % in that study for kids over 10. Twice as deadly as a normal flu season is for EVERYONE. And 20 times as deadly as a normal flu season is for children. To translate that into real numbers, in 2017-2018 an estimated 11.2 million US children get the flu. 46,000 of them ended up in hospital. 643 of them died. If you use the estimated Coronavirus rate of 0.02 %, using the number of kids that got the flu in 2017-2018, that number rises to well over 10,000 dead children. Even if you only base on kids aged 10 or higher. For the entire US population, about 44 million people got the flu in 2017-2018. 800,000 were hospitalized, and just under 61,000 died. That's a "normal flu" death rate in the ballpark of 0.1 %, as Dr. Fauci keeps saying. Where it really gets scary with COVID-19 is 65 and older. The death rate for "normal" flu for that group goes up to 1 %. In 2017-2018, about 6 million US seniors got the flu, about 550,000 ended up in hospital, and about 51,000 died. If you use the estimated Coronavirus death rate, it's 3.6 % for people aged 60-69 alone, and much higher for everyone older. So of 6 million US seniors, at least 200,000 would die, if you use the 3.6 % estimate. If you go with Italy, and say 10 %, that's over half a million seniors killed by Coronavirus. And probably 2-3 million of them would need hospitalization. The hospitals would collapse just based on seniors alone. And, yeah, they would be the ones pulled off ventilators to try to save the lives of the tens of thousands of kids with COVID-19 in the hospital. No politician wants to talk about numbers, or choices, like that. Nor does any doctor - although they are the ones who are having to make these battlefield triage decisions. I think we agree, either completely or almost completely. The point I feel most emphatic about is that right now this is a huge workforce issue. To put the bullseye on Amazon, Jeff Bezos wants his employees to come to work. I just talked to a friend tonight who ordered toilet paper on Amazon. He's also thinking of going to work at Amazon, since he has no income right now. So it's probably fair to say some of us want these Amazon employees to go to work, too. And many of them "want" to go to work, if only because they need the money. A few of them have already gotten sick, as this article describes. Amazon will give them two weeks of sick pay. That article is about European employees. So they presumably all have public health insurance. But who wants to be in an Italian hospital now? The article says Amazon wants to hire 100,000 people in the US to meet exploding demand. You'd get health insurance, but with thousands of dollars in deductibles and co-pays. So there are two issues here, but they are intertwined. One issue is are we saying that everybody - 100 % -of workers in their 20's or 30's or 40's should stay home, because the risk to their health is too great? And if we are not (reality check: we're not) what does it mean to say we have their back?

I read or scanned all six of those stories. So let offer a few other conclusions, which echo the ones above. Of those 6, 3 lived and 2 died. One was a nurse infected while caring for sick people who was on a ventilator when the story was written. The three that lived were two athletes, and a 25 year old guy who looks very athletic. Their point is that they felt like shit, and this was worse than anything they've ever felt before. That said, the story about the 25 year old Gay hottie also said this: "His friend, meanwhile, hasn't experienced any symptoms at all." Congressman with coronavirus feels 'about as sick as I've ever been' There's a brief video in there of Rep. Ben McAdam, 45 and fit, that is worth watching. I think the more of these videos that get out, the better. They make two points: 1) You're not going to die. 2) This is serious shit. Don't toy with it. Both of those are great messages, I think. There are a bunch of people questioning whether the treatment we are giving ourselves is worse than the disease. Why not just tough it out? Apart from the idea that we don't want dead bodies piled up in hospitals that are collapsing from lack of everything, the idea that even trained Olympic athletes find this a rough ride supports the argument that we are probably wise to try to avoid this. One of the two who died and the one on the ventilator were young health care workers. Again, this is not a political forum. So I will say this emphatically, but hopefully nonpartisan. It just seems morally intolerable to me that we are asking young doctors and nurses to face this crisis, where they are most at risk of being exposed, but not giving them all the protective equipment they need. I get that in the poorest parts of Africa they simply may not have the resources. That's why America or Canada or Europe or Bill Gates sends its to them. But in NYC? That's just not okay. It's a disgrace. This is a citation for the article you posted on the young doctor who died: "Dr Usama’s colleagues called his death a “huge loss” and complained that the government had not provided protective equipment to the medical and paramedical staff screening the pilgrims or those deputed at the isolation centre." This is a guess, but there's another possible issue. Hospital ventilators are great places for bacteria to live. That's true anytime. But it's even more true in a crisis where you are reusing equipment and desperately trying to keep as many people as possible alive. So that may or not be an issue with either the doctor who died or the nurse in the ICU. But it is a reason why we should try to avoid putting hospitals in crisis. And, again, it is a reason why we should do everything we can to keep these doctors and nurses well. The 18 year old who died in the UK was described as having "pre-existing conditions." It did not state what they were. I'll reiterate my point above. My guess is there is a subset of young people that are at higher risk. Anyone with lung or heart problems, for sure. Maybe vapers, but we don't know. This is a citation from the article on the 18 year old you posted: "In England, 37 more people who tested positive for Covid-19 have died, bringing the total number of confirmed deaths there to 257. Those who died - including the teenager - were all in vulnerable groups, including with underlying health conditions." I think the easy out on this is to say that young people are at risk, and everybody should just stay home. The reality is that is just not an option. Some people want to work, and some people need to work. To me the better way to deal with this is to be brutally honest and grounded in facts. If they are 30 and they are willing to work at Amazon or a grocery store or a hospital, we need their labor, arguably more then ever. But we ought to have their back. And if we know that vapers are 5 times more likely to die, we should be telling them that.

