Precaution v. Paranoia

[xyz48B]

What is precaution?

 

What is caution?

 

What is overreaction?

 

What is paranoia?

 

I ask this because as we look at numbers coming in throughout the country, we see that many states are experiencing “surges.” When you look at the numbers, these are nothing like March or April numbers. To be sure, they seem to be cause of precaution, but the actions of, say, California in light of what I see on CovidActNow don’t seem nearly as alarming as earlier this year. It seems fear is behind some of what’s going on as far as the political response.

 

No one really knows much about this disease, so we’re told. Except every horrible imaginable thing about it is incontrovertibly true. That seems like paranoia to me. Precaution seems like looking at the facts and acting accordingly. No doubt, some behavioral changes need to be made right now, but too many are acting like this disease has poisoned the very air we breathe the world over.

[Todd Jenkins]

What is precaution?

 

What is caution?

 

What is overreaction?

 

What is paranoia?

 

I ask this because as we look at numbers coming in throughout the country, we see that many states are experiencing “surges.” When you look at the numbers, these are nothing like March or April numbers. To be sure, they seem to be cause of precaution, but the actions of, say, California in light of what I see on CovidActNow don’t seem nearly as alarming as earlier this year. It seems fear is behind some of what’s going on as far as the political response.

 

No one really knows much about this disease, so we’re told. Except every horrible imaginable thing about it is incontrovertibly true. That seems like paranoia to me. Precaution seems like looking at the facts and acting accordingly. No doubt, some behavioral changes need to be made right now, but too many are acting like this disease has poisoned the very air we breathe the world over.

 

 

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[+ keroscenefire]

 

I ask this because as we look at numbers coming in throughout the country, we see that many states are experiencing “surges.” When you look at the numbers, these are nothing like March or April numbers.

 

Yes, the numbers now are actually much worse both in the United States generally and in specific states. These are all articles published in mainstream, credible news sites in the last three days. In many parts of the country, COVID cases are the worst they have ever been. However, COVID cases are truly stabilizing or declining in other places like NYC.

 

For first time, U.S. records more than 70,000 new coronavirus cases in single day

 

Florida shatters US record for new single-day Covid-19 cases

 

Coronavirus case averages reach record highs in more than a third of U.S. states as deaths climb

[+ honcho]

I ask this because as we look at numbers coming in throughout the country, we see that many states are experiencing “surges.” When you look at the numbers, these are nothing like March or April numbers. To

 

Yes, the numbers now are actually much worse both in the United States generally and in specific states. These are all articles published in mainstream, credible news sites in the last three days. In many parts of the country, COVID cases are the worst they have ever been. However, COVID cases are truly stabilizing or declining in other places like NYC.

 

For first time, U.S. records more than 70,000 new coronavirus cases in single day

 

Florida shatters US record for new single-day Covid-19 cases

 

Coronavirus case averages reach record highs in more than a third of U.S. states as deaths climb

 

ICU occupancy in AZ and TX is now like that of NYC at its peak; In Phoenix they are using refrigerated trucks as temporary morgues,

also like that of NYC at its worst. In CA, the increase in hospitalizations is worse than it was in April.

 

What Gov. Newsom is doing has been not entirely accurately reported in the national press. Indoor retail is still allowed, even in counties on the watch list. Outdoor Religious services are also permitted. Those were not allowed during the first stay-at-home order.

[xyz48B]

Well, the media loves to skew words.

 

Still haven’t learned what “increase,” “uptick,” “surge” mean. What are those metrics?

 

Of course if you have low, low rates, any increase is going to look drastic by percentages. Are we looking at this as a percentage of the population? As raw numbers? As percentage increase over 3, 5, 7, 10, etc. days?

 

Data is important but it’s really helpful when you know what the data is telling you. That’s where understanding happens. “It’s bad”* isn’t necessarily helpful unless you can understand the data.

