COVID-19

[Sam]

I believe the reason the Surgeon general recommended for people not to work mask to hasten the infection to its maximum velocity. See the above video at 6:18.

They took the maximum casualties to hasten the end of the infection. I suppose they think there is an economic advantage to such foolishness.

I would suppose that decisions like that are what madam guillotine is for, once society collapses.

Sam

[Hefaistos]

The United States has apparently decided to try the most egregious solution.

On the current course, expect in excess of 25 million American dead over the next five weeks, and a wrecked economy.

25 million?  Really?  Didn’t I just see you on a corner with a sign that read, “The end is near”?

...That would take us to 14-17 million dead. That is committed by 7-8 weeks from now, though the actual dying takes another week.

Then add the perversity we’ve seen in the governments response and 25 million dead is possible.

Sam, your forecasted numbers of deaths is an extreme right tail risk estimate based on the number of infections.
 
You have to ask also how many prospects for dying in Covid19 there are in the population. How many old and sick in lifestyle diseases are there? How many younger people are there that have multiple lifestyle diseases? Those are the ones actually dying. The others recover. The pool of prospects isn't unlimited, and it's unlikely that the virus will reach and kill all of them, given the counter-measures we're seeing.

[swoozle]

...
 
You have to ask also how many prospects for dying in Covid19 there are in the population. How many old and sick in lifestyle diseases are there? ...

There are more than 50 million people 65 and older in the US. That's a rather large pool.

[interstitial]

US fatalities doubling every 3 days

Mar 19   154
Mar 22   308
Mar 25   616
Mar 28   1232
Mar 31   2462

I believe that much is inevitable

march 25 10:21 pm pacific time 1050 dead

[vox_mundi]

Indonesia Could Have Thousands of Hidden Coronavirus Cases, Study sSays
https://www.theguardian.com/global-development/2020/mar/26/indonesia-could-have-thousands-of-hidden-coronavirus-cases-study-says

The country already has the most deaths in south-east Asia, but research suggests the official 800 infections so far may only be 2% of the total

Study: https://cmmid.github.io/topics/covid19/severity/global_cfr_estimates.html

It was just last month that Indonesia’s coronavirus cases stood at zero, with officials fiercely rejecting suggestions that infections were spreading undetected.

Weeks later, 58 fatalities have now been linked to the virus, the highest number in south-east Asia. Seven health workers are among those who have died.

While confirmed case have risen to almost 800, researchers have estimated that there could be tens of thousands of hidden infections across the country, and there is growing concern that medical facilities will be unable to cope in the event of a major outbreak.

Over the past week, two major hospitals have appealed for supplies, while some healthworkers threatened to go on strike after they were forced to wear raincoats for protection.[
 As of Monday, as many as 42 medical staff were infected with coronavirus in Jakarta.

... Modelling by the Eijkman-Oxford Clinical Research Unit (EOCRU), reported by the Jakarta Post, has suggested that, without tough steps to contain the virus, there could be up to 71,000 infections by the end of April.

https://www.thejakartapost.com/news/2020/03/22/some-70000-indonesians-could-be-infected-with-covid-19-before-ramadan-scientists-say.html

Analysis by Reuters suggests that the country’s health system is significantly less well resourced than that of Italy or South Korea, which have both faced major outbreaks.

Indonesia has 321,544 hospital beds, according to health ministry data, which is equal to about 12 beds per 10,000 people. South Korea has 115 per 10,000 people, according to the World Health Organization (WHO).

In 2017, the WHO found Indonesia had four doctors per 10,000 people. Italy had 10 times more, on a per capita basis. South Korea has six times more doctors.

[vox_mundi]

Trump Team Failed To Follow NSC’s Pandemic Playbook
https://www.politico.com/news/2020/03/25/trump-coronavirus-national-security-council-149285

The 69-page document, finished in 2016, provided a step by step list of priorities – which were then ignored by the administration.

