COVID-19 - Wuhan Coronavirus (a non-political thread, see pg. 36 #1778)

[AlexB]

I don’t think it was a bad idea in theory, but yeah, armed with the information we now know about the length and severity of illness some people suffer from, social distancing and restrictions on movement are clearly the better option, primarily for healthcare capacity reasons and to protect those most at risk

[Arles]

After all the data I've looked at, the simplest way to get "closer" to what the real numbers are is this: Do 10X on cases and 2.5X on deaths. Right now, we have 257,379 cases and 6,558 deaths. So, a ballpark would be 2.57 million cases and about 16,400 deaths (about 0.63% rate). If the testing ever ramps up, this model will need to drop the number of cases (and potentially dead). But, I would feel much better with these numbers than the ones on the website.

[Edward64]

Originally Posted by Arles

After all the data I've looked at, the simplest way to get "closer" to what the real numbers are is this: Do 10X on cases and 2.5X on deaths. Right now, we have 257,379 cases and 6,558 deaths. So, a ballpark would be 2.57 million cases and about 16,400 deaths (about 0.63% rate). If the testing ever ramps up, this model will need to drop the number of cases (and potentially dead). But, I would feel much better with these numbers than the ones on the website.

Not sure how you came to your conclusion but I will consider 16,400 deaths a relatively good outcome for this pandemic.

[Arles]

That's just to this point. As more days go on, the numbers will go up. My point is if you look at all the data and how this virus has spread in different countries, we are woefully under-reporting both cases (current and prior) and total deaths. Trying to project the future (even just through the summer) is extremely difficult. Some areas have done a much better job at social distancing (or don't have the mass transit/high density to make it more difficult). Just compare the LA/SF/Oakland area and New York City. Both have pretty decent populations, but the LA area is such more spread out, doesn't have nearly the people using mass transit and started their shelter in place before New York. So, New York city is getting hit much harder.

[PilotMan]

The link to the article that SI posted above is fantastic.



Thanks SI

[CU Tiger]

Originally Posted by Warhammer

This has been a concern of my wife and I. My son does click list at Kroger and has picked up hours during this. He has been moodier than normal so I figure that he hasn't been, but the thought has crossed our minds.

So this is one area we've been breaking.
Have allowed the daughter's boyfriend to come over a couple times.
His family has been on total lockdown and ours has been for the most part, my work still requires some travel but very little human interaction.

I figure allowing a +1 into our home for dinner or a movie hangout isnt greatly increasing our risks. But I also question the decision.

[CU Tiger]

I know the CDC data is skeptical (at best) but this is two consecuitve "cleared" days of decline.
So that's something, maybe.

[JPhillips]

Saw a CNN interview that mentioned the US has done 1.3 million tests, but almost have of those have yet to be processed. Has anyone else heard that stat?

[IlliniCub]

Originally Posted by sterlingice

The (simple) model I've been using would have had us around 4M today. However, it also assumed no social distancing or other mitigations. Clearly, we've made some societal changes so we're to the point where I'm not comfortable with how accurate my numbers are anymore.

Fortunately, someone is doing that job for me:
https://medium.com/@tomaspueyo/coron...e-36b886af37e9

Number of cases by state (graph)
https://miro.medium.com/max/2000/0*19GxUL6emgR1EqUx



I think his economic conclusions are flawed, but that's because he's treating this like recent pandemics, which were not nearly this large in scale, and didn't build in that we were due for a recession and the assorted bubbles that get generated from 10 years of expansion.


SI

I've been using this one that's funded by Bill Gates. We're pretty well on track with it so far. I think it was only off by 200 deaths or so yesterday. COVID-19

[panerd]

Originally Posted by IlliniCub

I've been using this one that's funded by Bill Gates. We're pretty well on track with it so far. I think it was only off by 200 deaths or so yesterday. COVID-19

I've seen this one as well. Seems to update fairly often which is both good and bad. What I mean by that is somebody was hyping everyone into 150 deaths per day in Missouri just last week using this site and now it says the peak will be 22. I like that it is at least accounting for some major errors but seems like it can be misused by somebody one on either side the great "death debate".

