Coronavirus Numbers

[+ stevenkesslar]

Here's the link to the article I citied above that convinced me almost 2 months ago that this was airborne and made to go buy masks quick. https://www.dailymail.co.uk/news/article-8094933/How-one-man-spread-coronavirus-NINE-people-bus.html

 

One of the few benefits of a surveillance state is that there are cameras and trackers everywhere for disease tracking and this man evidently was traced to spreading it to people far apart on the bus.

 

Thanks for posting that. Here's the main takeaways for me.

Dr Shixiong and colleagues wrote: 'It can be confirmed that in a closed environment with air-conditioning, the transmission distance of the new coronavirus will exceed the commonly recognised safe distance.

 

'The possible reason is that in a completely enclosed space, the airflow is mainly driven by the hot air generated by the air conditioning. The rise of the hot air can transport the virus-laden droplets to a greater distance.

 

'When riding on more closed public transportation such as subways, cars, planes, etc, you should wear a mask all the time, and at the same time, minimise the contact between your hands and public areas, and avoid touching your face before cleaning.'

 

Public Health England defines a close contact as anyone who spends more than 15 minutes within two metres of an infected person, rather than simply passing them in the street or be around them in a shop.

 

It sounds very much like the restaurant story and chart. We can think of the bus as the same as a restaurant on wheels. Like with the restaurant, one of the key variables is air conditioning and air flow. I agree with you that the other variable is wearing the mask.

 

I still feel this has to be an outlier. They say Patient A infected 13 others that they know of. So this is an outlier. And it's not clear from the story that they know for sure that the one person who got on the bus 30 minutes later got infected by Patient A. There is no way they could know that.

 

One other factor is that this guy was on a long distance bus for four hours. So I don't know that is the same as being on a bus or subway for 10 or 20 minutes. Again, I agree with you 100 % that masks are seemingly a solution to this problem.

 

All of this puts the lie to the notion that we can just work our way through a pandemic. The main problem with the ideas are the most obviosu ones. You can't have 35 % of your workforce contagious, 25 % sick, 10 % hospitalized, and 1 % dead. So issues like how people get to work are secondary. But it just doesn't make sense that during a pandemic people are going to go eat at a restaurant or ride a bus or go work in enclosed spaces close to lots of people - if they have a choice in the matter.

 

I think this actually explains why we know, from history, that trying to keep the economy going by just working through a pandemic actually drives economic and social collapse.

 

I doubt people in South Korea feel "safe" right now. But they do feel safe enough to go to work in offices, go out to eat, and ride subways. That has to be because only a handful of people in the country are infected every day. And at least if you happened to be near one of them, you will learn that through those apps immediately.

 

In an environment like NYC, where every time you leave your home or apartment you are at risk of running into many infected people, the economy and the social order are much more vulnerable to collapse.

[+ stevenkesslar]

Here's the link to the article I citied above that convinced me almost 2 months ago that this was airborne and made to go buy masks quick. https://www.dailymail.co.uk/news/article-8094933/How-one-man-spread-coronavirus-NINE-people-bus.html

 

One of the few benefits of a surveillance state is that there are cameras and trackers everywhere for disease tracking and this man evidently was traced to spreading it to people far apart on the bus.

 

Thanks for posting that. Here's the main takeaways for me.

Dr Shixiong and colleagues wrote: 'It can be confirmed that in a closed environment with air-conditioning, the transmission distance of the new coronavirus will exceed the commonly recognised safe distance.

 

'The possible reason is that in a completely enclosed space, the airflow is mainly driven by the hot air generated by the air conditioning. The rise of the hot air can transport the virus-laden droplets to a greater distance.

 

'When riding on more closed public transportation such as subways, cars, planes, etc, you should wear a mask all the time, and at the same time, minimise the contact between your hands and public areas, and avoid touching your face before cleaning.'

 

Public Health England defines a close contact as anyone who spends more than 15 minutes within two metres of an infected person, rather than simply passing them in the street or be around them in a shop.

 

It sounds very much like the restaurant story and chart. We can think of the bus as the same as a restaurant on wheels. Like with the restaurant, one of the key variables is air conditioning and air flow. I agree with you that the other variable is wearing the mask.

 

I still feel this has to be an outlier. They say Patient A infected 13 others that they know of. So this is an outlier. And it's not clear from the story that they know for sure that the one person who got on the bus 30 minutes later got infected by Patient A. There is no way they could know that.

 

One other factor is that this guy was on a long distance bus for four hours. So I don't know that is the same as being on a bus or subway for 10 or 20 minutes. Again, I agree with you 100 % that masks are seemingly a solution to this problem.

 

All of this puts the lie to the notion that we can just work our way through a pandemic. The main problem with the ideas are the most obviosu ones. You can't have 35 % of your workforce contagious, 25 % sick, 10 % hospitalized, and 1 % dead. So issues like how people get to work are secondary. But it just doesn't make sense that during a pandemic people are going to go eat at a restaurant or ride a bus or go work in enclosed spaces close to lots of people - if they have a choice in the matter.

 

I think this actually explains why we know, from history, that trying to keep the economy going by just working through a pandemic actually drives economic and social collapse.

 

I doubt people in South Korea feel "safe" right now. But they do feel safe enough to go to work in offices, go out to eat, and ride subways. That has to be because only a handful of people in the country are infected every day. And at least if you happened to be near one of them, you will learn that through those apps immediately.

 

In an environment like NYC, where every time you leave your home or apartment you are at risk of running into many infected people, the economy and the social order are much more vulnerable to collapse.

[+ keroscenefire]

Coronavirus patient dead after medical residents set ventilator too high

 

There actually has been some recent analysis that suggests hospitals should use ventilators less for COVID-19 patients even those with hypoxia (low-oxygen in tissues and blood). For some reason, many COVID-19 patients are able to handle some hypoxia much more than patients with other forms of pneumonia. Intubating patients causes inflammation, poor reactions to sedatives and can even cause damage and death in some cases. They are finding that simply providing oxygen through nose-prongs and supporting breathing through body positioning and other techniques might be the better course of treatment for many patients. Keep the ventilators to only the ones with dangerously low oxygen levels and those obviously struggling to breath.

[+ keroscenefire]

Coronavirus patient dead after medical residents set ventilator too high

 

There actually has been some recent analysis that suggests hospitals should use ventilators less for COVID-19 patients even those with hypoxia (low-oxygen in tissues and blood). For some reason, many COVID-19 patients are able to handle some hypoxia much more than patients with other forms of pneumonia. Intubating patients causes inflammation, poor reactions to sedatives and can even cause damage and death in some cases. They are finding that simply providing oxygen through nose-prongs and supporting breathing through body positioning and other techniques might be the better course of treatment for many patients. Keep the ventilators to only the ones with dangerously low oxygen levels and those obviously struggling to breath.

[+ stevenkesslar]

While I do think the availability of rapid testing is essential to getting this under control, as far as I am aware, the quickest test takes about an hour. Perhaps I am only dealing with hospital available tests and regulations that are done for the testing to take place in the hospital at which I work. I am sincerely asking if there are tests at this time that are readily available which can be done in minutes.

Robert Wood Johnson Rutgers, the University System for which I work has a saliva test undergoing testing but it is not readily available to associated hospitals here in NJ. By doing a saliva test, that takes away the need for the nasal swab, which when done here in the ER, requires someone with an N95 mask and a negative flow room. Though the test may take less than an hour, the rigamarole to do it and get it to the lab and back brings the time from entry to discharge to more than 2 hours. Saliva test, if it works, would cut the time in half or even less time than that.

 

I'm not 100 % sure. But I think the answer is no. There is no 15 minute, do it yourself saliva-type test. I think they are being worked on. But I don't think they are available.

 

First Saliva Test for COVID-19 Approved for Emergency Use by FDA

 

This stuff is above my pay grade. So you can read that and maybe your takeaway is different. I think the main benefit of this particular test is it gets rid of swab testing that has to be administered by a trained person wearing PPE. But it still needs to be analyzed by a machine, I think. It is not a "do it yourself" pregnancy-type test. And that article says it is still administered in hospital settings.

 

Another issue is that a lot of the tests the FDA has given their blessing to suck. I say "given their blessing" because the protocols and standards are above my pay grade. I think the antibody tests we read about in these large studies, like the ones in New York and California, are probably better tests with more reliability. The results from those studies make sense. But I don't know that we know for sure that even they are valid.

 

A test that individuals could take on their own or that hospitals or employers could use that gives results in 15 minutes and is mostly reliable would be a huge game changer. i don't think we have it yet, unfortunately.

Edited May 2, 2020 by stevenkesslar

[+ stevenkesslar]

While I do think the availability of rapid testing is essential to getting this under control, as far as I am aware, the quickest test takes about an hour. Perhaps I am only dealing with hospital available tests and regulations that are done for the testing to take place in the hospital at which I work. I am sincerely asking if there are tests at this time that are readily available which can be done in minutes.