Pandemic Playbook: https://www.documentcloud.org/documents/6819268-Pandemic-Playbook.html#document/p1

President Donald Trump's administration was briefed on the playbook’s existence in 2017, said four former officials.

The Trump administration, state officials and even individual hospital workers are now racing against each other to get the necessary masks, gloves and other safety equipment to fight coronavirus — a scramble that hospitals and doctors say has come too late and left them at risk. But according to a previously unrevealed White House playbook, the government should’ve begun a federal-wide effort to procure that personal protective equipment at least two months ago.

... ‘Is there sufficient personal protective equipment for healthcare workers who are providing medical care?’ the playbook instructs its readers, as one early decision that officials should address when facing a potential pandemic. ‘If YES: What are the triggers to signal exhaustion of supplies? Are additional supplies available? If NO: Should the Strategic National Stockpile release PPE to states?’

The strategies are among hundreds of tactics and key policy decisions laid out in a 69-page National Security Council playbook on fighting pandemics, which POLITICO is detailing for the first time. Other recommendations include that the government move swiftly to fully detect potential outbreaks, secure supplemental funding and consider invoking the Defense Production Act — all steps in which the Trump administration lagged behind the timeline laid out in the playbook.

“Each section of this playbook includes specific questions that should be asked and decisions that should be made at multiple levels” within the national security apparatus, the playbook urges, repeatedly advising officials to question the numbers on viral spread, ensure appropriate diagnostic capacity and check on the U.S. stockpile of emergency resources.

The playbook also stresses the significant responsibility facing the White House to contain risks of potential pandemics, a stark contrast with the Trump administration’s delays in deploying an all-of-government response and President Donald Trump's recent signals that he might roll back public health recommendations.

The guide further calls for a “unified message” on the federal response, in order to best manage the American public's questions and concerns. “Early coordination of risk communications through a single federal spokesperson is critical,” the playbook urges. However, the U.S. response to coronavirus has featured a rotating cast of spokespeople and conflicting messages; Trump already is discussing loosening government recommendations on coronavirus in order to “open” the economy by Easter, despite the objections of public health advisers.



The playbook was designed “so there wasn’t piecemeal thinking when trying to fight the next public health battle,” said one former official who contributed to the playbook, warning that “the fog of war” can lead to gaps in strategies.

“These are recommended discussions to be having on all levels, to ensure that there’s a structure to make decisions in real-time,” said a second former official.

... Trump has claimed that his administration could not have foreseen the coronavirus pandemic, which has spread to all 50 states and more than 180 nations, sickening more than 460,000 people around the world. “Nobody ever expected a thing like this,” Trump said in a Fox News interview on Tuesday.

But Trump’s aides were told to expect a potential pandemic, ranging from a tabletop exercise that the outgoing Obama administration prepared for the president’s incoming aides to a “Crimson Contagion” scenario that health officials undertook just last year and modeled out potential risks of a global infectious disease threat. Trump’s deputies also have said that their coronavirus response relies on a federal playbook, specifically referring to a strategy laid out by the Centers for Disease Control.

The document rested with NSC officials who dealt with medical preparedness and biodefense in the global health security directorate, which the Trump administration disbanded in 2018, four former officials said.

The NSC playbook would have been especially useful in helping to drive the administration’s response to coronavirus, given that it was intended to guide urgent decisions and coordinate the all-of-government approach that Trump so far has struggled to muster, said people familiar with the document.

The playbook lays out different strategies for policymakers based on the severity of the crisis and shares lessons gleaned from past outbreaks. For instance, one section is devoted to addressing 34 “key questions” and 21 “key decisions” as soon as there is a “credible threat” — which in the case of coronavirus would have been early-to-mid January, as it raged in China and as the first U.S. case was detected on Jan. 20 — and calls on officials to move quickly.