Also it seems to think there will be 0 deaths per day for the entire country in June. This would be fantastic news but wonder how they are counting on virus eradication.

[whomario]

Originally Posted by JPhillips

Saw a CNN interview that mentioned the US has done 1.3 million tests, but almost have of those have yet to be processed. Has anyone else heard that stat?

The tests, yes. The extreme delay is news to me ...

As an aside, the CDC on their website is only registering about 10k tests a day from private labs or am i missing sth ? I know it is a big country with tons of reporting agencies but seems weird that there is such little coordination and data collating going on. The institute in Germany manages fine despite 400k tests a week (surely less than the US but not a trifle).

I mean, what data does the task force use then, guessing Johns Hopkins ?

This is where i was looking: Testing in the U.S. | CDC

[whomario]

Would give some insight to compare tests/positives for some idea, ideally seen in context as to where the tests happen (test done in hospital vs other venues like drive thru).

For Germany the last 3 weeks about 7.7% have been positives, Italy sits at about 20% but getting less and less.

[Fidatelo]

Just had an interesting dialog with my dad over text. He mentioned they (the government) may have to put in place stricter measures, like actively policing the lockdown or even tracking citizens. He seemed to think this was a good idea. As much as I've been saying we need to self-isolate and flatten the curve since the day I learned about the threat of overwhelming hospital systems, I don't agree with that level of enforcement at all.


What do you all think? At what point are we handing the government power that just isn't worth it? How far is too far?

[Arles]

I think it depends on the area. If hospitals are full in an area and it's a super high risk for people to get sick, I could see a more strict lockdown for a few weeks. But, we are so spread out as a whole and many area seem to be social distancing fairly well that I don't think it will come to that here.

[ISiddiqui]

Also have to consider how much law enforcement we want to use on that. I realize they probably have less to do these days, but I'd rather them break up groups of people than just look for random individuals out for no reason (I also fear that they'll track and arrest folks that are poor or black more than those who are rich or white).

[sterlingice]

Originally Posted by Fidatelo

Just had an interesting dialog with my dad over text. He mentioned they (the government) may have to put in place stricter measures, like actively policing the lockdown or even tracking citizens. He seemed to think this was a good idea. As much as I've been saying we need to self-isolate and flatten the curve since the day I learned about the threat of overwhelming hospital systems, I don't agree with that level of enforcement at all.

What do you all think? At what point are we handing the government power that just isn't worth it? How far is too far?

It's one of the nasty parts of the Korea system that's scary to me. I'd like their level of efficacy but that's too many rights to give up in this country with too powerful interests that could turn this into a dystopia very fast.



SI

[Brian Swartz]

I think it depends on what the details are. Actively policing the lockdown has already been done as regards to businesses that didn't want to close, the pastor who was arrested, etc.

If you get into stuff like wanting the government to electronically monitor the real-time location of individuals, yeah I think that's too far. Breaking up parties etc. of people violating the lockdown? I think that's fine.

[miami_fan]

Originally Posted by Fidatelo

Just had an interesting dialog with my dad over text. He mentioned they (the government) may have to put in place stricter measures, like actively policing the lockdown or even tracking citizens. He seemed to think this was a good idea. As much as I've been saying we need to self-isolate and flatten the curve since the day I learned about the threat of overwhelming hospital systems, I don't agree with that level of enforcement at all.


What do you all think? At what point are we handing the government power that just isn't worth it? How far is too far?

I think it is a future step, I just don’t think it is the next step.

I also can’t get too indignant about that level of law enforcement in this case when we have allowed it to be acceptable in cases I think are nowhere near as serious as this pandemic. We have already gone too far IMO but that is probably a topic for a different thread.