Robert Wood Johnson Rutgers, the University System for which I work has a saliva test undergoing testing but it is not readily available to associated hospitals here in NJ. By doing a saliva test, that takes away the need for the nasal swab, which when done here in the ER, requires someone with an N95 mask and a negative flow room. Though the test may take less than an hour, the rigamarole to do it and get it to the lab and back brings the time from entry to discharge to more than 2 hours. Saliva test, if it works, would cut the time in half or even less time than that.

 

I'm not 100 % sure. But I think the answer is no. There is no 15 minute, do it yourself saliva-type test. I think they are being worked on. But I don't think they are available.

 

First Saliva Test for COVID-19 Approved for Emergency Use by FDA

 

This stuff is above my pay grade. So you can read that and maybe your takeaway is different. I think the main benefit of this particular test is it gets rid of swab testing that has to be administered by a trained person wearing PPE. But it still needs to be analyzed by a machine, I think. It is not a "do it yourself" pregnancy-type test. And that article says it is still administered in hospital settings.

 

Another issue is that a lot of the tests the FDA has given their blessing to suck. I say "given their blessing" because the protocols and standards are above my pay grade. I think the antibody tests we read about in these large studies, like the ones in New York and California, are probably better tests with more reliability. The results from those studies make sense. But I don't know that we know for sure that even they are valid.

 

A test that individuals could take on their own or that hospitals or employers could use that gives results in 15 minutes and is mostly reliable would be a huge game changer. i don't think we have it yet, unfortunately.

Edited May 2, 2020 by stevenkesslar

[+ bigjoey]

A test that individuals could take on their own or that hospitals or employers could use that gives results in 15 minutes and is mostly reliable would be a huge game changer. i don't think we have it yet, unfortunately.

 

The Abbott test seems to be there. The protocol was changed this week to make it more accurate.

https://www.medtechdive.com/news/fda-abbott-coronavirus-test-updated-instructions-accuracy-concerns/576586/

[+ bigjoey]

A test that individuals could take on their own or that hospitals or employers could use that gives results in 15 minutes and is mostly reliable would be a huge game changer. i don't think we have it yet, unfortunately.

 

The Abbott test seems to be there. The protocol was changed this week to make it more accurate.

https://www.medtechdive.com/news/fda-abbott-coronavirus-test-updated-instructions-accuracy-concerns/576586/

[Guest]

While I do think the availability of rapid testing is essential to getting this under control, as far as I am aware, the quickest test takes about an hour... Though the test may take less than an hour, the rigamarole to do it and get it to the lab and back brings the time from entry to discharge to more than 2 hours. Saliva test, if it works, would cut the time in half or even less time than that.

The Abbott test seems to be there. The protocol was changed this week to make it more accurate.

https://www.medtechdive.com/news/fda-abbott-coronavirus-test-updated-instructions-accuracy-concerns/576586/

 

Yes, according to that article: "Abbott was not the first company to get emergency use authorization for a point-of-care coronavirus test — Cepheid claimed that milestone. But the potential for Abbott's test to detect positive cases in five minutes and negative results in 13 minutes, as well as the company's claim its ID Now machines were the most widely available molecular POC testing platform in the country, made its EUA a hopeful step for U.S. coronavirus testing infrastructure."

Having a point of care testing means you don't have the long delay in getting the sample to the lab, having to have the lab personnel act on it, put results into the computer, etc. It can be done either in the doctor's office, or even at the airport, while waiting for the documents to board the cruise ship, etc. Someone could swab you as you enter the security line, and you could get the results by the time you clear security (and it could be sent directly to the airline before you board the plane).

[Guest]

While I do think the availability of rapid testing is essential to getting this under control, as far as I am aware, the quickest test takes about an hour... Though the test may take less than an hour, the rigamarole to do it and get it to the lab and back brings the time from entry to discharge to more than 2 hours. Saliva test, if it works, would cut the time in half or even less time than that.

The Abbott test seems to be there. The protocol was changed this week to make it more accurate.

https://www.medtechdive.com/news/fda-abbott-coronavirus-test-updated-instructions-accuracy-concerns/576586/

 

Yes, according to that article: "Abbott was not the first company to get emergency use authorization for a point-of-care coronavirus test — Cepheid claimed that milestone. But the potential for Abbott's test to detect positive cases in five minutes and negative results in 13 minutes, as well as the company's claim its ID Now machines were the most widely available molecular POC testing platform in the country, made its EUA a hopeful step for U.S. coronavirus testing infrastructure."

Having a point of care testing means you don't have the long delay in getting the sample to the lab, having to have the lab personnel act on it, put results into the computer, etc. It can be done either in the doctor's office, or even at the airport, while waiting for the documents to board the cruise ship, etc. Someone could swab you as you enter the security line, and you could get the results by the time you clear security (and it could be sent directly to the airline before you board the plane).

[+ stevenkesslar]

There actually has been some recent analysis that suggests hospitals should use ventilators less for COVID-19 patients even those with hypoxia (low-oxygen in tissues and blood). For some reason, many COVID-19 patients are able to handle some hypoxia much more than patients with other forms of pneumonia. Intubating patients causes inflammation, poor reactions to sedatives and can even cause damage and death in some cases. They are finding that simply providing oxygen through nose-prongs and supporting breathing through body positioning and other techniques might be the better course of treatment for many patients. Keep the ventilators to only the ones with dangerously low oxygen levels and those obviously struggling to breath.

 

Nick Cordero's Lungs Are 'Severely Damaged' and Have Holes in Them, but His Wife 'Is Not Giving Up Hope'

On her Instagram stories, the fitness instructor said on Thursday that while Cordero's CT scans showed he was "clear of internal bleeding," Cordero's lungs had become "severely damaged to look almost like he's been a smoker for 50 years."

 

"They're that damaged," she added. "There are holes in his lungs where obviously you don't want holes to be. So this kind of was found because his oxygen count went down and so they kind of went down and deep into the lungs. They cleaned out his lungs again. It wasn't as bad as the couple of days before, but they had to clean out his lungs again."

"The doctor that I was speaking to is absolutely wonderful and has the best bedside manner," Kloots continued. "So the doctor told me that if Nick was in his seventies, we'd be having a different conversation. He's 41, and he's been fighting. He's been fighting really hard. We know he's literally been thrown every curve ball that he could be thrown. He told me that if it was his brother in there that he would not be giving up hope. So I'm not giving up hope. I'm not giving up hope."

 

 

I have two strong reactions to this.

 

The first is that we do need to release doctors and hospitals from liability on COVID-19. Just trying to understand this as a non-professional is beyond comprehension. I was at an escort buddy's deathbed when he died of septicemia. So I have some understanding of how everything can go wrong and be a living horror story, in real time. The death, the drive home with his partner, the days of sobbing after. It stays with me. In some ways it is a relief, perhaps, that Kloots CAN NOT be there next to him. It may help her to endure this that she knows she has a healthy young baby to focus on. But it just makes no sense to me that this could happen to a 41 year old healthy man. A Broadway star.

 

I have not followed Cordero's tragedy that close, but my impression is that very early in the game his oxygen nosedived and they ventilated him. She dropped him off at a hospital thinking she'd be picking him up a few hours later. He called her to say they were checking him in. I don't think it was more than a day that he was on a ventilator. Some part of me thinks that him being on a ventilator didn't help. But the main way I feel about it is that I could not endure having to think about whether "a" should not have happened or "b" should have happened.

 

That is, of course, why doctors and health professionals and scientists get paid the big bucks - to figure out what application of this drug or that way of delivering oxygen at what point makes the most sense. As a non-professional, my emotional reaction is that it is more than any human heart should be asked to bear. This is probably why it is good that doctors have to emotionally distance, and loved ones have to love, and never give up hope. They are two very different jobs.

 

Now I will say something else that I know I shouldn't, and wouldn't if I thought that Kloots or anyone that knew him was reading this. I hope he dies. He doesn't have a leg, his lungs are ravaged, and probably every other organ in his body is severely compromised. That is what this virus does. If there were not ICU's he would be dead. If it were 1918, he might be dead at home, and nobody would be quite sure what to do with the body. It would be picked up by a horse and buggy with stacks of bodies, and buried in a mass grave.

 

@purplekow wrote something about how a few very old patients under his care have loved ones who want the medical professionals to do whatever it takes. My siblings and I went through that not too long ago, and did the opposite, which is what my Dad wanted and my Mom had no say in, since she had severe dementia. (It obviously runs in the family. ) It makes very little sense to me that we would be spending $1 million dollars to keep someone my Mom or Dad's age alive if they had COVID-19. But that is the situation we are in. And families will do what families will do.

 

This is part of why we can't work our way through a pandemic. Anybody who thinks that Broadway will be open during the pandemic, or even that people will choose to go to the restaurants around Broadway during a pandemic, better rethink this. Not when thousands of people are dying every day, and probably hundreds of thousands are being infected everyday. You could say let's all order the classic herd immunity, 1918 vintage, and do it all at once. But then what you actually get is hospitals at 1000 % of capacity, and people dying at home. That's not good for the economy or Broadway, either. I don't think anybody should need a multivariate equation to understand why.