I'm not sure about that, Mike. The best evidence we do have so far tends to suggest the opposite. That said, right now the correct message the CDC and just about every leader is trying to send is that this is not something young adults should take lightly. The CDC is saying it from the perspective of how a young adult could end up in a hospital. But for most leaders, I think this is closer to the rhetoric being used: Earlier Sunday, New York Gov. Andrew Cuomo ordered New York City to come up with a plan to reduce the number of people gathering in public spaces within 24 hours. Cuomo said he saw people gathered in large groups and playing recreational sports during a tour of public places in the city on Saturday. He said such activity is “insensitive, it’s arrogant, it’s self-destructive, it’s disrespectful to other people and it has to stop and it has to stop now.” That data from Italy documents that most of the people who died were old, and had a bunch of underlying illnesses. The CDC data essentially backed that up. It is scary that 15 % of patients under 44 ended up in hospitals. But only one of them died. https://www.nejm.org/doi/full/10.1056/NEJMoa2002032 I've posted that before, but that's data from 1099 patients in China. Less than half of them live in Wuhan, and the average age was 47. So I think those are people all across China who either traveled to Wuhan, or knew someone who did. This is probably the closest we have right now to a picture of a typical workforce-age population of infected people. 1 % of them were under 14, and 15 % of them were over 65. But the vast majority are basically workforce age. Of these 1099 people, 173 had "severe" symptoms. It does not list their age, but it does say 261 of them had some co-existing disorder. Like hypertension, diabetes, cancer, heart disease, etc. 137 of the total group were smokers. Of the entire group of 1099 people, 15 died. That's a 1.4 % death rate. This is a guess on my part. But based on the CDC data and the data from Italy, it suggests that in three different countries the people at risk of dying probably are those that are old, or sick (significant pre-existing conditions), or both. In the 1918 pandemic, young men and women in their 30's were dropping like flies and dying in a matter of hours. If that were happening right now, we'd know it. It just isn't. I've looked at that Chinese data several times. What I just noticed now is that almost all 1099 patients had pneumonia. When I posted on this several days ago, I assumed that these 1099 people were all caught in this huge national dragnet right after the lock down simply because they tested positive. I assumed they were all sent to hospital in part to be safely isolated. But I think my initial assumption was wrong. If they all had pneumonia, and the average age was 47, that strongly suggests this was a subset of all the people infected. These were likely the ones who had a tougher time beating COVID-19. In other words, the true death rate for a "workforce age" group like this might be lower than what these figures indicate. In South Korea, where lots of younger people were tested, the death rate is currently 1.1 %. That said, if almost all these people had pneumonia, that makes your part. This is not like swine flu. It is serious shit. So if you are 30 or 40 you are very likely not going to die. But like Rep. Ben McAdam, who is 45, you are really going to feel like shit for a few weeks. The reason I think this is important is right now, workers at Amazon or workers in government offices are legitimately scared. If the fact is that 10 % or 30 % of anybody aged 40 or 50 who works at Amazon or for the US government and gets this virus is going to die, we are truly fucked. You can't run a business where going to work and getting sick means you have a 1 in 3 chance of being dead in a few weeks. Who is most at risk in the coronavirus crisis: 24 million of the lowest-income workers Cashiers, nursing assistants, paramedics: These people are at highest risk of exposure to coronavirus — and make a median wage of less than $35,000 a year That article makes my point. As much as this is a good time to encourage everyone to stay home and be safe, that's just not an option for tens of millions of workers in the US or Canada or Australia right now. Some of them need the money, even if they don't really want the risk. Some of them just would rather work, and are okay with the risk. And we can't keep a partly hibernating economy even for a few months without grocery stores, pharmacies, and government offices. I hope somebody is thinking about this from the standpoint of workforce issues. I don''t want to make this political. But my view is that whether this is Great Depression II or not, it will have the same impact on societal norms: "we are all in this together". So these people working right now, and two and four weeks from now when it's definitely going to get worse, at the very least deserve sick pay. And health care. If they are bagging our groceries, they shouldn't be going bankrupt if they get sick and have to be in a care center or hospital for a few weeks. Again, I get the message that we don't want spring breakers partying on the beach. But we do want them bagging our groceries, and delivering our pizzas. I think it would be helpful if we got this sorted out. We ought to be able to tell people what the risks are, who is best to stay at home, and who can be performing essential services at relatively low risks. For all my adult life, there's been no shortage of people over 50 who think people who are 20 should be required to perform "national service". I always thought it was kind of hypocritical. But right now, it's an idea whose time has come. It's just not a good time for some 70 year old women with heart disease to be working in a grocery store. It probably is a far better time for a 25 year old woman who hiked in Peru last summer to be doing that job. And if she is at serious risk of having a bad outcome if she does get sick because she has vaped a lot, or because she has heart disease or is obese, that would actually be a very good health message to get out. But anybody who is willing and able to work in this environment is doing a sort of everyday national service. There are able bodied men and women building emergency hospitals for us right now. Bottom line: we need workers. Including probably a lot of temporary workers who need the money. Employers and politicians are not going to put themselves in a position where they say, "You have to keep working. Even though it may kill you." But if we have really clear information, and let workers make their own choices based on that information, that's probably the best way to get through this crisis.

That's a cool dashboard. https://covidtracking.com/data/ https://experience.arcgis.com/experience/96dd742462124fa0b38ddedb9b25e429/ That's a link to every state's public health department data. And the one that I think is best of the ones I browsed: Florida. Props to Guv DeSantis. It tells you results in each county - total tests, total positives and negatives, hospitalizations, deaths. (Click on the "Florida Testing" tab at bootom.) If suppression works, it will be because we're all essentially all well trained soldiers in the anti-viral army. Websites like this will help build public awareness. Speaking of which, I wonder whether there is an antibody test, or will be? In other words, a test that indicates you had COVID-19, and now have an antibody for it, or immunity to it. I get that right now the focus is on trying to get people to stop throwing fuel on the fire. But at some point, if we don't want a Great Depression, we'll have to figure out how young people can interact with old ones - especially in work environments. The most vulnerable situation would be a nursing home with lots of entry-level college student employees. But if we are operating in an environment where being 80 and going to McDonalds and getting a cup of coffee handed to you by a 20 year old can get you infected, that's not a good thing. It doesn't restore confidence. My assumption based on the South Korea data is that maybe 20 % or even one third of infected people are under 30, and often asymptomatic. It's n not completely understood yet, but that seems to be one reason this is spreading so quickly. And it's not realistic to test young people who work in nursing homes every week. Arguably, for some interim period, there would would be an advantage in being someone who was infected, and now has immunity. In my mind, the real point of this exercise is making live less hellish for anyone over 65 or so, anyone under 65 that is really sick, anyone who works in the medical profession, or anyone who needs a hospital for any reason for maybe the next year or so. It would border on job discrimination. But as part of a suppression strategy, it would actually make medical sense to test people to find out they have immunity. Those would be the safest people to have working in nursing homes, where this virus is definitely a kiss of death.

Is there any doubt that it will be? I find it comforting. Somebody will think of a great slogan. "Save a life. Stay home and bake a cookie!"

I'm going to cut and paste part of what I just posted in the Politics Forum. This is the part of the post that is apolitical and relates to this question: I'll keep repeating certain points. I think Newsom's strategy is that a lot of young people are going to get sick, anyway. No Governor can say, "Hey, go on Spring break and get a virus, kids." But in some ways, that's good policy. Their risks are about the same as the whole population faces every Winter, anyway. Clearly, many of them feel young and invulnerable. The massive workforce problem is that whether this peaks in May or July, my experience with my parents is that young people, like college students, are the ones who do most the front-line and entry-level jobs in nursing homes. They serve the food to seniors, clean the tables, provide personal care, etc. We know from Washington state's experience that the last thing you want is this virus ripping through a nursing home full of seniors. One way or the other, a lot of these young people want to go to work and simply have to go to work now - at Albertsons, or Dominos, or a Kaiser pharmacy, or a construction job. Their risk of getting seriously ill or dying is low - or at least much lower than the risks for seniors. If we didn't have a "hospital-demic", arguably it would make sense to tell everyone under 30 or 40, or even 50 or 60 if they have no serious health problems already, to just keep living their lives normally. You're going to get a bad flu, but you'll be fine. No Governor can say that, because it is horrible politics. And even if they did, the problem is that unless you can put all the higher risk groups in a bubble, you're going to have a hospital crisis, anyway. As an aside, this may end up being nature's most effective commercial against smoking and vaping, ever. I've been trying to figure out why it is that 20 % of young adults end up in hospitals, as reported by the CDC. At least based on this data, I think the answer is clear. Of a group of 2449 COVID-19 cases, 705 were aged 20-44. Of that group, 15 - 20 % were hospitalized. 2 - 4 % of the total group (so maybe 15 or so people) were admitted to the ICU. Of all 705 people with COVID-19 aged 20-44, one died. All this is going to change. Under normal policy, the 100 or so 20-44 year olds would be kept in a hospital for observation, and also for isolation. That's probably not going to happen now. In NYC, every one of those beds is urgently needed for people who may need life saving care. I'm no doctor, but I think the health care problem is that you can't tell in advance, necessarily, which 15 of those 100 patients aged 20-44 will need to be admitted to the ICU. Rep. Ben McAdam, 45, is at home, but he says this: “I got really labored breathing. I feel like I have a belt around my chest, really tight. When I cough, my muscles are so sore so I just feel pain every time I cough, which is frequently. I feel short of breath, and I have a fever of about 102. So, it’s pretty bad.” So he should be fine. But if there are a lot of healthy 45 year olds out there, and this is how sick they get, it goes back to the basic "hospital-demic" problem. No one knows why a small group of young people need to be in an ICU. But one theory is that they smoke or vape. Since this is an illness that screws up your lungs, that at least makes sense as a theory. So one benefit of COVID-19 is it could scare young people out of smoking, or vaping. To me knowledge, that CDC study is the best one in the US. And it is being used to document the headlines that a significant percentage of the people in hospitals are young. That is true. But they are not a significant part of the people who are dying. The real health care problem is that if some of them (about 15 % of those hospitalized) had not been admitted to an ICU, they may have died. Here's a story about workers at Amazon who are rightfully scared. The massive workforce issue is that even young and healthy people like Ben McAdam don't particularly want to get the nastiest flu ever - even if they know they will be fine. They certainly deserve sick pay, because they are the front line soldiers, in effect, in a global war against a virus. And some of these industries are critical now. We can't just close grocery stores and pharmacies and Amazon down. And part of the reason why is that no matter what the federal government sends out as a cushion, a lot of people want to work, and need the money. We were not prepared. But sooner rather than later this has to get sorted out, and will get sorted out. In California, I think the implicit message is that if you are a 40 year old construction worker, we desperately need your labor now. You're in a union, so if you get sick you will get sick pay. And if you are one of the unlucky ones who need an ICU, we have your back - just like you have our's. And if you are 70 and have lung and heart conditions, please stay home and avoid this mess. I don't think anybody in office can say it as bluntly as I just did. But, in effect, and right or wrong, that is what is being said through policy. What would help a lot if the goal is to suppress this once we get it under control is to get everybody tested ASAP. The FDA is already approving fast track do-it-yourself test kits, I think. Everybody should get one in the mail, for free, just like everybody gets one in the mail. we should have drive through tests stations everywhere, like South Korea does. So Patriotism 2020 means you test yourself, and isolate yourself if you test positive. It may save lives or a stay in the hospital - even if you are 20 and very unfortunate. Whatever this would cost, it is a small fraction of what we are all going to pay because we were totally unprepared.