[RainMaker]

Originally Posted by JPhillips

Saw a CNN interview that mentioned the US has done 1.3 million tests, but almost have of those have yet to be processed. Has anyone else heard that stat?

Yes, there is a huge backlog at all those wonderful places that got a free infomercial during a press conference.

N.J.-based lab company Quest had huge backlog of coronavirus tests, report says - nj.com

At some point you have to assume the test shortage is deliberate.

[Vince, Pt. II]

Originally Posted by JPhillips

Saw a CNN interview that mentioned the US has done 1.3 million tests, but almost have of those have yet to be processed. Has anyone else heard that stat?

I had an employee who was tested in mid-March and had to wait 11 days to get the results. With the huge increases to testing in the last couple weeks, delays don't surprise me at all.

[RainMaker]

Originally Posted by Vince, Pt. II

I had an employee who was tested in mid-March and had to wait 11 days to get the results. With the huge increases to testing in the last couple weeks, delays don't surprise me at all.

Wonder what's the point if your results come back when you're close to the recovery point.

[whomario]

The Atlantic apparently really puts work into reporting on testing issues from the start, here is their take:

The New Coronavirus Testing Crisis at Private Labs - The Atlantic

This makes me doubt how much reliable data the taskforce even has. Not the positives/deaths per se as others collect them like Johns Hopkins, but also the timing is huge to judge development and if a lot of the raw data comes in delayed ...

[whomario]

Originally Posted by RainMaker

Wonder what's the point if your results come back when you're close to the recovery point.

Or land in the hospital with bad symptoms and then presumably have to get tested again to send it to a state lab instead or something.

[Fidatelo]

Originally Posted by sterlingice

It's one of the nasty parts of the Korea system that's scary to me. I'd like their level of efficacy but that's too many rights to give up in this country with too powerful interests that could turn this into a dystopia very fast.

SI

This is how I feel. The government isn't going to type LUCIOUS FOX into the systems once the pandemic ends. Once that stuff is in place I think it's there for good, if not as overtly.

[PilotMan]

Right now the trend for deaths per day isn't exponential. It's rising, but it's rising at a rate that is less than you'd expect for an exponential effect. That is a good sign. However, the numbers are still going to rise, and if the intensity of the infected spreads across the US to the same level that we're seeing in New York, then we should see another spike toward the exponential again. I think it's good news that we don't see that day to day, even though we are seeing strong rises, but it also needs to be taken with a grain of salt.

One thing that I read this morning in the article SI shared, was that the infection %/per test rises substantially higher the further behind that area is in testing. Low infection rates per capita should be standard so areas that are trending back toward that expected rate are actually getting caught up on testing and are not being overrun any longer. If we start to see other areas where those %infected/tested start to get out of whack you know that it's a giant red flag.

[miami_fan]

Originally Posted by Fidatelo

Just had an interesting dialog with my dad over text. He mentioned they (the government) may have to put in place stricter measures, like actively policing the lockdown or even tracking citizens. He seemed to think this was a good idea. As much as I've been saying we need to self-isolate and flatten the curve since the day I learned about the threat of overwhelming hospital systems, I don't agree with that level of enforcement at all.


What do you all think? At what point are we handing the government power that just isn't worth it? How far is too far?

It may already be too late.

https://www.foxnews.com/us/kentucky-...g-to-stay-home

[whomario]

Originally Posted by PilotMan

One thing that I read this morning in the article SI shared, was that the infection %/per test rises substantially higher the further behind that area is in testing. Low infection rates per capita should be standard so areas that are trending back toward that expected rate are actually getting caught up on testing and are not being overrun any longer. If we start to see other areas where those %infected/tested start to get out of whack you know that it's a giant red flag.

I think this and death/Positive are really good indicators on how good testing has been and that in terms keep deaths low later.