 

This is not what Australia or New Zealand, among others, are choosing to do. This is not what much of the world is choosing to do. It is unimaginable to me that somehow we are making this choice. I can not fathom why a nation or a community would do this, by choice. It is beyond human comprehension to me. Perhaps that is my dementia.

 

Speaking of Australia, and as an offset to my negativity, have a look at this.

 

 

That video is completely relevant to this particular discussion. When I stumbled on that I spent a few hours figuring out who Nick Afoa is. He's the gorgeous guy in the front row. Search his name on YouTube and you can see him

more than half naked on stage. My point in this context is he would be a candidate to be the completely unexpected person who for some reason is in an ICU on a ventilator down one leg and with lungs that will pretty much never function again. He is from New Zealand. And that video was shot during the Australia tour of The Lion King. So this is directly relevant to what choices different countries are making, right now.

 

So right now we know that that video could not be shot. If anybody is on an airplane, they are going to be wearing masks, not singing. And more likely than not, people will not be gathering to watch The Lion King for a year or two in Australia or New Zealand. But the offset in this multivariate analysis is that none of the people on that airplane will be dead. Almost nobody will be dead. And they will also have an economy that functions way better than that of the US. So everybody can construct their own multivariate analysis about the human and economic cost of Nick Afoa, or any other real human being on that plane, being a life worth saving. If the goal is saving the economy, my analysis says its better to save them all.

 

And at the risk of being cheesy, the circle of life part applies. Part of the moral lesson that makes that story so powerful is that we are all a community. And our lives all do depend on each other. It's a great way to think about nations and the whole planet in the age of COVID-19.

 

This is a real choice. And nobody is telling us that 2000 Americans a day have to die. Soon it will be 3000 a day, and then 5000. And I'm pretty sure Nick Cordero will be one of the dead very soon. The virus is not telling us it has to be that way. We are deciding it will be this way. Australia and New Zealand simply made very different choices. Maybe they won't work for the long term. So far, they are working great, though.

 

Speaking of other artists I admire, in this case for his mind more than his body, it is what Marcel Ophuls would describe as a sorrow and a pity. Even in the worst of times, it is always a matter of human choice.

Edited May 2, 2020 by stevenkesslar

[+ stevenkesslar]

There actually has been some recent analysis that suggests hospitals should use ventilators less for COVID-19 patients even those with hypoxia (low-oxygen in tissues and blood). For some reason, many COVID-19 patients are able to handle some hypoxia much more than patients with other forms of pneumonia. Intubating patients causes inflammation, poor reactions to sedatives and can even cause damage and death in some cases. They are finding that simply providing oxygen through nose-prongs and supporting breathing through body positioning and other techniques might be the better course of treatment for many patients. Keep the ventilators to only the ones with dangerously low oxygen levels and those obviously struggling to breath.

 

Nick Cordero's Lungs Are 'Severely Damaged' and Have Holes in Them, but His Wife 'Is Not Giving Up Hope'

On her Instagram stories, the fitness instructor said on Thursday that while Cordero's CT scans showed he was "clear of internal bleeding," Cordero's lungs had become "severely damaged to look almost like he's been a smoker for 50 years."

 

"They're that damaged," she added. "There are holes in his lungs where obviously you don't want holes to be. So this kind of was found because his oxygen count went down and so they kind of went down and deep into the lungs. They cleaned out his lungs again. It wasn't as bad as the couple of days before, but they had to clean out his lungs again."

"The doctor that I was speaking to is absolutely wonderful and has the best bedside manner," Kloots continued. "So the doctor told me that if Nick was in his seventies, we'd be having a different conversation. He's 41, and he's been fighting. He's been fighting really hard. We know he's literally been thrown every curve ball that he could be thrown. He told me that if it was his brother in there that he would not be giving up hope. So I'm not giving up hope. I'm not giving up hope."

 

 

I have two strong reactions to this.

 

The first is that we do need to release doctors and hospitals from liability on COVID-19. Just trying to understand this as a non-professional is beyond comprehension. I was at an escort buddy's deathbed when he died of septicemia. So I have some understanding of how everything can go wrong and be a living horror story, in real time. The death, the drive home with his partner, the days of sobbing after. It stays with me. In some ways it is a relief, perhaps, that Kloots CAN NOT be there next to him. It may help her to endure this that she knows she has a healthy young baby to focus on. But it just makes no sense to me that this could happen to a 41 year old healthy man. A Broadway star.

 

I have not followed Cordero's tragedy that close, but my impression is that very early in the game his oxygen nosedived and they ventilated him. She dropped him off at a hospital thinking she'd be picking him up a few hours later. He called her to say they were checking him in. I don't think it was more than a day that he was on a ventilator. Some part of me thinks that him being on a ventilator didn't help. But the main way I feel about it is that I could not endure having to think about whether "a" should not have happened or "b" should have happened.

 

That is, of course, why doctors and health professionals and scientists get paid the big bucks - to figure out what application of this drug or that way of delivering oxygen at what point makes the most sense. As a non-professional, my emotional reaction is that it is more than any human heart should be asked to bear. This is probably why it is good that doctors have to emotionally distance, and loved ones have to love, and never give up hope. They are two very different jobs.

 

Now I will say something else that I know I shouldn't, and wouldn't if I thought that Kloots or anyone that knew him was reading this. I hope he dies. He doesn't have a leg, his lungs are ravaged, and probably every other organ in his body is severely compromised. That is what this virus does. If there were not ICU's he would be dead. If it were 1918, he might be dead at home, and nobody would be quite sure what to do with the body. It would be picked up by a horse and buggy with stacks of bodies, and buried in a mass grave.

 

@purplekow wrote something about how a few very old patients under his care have loved ones who want the medical professionals to do whatever it takes. My siblings and I went through that not too long ago, and did the opposite, which is what my Dad wanted and my Mom had no say in, since she had severe dementia. (It obviously runs in the family. ) It makes very little sense to me that we would be spending $1 million dollars to keep someone my Mom or Dad's age alive if they had COVID-19. But that is the situation we are in. And families will do what families will do.

 

This is part of why we can't work our way through a pandemic. Anybody who thinks that Broadway will be open during the pandemic, or even that people will choose to go to the restaurants around Broadway during a pandemic, better rethink this. Not when thousands of people are dying every day, and probably hundreds of thousands are being infected everyday. You could say let's all order the classic herd immunity, 1918 vintage, and do it all at once. But then what you actually get is hospitals at 1000 % of capacity, and people dying at home. That's not good for the economy or Broadway, either. I don't think anybody should need a multivariate equation to understand why.

 

This is not what Australia or New Zealand, among others, are choosing to do. This is not what much of the world is choosing to do. It is unimaginable to me that somehow we are making this choice. I can not fathom why a nation or a community would do this, by choice. It is beyond human comprehension to me. Perhaps that is my dementia.

 

Speaking of Australia, and as an offset to my negativity, have a look at this.

 

 

That video is completely relevant to this particular discussion. When I stumbled on that I spent a few hours figuring out who Nick Afoa is. He's the gorgeous guy in the front row. Search his name on YouTube and you can see him

more than half naked on stage. My point in this context is he would be a candidate to be the completely unexpected person who for some reason is in an ICU on a ventilator down one leg and with lungs that will pretty much never function again. He is from New Zealand. And that video was shot during the Australia tour of The Lion King. So this is directly relevant to what choices different countries are making, right now.

 

So right now we know that that video could not be shot. If anybody is on an airplane, they are going to be wearing masks, not singing. And more likely than not, people will not be gathering to watch The Lion King for a year or two in Australia or New Zealand. But the offset in this multivariate analysis is that none of the people on that airplane will be dead. Almost nobody will be dead. And they will also have an economy that functions way better than that of the US. So everybody can construct their own multivariate analysis about the human and economic cost of Nick Afoa, or any other real human being on that plane, being a life worth saving. If the goal is saving the economy, my analysis says its better to save them all.

 

And at the risk of being cheesy, the circle of life part applies. Part of the moral lesson that makes that story so powerful is that we are all a community. And our lives all do depend on each other. It's a great way to think about nations and the whole planet in the age of COVID-19.

 

This is a real choice. And nobody is telling us that 2000 Americans a day have to die. Soon it will be 3000 a day, and then 5000. And I'm pretty sure Nick Cordero will be one of the dead very soon. The virus is not telling us it has to be that way. We are deciding it will be this way. Australia and New Zealand simply made very different choices. Maybe they won't work for the long term. So far, they are working great, though.

 

Speaking of other artists I admire, in this case for his mind more than his body, it is what Marcel Ophuls would describe as a sorrow and a pity. Even in the worst of times, it is always a matter of human choice.

Edited May 2, 2020 by stevenkesslar

[+ stevenkesslar]

The Abbott test seems to be there. The protocol was changed this week to make it more accurate.

https://www.medtechdive.com/news/fda-abbott-coronavirus-test-updated-instructions-accuracy-concerns/576586/

 

I think there are several issues. If I read that right, it's a swab test, right? Not a saliva test.