 

*I’m not saying it’s not bad. Just I want to know how we arrived at that conclusion. After all, we are disrupting the very basic day-to-day goings-on of our lives based off of “It’s bad.”

[+ Lucky]

Percentage increases? Consumer Reports billed me $20. Then I got an email inviting me to pay that online. So I did. A few hours later I got a receipt for $26! That's an unexplained 30% increase...from Consumer Reports. Aren't they supposed to be the good guys.

And try calling them. The worst circus I have yet experienced. I never got a person.

Okay, I detoured on percentage increases. But now I am paranoid to subscribe to something!

[+ keroscenefire]

 

*I’m not saying it’s not bad. Just I want to know how we arrived at that conclusion. After all, we are disrupting the very basic day-to-day goings-on of our lives based off of “It’s bad.”

 

Bad and worse and better and best are all subjective words, but the media in the articles I posted are sharing that there are more cases of COVID-19 now in the United States overall and in many specific states than there ever had been since the beginning of the pandemic. And as Honcho points out, we are in many places running out of ICU beds, ventilators and other medical supplies needed to help people with severe cases, which again as he points out can (and already has) lead to more people dying for the disease.

 

More links (All articles within the last three days from credible news sites):

 

ICU beds reach new low in Texas as COVID cases pass 250,000 mark

 

ICU beds, ventilators in use hit new records as Arizona reports 1,357 new COVID-19 cases

 

Florida’s Covid-19 Deaths Might Rival New York's

[Islesguy]

Suffolk County, NY had it's first triple digit number of positive cases since May yesterday. That's a worrying number in light of it being a little more than a week post 7/4.

[+ keroscenefire]

Suffolk County, NY had it's first triple digit number of positive cases since May yesterday. That's a worrying number in light of it being a little more than a week post 7/4.

 

I heard that..so sad because NYC has been doing so well recently..really hope all those returning from the Hamptons quarantine themselves for 2-weeks.

[Islesguy]

I heard that..so sad because NYC has been doing so well recently..really hope all those returning from the Hamptons quarantine themselves for 2-weeks.

Yeah, I'm hoping it's a temporary blip since Long Island has had three days worth of an uptick. Nassau has been a little better but still worrying.

[SirBillybob]

Precaution, caution, reaction, etc, are fluid terms and our individual subjectivity cannot be dictated or aligned collectively. The metrics, purist epidemiological terms, and colloquial terms/expressions all get thrown into the mix and can be difficult to interpret.

 

I personally dislike the metric of ‘total cases’ to date because it tends to be milestone-oriented (eg, just hit 10,000! blah blah, and now we have surpassed X disease and Y natural disaster for casualties! blah blah.) It is also usually nation-centric and described out of context of a population-size denominator. Total count may be useful for corollary considerations but not so much for describing the attack rate of a disease as you are trying to keep up and manage it.

 

I also sometimes look at the logarithmic curve for total cases to detect a visual of exponential-ity. This takes a little bit more experience because this visual should be cross-referenced to the daily case histogram bar depicted with rolling average line. A tilt of the logarithmic line (typically base10 format; 0, 10, 100, 1000, 10000, 100000, 1000000, etc where for example 1 million is ‘log 6’) away from 90 degrees horizontal and towards 0 degrees north/top on the graph suggests a, well, ‘surge’ in case incidence progression. This can be seen in the USA total case curve, ever so slight because log curves maintain greater stability at high counts in the millions, but it is bad news for sure.

 

Total cases also misrepresents the count of active cases. For what it is worth in terms of this disease (ie, what is truly the future of morbidity for some that survived), recovered cases in many countries exceeds the current count of active cases even when daily incidence rates continue to climb.

 

I am mostly interested in the tally of active cases and in the trend of daily new cases. What I would consider worrisome for a disease that has a fairly high mortality rate considering the duration from infection to death, and also considering the resources needed to prevent death among a percentage of cases with severe morbidity, is that the number of recoveries does not keep pace with the number of active cases at a point in time when the needed resources for offsetting a death that could be prevented are depleted or diluted in comparison to a point in time earlier in the pandemic when ‘all the stops can be pulled out’ for the most part at point of critical care.