Another to watch for if available: Average Age of confirmed cases. The younger, the more likely that testing happens on mild cases or even contacts of confirmed cases rather than mainly people with symptoms turning up at hospitals or at the doctors (other respiratory issues also tend to be older patients and 'block' testing capacity to rule them out)

The average Age for Positive Tests in Germany is 17 years younger than Italy, yet the age for dead patients was pretty much the same. Basically indicates a lot less spread among the elderly and that the test capacity is high enough to test a lot if younger people that either travelled from say Italy (early on) or were tested due to being contacts or had mild symptoms, not because their symptoms were already bad.

One other thing why good testing (not only in numbers but widespread) and quick turnaround are so important is also getting people 'sorted' and treated early. There was a very interesting piece inna german paper referencing head of departments in hospitals that laid out one key difference between Germany and Italy/Spain : the percentage of patients coming into hospitals that were already tested positive multiple days prior is very high so far.

Aside from not infecting as many people potentially since they are in quarantine they also know to watch out for warning signs and and when they do have to get admitted they can go straight into treatment as confirmed Covid19 (and seperated from non-confirmed or non-covid) without having to test them and wait for results.

[Fidatelo]

Originally Posted by miami_fan

It may already be too late.

https://www.foxnews.com/us/kentucky-...g-to-stay-home

Super interesting blurry area. So on the one hand, if some HIV positive dude is going around banging people without telling them, we all agree he should be punished by the law right? So I think I sort of get the ankle-bracelet on COVID-positive people that aren't staying at home, it's the same thing.

Where it blurs is the one that's living with COVID-positive people. That's a super interesting intersection point between public safety and personal freedoms. I can see both sides' arguments being totally valid here, and I have no idea where you draw the line. What about their neighbors? Yeesh.

[tarcone]

And our Governor issues the stay at home order. Through April 24.

Our county issued one through April 30th yesterday.

[JPhillips]

MA Governor says the story behind the Kraft flight is that the feds seized 3 million masks MA had bought, so the flight to China was set up as a way to make sure the feds wouldn't take the masks.

[Edward64]

So here's how many hospitals will decide who gets a ventilator when there is a shortage aka the "death panels".

https://www.cnn.com/2020/04/03/healt...nvs/index.html

If the current rate of hospitalization and intubation continues in New York, "we have about six days" left of ventilators in the stockpile, Gov. Andrew Cuomo said during Thursday's coronavirus briefing.

"If a person comes in and needs a ventilator and you don't have a ventilator, the person dies. That's the blunt equation here," Cuomo said.

The demand for ventilators has skyrocketed in intensive care units across the country as coronavirus patients have flooded in. Typically, adult patients will stay in the ICU -- and on a ventilator -- for only three to four days, as one Connecticut doctor explained, but Covid-19 patients need them for up to two or three weeks, dramatically increasing demand.
:
:
One of the better frameworks to follow, he said, is one developed by Dr. Douglas White, a professor of critical care medicine at the University of Pittsburgh and the University of Pittsburgh Medical Center (UMPC).
:
:
It is essentially a point system calculating a patient's likelihood to benefit from ICU care, based on two considerations: 1) saving the most lives and 2) saving the most lives.

The lower the patient scores, the higher their prioritization for care. In the system's eight-point scale, the first four points illustrate the patient's likelihood to survive hospitalization, and the last four points assess whether, assuming they survive hospitalization, they have medical conditions associated with a life expectancy of less than one year or less than five years.

In the event of a tie, White's framework directs doctors to consider life cycle, with priority being given to younger patients.

It's not going to be perfect and I can accept the model. However my cynical self thinks he is talking out of both sides. Above 4+4 points does seem to contradict below bolded.

Its like yeah, these factors won't excluded you from being considered for a ventilator. But they will reduce your chances of getting one if someone else needs the same one.

White said that his framework is meant to be inclusive and nondiscriminatory against people with disabilities.