 

Part of what @purplekow was saying is that administration of swab tests usually requires PPE. I know Gates network came up with a self-administered swab test, which would essentially serve a similar function as a saliva test. That one is FDA approved, I believe he has said. If a test is accurate, whether I put a swab in my nose or spit into something is probably irrelevant. Part of the point is that either eliminate the need for a professional to administer it using up limited PPE. The article you posted makes it sound like the Abbot test is administered from start to finish by professionals. In other words, it does require someone in PPE, I think.

 

It does solve the other problem PK was talking about, which is mobility and quick turn around. I think this was the test that Abbot announced in the Rose Garden a month or so ago, and you and I both said it was great news. So it is good to know it is in the field, and they are trouble shooting it.

 

The part of my quote that you cited was my own very different point. I'll restate it:

A test that individuals could take on their own or that hospitals or employers could use that gives results in 15 minutes and is mostly reliable would be a huge game changer. i don't think we have it yet, unfortunately.

 

I mentioned hospitals, but what I mostly was thinking of is at-home individuals, and employers. In a lot of countries I think there is a very good chance that with the tests they have, and a relatively small army of paid contact tracers, they can control the spread of the virus. If you have 10 or 100 cases a day in a country the size of South Korea or Australia, or hopefully soon France or Germany, you can do it that way. There will be outbreaks. But the good news so far is that where there have been outbreaks, they are conceptually the same as a wildfire. You send in the pros and they put it out. With COVID-19 they use testing and tracing and isolation to do it. So far, it seems to work.

 

In the US, I think that individual testing kits could make a huge difference. Not to be cute, but it does play to what we are good at: individualism. So people will do it at home, and you can catch a lot of infection voluntarily that way. Same with employers. Think of a restaurant with 10 employees. Even if you have to buy them at $25 a pop, if it cost $250 a week to test every employee, finding one positive case and sending them home on sick pay is a better economic plan than having an outbreak and having to close your restaurant.

 

I've read lots of think pieces on testing models. The math that is almost indisputable is that even if it costs the US government $100 billion a year for a few years to be throwing free tests around to every employer in America, it saves the US government from spending trillions. Gates can legitimately say that if we had listened to him, we could have spent $100 billion and saved the trillions we've already just spent.

 

In fairness, hindsight is always 20/20. There were thousands of smart people like Gates around warning about thousands of possible problems, including asteroids and aliens. But it certainly makes sense to listen to Gates now. And he is pretty much saying we can't throw enough money at testing and tracing quickly enough. Globally.

 

In the US, given that we probably have hundreds of thousands being infected a day, we either have to let it rip and have millions dead and complete economic collapse for a period of time, or we need massive testing. My point is that a self-administered saliva test for individuals and employers that did not require medical staff in PPE would make this enormously easier.

Edited May 2, 2020 by stevenkesslar

[+ stevenkesslar]

The Abbott test seems to be there. The protocol was changed this week to make it more accurate.

https://www.medtechdive.com/news/fda-abbott-coronavirus-test-updated-instructions-accuracy-concerns/576586/

 

I think there are several issues. If I read that right, it's a swab test, right? Not a saliva test.

 

Part of what @purplekow was saying is that administration of swab tests usually requires PPE. I know Gates network came up with a self-administered swab test, which would essentially serve a similar function as a saliva test. That one is FDA approved, I believe he has said. If a test is accurate, whether I put a swab in my nose or spit into something is probably irrelevant. Part of the point is that either eliminate the need for a professional to administer it using up limited PPE. The article you posted makes it sound like the Abbot test is administered from start to finish by professionals. In other words, it does require someone in PPE, I think.

 

It does solve the other problem PK was talking about, which is mobility and quick turn around. I think this was the test that Abbot announced in the Rose Garden a month or so ago, and you and I both said it was great news. So it is good to know it is in the field, and they are trouble shooting it.

 

The part of my quote that you cited was my own very different point. I'll restate it:

A test that individuals could take on their own or that hospitals or employers could use that gives results in 15 minutes and is mostly reliable would be a huge game changer. i don't think we have it yet, unfortunately.

 

I mentioned hospitals, but what I mostly was thinking of is at-home individuals, and employers. In a lot of countries I think there is a very good chance that with the tests they have, and a relatively small army of paid contact tracers, they can control the spread of the virus. If you have 10 or 100 cases a day in a country the size of South Korea or Australia, or hopefully soon France or Germany, you can do it that way. There will be outbreaks. But the good news so far is that where there have been outbreaks, they are conceptually the same as a wildfire. You send in the pros and they put it out. With COVID-19 they use testing and tracing and isolation to do it. So far, it seems to work.

 

In the US, I think that individual testing kits could make a huge difference. Not to be cute, but it does play to what we are good at: individualism. So people will do it at home, and you can catch a lot of infection voluntarily that way. Same with employers. Think of a restaurant with 10 employees. Even if you have to buy them at $25 a pop, if it cost $250 a week to test every employee, finding one positive case and sending them home on sick pay is a better economic plan than having an outbreak and having to close your restaurant.

 

I've read lots of think pieces on testing models. The math that is almost indisputable is that even if it costs the US government $100 billion a year for a few years to be throwing free tests around to every employer in America, it saves the US government from spending trillions. Gates can legitimately say that if we had listened to him, we could have spent $100 billion and saved the trillions we've already just spent.

 

In fairness, hindsight is always 20/20. There were thousands of smart people like Gates around warning about thousands of possible problems, including asteroids and aliens. But it certainly makes sense to listen to Gates now. And he is pretty much saying we can't throw enough money at testing and tracing quickly enough. Globally.

 

In the US, given that we probably have hundreds of thousands being infected a day, we either have to let it rip and have millions dead and complete economic collapse for a period of time, or we need massive testing. My point is that a self-administered saliva test for individuals and employers that did not require medical staff in PPE would make this enormously easier.

Edited May 2, 2020 by stevenkesslar

[+ stevenkesslar]

Great news?:

https://apple.news/ApbPFgW2URz6Ku1-xaAYolg

 

I read that to say unless there is a vaccine, we are heading towards herd immunity to end the pandemic.

 

I read it to say pretty much nothing at all.

 

I don't really mean that. It's a perfectly fine study. As far as I can tell, CIDRAP is affiliated with the University of Minnesota. It's not clear to me that there is anything there that's not been said repeatedly in many other studies. I think you are right. A vaccine is just factored out of their equation. More significantly, the words "test, trace, treat" or "social distancing" are factored out. So what I took the study to mean is that if we factor out anything related to human choice, and assume we are just the helpless victims of this alien virus inside us, this is what will happen.

 

 

Lucky us!

 

It's fun stuff. But it's not very multivariate, if that's what you prefer. The only variable in this study is this: what happens if we liberate the virus? That's it, basically. Liberate it and see what happens. The answer is: 70 % of people will get infected. It will take 18 to 24 months. We have no choice.

 

The authors beg the question of a death rate. I'd be curious to know how many people they think will die, at what rate. They don't say, other than whatever happens could happen in various forms of waves. I'd also love to see someone actually model out how the economy fares if we actually had 70 % of Americans - meaning probably close to 100 % of workers - infected. How many workers are sick? Hospitalized? Dead? How many hospitals go bankrupt? How many businesses go bankrupt? How many doctors and nurses die? How many seniors die in nursing homes? Outside of Tom Freidman, who posits this vague idea of "harmonious balance", I haven't seen any specific models of anything. Sorry, but the multivariate "herd immunity" crowd is kind of slacking, I think.

 

They also say nothing about whether 70 % of people getting this virus would actually result in herd immunity. This is what they say about herd immunity in the study:

This may be complicated by the fact that we don’t yet know the duration of immunity to natural SARS-CoV-2 infection (it could be as short as a few months or as long as several years).

 

So I guess my question to these folks would be: If you think immunity could be as short as a few months, what does herd immunity mean? By definition, it can't exist. I can get sick this month, and then get sick with COVID-10 again this Winter. That's not herd immunity.

 

The same problem exists with a vaccine, of course. The flu vaccine is never 100 % effective. So there is no reason to assume a COVID-19 vaccine will be. At the very least, a vaccine would dramatically reduce the transmission of the virus. Combined with testing and tracing and isolation, it should make it much easier to effectively eradicate the virus, like we have with SARS and MERS and Ebola.

 

I assume if this is Plan A, it explains why almost every country outside the US said we have to get our shit together, immediately, and go for Plan B. This is very much like the Imperial College study. Except they said it would be 2.2 million dead Americans , and quicker. That's a jolting concept. What's even more jolting is the idea that, after you let 2.2 million die, you maybe only had immunity for three months. So now we have to do it all over again. That's probably why every other nations said, "Plan B and only 500 deaths, please."

 

Coronavirus: The Hammer and the Dance

What the Next 18 Months Can Look Like, if Leaders Buy Us Time

March 19, 2020

 

If you want a multivariate analysis, you should love this Tomas Pueyo piece:

 

 

As you can see, there's 11 variables built into that model. Pretty cool, huh?