“We recommend early budget and financial analysis of various response scenarios and an early decision to request supplemental funding from Congress, if needed,” the guide urges. But the Trump administration waited more than a month to ask for emergency funding after the timeline laid out in the playbook.

The playbook also repeatedly urges officials to question official numbers about the viral spread. “What is our level of confidence on the case detection rate?” reads one question. “Is diagnostic capacity keeping up?” But across January and much of February, Trump administration officials publicly insisted that their diagnostic efforts were sufficient to detect coronavirus. Officials now privately concede that the administration’s well-documented testing problems have contributed to the outbreak’s silent spread across the United States, and health experts say that diagnostic capacity is only now in late March catching up to the need.

In a subsequent section, the playbook details steps to take if there’s evidence that the virus is spreading among humans, which the World Health Organization concluded by Jan. 22

Under that timeline, the federal government by late January should have been taking a lead role in “coordination of workforce protection activities including… [personal protective equipment] determination, procurement and deployment.” Those efforts are only now getting underway, health workers and doctors say.

--------------------------



----------------------------

[Rodius]

US fatalities doubling every 3 days

Mar 19   154
Mar 22   308
Mar 25   616
Mar 28   1232
Mar 31   2462

I believe that much is inevitable

march 25 10:21 pm pacific time 1050 dead

Their are aproximately 73 million baby boomers in the us.
if 80% get it and 1.5% die That is 876,000 dead.

Not sure why you think 1.5% applies to baby boomers.
At least 4% of them would die based on the stats, and I am probably being kind.
That means that IF 80% of boomers catch it, and 4% die, that is 2.3 million (approx)

https://www.worldometers.info/coronavirus/coronavirus-age-sex-demographics/

[KiwiGriff]

That means that IF 80% of boomers catch it, and 4% die, that is 2.3 million (approx)

If when  we start seeing that level of death it will be multiple times 4% as hospitals become over loaded.
https://www.nationalreview.com/the-morning-jolt/a-hard-look-at-the-remaining-hospital-capacity-across-america/

 

[El Cid]

...With the hospitals saturated, death rates go to ~12%.

Holy shit! Now we are at 12% mortality. Soon it will be like the Black Death!

Considering that cca. 5% of cases need hospital care that is a pretty tall order... Also need to consider that many mild cases are not even reported, and we know that there are many asymptomatic carriers (estimated variously between 20-40% AFAIK). So 12% death rate out of a realistic 2-3% hospitalization rate...wow.

I do not want to belittle this pandemic because it is a huge problem and need to be dealt with, but come on, let's get real:

https://www.vox.com/2020/3/5/21165973/coronavirus-death-rate-explained

[vox_mundi]

Nigerian Army Preparing for Strict Lockdown, Forced Transfers of Sick
https://www.aljazeera.com/news/2020/03/coronavirus-threat-humanity-live-updates-200326000412411.html

The Nigerian Army is preparing to forcibly transfer the sick to hospital and enforce strict curbs on movement to curb the spread of the coronavirus in Africa's most populous country, according to Reuters news agency.

A memo from army headquarters seen by the news agency outlines measures to protect government food storage from looters and says the military is also leasing equipment for "possible mass burial".

---------------------------

Trump Administration Cut CDC China Staff
https://www.aljazeera.com/news/2020/03/coronavirus-threat-humanity-live-updates-200326000412411.html

Reuters news agency is reporting that the administration of US President Donald Trump cut the staff of the US Centers for Disease Control and Prevention (CDC) working in China by two-thirds in the two years before the coronavirus emerged.

Most of the reductions were at the Beijing office. The CDC's headcount in China has dropped from about 47 when Trump took office in January 2017 to about 14 now, Reuters said.

[interstitial]

US fatalities doubling every 3 days

Mar 19   154
Mar 22   308
Mar 25   616
Mar 28   1232
Mar 31   2462

I believe that much is inevitable

march 25 10:21 pm pacific time 1050 dead

Their are aproximately 73 million baby boomers in the us.
if 80% get it and 1.5% die That is 876,000 dead.