"It is critical to make clear that stereotypical judgments about quality of life have no role in these decisions, and no one is disqualified from treatment because of disabilities," White said.
:
"Advanced age, severe cognitive impairment and chronic heart and lung diseases were all used as exclusion criteria. That didn't seem ethical to me. Exclusion criteria send the wrong message that there are some lives that are not worth saving," White said.

This could lead to a perception of unfairness, he has said, during a public health emergency where trust is essential. By contrast, the framework White and his team developed ensures no one is disqualified from critical care from the outset.

"Everyone who is normally eligible for intensive care remains eligible in a public health emergency," White said.

[Edward64]

1,320 deaths so far today according to worldometers. Sliced through the 1,000 barrier pretty damn easily.

United States Coronavirus: 276,965 Cases and 7,391 Deaths - Worldometer

[BYU 14]

Originally Posted by Edward64

So here's how many hospitals will decide who gets a ventilator when there is a shortage aka the "death panels".

https://www.cnn.com/2020/04/03/healt...nvs/index.html


It's not going to be perfect and I can accept the model. However my cynical self thinks he is talking out of both sides. Above 4+4 points does seem to contradict below bolded.

Its like yeah, these factors won't excluded you from being considered for a ventilator. But they will reduce your chances of getting one if someone else needs the same one.

I am not reading this the way I think you might be. The bolded criteria in your second quote appears to be the automatic exclusion criteria that was in place when he developed his criteria, so while it obviously factors in, it does not automatically exclude these patients unless there are other more likely to survive and not enough equipment for everyone.

[PilotMan]

Originally Posted by Edward64

1,320 deaths so far today according to worldometers. Sliced through the 1,000 barrier pretty damn easily.

United States Coronavirus: 276,965 Cases and 7,391 Deaths - Worldometer

This isn't and shouldn't be, surprising.

[Edward64]

Originally Posted by BYU 14

I am not reading this the way I think you might be. The bolded criteria in your second quote appears to be the automatic exclusion criteria that was in place when he developed his criteria, so while it obviously factors in, it does not automatically exclude these patients unless there are other more likely to survive and not enough equipment for everyone.

Yes, that is how I read it. Those factors won't automatically exclude you but is part of the decision criteria when ventilators get low. He said its not exclusionary but it really is "exclusionary" when ventilators get low.

[BYU 14]

Originally Posted by Edward64

Yes, that is how I read it. Those factors won't automatically exclude you but is part of the decision criteria when ventilators get low. He said its not exclusionary but it really is "exclusionary" when ventilators get low.

All things being equal than yes, I agree. but you will also have folks in those groups that may get ventilators due to tiebreakers or others having multiple factors.

Still, truth be told it sucks that anyone may have to face this reality and I have lots of empathy for any medical professional that has to make that decision. An absolutely brutal burden to bear.

[Edward64]

Originally Posted by BYU 14

All things being equal than yes, I agree. but you will also have folks in those groups that may get ventilators due to tiebreakers or others having multiple factors.

Still, truth be told it sucks that anyone may have to face this reality and I have lots of empathy for any medical professional that has to make that decision. An absolutely brutal burden to bear.

Yup, nothing is going to be perfect and some will see it as unfair (e.g. rich people can stay in better health than poor people).

I don't envy them at all.

[JPhillips]

A lot of good thoughts from Gen. Honore on how to better supply hospitals.

After hearing the White House say critical supplies are going to commercial distributors who are then selling them to the states which are begging for help, I called @ltgrusselhonore who commanded federal troops after Hurricane Katrina to get his reaction. Watch this: pic.twitter.com/x7u3qoQ0v6

— David Begnaud (@DavidBegnaud) April 3, 2020

[Brian Swartz]

Originally Posted by Edward64

1,320 deaths so far today according to worldometers. Sliced through the 1,000 barrier pretty damn easily.

Was 1100 a couple days ago. As others have said, I'm actually taking it as *relatively* positive news that it is going up slower than expected. Obviously like everyone else looking forward to the time when it goes in the other direction, but I'll take this over breakaway exponential increases.