 

To really oversimplify a very rich and multivariate analysis, Pueyo says that really liberating the virus will more than double the death rate of all those infected, at least. Most hospitals in America would be crushed. Beyond the impact of mass infections on quality of care and death in hospitals, including sickening and killing many doctors and nurses. The even larger issue is that most people won't even die in hospitals. The data @LivingnLA posted suggests that, even with "only" 65,000 deaths, we might have up to double the number who died of COVID-19 but are not being counted. That's based on the actual, and unexpectedly high, non-COVID 19 death rate. Once you get into the millions of deaths, the models suggest it only gets worse.

 

So that chart is Pueyo's much richer and much more specific multivariate model of what living hell looks like under herd immunity (news flash: it turns out to be the absolutely worst choice for the economy, as well as for human life). Now I'll step back and talk about the more optimistic future Pueyo has modeled.

 

On March 10, he published this essay:

 

Coronavirus: Why You Must Act Now

Politicians, Community Leaders and Business Leaders: What Should You Do and When?

March 10, 2020

 

It is a very interesting and multivariate read. But the essay above, The Hammer and The Dance, is far more urgent reading. Because in that essay he presents the ideas of a whole bunch of people that I think are now becoming the conventional wisdom about how we prevent millions of US deaths.

 

The reason I posted his earlier work is that I think that, along with the Imperial College model, he helped move the needle. Especially in California, where he is based, and which was one of the key states to get the lock down ball rolling. As of today, California has had 2,134 deaths. That's a little less than half the annual flu deaths in California. If we had the same actual infection rate and death rate as New York, we'd have over 50,000 deaths in California alone. Had we done absolutely nothing to prevent mass death, it would have actually been far worse. The state modeled up to 20 million infections, hundreds of thousands dead, at a minimum.

 

Pueyo predicted what happened in New York. Mass infection far beyond the scale of what was understood in early March. He said, correctly, locking down a few days earlier could prevent thousands of deaths in states like California. He was right.

 

What has actually happened in New York since he wrote that March 10 essay would be a picnic compared to what will happen if we just let this thing race all over America unchecked, he said. 10 million dead. Again, some of that is that a crushing wave of infections of 70 % of America would mean lots of people crush the capacity of hospitals, and millions die at home. It would be a repeat of 1918, with a much larger population.

 

While we will hopefully never be able to fact check Pueyo on that, almost everything he predicted in the short term played out. Except it was even worse, and deadlier, than he modeled.

 

Pueyo's hammer and dance model is complicated, and extremely multivariate of course. But conceptually it looks like this:

 

 

I think the easiest way to understand this idea is that some much more complicated version of this is in the ballpark of what Australia, Austria, China, Hong Kong, Iceland, Japan, New Zealand, Singapore, South Korea, Taiwan and others have done. China is the best example, because it was the fiercest hammer (or, if you prefer, a fascist hammer) and it hammered the virus into near eradication. Australia and New Zealand did more user-friendly versions, but it seems to have had about the same effect. So with the exception of China, I think every one of those countries have had fewer than 1 % of the deaths we have had in the US.

 

There's one other significant thing about that chart. Note that it does not look like the "flatten the curve" chart. The idea is NOT that will will have the same number of deaths, but just space them out more efficiently. The idea is that we are in World War III with a virus, and like any good army our generals are going to try to keep the casualties to a minimum. The idea is to "dance" with the virus until we have a vaccine.

 

My guess is some people here think that can't be done. Talk to China, or Australia, or Austria, or South Korea. My guess is they are not sure, either. But speaking as an American, I sure appreciate the fact that they are showing the kind of pragmatic global scientific leadership the US was once known for.

 

The Hammer and The Dance is a very rich analysis, and a cause for optimism in human creativity and resilience.

Edited May 2, 2020 by stevenkesslar

[+ stevenkesslar]

Great news?:

https://apple.news/ApbPFgW2URz6Ku1-xaAYolg

 

I read that to say unless there is a vaccine, we are heading towards herd immunity to end the pandemic.

 

I read it to say pretty much nothing at all.

 

I don't really mean that. It's a perfectly fine study. As far as I can tell, CIDRAP is affiliated with the University of Minnesota. It's not clear to me that there is anything there that's not been said repeatedly in many other studies. I think you are right. A vaccine is just factored out of their equation. More significantly, the words "test, trace, treat" or "social distancing" are factored out. So what I took the study to mean is that if we factor out anything related to human choice, and assume we are just the helpless victims of this alien virus inside us, this is what will happen.

 

 

Lucky us!

 

It's fun stuff. But it's not very multivariate, if that's what you prefer. The only variable in this study is this: what happens if we liberate the virus? That's it, basically. Liberate it and see what happens. The answer is: 70 % of people will get infected. It will take 18 to 24 months. We have no choice.

 

The authors beg the question of a death rate. I'd be curious to know how many people they think will die, at what rate. They don't say, other than whatever happens could happen in various forms of waves. I'd also love to see someone actually model out how the economy fares if we actually had 70 % of Americans - meaning probably close to 100 % of workers - infected. How many workers are sick? Hospitalized? Dead? How many hospitals go bankrupt? How many businesses go bankrupt? How many doctors and nurses die? How many seniors die in nursing homes? Outside of Tom Freidman, who posits this vague idea of "harmonious balance", I haven't seen any specific models of anything. Sorry, but the multivariate "herd immunity" crowd is kind of slacking, I think.

 

They also say nothing about whether 70 % of people getting this virus would actually result in herd immunity. This is what they say about herd immunity in the study:

This may be complicated by the fact that we don’t yet know the duration of immunity to natural SARS-CoV-2 infection (it could be as short as a few months or as long as several years).

 

So I guess my question to these folks would be: If you think immunity could be as short as a few months, what does herd immunity mean? By definition, it can't exist. I can get sick this month, and then get sick with COVID-10 again this Winter. That's not herd immunity.

 

The same problem exists with a vaccine, of course. The flu vaccine is never 100 % effective. So there is no reason to assume a COVID-19 vaccine will be. At the very least, a vaccine would dramatically reduce the transmission of the virus. Combined with testing and tracing and isolation, it should make it much easier to effectively eradicate the virus, like we have with SARS and MERS and Ebola.

 

I assume if this is Plan A, it explains why almost every country outside the US said we have to get our shit together, immediately, and go for Plan B. This is very much like the Imperial College study. Except they said it would be 2.2 million dead Americans , and quicker. That's a jolting concept. What's even more jolting is the idea that, after you let 2.2 million die, you maybe only had immunity for three months. So now we have to do it all over again. That's probably why every other nations said, "Plan B and only 500 deaths, please."

 

Coronavirus: The Hammer and the Dance

What the Next 18 Months Can Look Like, if Leaders Buy Us Time

March 19, 2020

 

If you want a multivariate analysis, you should love this Tomas Pueyo piece:

 

 

As you can see, there's 11 variables built into that model. Pretty cool, huh?

 

To really oversimplify a very rich and multivariate analysis, Pueyo says that really liberating the virus will more than double the death rate of all those infected, at least. Most hospitals in America would be crushed. Beyond the impact of mass infections on quality of care and death in hospitals, including sickening and killing many doctors and nurses. The even larger issue is that most people won't even die in hospitals. The data @LivingnLA posted suggests that, even with "only" 65,000 deaths, we might have up to double the number who died of COVID-19 but are not being counted. That's based on the actual, and unexpectedly high, non-COVID 19 death rate. Once you get into the millions of deaths, the models suggest it only gets worse.

 

So that chart is Pueyo's much richer and much more specific multivariate model of what living hell looks like under herd immunity (news flash: it turns out to be the absolutely worst choice for the economy, as well as for human life). Now I'll step back and talk about the more optimistic future Pueyo has modeled.

 

On March 10, he published this essay:

 

Coronavirus: Why You Must Act Now

Politicians, Community Leaders and Business Leaders: What Should You Do and When?

March 10, 2020

 

It is a very interesting and multivariate read. But the essay above, The Hammer and The Dance, is far more urgent reading. Because in that essay he presents the ideas of a whole bunch of people that I think are now becoming the conventional wisdom about how we prevent millions of US deaths.

 

The reason I posted his earlier work is that I think that, along with the Imperial College model, he helped move the needle. Especially in California, where he is based, and which was one of the key states to get the lock down ball rolling. As of today, California has had 2,134 deaths. That's a little less than half the annual flu deaths in California. If we had the same actual infection rate and death rate as New York, we'd have over 50,000 deaths in California alone. Had we done absolutely nothing to prevent mass death, it would have actually been far worse. The state modeled up to 20 million infections, hundreds of thousands dead, at a minimum.

 

Pueyo predicted what happened in New York. Mass infection far beyond the scale of what was understood in early March. He said, correctly, locking down a few days earlier could prevent thousands of deaths in states like California. He was right.

 

What has actually happened in New York since he wrote that March 10 essay would be a picnic compared to what will happen if we just let this thing race all over America unchecked, he said. 10 million dead. Again, some of that is that a crushing wave of infections of 70 % of America would mean lots of people crush the capacity of hospitals, and millions die at home. It would be a repeat of 1918, with a much larger population.

 

While we will hopefully never be able to fact check Pueyo on that, almost everything he predicted in the short term played out. Except it was even worse, and deadlier, than he modeled.