I think people are going to be digging in for the long haul. Which means they are going to have to go to the grocery store "regularly", whatever that means. Nobody really knows what it means yet, and nobody can tell us. In some cases it may mean having people they know go for them. In California, Gov. Newsom is deploying the National Guard to help both at food shelters and, I think, bringing food to people's doors as necessary. If California's planning is right, there's going to be an awful lot of sick people in April and May. The scientific model is that, absent mitigation, 25 million Californians would get sick over an 8 week period this Spring. The people most vulnerable include pretty much anyone working in grocery stores or pharmacies. I presume that when they get sick, they'll go home for a few weeks and hopefully have paid sick leave. I also assume some of them will be infected but healthy - "the walking well". They won't be a priority for testing, since they are basically young and healthy, so they will unknowingly work their way through this. One of the things that makes sense to me about where California is going is that it's arguably a good thing if young people get sick now. For them, mostly, it's the same thing as the flu. In theory, if everybody under 30 or 40 got the virus in April or May, that would dramatically lower transmission rates, without putting a lot of those people in harm's way. It's what we're used to every flu season. And whether it's explicit policy or not, what California seems to be saying is just that this is reality. It is going to happen. I assume that is why Newsom is deploying the National Guard. If you are old and frail, it is better to just stay home as much as possible. The same goes for every other vital industry. People need to be staffing government offices, post offices, unemployment offices. Construction workers are actually going to be getting a lot of work re-fitting structures into emergency care centers. They will get sick, too, and mostly be fine after. I'm not trying to single out California. I'm using it as an example because, since I live here, I'm paying particularly close attention to what the state government is telling me to do. And it does seem like there is a pro-active and thoughtful plan to get through this. My prediction is that grocery shopping will be pretty easy in April and May. One of my escort buddies, who is also a tenant of mine, is actually thinking about taking a job at Albertsons, since they need temporary workers. As their employees get sick and have to stay home, the need for temporary workers will increase. And they won't be hiring seniors with pre-existing conditions, who won't want the jobs, anyway. I hope Albertson's has paid sick leave. If they don't, I hope the federal government makes these workers whole when they get sick. Those workers at Albertsons are basically now soldiers in the war against this virus.

Okay. But what happened to one for all and all for me?

I think STD rules apply here, in ways we don't know yet. The smartest people I'm listening to are using the word "roller coaster" to describe this ride. There will be a big wave and a crest. Maybe this summer it will seem like the coast is clear. Maybe warmer weather will suppress transmission. We don't know. In the Fall there may be a second wave, which we are better prepared for. I'm going to keep comparing this to gonorrhea. Or a bad flu. Except with the flu you know you have it, and it is obvious. With the clap, you very well may not. So you could have a test from a week ago saying you are clean, and it's irrelevant. The reason this is relevant is that in normal times, anybody is always taking some risk - even if they are hiring someone they have known for years. I'm playing crack psychologist, but I think what will matter is the feeling that things are relatively safe. I checked and something like 100 people died in NYC last year simply going to work. They were a pedestrian that crossed a street, or a young guy on a bike. That didn't create a widespread feeling of fear, or stop people from going to work. Somehow, we'll arrive at a new normal. Just like with STDS, having really good policies that inform the public, and test, trace, and treat quickly, will help create confidence. In this particular market of generally older men, I think this has to be thought of as a "hospital-demic". Several times I've been with clients where one of us had to get medical care. One client tripped and hit his head on a sidewalk and bled pretty badly. Or I got a sinus infection. It was a minor drama, but really no big deal. It's very different when you are in this risk group where you have maybe a 1 in 5 chance of needing hospital care. And the entire hospital and public health system are totally fucked before you even get near the emergency room door. While it's apples to oranges, I think on COVID-19 the best example of how we learn to live with this is South Korea. They have it down in the last week to where less than 100 people a day test positive. That's in a country with 50 million people. Not everyone gets tested. But the odds of you getting sick are extremely low. And if you get sick, the odds of you coming out fine after a few weeks of minor drama are very high. If you need a hospital, you won't have a problem. That's radically different than California, which has over 1000 cases. That number is just a fraction of the number actually infected. And the Governor says maybe 25 million people will become infected this Spring. Those are not very good odds, I think this is a good time to embrace uncertainty. We'll figure it out as we go. For now, go for the vibrator. Not the ventilator.

Coronavirus: New graph shows people in their 20s are more asymptomatic and not being tested for COVID-19 I'm posting that in multiple forums. It's very important that anyone thinking of hiring internalize that data. No one knows for sure how transmission works. But we have some very educated guesses. The red bars are the picture of how this transmits in South Korea, which has the most comprehensive data based on voluntary mass testing. The green bars are Italy, where the people who were tested are probably mostly ones that showed up at a hospital sick. As you can see, it is two very different pictures. In South Korea, people under 30 were about one third of the cases. Since this was probably mostly drive through testing, my guess is that chart underestimates the percentage of children who are carrying the virus but seem just fine, because they won't get sick. It's likely that a lot of people in the US under the age of 30 are infected, and the walking well. They will experience mild or no symptoms. Even if they get symptoms, they are contagious before they develop symptoms. So to compare this to an STD, this is like the clap on steroids, as opposed to HIV. Meaning it is very easy to get it, because you're perhaps as likely as not to get it from somebody young who is perfectly healthy, except for the fact that a virus that is benign to them is accompanying them for a few weeks. So this is NOT completely like the clap. Because it is even easier to spread. You can get this from the hot young grocery store clerk who coughs near you, or perhaps the grandchild you are playing with. My guess is that unfortunate family in New Jersey where about half of them died after a family get together probably already suffered from a bunch of serious pre-existing conditions. But just eating dinner together was sufficient to pass the virus along. In China they learned quickly that families were spreading the virus just by spending a few hours together at dinner. That's why, unlike South Korea, China actually separated sick parents from the family and had them get well in care centers. It did slow and then stop the community spread. To spell it out, a kiss is probably more dangerous than just having dinner together and cuddling. But unlike with STDS, having dinner together and cuddling is dangerous, too. And, like the clap, you can't blame it on an escort who doesn't even know he has this virus. If you are NOT a senior citizen and you DO NOT have serious pre-existing conditions, you'll likely be just fine. If you live in California, your Governor is now saying you have a 50/50 chance of getting this anyway. The real danger is that if you think there is any danger that you are in that 20 % that may need hospitalization, this is pretty much certain to be the worst time in your life to got to a hospital.