 

Hyperbolic terms are likely to be pulled out for use in headlines at any point in these cycles but especially when resources are progressively pushed to the limit.

 

To put the USA as a whole in perspective, active cases, as I said above an important metric for some prediction of resource allocation, numbered 181,600 Mar 31st, 868,500 April 30th, and today the tally is 1,760,000 ... that is alarming even if case severity proportion lowers for some reason.

 

Getting back to measurement terms, I look at the new daily cases and their daily rolling averages at a global level. The doubling effect, that is the duration of time for global daily new case incidence to double its respective previous measurement has been quite variable. It was merely 6 days towards the end of March, then it took 2 months to double again, and just doubled again 6 weeks following the previous date at the end of May. That last doubling point, to me, being of shorter duration yet at a much higher case volume, also suggests somewhat of a ‘surge’.

 

So there are a lot of ways to look at the data. They cannot be easily packaged for general consumption.

[xyz48B]

Suffolk County, NY had it's first triple digit number of positive cases since May yesterday. That's a worrying number in light of it being a little more than a week post 7/4.

Worrying, yes. Or perhaps worth watching. Raw numbers are critically important. But what’s also important is looking back to May and comparing the last triple digital day as far as testing. Was testing higher then? Now? About the same? If the percentage has remained low, it’s “fine.”

 

Look – I want the virus to go away. I also believe in sensible precaution. But data can be manipulated. A triple digit day means something radically different if you’re only doing total tests in the triple digits versus a triple digit day with total tests with five digits. Either way, I’d assess any number of positive cases as bad. But one situation is more concerning.

 

This goes back to the original question. Is an uptick measured by sheer raw numbers or by percentages of positive cases against tests done? I’ve heard talk about critical ICU bed usage remaining at 70% or lower. Then I read stories (not out of Arizona or the like but other “surging” places) where ICU usage is 10%. Do we want any COVID in ICU? No. Is 10% far from the critical 70%? Yes. So what’s the crisis point? Do we need to halt society when ICU usage is at 60% because we’re approaching 70%? 50%? 10%? Who decides this and on what grounds?

 

I know it sounds all rather inhumane to speak in numerical terms, but sadly we’re looking a numerical behemoth here. We have over 3 million people affected by this disease alone. It cannot sadly be a personal issue for all 3 million. To say nothing of the lives of those who are displaced for those 3 million directly affected so far.

[xyz48B]

So there are a lot of ways to look at the data. They cannot be easily packaged for general consumption.

Precisely. Precisely. And at some point, someone with real or metaphoric balls needs to say – this metric is the determinant. It can’t a constantly moving goal post. That logarithmic curve you talked about – that was what we wanted to flatten months ago. Little to nothing is said about that anymore. Now we just have to accept it’s too complicated for us to understand and just accept the experts are telling the politicians what is best! I don’t say they don’t know more than me or better than me. But if you can’t break it down in terms that are comprehensible, then someone is failing.

[Islesguy]

Worrying, yes. Or perhaps worth watching. Raw numbers are critically important. But what’s also important is looking back to May and comparing the last triple digital day as far as testing. Was testing higher then? Now? About the same? If the percentage has remained low, it’s “fine.”

 

Look – I want the virus to go away. I also believe in sensible precaution. But data can be manipulated. A triple digit day means something radically different if you’re only doing total tests in the triple digits versus a triple digit day with total tests with five digits. Either way, I’d assess any number of positive cases as bad. But one situation is more concerning.

 

This goes back to the original question. Is an uptick measured by sheer raw numbers or by percentages of positive cases against tests done? I’ve heard talk about critical ICU bed usage remaining at 70% or lower. Then I read stories (not out of Arizona or the like but other “surging” places) where ICU usage is 10%. Do we want any COVID in ICU? No. Is 10% far from the critical 70%? Yes. So what’s the crisis point? Do we need to halt society when ICU usage is at 60% because we’re approaching 70%? 50%? 10%? Who decides this and on what grounds?