 

Pueyo's hammer and dance model is complicated, and extremely multivariate of course. But conceptually it looks like this:

 

 

I think the easiest way to understand this idea is that some much more complicated version of this is in the ballpark of what Australia, Austria, China, Hong Kong, Iceland, Japan, New Zealand, Singapore, South Korea, Taiwan and others have done. China is the best example, because it was the fiercest hammer (or, if you prefer, a fascist hammer) and it hammered the virus into near eradication. Australia and New Zealand did more user-friendly versions, but it seems to have had about the same effect. So with the exception of China, I think every one of those countries have had fewer than 1 % of the deaths we have had in the US.

 

There's one other significant thing about that chart. Note that it does not look like the "flatten the curve" chart. The idea is NOT that will will have the same number of deaths, but just space them out more efficiently. The idea is that we are in World War III with a virus, and like any good army our generals are going to try to keep the casualties to a minimum. The idea is to "dance" with the virus until we have a vaccine.

 

My guess is some people here think that can't be done. Talk to China, or Australia, or Austria, or South Korea. My guess is they are not sure, either. But speaking as an American, I sure appreciate the fact that they are showing the kind of pragmatic global scientific leadership the US was once known for.

 

The Hammer and The Dance is a very rich analysis, and a cause for optimism in human creativity and resilience.

Edited May 2, 2020 by stevenkesslar

[Guest]

...

 

My point boils down to a simple number: 2 million dead. That's a hell of a lot more than the 40,000 traffic deaths you cited. So one way to think about any multivariate equation with COVID-19 is this: 2 million dead is probably a hell of a lot more than "x".

...

 

I'm a firm believer in flattening the curve, but you may be over-stating the number of extra deaths which will occur if we don't. The additional deaths will be a subset of the difference between our healthcare capacity (particularly ICU and ventilator capacity) and the total number of patients. In that group, only a certain subset of those would have been saved by intensive care. In addition, bear in mind that if we were to ever have to ration ventilators or intensive care, the rationing will not be random or 1st come-1st served. Most hospitals have policies to determine who will get to try and who will stay on a ventilator, so those who either won't be offered a ventilator to begin with, or whose ventilator will be withdrawn will be those with a lower likelihood to benefit.

Again, we don't want to go there. But this is what would happen (lower SOFA score is healthier, higher scores for sicker patients less likely to survive). I also think that the graph you showed is filled with false assumptions. I certainly don't trust the Chinese statistics one bit. The Aussies and the Kiwis also benefited from a much lower virus burden to begin with, as well as their isolation, and perhaps due to the fact that mitigation efforts started in their Summer (and ours in our winter), much as you may not want to believe it--and much as I acknowledge that this may not prove to be the case. If our efforts at mitigation were so meager as the graph suggests, they weren't worth the effort. I, however, believe mitigation probably saved many lives. We need to slowly ease things up and continually re-assess, in my opinion.

Edited May 2, 2020 by Unicorn

[Guest]

...

 

My point boils down to a simple number: 2 million dead. That's a hell of a lot more than the 40,000 traffic deaths you cited. So one way to think about any multivariate equation with COVID-19 is this: 2 million dead is probably a hell of a lot more than "x".

...

 

I'm a firm believer in flattening the curve, but you may be over-stating the number of extra deaths which will occur if we don't. The additional deaths will be a subset of the difference between our healthcare capacity (particularly ICU and ventilator capacity) and the total number of patients. In that group, only a certain subset of those would have been saved by intensive care. In addition, bear in mind that if we were to ever have to ration ventilators or intensive care, the rationing will not be random or 1st come-1st served. Most hospitals have policies to determine who will get to try and who will stay on a ventilator, so those who either won't be offered a ventilator to begin with, or whose ventilator will be withdrawn will be those with a lower likelihood to benefit.

Again, we don't want to go there. But this is what would happen (lower SOFA score is healthier, higher scores for sicker patients less likely to survive). I also think that the graph you showed is filled with false assumptions. I certainly don't trust the Chinese statistics one bit. The Aussies and the Kiwis also benefited from a much lower virus burden to begin with, as well as their isolation, and perhaps due to the fact that mitigation efforts started in their Summer (and ours in our winter), much as you may not want to believe it--and much as I acknowledge that this may not prove to be the case. If our efforts at mitigation were so meager as the graph suggests, they weren't worth the effort. I, however, believe mitigation probably saved many lives. We need to slowly ease things up and continually re-assess, in my opinion.

Edited May 2, 2020 by Unicorn

[+ stevenkesslar]

I also think that the graph you showed is filled with false assumptions. I certainly don't trust the Chinese statistics one bit. The Aussies and the Kiwis also benefited from a much lower virus burden to begin with, as well as their isolation, and perhaps due to the fact that mitigation efforts started in their Summer (and ours in our winter), much as you may not want to believe it--and much as I acknowledge that this may not prove to be the case. If our efforts at mitigation were so meager as the graph suggests, they weren't worth the effort. I, however, believe mitigation probably saved many lives. We need to slowly ease things up and continually re-assess, in my opinion.

 

I think you should read The Hammer And The Dance. It doesn't sound like you have. It would address much of what you said in great detail.

 

The chart does not describe what the US did. It was a prescriptive chart from an essay on March 19 recommending what the US should do. Which was to hammer, hammer, hammer. So the point of those others lines on the chart - doing nothing, or mitigating - is what Pueyo argued we would get if we followed that approach. Basically, he said we would not get the results we wanted.

 

"Mitigating" is a word that means different things to different people. But Pueyo's basic idea in mid-March was that half-hearted measures that only some people abide by would not get us the results we wanted. And I think since he wrote that on March 19, it has proven to be true. All the really hard hit European countries that were much more hard core about hammer, hammer, hammer have cut the infections by a half or two thirds or more.

 

France is a notable example. They had a high of 17,000 infections on one day, and a more normal daily high of about 5000 a day for several weeks at the peak. So now they are down to 509 three days ago, 758 two days ago, and 168 yesterday. That's a remarkable decline that took a lot of sacrifice.

 

So if you were to ask most Americans, would you rather see 30,000 people a day get this, or 168, we obviously know how most Americans would answer. So my point is that this hammer idea seems to have achieved what people really wanted - all over the world. Less sickness, and less death. Some of these European countries were fining people, or limiting you to two people that could be outside together at once and only for certain reasons - like to get food. So the idea was to take very hard core steps for a limited period of weeks, all at once, to dramatically lower the number of cases. It worked, in terms of quickly and dramatically hammering down the number of infections per day.

 

Back to that word "mitigating", I would argue that Pueyo pretty much called what happened in the US. What we did worked, but in a different way. The really good news is that had we done nothing, what was happening in New York would have played out all over the US to one degree or another. Probably more in California, less in South Dakota. But even in South Dakota and Iowa, even with some moderate restrictions, big outbreaks still occurred in some places. I think it's clear that if we have 65,000 deaths that are growing by 2,000 a day with the lock downs, it would have been much worse without them. So the lock downs worked.

 

That said, arguably it was more "mitigation" than hammer, I would argue. In truth, it was very different in every state. And sometimes very different in different parts of states. So the bottom line is we didn't grow from 30,000 to 100,000 new cases a day, thank God. But we are stuck at 30,000 a day. The polls say that most Americans want to focus more on getting this high number of cases down. People are worried about their health, and especially of all these deaths. (On May 1 the US has our second highest number of new cases - 36,007 new cases.)

 

All the other outcomes I mentioned in other countries that you are sort of rebutting had not even occurred yet. So what happens in Australia, or Austria, or China, or Hong Kong, or Iceland, or Japan, or New Zealand, or Singapore, may be irrelevant to the US. My point in bringing it up was this: they have all followed some version of the model Pueyo described, which is itself a compilation of what a lot of scientists and doctors are saying. The model is essentially the Fauci/Birx model. Although it is more aggressive, in that it advocates the use of a "hammer" in a way that maybe 20 % of Americans simply would not support, at least going off polls. Fauci and Birx have sort of baked into their cake that some percentage of Americans really do seem to feel that liberating the virus is the best scientific and economic approach. Other countries have said the best thing for the economy is to focus completely on crushing this virus. The idea was to just hammer, hammer, hammer relentlessly and uniformly for a period of weeks.

 

The countries that did it - like China, like South Korea, like New Zealand, like Australia, and the others - all seem to have achieved the same result. I'm oversimplifying, of course. There's complexity and many different variables in each of those countries. And part of it is what you said, which is the point I made several times above. It helps a lot that most of them started with no more than 1,000 confirmed infections on their worst day. That said, the outcome is true in every case: THE HAMMER PART WORKED.

 

The polls suggest people think we can do better than 2000 Americans dying every day. Which will likely be headed to 3000 a day as we reopen, according to at least some of the experts. The polls say 80 % of Americans feel like containing the virus is the top priority. Pueyo was speaking to that part of the nation. His message, like Fauci, is that many of the Fauci-types all over America think these ideas make sense. That's what he said in the middle of March, right after the lock downs he helped promote started.