You mean stay well, healthy, and fed! My favorite grocery store is a few blocks away and is still fairly well stocked. I think all the stores here have a few hours set aside for only seniors to shop in the morning so they can minimize their risk of exposure. I'm glad the state is figuring this out for older and more vulnerable seniors who don't feel safe going to the grocery store. Gavin Newsom deploys national guard to help distribute food March 20, 8:20 p.m. California Governor Gavin Newsom announced Friday night that California National Guard members will be deployed to help with distribution at food banks. “It’s in these times of crisis that Californians are at their best, coming to the aid of those in their community who are most in need," Newsom said in a statement. "Food banks provide a critical lifeline for families, and are needed now more than ever. Families across our state are suddenly losing work, and millions of Californians most vulnerable to COVID-19 are staying home to protect their health and the health of others." The California Guard will first deploy personnel and logistical equipment to a food bank distribution warehouse in Sacramento County, and will then "conduct immediate site assessments statewide for those counties that have requested short-term support and stabilization." Newsom also formally launched the Neighbor-to-Neighbor campaign, a government partnership with Nextdoor.com and California Volunteers intended to help deliver food to individuals facing an elevated risk of complications due to the coronavirus. "The collaboration will allow the state to reach more than 22,000 neighborhoods using the platform," the release reads. "Neighbors use Nextdoor to exchange helpful information and California Volunteers will use this site to share ways residents can safely check on each other during the COVID-19 outbreak. The platform will also be used to share ways to safely ensure community members have the basic necessities they may need during periods of home isolation."

Study shows how easily coronavirus can potentially spread According to a virologic study by researchers in Germany, COVID-19 can be spread before it causes symptoms and for as many as 12 days after recovery. The study of nine infected patients at a Munich hospital that was published Monday has not yet been peer-reviewed. In comparison to findings from the 2003 outbreak of SARS, the novel coronavirus began producing high viral loads — a term used to describe the quantity of virus in a given volume — more quickly. How does the new coronavirus compare with the flu? Virus transmission The measure scientists use to determine how easily a virus spreads is known as the "basic reproduction number," or R0 (pronounced R-nought). This is an estimate of the average number of people who catch the virus from a single infected person, Live science previously reported. The flu has an R0 value of about 1.3, according to The New York Times. Researchers are still working to determine the R0 for COVID-19. Preliminary studies have estimated an R0 value for the new coronavirus to be between 2 and 3, according to the JAMA review study published Feb. 28. This means each infected person has spread the virus to an average of 2 to 3 people. Coronavirus: New graph shows people in their 20s are more asymptomatic and not being tested for COVID-19 These three articles explain what this virus is spreading like crazy, and will now likely be impossible to eradicate. After missing the signals and covering it up for maybe a month, China reversed course and was extremely pro-active (or draconian) in testing, tracing, and treating. South Korea has basically done a different version of the same thing, with a softer touch. While the red bars in that graph are not "scientific", they probably represent a better picture of how COVID-19 is ditributed through the population. More than a third of the infected in South Korea were under 30 years old. The only reason we know they were infected is the voluntary mass testing effort. No one knows, but looking at that chart there's probably a good chance that a lot of children are probably infected, but they don't get sick and nobody knows it because there is not mass testing. https://www.statista.com/statistics/1102777/south-korea-covid-19-daily-new-cases/ South Korea has been able to keep it contained, so far. Just in the last week, as the graph in that link shows, there was a bump up in new cases again. But my guess is they traced contacts and tested those people, so the new of new cases a day is back down into the high double digits. Meanwhile, partly because of the fact that we are now finally testing, we have about 5000 new cases a day. And those are people who were probably tested because they are sypmtomatic. So probably very few of the people who are infected but not sick are being tested in the US right now. Add all this together and the plans I described in the prior post by Gov. Newsom sound very rational. We don't have adequate tests to do mass testing, since we weren't warned or prepared. Now it may be too late. So what he seems to be doing is trying to reduce and spread out the size of the first tidal wave, so that the state's health system is better able to handle it. And he's telling older and sicker people to stay home. Some of the articles I've been reading are saying this is going to be like a roller coaster. There will be waves of outbreaks, which will gradually grow smaller as more people get sick, recover, and get immunity - assuming that once you get sick and recover you are immune from this, and it doesn't mutate into something else. Herd immunity There's an interesting chart toward the bottom of that article that I can't cut and paste. It provides a broad range - about 30 % to 75 % - of Americans that would need to be infected and recovered so that the transmission of COVID-19 can be significantly slowed, or prevented. If Newsom is right, California will spend Spring 2020 going through a wave of mass infection. If that happens, my guess is we'll then move on to a period of mass testing to identify people who did not get sick but may be carrying the virus. Earlier in this thread I described an Italian village that reduces new infections to zero. They tested everybody, and 3 % of the population was positive but asymptomatic. They self-isolated those people and those they'd been close to, and a few weeks later tested again. At that point, 0.3 % of the population tested positive. After those people were isolated, they wiped it out. That may work in a village that is self-quarantining. But it obviously can't work in a globally connected economy like California's. What I've been wondering is how do you deal with the facts that seniors who could get seriously ill from this are being served coffee or dinner from 20 year olds who are asymptomatic but may be shedding the virus like crazy? If millions of young Californians get infected with COVID-19 this Spring and recover without even knowing they were sick, and then have immunity, that problem party solves itself. It will be a once in a lifetime form of Spring break, hopefully. As long as the state can provide the care for the small percentage of young people that experience this as something more than the flu. Even after that happens, which is where the state seems to think this is headed, we're still going to have an aggressive program to deal with the 40 %+ of the population that can create new outbreaks until we have a vaccine.

Great. And do I get a bonus if I provide foster care for the entire set? Obviously, they are used to strenuous team play together. In a challenging moment like this, why not just go with the flow?