 

I know it sounds all rather inhumane to speak in numerical terms, but sadly we’re looking a numerical behemoth here. We have over 3 million people affected by this disease alone. It cannot sadly be a personal issue for all 3 million. To say nothing of the lives of those who are displaced for those 3 million directly affected so far.

Positivity in Suffolk has gone from approx 1% to 2% in three days. Still lower than back in May but a discouraging trend.

[SirBillybob]

Up here in Canada we don’t have a circus clown & associates proclaiming that testing creates cases that in turn promotes havoc and unnecessary imposition of phases higher in the confinement hierarchy than warranted.

 

I understand curiosity about adding some factor related to testing to the denominator, a denominator that otherwise seems quite fixed on population (ie, per capita). However, it is difficult to combine population surveillance testing, along with confirmatory testing for symptoms or known exposure risk, into a denominator. Moreover, the likelihood that undercounting lowers visible

prevalence rates poses a greater ascertainment bias than the skew posed by less than precise tracking of surveillance versus diagnosis in context of more probable infection.

 

Rhode Island has tested the most, 28% of population, and has a separate case positive tally of 1.7% of population in total, while Colorado has tested the least, 7% percent of pop with a separate tally of 0.7% of population reported to have or have had the disease. Now then, this might lead to the conclusion that increased testing yields increased case prevalence. However, there are other checks and balances. Rhode Island has had 3 times the number of pop-adjusted CoV19 deaths as Colorado. In other words, testing rates are irrelevant in this example because the argument that testing inflates case tally is nullified by the reality that testing cannot possibly be proportional to fatality ... increased surveillance testing would simply raise the count of cases that would be under the radar if not detected, and certainly not lethal.

 

I think that the best anyone as an individual can do is to try to drill down and understand the numbers within their own little corner of the world. Personally, I am behaving no differently now that Montreal is really low in prevalence compared to when a few months ago the province of Quebec was among the most affected areas on the planet.

[xyz48B]

I think that the best anyone as an individual can do is to try to drill down and understand the numbers within their own little corner of the world. Personally, I am behaving no differently now that Montreal is really low in prevalence compared to when a few months ago the province of Quebec was among the most affected areas on the planet.

I believe THIS is critical to sane living. The problem of course is a population woefully unable to interpret data.

[SirBillybob]

I believe THIS is critical to sane living. The problem of course is a population woefully unable to interpret data.

I think I have a bit of an advantage because among my graduate degrees is a Master’s in Medical Science Research Methods, my thesis and much of subsequent ongoing research in the realm of Infectious Diseases, in fact. I also worked in a SARS hotspot in 2003. It is certainly frustrating to witness lack of understanding as well as lackadaisical attitude in relation to this disease. I get CNN up here but I cannot tune in to what is pretty much a train wreck. We have had some derailments but now better on track, for now.

[xyz48B]

Basic statistical analysis though is pretty incumbent upon someone being able to make an informed decision about anything. If you can’t read a graph, for instance, it’s pretty easy to be manipulated with emotional ploys.

[+ keroscenefire]

Basic statistical analysis though is pretty incumbent upon someone being able to make an informed decision about anything. If you can’t read a graph, for instance, it’s pretty easy to be manipulated with emotional ploys.

 

I don't think it's about emotional ploys. It's that in many places, they are literally running out of hospital beds and ventilators. This is already happening in Texas. It's close to happening in parts of California. Many areas are not flattening the curve, they are breaking it and our hospital systems are becoming overloaded again just like in NYC. Policymakers like Newsom in California and Abbott in Texas (although much too late for him) are simply doing what the data suggests and putting in measures to flatten the curve of this pandemic or risk overloading the medical system in a way that puts both COVID and non-COVID patients in danger of not getting the care they need. And just like it did in NYC, this will cause more deaths.