 

I'm a Doubting Thomas by nature, and I always prefer facts to theories. I brought up all these other countries because his theory turned out to work, in fact. So you can say in mid March, What if a country hammered this virus relentlessly for 3 or 4 or 5 or 6 weeks? Would that work? So now we can look at all these other countries and say that they tried it, and it worked. If we don't want 2000 or 3000 dead Americans every day, it is definitely food for thought.

 

I mentioned California because you can do the same examples in the US. If we had the same rate of infection as New York did, and the same rate of actual deaths relative to our population, we'd have had 50,000 dead in California. Basically double the population of New York, double the number of deaths. And that's nothing, compared to what Newsom talked to us about in mid-March, when all this was first coming down. He said up to 20 million could get infected by May or June. And all those models, like Imperial College and the Pueyo one I posted, bore it out mathematically. Exponential growth, left unchecked, will do that. That's why we have 25,000 known dead people from COVID-19 in New York.

 

I bold-faced that thing you said about Australia and New Zealand because that is an absolutely critical point. There is a huge difference between having 1,000 cases a day and 30,000 a day. Both Australia and New Zealand are on the leading edge of contact tracing. That is partly how they got the number of infections under control - along with the lock downs themselves, of course. When you have 30,000 new known cases every day, which probably means well over 100,000 new infections a day, it turns something that is hard work into impossible work. It's just too many people to trace. I'd strongly encourage reading Pueyo's whole thing, because it goes through a lot of these variables in a very detailed way. About how to really focus both on saving the economy, and of course save lives, too.

 

California will be a model on how, or even whether, testing and tracing can work. Even though it is really science, not politics, I'm putting most of this stuff on a thread there called Test, Trace, Treat to leave room for discussing the partisan differences between states. California is well into the process of hiring 10,000 contact tracers. That's way more than any other state. This past week there have been between 1000 and 2500 new cases per day in California. We are on par with where Australia was before their lock down, since we have twice their population. We are continuing the lock down here for another month.

 

I think the idea is that once we reopen, we really want to be able to stay open. Meaning people can go to work. Kids can go to school in the Fall, and maybe have the schools start early. That's the goal, at least. And I think based on everything in the world it's clear that "test, trace, treat" is our best shot at being able to keep the jobs and schools going. Of course, none of us will know until we see how bad the Fall gets.

 

 

I'm posting that chart to add a touch of nuance. That's from Pueyo's first paper on March 9th. At that time, South Korea looked like the global problem child. In fairness to them, there was a mass undetected infection cluster in a church sect. Over 4000 sect members were infected. They infected others. So in early March, the snapshot of South Korea looked bad. Now everyone sees them as a model.

 

The good news is we learned that to err is human, but to be determined is divine. They have been relentless about "test, trace, treat". So far it has worked. Only 250 deaths in South Korea. The bad news is Spain, France, the US are all those little lines at the bottom of the graph. Two months ago! That's how quickly this spreads and kills.

Edited May 2, 2020 by stevenkesslar

[+ stevenkesslar]

I also think that the graph you showed is filled with false assumptions. I certainly don't trust the Chinese statistics one bit. The Aussies and the Kiwis also benefited from a much lower virus burden to begin with, as well as their isolation, and perhaps due to the fact that mitigation efforts started in their Summer (and ours in our winter), much as you may not want to believe it--and much as I acknowledge that this may not prove to be the case. If our efforts at mitigation were so meager as the graph suggests, they weren't worth the effort. I, however, believe mitigation probably saved many lives. We need to slowly ease things up and continually re-assess, in my opinion.

 

I think you should read The Hammer And The Dance. It doesn't sound like you have. It would address much of what you said in great detail.

 

The chart does not describe what the US did. It was a prescriptive chart from an essay on March 19 recommending what the US should do. Which was to hammer, hammer, hammer. So the point of those others lines on the chart - doing nothing, or mitigating - is what Pueyo argued we would get if we followed that approach. Basically, he said we would not get the results we wanted.

 

"Mitigating" is a word that means different things to different people. But Pueyo's basic idea in mid-March was that half-hearted measures that only some people abide by would not get us the results we wanted. And I think since he wrote that on March 19, it has proven to be true. All the really hard hit European countries that were much more hard core about hammer, hammer, hammer have cut the infections by a half or two thirds or more.

 

France is a notable example. They had a high of 17,000 infections on one day, and a more normal daily high of about 5000 a day for several weeks at the peak. So now they are down to 509 three days ago, 758 two days ago, and 168 yesterday. That's a remarkable decline that took a lot of sacrifice.

 

So if you were to ask most Americans, would you rather see 30,000 people a day get this, or 168, we obviously know how most Americans would answer. So my point is that this hammer idea seems to have achieved what people really wanted - all over the world. Less sickness, and less death. Some of these European countries were fining people, or limiting you to two people that could be outside together at once and only for certain reasons - like to get food. So the idea was to take very hard core steps for a limited period of weeks, all at once, to dramatically lower the number of cases. It worked, in terms of quickly and dramatically hammering down the number of infections per day.

 

Back to that word "mitigating", I would argue that Pueyo pretty much called what happened in the US. What we did worked, but in a different way. The really good news is that had we done nothing, what was happening in New York would have played out all over the US to one degree or another. Probably more in California, less in South Dakota. But even in South Dakota and Iowa, even with some moderate restrictions, big outbreaks still occurred in some places. I think it's clear that if we have 65,000 deaths that are growing by 2,000 a day with the lock downs, it would have been much worse without them. So the lock downs worked.

 

That said, arguably it was more "mitigation" than hammer, I would argue. In truth, it was very different in every state. And sometimes very different in different parts of states. So the bottom line is we didn't grow from 30,000 to 100,000 new cases a day, thank God. But we are stuck at 30,000 a day. The polls say that most Americans want to focus more on getting this high number of cases down. People are worried about their health, and especially of all these deaths. (On May 1 the US has our second highest number of new cases - 36,007 new cases.)

 

All the other outcomes I mentioned in other countries that you are sort of rebutting had not even occurred yet. So what happens in Australia, or Austria, or China, or Hong Kong, or Iceland, or Japan, or New Zealand, or Singapore, may be irrelevant to the US. My point in bringing it up was this: they have all followed some version of the model Pueyo described, which is itself a compilation of what a lot of scientists and doctors are saying. The model is essentially the Fauci/Birx model. Although it is more aggressive, in that it advocates the use of a "hammer" in a way that maybe 20 % of Americans simply would not support, at least going off polls. Fauci and Birx have sort of baked into their cake that some percentage of Americans really do seem to feel that liberating the virus is the best scientific and economic approach. Other countries have said the best thing for the economy is to focus completely on crushing this virus. The idea was to just hammer, hammer, hammer relentlessly and uniformly for a period of weeks.

 

The countries that did it - like China, like South Korea, like New Zealand, like Australia, and the others - all seem to have achieved the same result. I'm oversimplifying, of course. There's complexity and many different variables in each of those countries. And part of it is what you said, which is the point I made several times above. It helps a lot that most of them started with no more than 1,000 confirmed infections on their worst day. That said, the outcome is true in every case: THE HAMMER PART WORKED.

 

The polls suggest people think we can do better than 2000 Americans dying every day. Which will likely be headed to 3000 a day as we reopen, according to at least some of the experts. The polls say 80 % of Americans feel like containing the virus is the top priority. Pueyo was speaking to that part of the nation. His message, like Fauci, is that many of the Fauci-types all over America think these ideas make sense. That's what he said in the middle of March, right after the lock downs he helped promote started.

 

I'm a Doubting Thomas by nature, and I always prefer facts to theories. I brought up all these other countries because his theory turned out to work, in fact. So you can say in mid March, What if a country hammered this virus relentlessly for 3 or 4 or 5 or 6 weeks? Would that work? So now we can look at all these other countries and say that they tried it, and it worked. If we don't want 2000 or 3000 dead Americans every day, it is definitely food for thought.

 

I mentioned California because you can do the same examples in the US. If we had the same rate of infection as New York did, and the same rate of actual deaths relative to our population, we'd have had 50,000 dead in California. Basically double the population of New York, double the number of deaths. And that's nothing, compared to what Newsom talked to us about in mid-March, when all this was first coming down. He said up to 20 million could get infected by May or June. And all those models, like Imperial College and the Pueyo one I posted, bore it out mathematically. Exponential growth, left unchecked, will do that. That's why we have 25,000 known dead people from COVID-19 in New York.

 

I bold-faced that thing you said about Australia and New Zealand because that is an absolutely critical point. There is a huge difference between having 1,000 cases a day and 30,000 a day. Both Australia and New Zealand are on the leading edge of contact tracing. That is partly how they got the number of infections under control - along with the lock downs themselves, of course. When you have 30,000 new known cases every day, which probably means well over 100,000 new infections a day, it turns something that is hard work into impossible work. It's just too many people to trace. I'd strongly encourage reading Pueyo's whole thing, because it goes through a lot of these variables in a very detailed way. About how to really focus both on saving the economy, and of course save lives, too.