I finally got the brilliant idea of watching Gov. Newsom's press conference today. It could not possibly be more sensational. Not in the sense that it is wrong. I mean in the sense that if it is right, we are going to go through a once in a lifetime roller coaster ride together. Gavin Newsom: 56% of California projected to be infected with coronavirus in 8-week period California Gov. Gavin Newsom requested a hospital ship from the federal government Thursday afternoon, citing a shocking projection from state officials. Newsom expects 56 percent of California’s population, a whopping 25.5 million people, will be infected over an eight-week period this spring. He did not say whether the projection covered the next eight weeks, a period that has already begun or a future period. Newsom’s huge projection of spread may seem outlandish. “Is it plausible? Is it possible? Yes. Should we be planning for the worst while hoping for the best? I think that’s what the governor is trying to do,” said Arthur Reingold, division head of epidemiology and biostatistics at UC Berkeley. “We need to plan for something as dire as that in terms of hospital beds, testing, ventilator, to try and convince people that this is a serious problem.” Reingold pointed out that that figure represents the number of people infected, not the number who may show symptoms or require a hospital visit. “If we’re talking about the population that will get infected, some proportion of that will not get sick and a lot of those who do get sick will be with a mild, self-limited illness,” he said. Newsom's tone was hopeful, and his language was cautious. He talked about "outcomes" rather than "death". He went through it very matter of factly and said California and Californians will rise to the occasion. But what is clear is the the state is preparing for the absolute worst while it tells Californians to be take this very seriously but also hope for the best. Here's his 45 minute press conference if anyone wants to watch it. Major Announcement on CA's Response to COVID-19 California is planning on the idea that they need to have "hospital" beds ready for 20 % of those roughly 25 million Californians. They are buying up hotels and redeploying construction workers to retrofit structures as emergency hospital or care centers. California construction workers prepare to mobilize for coronavirus surge response OAKLAND — The head of California’s powerful building and construction trades union says plans are in the works to deploy tens of thousands of construction workers to retool and refit hospitals, hotels and buildings the state needs as a surge response to the coronavirus pandemic. “We’re being mobilized — more than we’re being told to step back,’’ said Robbie Hunter, president of the California Building and Construction Trades Council, which represents 460,000 workers and 63,000 apprentices. They also are organizing recently retired medical professionals to come back to work to get us through this. Elon Musk, or some other "well known" entrepreneur, is working with the state on the emergency production of respirators. If I did the math right, Newsom walked through that the state has something in the ballpark of of 10,000 respirators. Using that study of 1000 sick patients in China I posted earlier in this thread, in that "normal" population with a median age of 47 something like 2 % of people needed them. So if 25 million Californians get sick, 20 % of them require hospital care, and 2 % of them may require respirators, that's about 100,000 repsirators needed. That's assuming that this all hits in one massive wave over eight weeks. Newsom kept using the number 19,543 as a primary cause of concern. He mentioned it several times, and it wasn't clear to me what he was talking about. So I Googled it. He was referring to 19,543 hospital beds that they are short, based on these projections. It was a smart approach, I thought. Whether anyone thinks it is hysterical or not, the feeling it creates it that there is a plan for the worst case scenario. And he is trying to make sure there are beds and care for all the people who need it. If something like that is happening at the federal level, I'm not hearing it. This surprised me. The average age of Californians is only 36. That's a few years younger than the average American. That should help in terms of capacity, because most young people who are infected don't get really sick, or even symptomatic in any way. So that 20 % hospitalization rate errs on the high side, which Newsom basically said. No one knows why certain patients in their 20's get hit harder than others. One theory is that young adults and teens who smoke or vape are more are risk, because it harms their lungs. Some of the young adults in ICUs are known to have been vapers. Mostly, the verdict appears to be coming in that a lot of young people - teens and in their 20's - are infected with the disease but not symptomatic. That is why this thing is spreading so quickly. They are highly contagious before they get sick with something that seems like the flu. And many of them never get sick. But they are unknowingly spreading a virus that is potentially life threatening to those who are older and/or sicker.

So I think the picture is already emerging of how we are going to be living and protecting ourselves for the next year, or however long it takes to eradicate or contain this virus. If that is what we actually try to do, as opposed to just letting it run its course through the population. This is the COVID-19 state by state tracker that Politico used to do that state-by-state graphic I posted above. The COVID Tracking Project It lists current diagnosed cases per state, deaths, and other data. It also has a list to each state's own website dealing with COVID-19. Of the half dozen or so I looked at, they are all run by the state's Department Of Public Health. 'The kinds of systems for public awareness and testing and tracing are being built state by state as we speak. No surprise, some states do better than others. Here are two state information systems that seem better than average to me. Colorado Case Summary Florida's COVID-19 Data and Surveillance Dashboard Florida Department of Health, Division of Disease Control and Health Protection As of right now, Colorado has 363 cases, 44 hospitalizations, and 4 deaths Florida has 563 cases, an unknown number of hospitalizations, and 10 deaths. The Florida website is the most user friendly and full of data of any of the ones I looked at. For each county they list the numbers of people tested, confirmed positive cases, people under investigation, people hospitalized. Every county in Florida lists "people under investigation". I assume that refers to the beginnings of an infrastructure to try to trace who else people with diagnosed infections may have infected. The current scientific best guess is that everyone infected goes on to infect 2.3 other people. Miami has it's work cut out for it. If you click on Dade County on the Florida website above, you will see there are 125 people currently hospitalized for COVID-19. That would mean that roughly 1250 people were infected in Dade County a week ago, and now 10 % of them need hospitalization. During the last week, it would also mean everybody with the virus infected 2.3 more people. That means there are possibly 4000 infections in Dade County now. The Dade County data says that only about 1000 people have been tested, of which 123 are positive. That means that maybe only about 3 % of the people with COVID-19 know they have it. My guess is those are people who ended up in hospitals, anyway, and were tested. Meanwhile, that leaves close to 4000 other people spreading the virus right now around Miami, unless they are isolating themselves.

This is worth reading or scanning. It is written by Michael Donnelly. Same data scientist as in the prior post. COVID-19: No Good Options An epidemiological, economic, and policy analysis of the novel coronavirus epidemic Michael Donnelly — March 11, 2020 Reported cases of COVID-19 in the US dramatically understate the current number of infected Americans. The current US mortality rate is likely much lower than reported (~0.4%). Asymptomatic and mild cases are hard to detect and make this disease incredibly difficult to contain. Without strong government intervention to slow the spread, the disease could spread to millions of Americans in very little time. This would overwhelm hospitals and increase the mortality rate of the disease. Federal, state, and local governments will be forced to take unprecedented steps to slow the spread of the virus, including quarantines, school and business closures, and domestic travel restrictions. While there will be significant economic fallout from these measures, the damage to the country and economy would be worse without them. Most of the economic costs of the government response will fall to lower and middle income wage workers. Policies, such as enhanced unemployment insurance, should be adopted quickly to compensate these workers for the sacrifices made in the best interest of the country. Policymakers should also implement smart economic policies that will slow the spread of the virus in order to protect the public. Requiring paid sick leave and guaranteed healthcare will slow the spread and economic consequences of COVID-19. Quick note from the author Disclaimer. I am writing this on my own behalf to try to increase transparency and information about the seriousness of the situation we’re facing. The views and work contained in this note are purely my own and represent no one else and no organization or company. (He works for Facebook.) Note what Donnelly wrote in that report just 9 days ago: As of writing this, the world has over 100,000 confirmed cases of the novel coronavirus disease, COVID-19. Most of the cases are still in China, but that picture is changing rapidly. As recently as two weeks ago (Feb 23), China’s cases represented >97% of global cases. As of March 10, that number has dropped to 68%. It is becoming clear that the rest of the world will soon surpass China’s infection count. In fact, we're now at 275,000 cases globally. About 30 % of them were in China, which has eradicated community spread for now. And in a week plus change, many of the unprecedented government actions he predicted would be needed have actually happened. Donnelly thinks the actual death rate may be as low as 0.4 %. Dr. Fauci thinks it is probably 1 %. If 200 million Americans get infected that means 1 million to 2 million deaths. And it actually probably means much more. Because the hospitals beds, doctors, nurses, and respirators that could have kept many alive will not be available. Italy has overtaken China as the country with the most cases, over 4000. Italy has just under 50,000 cases. They have consistently been averaging a death rate of slightly less than 10 % as the number of cases and deaths has grown. I think Italy illustrates that we have to think of this as both a pandemic and a "hospital-demic". The reason the death rate is so much higher in Italy is that partly the patients or older. Almost all of them had at least one underlying condition, like a heart or lung condition. But in addition they have run out of hospital beds and life saving equipment in the hardest hit areas. In a new study of 2003 Italian patients in this study who died, 1425 of them were in Lombardy (71 %) and 346 of them (17 %) were in Emilia-Romagna. So you had older people in their 60's, 70's, and 80's with serious pre-existing conditions crammed into hospitals without the capacity to save all of them. That's a "hospital-demic". We also now have a report that documents the huge difference between having a "hospital-demic" and catching this earlier through test, trace, and treat. This is a study of 1099 COVID-19 patients in China: Clinical Characteristics of Coronavirus Disease 2019 in China What's particularly interesting about this report is that it is almost the exact opposite of what happened in Italy. In Italy, the death rate is close to 10 %. In this study in China, it was 1.4 %. The average age of those who died in Italy is about 80. Only 15 of the Chinese patients in this study died, and it does not give their age. But the average age of all 1099 patients was only 47. This is a breakdown of those patients. I'm posting it because I think you could look at this as representative of "America's workforce". The huge problem every nation in the world has now is how can people go to work when just doing their day to day routine may kill them? Whether that is true or not is irrelevant. The panic is growing, and as the deaths mount it will only get worse. So right now having clear information and hope based on real numbers, not bullshit, is critical. Half of the patients are people who lived in Wuhan. Almost everyone else had either recently visited Wuhan, or had direct contact with Wuhan residents. The million dollar question for the rest of the world right now is: how did you find these infected people? I assume some of them got sick and came forward. But I also assume most of them were found quickly through a very aggressive tracing program, before they could spread the disease. It looks like all the people in this study were hospitalized. It's not clear to me whether the Chinese put everybody that had COVID-19 in hospitals, or whether this represents some portion of all the people infected who were judged to need hospital care. My guess from the numbers, and from China's aggressive policy, was that EVERYBODY who was found to be infected was hospitalized and isolated. From that point on, the news is actually pretty good. Of these 1099 patients, 926 (or 84 %) had "nonsevere" cases. That is consistent with everything we've heard so far. If you read the whole report, there are several other tables on what interventions were required, and how 14 people died - mostly acute respiratory distress syndrome and septic shock as organs shut down. The scary part to me is that 5 % of patients needed to be admitted to the ICU. 2.3 % underwent invasive mechanical ventilation. As I said above, 1.4 % died. The report does not list the age or pre-existing conditions of the 14 who died. But as you can see above almost one quarter of the 1099 patients had pre-existing conditions, including things like cancer, hepatitis B, and diabetes. Almost all of them lived. The reason I think this matters is that with every day it is more apparent that we are going to have to live with this virus and contain it, much like we do AIDS. We'll also need extremely aggressive testing and tracing protocols. If we had been told two months ago we needed to stop this virus immediately, because otherwise it will shut America and the world down, we probably would have almost all agreed to do whatever it takes. So I think once we get this under control we're going to have to live in a nation for a while where there is every reason to think this is under control. But also where we recognize there is going to be some risk of a new outbreak somewhere. At a minimum, I think we could mostly all go back to work at such a point if we knew that there were policies everywhere to nip this in the bud wherever it breaks out. As a matter of national policy, I think anyone who gets COVID-19 should get 100 % free medical care. If we really get it under control, I think anyone who gets COVID-19 should be sent immediately to a hospital, where they are isolated and treated until they are well. That's better than having thousands of infected people walking around infecting other people, because they don't have the money to be treated and they only have a mild illness themselves. The good news from the data from China above is that if you are a middle-aged employee and you get sick, despite that fact that everyone in the nation is now focused on wiping this virus out, you have an 85 % chance of this being like a bad case of the flu. Ideally, in my mind, people would think of it as a two week paid vacation, albeit spent in a hospital bed, so all the rest of us can work safely while you get well. The bad news is that 1 out of every 100 people or so will die. But the data suggest that those are most likely to be people who had serious health issues already. I can't see Americans tolerating a situation where this virus is allowed to run rampant, and we have hundreds of thousands of people dying in hospitals and makeshift hospitals all at once, until several million of us are dead. I can see America living with the consequences of where China and South Korea are right now. Until there is a vaccine or this virus goes away, it's a given that there will be outbreaks somewhere. But if we do some version of what China and South Korea did, we could realistically mostly contain the virus and prevent community spread. Perhaps we can limit the numbers of deaths that occur to what happens in a particularly bad flu season. We'll know much better soon, because the tidal wave is starting to hit.