[xyz48B]

I don't think it's about emotional ploys.

In this instance I was speaking more broadly.

 

It's that in many places, they are literally running out of hospital beds and ventilators.

Which is a valid point and makes sense to implement more invasive measures. The necessity is not my concern. My concern is still without a valid or satisfactory answer: what metrics are we using to implement mitigation efforts before exhaustion of resources happens?

 

For example – Cuomo, I understand, has stated that the virus is coming back to NY. What grounds does he have to say that other than fear? I’m suggesting he’s wrong. I’m asking how he knows. Is it an increase? Uptick? Spike? Surge? And what thresholds make him say that? Is there a reason the public isn’t privy to this information? In Massachusetts, we receive a daily dashboard of information, broken down pretty clearly what’s up. What in the NY data makes Cuomo say the virus coming back? Where in the “dashboard” for NY can we find that info, for instance?

 

Questions. Questions. Questions.

[SirBillybob]

I don’t listen to Cuomo but I think he means that the prevalence will increase in a subsequent “wave”. I do not think he literally means it is coming back (present tense). Perhaps it is a poor choice of words and grammar tense. Essentially, it is not disputed that one must brace for a return of the virus, with an equal or greater attack rate. It is not a metric. It is history repeats itself.

 

The daily NY incidence rate has held steadily higher than the rate that predated the Spring calamity. Think about it. It is at a level that, if introduced to the population for the first time in July, would likely escalate along the same devastating pattern already seen. The Spanish flu’s second surge in Fall 1918 far surpassed the initial wave of late Spring 1918.

 

The cyclical theory of pandemics is somewhat murky, with each pathogen behaving in its own unique way and subject to a large host of variables, but I don’t think it is irresponsible to frame the warning with emphasis.

Edited July 15, 2020 by SirBIllybob

[+ E.T.Bass]

IMO, the paranoid camp includes those believing vaccines have microchips that will be switched on by 5G cellular technology to establish the Gates/Soros world domination, that the vaccine for COVID exists, that COVID was created as part of the world domination conspiracy, and that Gates is merely delaying the release of the vaccine to align with 5G.

 

I first heard this theory from a massage provider 4+ months ago, and more recently on an NPR report on conspiracy theories. I expect there are members of the Forum that believe some or all of that.

 

The data, the information, and the knowledge about COVID are not perfect. No arguments about that. We may not know the best ways to treat and to prevent. This is new territory. We are making it up as we go. My health care provider (Hoag) initially told me not to wear a mask. Now a mask is required before entering their facility. We can sit in the corner and pout about that. We can ignore government health warnings and just carry on with a "fuck it" attitude. Or we can try to follow steps to mitigate risk.

 

If you choose to ignore news that the virus is not diminishing, that's your business. But to me it seems critical.

 

https://www.thegrowthop.com/wp-content/uploads/2018/08/GettyImages-1025365534-e1535728685755.jpg

 

Please keep politics out of the Lounge.

Edited July 16, 2020 by E.T.Bass

[xyz48B]

The cyclical theory of pandemics is somewhat murky.

It’s this that makes drawing historical parallel conclusions or inferences difficult, particularly the 1918 pandemic with regards to this one. I think it’s fair to say we might expect it to behave that way or that we suspect it will given historical precedent(s), but we shouldn’t say so cavalierly that it will. Perhaps I’m splitting hairs here, but when the world is hanging on every word scientists and politicians are saying, slicing, dicing, and interpreting them...it behooves us to be exact in our communication. At the end of the day we can guess, but we don’t know. The only thing we know for sure is we know nothing for sure.

[Rudynate]

To say nothing of the lives of those who are displaced for those 3 million directly affected so far.

 

Short-signted to think of it as 3 million. Thinks of it as 6 million, then 12 million, then 24 . . .

[xyz48B]

@Rudynate – so far. What is to come, that will be higher, but we cannot really know. But I did say “so far.”