 

California will be a model on how, or even whether, testing and tracing can work. Even though it is really science, not politics, I'm putting most of this stuff on a thread there called Test, Trace, Treat to leave room for discussing the partisan differences between states. California is well into the process of hiring 10,000 contact tracers. That's way more than any other state. This past week there have been between 1000 and 2500 new cases per day in California. We are on par with where Australia was before their lock down, since we have twice their population. We are continuing the lock down here for another month.

 

I think the idea is that once we reopen, we really want to be able to stay open. Meaning people can go to work. Kids can go to school in the Fall, and maybe have the schools start early. That's the goal, at least. And I think based on everything in the world it's clear that "test, trace, treat" is our best shot at being able to keep the jobs and schools going. Of course, none of us will know until we see how bad the Fall gets.

 

 

I'm posting that chart to add a touch of nuance. That's from Pueyo's first paper on March 9th. At that time, South Korea looked like the global problem child. In fairness to them, there was a mass undetected infection cluster in a church sect. Over 4000 sect members were infected. They infected others. So in early March, the snapshot of South Korea looked bad. Now everyone sees them as a model.

 

The good news is we learned that to err is human, but to be determined is divine. They have been relentless about "test, trace, treat". So far it has worked. Only 250 deaths in South Korea. The bad news is Spain, France, the US are all those little lines at the bottom of the graph. Two months ago! That's how quickly this spreads and kills.

Edited May 2, 2020 by stevenkesslar

[Guest]

I'm sorry, SK, but I would again have to state that the beliefs you espouse are based on mostly unfounded assumptions, often "supported" by cherry-picked data. China is an authoritarian state in which everything from the press to disease data can be completely fabricated and controlled, so their numbers cannot be trusted. I have discussed Australia's and New Zealand's differences previously. South Korea's data was greatly skewed by the one big outbreak they had. Pueyo also made a bunch of assumptions in early March, much of which we know were wrong (see my prior reference to see how wrong California's prognostications were).

Why was NY/NJ's experience so far different from California's, even though they had similar lockdowns? Was is because California started one week earlier? Were different strains of the virus involved? Was it because the weather in March in NYC is cold, and it's mild in California? Is it because of the higher population density? Is it because New Yorkers usually commute by public transit, all touching the same subway/train handles/posts (it's probably not possible to sanitize every single thing one touches), whereas Californians usually commute by car? A combination of factors (pretty likely)? At this point, we don't have enough hard knowledge to know for sure, and any statement to the contrary probably displays a certain degree of arrogance.

https://thehill.com/policy/healthcare/494324-27m-new-yorkers-have-had-coronavirus-preliminary-data-shows

From the fairly recent data referenced above, "...13.9 percent of the population of New York state — about 2.7 million people — have at some point been infected with the coronavirus... In New York City, 21 percent of residents had antibodies for coronavirus, compared with 3.6 percent in upstate New York, 16.7 percent in Long Island and 11.7 percent in the Westchester and Rockland area...The data indicates the COVID-19 death rate in New York is about 0.5 percent. The tests were conducted over a two-day period in 19 counties and 40 localities."

That, at least, shows some hard data rather than theories and trying to compare one country to another based on one's ideas and long-winded rhetoric. It is one thing to contain a virus in an isolated country with only a few thousand infected. This cannot work in the US or in Europe where millions are carrying the virus. Australia and New Zealand can probably isolate themselves until they can test every person entering the country and a vaccine becomes available sometime in 2021 (hopefully). The cat is out of the bag in the US, Canada, and Europe. Probably a majority of the population will contract Covid-19 before a vaccine becomes available (if that ever comes to pass). The goal is to slow, not stop, the spread so that the healthcare system isn't overwhelmed. I believe any thought of stopping the virus in North American and Europe is foolish.

Now is probably a good time to start loosening things up, keeping a close eye on hospital and ICU admissions (with particular attention to those related to Covid19, of course). Better to start now (and observe), rather than wait until the Fall, when, if this strain of coronavirus acts like every other known stain of coronavirus, infections are likely to be more virulent (and there will be millions out of work for months, potentially homeless, without insurance, etc).

Edited May 2, 2020 by Unicorn

[LivingnLA]

The math is irrefutable without magical thinking. The nonpartisan reality is the USA being on trend for 80,000 to 100,000 dead by the end of May in a best case scenario. Epidemiologically, it's impossible to contain a pandemic when a large enough portion of a population fail to comply with public health guidelines and the USA has somewhere between 20 and 30% noncompliance depending on the city, state, and specific demographics being discussed. The USA seems to have chosen to mitigate and reopen while attempting to "thread a needle" of a few hundred thousand deaths this year as a best possible case. These deaths will disproportionately be among the poor, which is presumably why this choice was made since we already tolerate hundreds of thousands of dead poor every year in our society. This is different though, because there is a real risk that these additional deaths will cause major disruptions in supply chains, especially food, and the immigration freezes only increase this risk. If these disruptions occur, consumer panic will likely crash the economy again and likely be worse than what we've just been through these past two months. That could cascade causing another lost decade for the vast majority of Americans. For the record, I very much hope to be wrong, but to deny the data is to succumb to magical thinking and I rarely do that, especially as I need to plan and prepare to continue protecting my family.

Edited May 2, 2020 by LivingnLA

[samhexum]

The math is irrefutable without magical thinking. The nonpartisan reality is the USA being on trend for 80,000 to 100,000 dead by the end of May in a best case scenario.

 

Another 299 people across New York died from the coronavirus in the last 24 hours — an “obnoxiously” high number, Gov. Andrew Cuomo announced Saturday.

 

Fatalities jumped 10 deaths from the day before, and include 276 who died in hospitals and 23 in nursing homes, for a statewide total of 18,909.

 

“That number has remained obnoxiously and terrifyingly high and is still not dropping at the rate we would like to see,” Cuomo said at a daily briefing from New York City Transit’s Corona Maintenance Facility in Flushing, where trains will be disinfected nightly.

 

An additional 831 New Yorkers were admitted to hospitals with COVID-19 cases, Cuomo said, a decrease from the several days prior, when admissions were plateaued at around 900.

 

More than 10,300 New Yorkers remain hospitalized with COVID-19, with 2,923 on ventilators in intensive care, according to state data.

 

Diagnoses grew by 4,663, state officials said Saturday, to a statewide total of 312,977.

 

Cuomo also announced preliminary results of the state’s 15,000 antibody tests it began conducting April 22.

 

On that date, when 2,933 had been tested for signs they had already fought the disease, the rate of positivity was 14 percent statewide. It has since dropped to 12 percent.

 

Only one age group has seen an increase in positive antibody tests: 18- to 24-year-olds. Their positive-test rate grew from 8 percent on April 22 to 11 percent Saturday, the governor said.

 

New Yorkers between the ages of 45 and 54 had the highest percentage, 14, of positive antibody tests.

 

In New York City, the percentage of those positive for antibodies stood at about 20 percent on Saturday, a two-percentage-point drop from April 22.

 

The results show the Bronx has been hit harder than any borough, with 28 percent positive for antibodies, compared to 19 percent in Brooklyn and Staten Island, 18 in Queens, and 17 in Manhattan.

 

“We’re going to do more research to understand what’s going on there. Why is the Bronx higher than the other boroughs?” Cuomo said.

 

In counties outside New York, about 1 to 3 percent tested positive for antibodies.

 

Cuomo said the state would begin Saturday testing all transit workers for antibodies, among several new initiatives.

 

And state workers will distribute 7 million face masks beginning Saturday to high-risk communities, including NYCHA complexes and nursing homes.

 

The state will also distribute $25 million to food banks across the state, with $11 million to New York City, he said.

[Guest]

I think you should read The Hammer And The Dance. It doesn't sound like you have. It would address much of what you said in great detail.

...

I most certainly did not read that silly oration, since it bases its "argument" on assumptions now known to be false. Just to look at the graph you posted:

From my prior post, the case mortality rate in New York, the hardest-hit area in the US, is now known to be 0.5%, to the best of our knowledge. The total population of the US is about 330 million. Even if every single man, woman, and child in the US were to get Covid-19, total deaths would number about 1.6 million, not ">10,000,000" as your theorist espoused. And that's if all strains of Covid19 are as deadly as the NYC strain, and also assumes that virulence in the hot months will be the same as in the cool/cold months, and also assumes remdesivir will have no beneficial effect on mortality. Sorry, but I prefer founding my opinions on facts, data, and science, rather than rhetoric and ideas one has in one's head. Being long-winded doesn't make one right. I can't remember the exact quote, but Einstein once commented on the dozens of criticisms and arguments he had from others who "disproved" his theory of relativity. It was something along the lines of "Why dozens of papers? It would only take one correct one."

[BgMstr4u]

“Why is the Bronx higher than the other boroughs?” Cuomo said.

Just a thought on this: Was not the first NY State outbreak of Covid-19 in Westchester County (New Rochelle?), bordering The Bronx? Which is, perhaps not incidentally, the only NYC borough attached to the mainland. Perhaps there is a geographical factor in the viral spread, i.e., that islands often have more restricted points of ingress. E.g., New Zealand.