Not sure why you think 1.5% applies to baby boomers.
At least 4% of them would die based on the stats, and I am probably being kind.
That means that IF 80% of boomers catch it, and 4% die, that is 2.3 million (approx)

https://www.worldometers.info/coronavirus/coronavirus-age-sex-demographics/

It was a crude guess based on numbers in my head so I decided it wasn't helpful and deleted it.

[blumenkraft]

It all works in favor of the orange fascist.

His approval rating is high.

Cutting social security is done by just letting recipients die in tropes, the next round of tax cuts for his rich buddies is already financed this way. The insurance industry will also save a lot of money, guaranteeing big bonuses for the CEOs.

Small businesses will also die all over the country. They will be overtaken by monopolists GOP donors receiving bailouts which will further strengthen their and his power.

Mr. Trump is a very very lucky guy.

[Hefaistos]

...
 
You have to ask also how many prospects for dying in Covid19 there are in the population. How many old and sick in lifestyle diseases are there? ...

There are more than 50 million people 65 and older in the US. That's a rather large pool.

That is not the pool!
The pool consists of people with one or several lifestyle diseases, especially old people with such diseases. Practicallt no on dies from Covid19 without having such diseases.

Please check data and attached figure from Italy, I posted it before, but it's apparently worth repeating:
Italian co-morbidities with Covid-19.
From a report in Italian, I think it's a government report.
It's a sample of 355 dead in Covid19, but with other health issues.
Total sample of infected was 2003.
Average age of dead: 79 y.o.

Esp. hypertension is common. 76% of those who died also suffered from hypertension.
Most of the dead had several conditions. 48% of them had 3 or more lifestyle diseases.


https://www.epicentro.iss.it/coronavirus/bollettino/Report-COVID-2019_17_marzo-v2.pdf

[Sam]

...With the hospitals saturated, death rates go to ~12%.

Holy shit! Now we are at 12% mortality. Soon it will be like the Black Death!

Considering that cca. 5% of cases need hospital care that is a pretty tall order... Also need to consider that many mild cases are not even reported, and we know that there are many asymptomatic carriers (estimated variously between 20-40% AFAIK). So 12% death rate out of a realistic 2-3% hospitalization rate...wow.

I do not want to belittle this pandemic because it is a huge problem and need to be dealt with, but come on, let's get real:

https://www.vox.com/2020/3/5/21165973/coronavirus-death-rate-explained

El Cid,

It no longer matters, at least in the US. The administration failed to follow the NSC playbook or any reasonable approach. And they have subverted any action along the way, save one (stopping flights from China).

If no further actions are taken, nearly the worst case scenario will play out. That takes about four weeks less 12 days for the lag time from infection to confirmed. That’s 16 days to do anything. For it to be meaningful at all now it must be a comprehensive quarantine. Only the next week to ten dats matter. After that it’s all history but the crying.

Whatever the ultimate death rate is, we should know that quite well in eight weeks. We will mostly know it in six weeks.

But again, there are just over two weeks left to make any difference. And with the piss poor testing done so far, there may be several days less than even these numbers suggest. Now we wait to see what happens.

Sam

[oren]

Since when have people decided that only old people die from COVID-19? Are we scientists or not?
It's all a question of percentages.
South Korea statistics are quite accurate as they have done extensive testing, also of asymptomatic cases, and their hospitals were not overwhelmed. So these are very reasonable to optimistic stats. Please bear in mind many cases in SK have still not resolved, so death rate could still go up even under these assumptions.
They show roughly (see image for stats updated to March 16):
0.1% for ages 30-49
0.4% for 50-59
1.4% for 60-69
5.3% for 70-79
9.2% for 80+

These may seem like negligible percentages but multiplied by big numbers they add up to hundreds of thousands. Actual CFRs may vary based on luck, medical know-how, prevalence of preexisting medical conditions, general health of the population. Total case counts and transient case loads will vary based on quarantine and other policies.
My little spreadsheet says over 2 million dead expected in the US, assuming 70% total infection rate and using SK CFR. I think that's quite a lot of dead people.
Add hospital overwhelm and deaths could easily double or triple or even quadruple, depending on infection patterns and management strategy.