[Brian Swartz]

Also the crunch is starting to hit the Detroit area. Grand Rapids (and other areas as well) are being requested to reserve 10% of capacity for patients relocated from there. For now that should be a workable solution, but I'm wondering how long it holds.

[Galaril]

We need to have ourselves the math is trending to 10000 deaths per week at minimum and am not buying it is going down soon based on actions taken to date. Hope I am wrong.

[CrimsonFox]

Originally Posted by JPhillips

A lot of good thoughts from Gen. Honore on how to better supply hospitals.

After hearing the White House say critical supplies are going to commercial distributors who are then selling them to the states which are begging for help, I called @ltgrusselhonore who commanded federal troops after Hurricane Katrina to get his reaction. Watch this: pic.twitter.com/x7u3qoQ0v6

— David Begnaud (@DavidBegnaud) April 3, 2020

that is AMAZING!

[tarcone]

Rich get richer

[Warhammer]

I did not listen to the whole video, stopped half way through, but they aren't going through the RFP process?

Having been tangentially involved with Katrina recovery efforts, half the problem there was local officials in New Orleans did not have a plan when FEMA came in, as compared to Mississippi. They couldn't tell FEMA what to get, etc. MEMA (Mississippi EMA) had their plan, told FEMA what they needed and FEMA got it.

Part of the reason Halliburton is so big and tied to the government, they have most of this emergency stuff sitting in a warehouse somewhere, and when something happens and its needed in a hurry, they show up and say, we have it here, how fast do you need it? Similar to how the general explains it in the video. With ventilators, I do not think any one has any sitting in a warehouse anywhere.

Even if they were, would they meet the sanitation and cleanliness standards required?

[JPhillips]

We really need a federal response for ventilators in particular. My guess is there are thousands, maybe tens of thousands in hospitals around the country that aren't being used currently. We need to move supplies to areas that need them and then as one area cools down, move those supplies to a new area. That approach won't work for PPE, but it would for ventilators, beds, etc.

What's going to happen to all the supplies in NY when the deaths decrease? Are their plans to share from state to state?

[Brian Swartz]

I don't think it's going down soon, and 10k a week is bad but it's not nearly as bad as, say, 10k a day. It wouldn't have shocked me if we were approaching that by now - that's what I mean by *relatively* positive.

[Radii]

Originally Posted by JPhillips

We really need a federal response for ventilators in particular. My guess is there are thousands, maybe tens of thousands in hospitals around the country that aren't being used currently. We need to move supplies to areas that need them and then as one area cools down, move those supplies to a new area. That approach won't work for PPE, but it would for ventilators, beds, etc.

What's going to happen to all the supplies in NY when the deaths decrease? Are their plans to share from state to state?

Tangentially - I'm watching Gov Cuomo's briefing from earlier today and he mentioned that the Governor of Oregon reached out to him, unsolicited, and Oregon is sending 140 ventilators to New York.

I certainly expect New York will distribute ventilators once they do not need them anymore, themselves if the federal government isn't doing that, but it's absolutely a thing to pay attention to and to make sure it happens.

[whomario]

(Estimate because the last couple days from march were not yet accesible)

Yes they were especially hard hit and vulnerable population wise and with a lack of ressources, but it is also the early stages still and with very stringent measures after March 8th.

[whomario]

Austria with more Recovered than New Positives today for the first time, might actually be the first European Country to have that happen. Baby steps but still a good sign

But the health minister also said that aside from the shortage on masks currently about 9/10 proposals turn out to be substandard quality even when one would be allowing for some drop in standard) or just flat out "buy without sample" offers which is what the Netherlands did the other day and had to trash the whole shipment as they were utterly useless.

And Italy for the first time has less people in ICUs than the day before.

[Arles]

Nate Silver gets it

Coronavirus Case Counts Are Meaningless* | FiveThirtyEight