And here is an early and tragic example that I think underlines this point. COVID-19: NYC should brace for impact and shut down now. Those charts, which I'll grow through, explain why we will all have to view this partly as a "hospital-demic". And any hope of getting back to anything near normal is fucked until we lower the number of infections and hospitalizations by getting this virus under control. Michael Donnelly is a professional data scientist at Facebook. But the charts above are his own projections he is putting out there to create public awareness. It is getting picked up in news pieces by credible outlets of journalism like Politico. And whether the guy is 100 % right or 70 % right, what he is doing is brilliant. It could save a hell of a lot of lives. It would be a very good thing if the Governors Association (or The White House) adopted some standard like this ASAP, so that people in every state could know what their risk looked like. If you assume that we will get this in control in most parts of the US in a few months, daily updates like this also really help the public and restore confidence. Like we would know WHEN and WHERE it is save to go back outside. And WHEN and WHERE they have to be extremely careful. Every large city in the US could be doing this, too. We know enough about how this played out in China and is playing out in Italy to make some educated guesses. So the math is simple and sound, even though it is based on assumptions. And you could do math like this for any state or any city in the US. There are 777 COVID-19 hospitalizations in NYC as of yesterday. The assumption this guy makes is that 10 % of cases require hospitalization. (I've read reports on cases in China that suggest that it could be as high as 20 %. That said, probably 10 % of all cases are serious, but not so severe that sending you home because the hospital does not have any more beds is not an automatic death sentence.) So he backs up and says that 777 cases means that's from a population of 7770 infected people, 10 % of whom now need to be in a hospital. And he backs that 7770 infections up a week, because the 777 people in the hospital today got infected a week ago. (I've read things that suggest it could be up to two weeks from infection to hospitalization. So if anything this may underestimate the actual number of infections.) Finally he takes the actual number of diagnosed infections a week ago (220) and divides that by his estimate of how many infections he thinks there really were (7770). He concludes that only about 3 % of infected people last week were diagnosed. He estimates that now that we are finally ramping up testing, maybe 5 % of cases are being diagnosed today. Based on that, he estimated that there are now about 70,000 infected people in NYC. In a week, there will be about 400,000 people. He's calling for a complete shutdown of NYC, like we have in California, other than essential services. Gov. Cuomo, after resisting the idea for days, has now issued similar state at home orders statewide. I assume this is why. The obvious flaw in the logic here is that the rate of infection may have declined. The scientists seem to agree that every infected person infects two more people, often or maybe usually without even knowing they are sick. Which is why we have to stop letting this grow exponentially before we have a NYC-style like crisis in all 50 US states. Donnelly is estimating that by next week all 3000 beds that NYC has available for COVID-19 patients will be full by next week. He is also saying that all 3000 people who will need those beds are already infected. We will know in a week if his estimates were right. Safety net hospitals a 'disaster' as coronavirus patients begin to flood in “It’s a disaster,” said Dr. Conrad Fischer, residency program director in internal medicine at Brookdale University Medical Center. “We just had a half dozen staff just test positive. We have 17 ventilators left in the institution. Some staff can't come because they’re getting wiped out.” Gov. Andrew Cuomo expects the surge of Covid-19 patients to come within the next 43 days, though Michael Donnelly, a data scientist at Facebook, believes New York City hospitals will reach capacity of 3,000 cases by Tuesday. Based on his modeling, hospitals could see 100 new patients an hour by March 28. Greater New York Hospital Association, which represents many private hospitals in the city, did not return a request for comment on the analysis. The increase in caseload could not only overwhelm the bed capacity but also sicken front-line health care workers who have limited protective gear. Under mandates that all health care workers report for duty, even if those staffers were furloughed, units could fall sick to the virus should someone test positive, but show no symptoms. That article from Politico is how I got to Donnelly. This is going to be a disaster. It is already a disaster in the "safety net" hospitals. But soon it will be a disaster for hospitals the serve the relatively affluent, just like it is in Italy. This will definitely help get the message through that if you are well you need to stay home. If you even possibly could be infected, you need to stay away from other people. The experience of China and South Korea is that as bad as it is going to get, if we do that we can get it under control in a month in many places, and a few months in the hot spots.

Come to think of it, they've closed all the campuses and dorms. Is there a foster college athlete service?

I've watched way more TV news than usual. And it's mostly the same faces I am used to seeing on a studio set. So it is interesting seeing what I assume is their office, their book shelf, their decorating taste. And they don't look as made up. Some of that is the quality of video. But I assume some of it is they just don't have make up artists. For me, there's actually something mildly comforting about it all. The pictures are hardly normal. But everybody is getting by.