To all, make your own assumptions as you please - but please don't throw numbers around without calculating them based on your assumptions.

https://www.statista.com/statistics/1105088/south-korea-coronavirus-mortality-rate-by-age/
https://www.statista.com/statistics/241488/population-of-the-us-by-sex-and-age/

[El Cid]

One more thing: although it is absolutely true that US authorities are in many cases truly clueless, as case numbers blow up, people will self isolate and that will reduce the spread very much.
In economics classes they often use the term "ceteris paribus" - meaning all else unchanged. But in reality all else is NOT unchanged. When people see what is happening they change their behaviour so that an uncontrolled, quick spread is very unlikely in my view. Besides, as the body count rises, politicians get their shit together and do things that were unthinkable before (see Italy). The world is not static, it adapts...

[blumenkraft]

COVID-19 daily U.S. deaths compared to daily rates of leading causes of death (#16 to #8 in 5 days)



Link >> https://www.reddit.com/r/dataisbeautiful/comments/fp6654/oc_covid19_daily_us_deaths_compared_to_daily/

[vox_mundi]

Hospitals Consider Universal Do-Not-Resuscitate Orders for Coronavirus Patients
https://www.washingtonpost.com/health/2020/03/25/coronavirus-patients-do-not-resucitate/?outputType=amp

Worry that ‘all hands’ responses may expose doctors and nurses to infection prompts debate about prioritizing the survival of the many over the one

... Northwestern Memorial Hospital in Chicago has been discussing a do-not-resuscitate policy for infected patients, regardless of the wishes of the patient or their family members — a wrenching decision to prioritize the lives of the many over the one

Officials at George Washington University Hospital in the District say they have had similar conversations, but for now will continue to resuscitate covid-19 patients using modified procedures, such as putting plastic sheeting over the patient to create a barrier. The University of Washington Medical Center in Seattle, one of the country’s major hot spots for infections, is dealing with the problem by severely limiting the number of responders to a contagious patient in cardiac or respiratory arrest.

Several large hospital systems — Atrium Health in the Carolinas, Geisinger in Pennsylvania and regional Kaiser Permanente networks — are looking at guidelines that would allow doctors to override the wishes of the coronavirus patient or family members on a case-by-case basis due to the risk to doctors and nurses, or a shortage of protective equipment, say ethicists and doctors involved in those conversations. But they would stop short of imposing a do-not-resuscitate order on every coronavirus patient. The companies declined to comment.

“We are now on crisis footing,” he said. “What you take as first-come, first-served, no-holds-barred, everything-that-is-available-should-be-applied medicine is not where we are. We are now facing some difficult choices in how we apply medical resources — including staff.”

The new protocols are part of a larger rationing of lifesaving procedures and equipment — including ventilators — that is quickly becoming a reality here as in other parts of the world battling the virus. The concerns are not just about health-care workers getting sick but also about them potentially carrying the virus to other patients in the hospital.

... “From a safety perspective you can make the argument that the safest thing is to do nothing,”

-----------------------------

Southern States Face Spike In Coronavirus Cases
https://www.cbsnews.com/amp/news/coronavirus-southern-states-face-spike-in-virus-cases/

The coronavirus is spreading rapidly in the South, and hospitals are becoming overwhelmed. Louisiana, Florida and Georgia are facing alarming spikes, with more than 4,700 cases and 125 deaths in those states alone.

There are more cases in the New Orleans area than there are in Los Angeles County — and Los Angeles County is 25 times larger. In just over two weeks, the number of cases in Louisiana has skyrocketed to almost 1,800.