Hmm. Go figure. I guess to each his own. I was an escort from 2000 to 2018 or so. It often involved working from home. The upside was the live interaction. The other upside was that I always had to shower afterward.

So here are three very comprehensive sources of data. If you don't like charts and graphs, definitely give this post a pass. What seems obvious already is that the spirit of "all for one and one for all", with extra big helpings of human kindness, is kicking in. AIDS - or any STD - is a helpful analogy for thinking about this to me. It is real. It is scary. And staying healthy means staying informed and being smart, and working through this together. I had a line I always used when new clients asked me about STDs. I always advised them that while AIDS is a killer, the things they really needed to worry about are things like gonorrhea. AIDS is pretty hard to get, as long as you do easy things to prevent it. The clap is very easy to pass along before you even know you have it. This is somewhere between the two. Much more like gonorrhea than AIDS. The difference is the risk group is the entire human population. And basic human behavior is now risky. Live tracker: How many coronavirus cases have been reported in each U.S. state? That shows testing rates and numbers of positive results by state. I think Politico updates it daily. The hopeful lesson from provinces in China is that by acting quickly, and aggressively testing and tracing, they minimized the spread of the virus in almost every province. Very few people outside Hubei Province died. Like 0 to 10 people died in provinces bigger than California. I suspect that, absent a tidal wave of thousands getting this all at once, the risk groups that did get very ill in the other provinces all got the life saving medical care they needed. They avoided the "hospital-demic" that befell Wuhan. We've missed the ball in some states, starting with New York. But I'm hoping people in North Dakota, where they have 15 positives out of some 500 tests, are watching TV and hearing about that family of 8 in New Jersey that was half wiped out just because they celebrated together a few weekends ago. Nobody will want this movie playing in their dining room, or their local hospital ER rooms, if they can avoid it. And I'm sure this is now priority # 1 for every Governor in America. It will take a while to get the tests outs. But my guess is within a few months tops there will be a tidal wave of testing, including hopefully "do it at home" tests. I for one think it would be smart if we did impose more restrictive quarantines in certain hot spots, like China did. People agreed with it once they understood the basic idea was to keep them alive and well. But this is America, where individualism rules. To go back to AIDS, it is the equivalent of saying we will close the bath houses, so that when we reopen them we are all safe. I hope part of hunkering down is we're all going to be training ourselves to think not only about six feet around us. I hope we all start drawing circles out from that: is my community safe? is my city safe? is my state safe? Living in a state like California that is going to have a huge wave of cases for a while, it would give me a reason to feel good and hope that this is something people in North Dakota don't have to worry about, at least. Hopefully, they have all the tests and ICU beds they need. People in North Dakota will of course be hoping California gets it contained soon, so they can come bike through the Presidio and hang out at Fisherman's Wharf again. How Much Worse the Coronavirus Could Get, in Charts That is a cooler version of the "flatten the curve" graphic we have all seen by now. It was helpful for me to think about this. (The New York Times now offers all COVID-19 news, like the article above, free to non-subscribers we sign in on Facebook or Google.) Here's the things that were helpful for me to think about. 1. It will get a lot worse before it gets better. The better job we all do of taking care of ourselves and those we care about the less horrible this will be. But it will be horrible. I think this is one where it's just hard to overreact - which is what Dr. Fauci has been saying consistently. 2. Look at those timelines. Gov. Newsom said in California we're in "shelter at home" mode for a few months, which I think is correct. He's also said it could go on for longer. My view of this is that China was able to eradicate community spread of the virus in a few months - FOR NOW - by using a heavy hand. South Korea has been able to largely contain community spread in about a month while using a softer hand. Remember the magic words: test, trace, treat. For those of us who like whoring, we're just doing a reverse Halloween. First we treat, then we can trick again. After looking at that chart, I changed my "emergency" timeline from three months to one year. Which is to say, we are all living on the timeline of the virus now. Sort of like we live on the timeline cancer gives us, if we get it. This is actually a much better prognosis than almost any form of cancer. Because even if it can't be treated with a vaccine, this form of cancer is 99 % survivable, if we catch it. And the virus will likely go away in a year or so. But if you look at those infection curves, this is going to be around for much longer than a few months - no matter what we do. I'm trying to get a handle on how my tenants pay rent for the next year, how much I can cut the rent to help them while still being able to pay mortgages and utility bills, etc. There are at least some industries that are likely to take quite a while to get back to normal, no matter how big a bailout they get. Schumer said something that struck me as wise: this is worse than 9/11 or the predatory lending crisis. Because we're just all going to have to learn to live with a lot of uncertainty for a while. The 1918 pandemic is probably the best analogy. At some point this shall pass. But it may take a year. And we don't get to decide whether, like in 1918, the virus backs off in the Summer and then comes back even worse in the Fall. But even in the worst case, at least we now know we have six months to prepare for that possibility. As the politicians and scientists and doctors think this through, it seems inevitable that we're going to have to think of living with this like we think about living with AIDS, or some forms of cancer. Meaning the majority of people in low risks groups can act one way. But the minority in high risk groups have to be way more careful. The young and healthy won't want to stay home for a year. So we'll have to find a way they can go back to 90 % normal work and play. As of what we know now, they'll face less risk of dying from COVID-19 than they do from a car crash or drug overdose. So by next Spring, hopefully they'll be tons of them partying on the beach in Florida or Mexico so that airlines and hotels have revenue again. That said, the significant minority of people that are older or sicker are going to have to live by different rules. Maybe for like a year. It's not clear how a 70 year old with diabetes and a heart condition goes to Starbucks and gets served by a college student who may have an undiagnosed infection. Unless they know there are zero cases of COVID-19 in their state. We'll all probably have to recalibrate what acceptable risks mean. Unless this magically disappears, or we expedite an effective vaccine. I assume the people who make the big bucks are all trying to figure out how you have an economy that can get back to "mostly normal", while we all have the threat of this virus hanging over us for a year, or maybe for longer. At a minimum, I think we're going to have to deal with the "hospital-demic" issue before people who are at higher risk of ending up in a hospital are going to feel safe at Olive Garden, or in a casino. Being a senior, or younger and sick, is going to be like the new "Gay" for a while. Just like AIDS, this will require a different set of needs, treatments, and precautions. Unlike Gays and AIDS in the 80's, it will be impossible for the rest of society to sweep this under the rug. Which Country Has Flattened the Curve for the Coronavirus? Those charts from China and South Korea are the things that give me the most hope. And those charts from almost every country really bring home that we are in the early stages of a huge global mess. The idea that we'll be able to just hop on a plane and go to Mexico or Brazil or Thailand this Fall doesn't sound very likely. And when we are able to do it, it's going to be different. I'm glad every country is shutting down their borders. We should have done that earlier, in my mind. But once the borders are open again this is going to require a greater degree of global cooperation than before. We now know, from experience, that this could start anywhere in the world and be everywhere in a few months. We're going to pay a huge price for letting this happen, and we only want to pay that price once. No country that beat this back is going to want business travelers and tourists coming in and kicking off a second wave of infections. The other "good news", if you can call it that, is that this is a form of democracy at work. Some nations will handle this better than others. We'll all learn from them. Scientists all over the globe are working together to understand the virus and find treatments and vaccines. So we'll gradually get a better handle on how we get this under control, and keep it under control.

Those of us with short penises have to compensate somehow. So I guess what I'm saying is count your blessings. To say the obvious, @MrMattBig.

This relates to the post above, but I'm pulling it out separately. We can all breathe a huge sigh or relief that we don't get to relive this terror. That's the "Spanish" flu epidemic-related death rate of 1918. For whatever reason, it preyed on the young and the healthy. This was partly what sounded so scary about the anecdotal stories coming out of Italy. And now US officials are pushing this message, in part I think to get Millennials to give up bars and beaches for a few weeks and just stay home. Here are some not so fun facts. In 1917 the life expectancy of the average American was 48.4 years for men and 54.0 years for women In 1918 the life expectancy of the average American was 36.6 years for men and 42.2 years for women In 1919 the life expectancy of the average American was 53.5 years for men and 56.0 years from women Obviously the rates are computed based on the number of deaths that year. So my emotional take on this is that if we were facing a pandemic like 1918, we'd be deeply fucked. It would be like 9/11 every day. And the youngest and healthiest people that carry a lot of the weight of a lot of entry-level jobs at Starbucks or Apple stores are the ones the planes are headed directly towards. It will be a very good thing if we don't have that problem. The problem we will have if this virus is not contained is how do the 15 -20 % of people who are 65 +, or younger people with serious conditions, walk into a Starbucks or cinema and order popcorn without feeling they are putting their life at risk? Assuming this virus is still maybe hidden in the nooks and crannies. Which it likely will be.

Nobody has posted on this so I should probably leave it alone. But of course I can't do that. These numbers in that video are goofy. I think the argument it makes - that COVID-19 = the common flu - has been officially put to bed. Good night, and good riddance. Part of the argument in this video is that if you go by "confirmed" flu rates - whatever that means - the death rate for common flu is 10 %. That of course makes no sense. Were that true, we'd all be terrified constantly. I think I'd rather do this once in a lifetime, thank you. The death rate being thrown around in Italy for confirmed COVID-19 cases is often in the ballpark of 10 %. That's created mass terror. Were the rate accurate - meaning if everyone in Italy got tested - one projection in an article I'll post below estimates a true rate of 2 %. In fact, no one knows. I'm with Dr. Fauci on this. He's saying 1 % death rate is an informed guess, meaning it is 10 times more deadly than the common flu. That's lower than most of the numbers being thrown around based on limited populations of fairly to very sick people. He factors in that most people who just experience this as "the flu" haven't been tested, and they are fine. The scientists like him saved us from AIDS. I'm happy to trust them to save us from COVID-19. The swine flu data from 2009 have been thrown around a lot. On the face of it they suggest COVID-19 is 50 times worse than the 2009 flu pandemic. The figures for that are estimated to be 61 million cases in the US, with 274,000 hospitalizations and 12,400 deaths. In that video above, I think what the guy did is substituted "confirmed cases" for a typical seasonal flu with "hospitalizations" to get a 10 % death rate. That's nonsense, since we all know that few people who get the regular flu end up in a hospital. It may well be true that if you get the regular flu and end up in the hospital, you have a 10 % chance of dying. In the case of swine flu, as you can see from those numbers, if you got it and ended up in the hospital, it was more like a 4 % chance of dying. The overall death rate from swine flu in 2019 was 0.02 %. I think Fauci's numbers are 0.1 % death rate for the annual flu, and 1 % death rate for COVID-19. As he keeps saying, 10 times as deadly is his guess. The other reality check on this for me: go walk through a hospital in Italy. That should resolve any lingering question about whether this is "normal". Meanwhile, the thing I'm curious about is this: if you pick any province in China other than Hubei, it may have had 50 or 500 or tops maybe 2000 cases. But almost nobody died. https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 You can zoom in on China and look at it province by province. These provinces mostly have populations like California or New York or larger. In some cases there are zero deaths, but in I think every case other than Hubei the deaths are a single digit number. It could be China is just lying. But there is research coming out on characteristics of who died and why, and it seems to be running through WHO. So I'm not sure they'd just make it up. Add then there is this, which is probably one of the most significant pieces of learning to date - if this holds up: 99% of Those Who Died From Virus Had Other Illness, Italy Says The Rome-based institute has examined medical records of about 18% of the country’s coronavirus fatalities, finding that just three victims, or 0.8% of the total, had no previous pathology. Almost half of the victims suffered from at least three prior illnesses and about a fourth had either one or two previous conditions. More than 75% had high blood pressure, about 35% had diabetes and a third suffered from heart disease. The average age of those who’ve died from the virus in Italy is 79.5. As of March 17, 17 people under 50 had died from the disease. All of Italy’s victims under 40 have been males with serious existing medical conditions. This directly contradicts some of the messages coming out of Italy about "the young". To some degree this is stuff off YouTube videos or Twitter. But I also have read stuff quoting actual Italian doctors. Meaning the messages have been that 30 year old men and 35 year old young Moms are on respirators, for no apparent reason. That may be true. But what this suggests, if true, is that it was a 30 year old man with diabetes and a heart condition, perhaps. One article I read said that up to 70 % of the US population has some "pre-existing condition". But the medical professionals and science seem to be quickly figuring out who is most at risk, and why. This would also be a logical explanation for China's numbers. There was a mass exodus from Wuhan's New Years festivities right around the Jan. 23 lock down. So assuming many or most of those cases in other provinces were directly tied to travel to Wuhan, they caught it early. They may also have been relatively younger and healthier people that would likely travel, as opposed to an 80 year old at home in a wheelchair. If the question is: "How the fuck do we get out of this mess, Sherlock?" this may be relatively good news. It suggests that the way to think of this may be less as a pandemic, and more as a hospi-demic. Meaning not enough hospitals. The biggest problem this poses, which Italy is facing, is that you just can't let this roll through a population without putting tremendous stress on the entire health system of a country, and freaking everybody healthy out. Partly because a death rate of 8 % sound horrific, even if you factor in an older and sicker population. And partly because everybody healthy is also a potential emergency room intake due to car crashes, or drug overdoses, or gunshot wounds. Elective surgery? Forget it. Coronavirus death rate drops: Better math, better treatment or more testing? The death rate in Wuhan, China, where the outbreak began, is now estimated at 1.4 percent after initial reports of 4 percent. That's a new and improved take on the WHO's initial number. It's based on a sample of about 1100 patients across China. From other reports I think we know the death rate in the first week in Wuhan was something like 17 %, and the death rate in the last week in Wuhan was under 1 %. I think the picture this all adds up to is that Dr. Fauci gets paid the big bucks for a reason. Under "normal" circumstances, maybe about 1 % of the population that gets infected and symptomatic is likely to die. It still doesn't seem at all clear how many people and what age of people may be infected but completely asymptomatic. Another key piece of data from that NOJM report on China is that of those 1100 patients, 5 % ended up in the ICU. In other words, with a death rate of 1.4 %, your chances of going into an ICU and coming out of it alive were slightly less than 3 in 4. That's not awful odds for the worst cases of the worst cases of the worst case scenario. Again, this suggests that we will perhaps move to a clearer understanding of this as "hospi-demic". That's already of course what's at the bottom of the "flatten the curve" concept. The US worst case scenario is 2 million dead. I think the way they got to that is took 330 million people, assumed 60 % were infected (200 million), and of those 1 % died (2 million). If you take those Wuhan numbers, that implies 10 million people (5 % of those infected) may need ICU care. This USA Today article says 3 million ICU beds needed if we redo the 1918 pandemic. Either way, we're fucked. USA Today says of the 1 million hospital beds about 100,000 of them are the most intensive care. I can't imagine we can have 100 % normal business in a world where every nation harbors the potential for infection or new outbreaks. My guess is we're going to have to make a choice at some point. Do we live in a world that is relatively safe for most people, but we have to treat COVID-19 like it is the new ISIS, and always be on guard for it? Or do we stay at home for a year perhaps until there is a vaccine? That is probably a no-brainer. There are tremendous practical implications. My Mom and Dad were both in their 90's at a nursing home where most of the entry level staff was in their 20's. In their 80s I'd take them to Applebees, where the wait staff was college students. So can you have 20 year olds who are healthy but infected feeding 80 or 90 year olds who they could infect? Can the grandkids visit? What are the new rules? How do we make sure we jump on any new outbreak immediately? Those are among the questions that will need to be debated before we can get back to work. Given that we are not China, I don't see how we get to 100 % eradication. And it's not clear China is there, or can stay there. Is eradication the goal, or containment and control like the way we view terrorism?