Former state health director Rebekah Gee said masks and other protective equipment are running out, and that the state needs supplies immediately.

"I'm concerned about the fact that we're now worried about protective equipment already and we haven't hit the surge of patients," Gee told CBS News.

Doctors believe the city's yearly Mardi Gras festivities escalated the spread of the virus. The French Quarter has been shut down, as the city braces for even more cases.

----------------------------------

'That's When All Hell Broke Loose': Coronavirus Patients Start to Overwhelm US Hospitals
https://amp.cnn.com/cnn/2020/03/25/health/coronavirus-covid-hospitals/index.html

... "We don't have the machines, we don't have the beds," ... "To think that we're in New York City and this is happening," he added. "It's like a third-world country type of scenario. It's mind-blowing."

... "Last week when I went to work, we talked about the one or two patients amongst the dozens of others that might have been a Covid or coronavirus patient," Spencer told CNN's Anderson Cooper Tuesday. "In my shift yesterday, nearly every single patient that I took care of was coronavirus, and many of them extremely severe. Many were put on breathing tubes. Many decompensated quite quickly.

"There is a very different air this week than there was last week."

... "In my own hospital -- and I don't think it's unique -- we have a nurse who is on a ventilator right now who contracted the virus."

[Sam]

One more thing: although it is absolutely true that US authorities are in many cases truly clueless, as case numbers blow up, people will self isolate and that will reduce the spread very much.
In economics classes they often use the term "ceteris paribus" - meaning all else unchanged. But in reality all else is NOT unchanged. When people see what is happening they change their behaviour so that an uncontrolled, quick spread is very unlikely in my view. Besides, as the body count rises, politicians get their shit together and do things that were unthinkable before (see Italy). The world is not static, it adapts...

True - if we are dealing with rational actors, and if there isn't significant lag time involved, and if there aren't large exponential growth factors, and if the data is good, and if the data is rapidly reported, and if the information is well conveyed to the public. None of those are true in this case. All of those are false in this case.

There is a huge lag time, both from infection to symptoms, symptoms to testing, and testing to confirmation. The rules for testing preclude testing in most cases, simply because the tests are not available. But also because the tests produce numbers that are considered bad and that the leader does not want to hear. There is very poor data due to serious lack of testing. There is poor information sharing with the public. Often such information as there is is conveyed falsely suggesting the opposite of its true meaning. The exponential growth rate is astounding.  Decision makers in many cases compound that and make it worse. And many of the major actors are considerably less than well informed or rational. Instead, the major decision make is clearly a malignant narcissist incapable of hearing anything he considers adverse to his own interests.

This creates a perfect storm to reach a truly terrible outcome. But then, we have seen this all before. Very much the same things happened in 1918.

Sam

[vox_mundi]

Coronavirus Measures Could Cause Global Food Shortage, UN Warns
https://www.theguardian.com/global-development/2020/mar/26/coronavirus-measures-could-cause-global-food-shortage-un-warns

Protectionist measures by national governments during the coronavirus crisis could provoke food shortages around the world, the UN’s food body has warned.

Harvests have been good and the outlook for staple crops is promising, but a shortage of field workers brought on by the virus crisis and a move towards protectionism – tariffs and export bans – mean problems could quickly appear in the coming weeks, Maximo Torero, chief economist of the UN Food and Agriculture Organisation, told the Guardian.

“The worst that can happen is that governments restrict the flow of food,” he said. “All measures against free trade will be counterproductive. Now is not the time for restrictions or putting in place trade barriers. Now is the time to protect the flow of food around the world.”

Governments must resist calls from some quarters to protect their own food supply by restricting exports, he said, as some have begun to do.

Kazakhstan, for instance, according to a report from Bloomberg, has banned exports of wheat flour, of which it is one of the world’s biggest sources, as well as restrictions on buckwheat and vegetables including onions, carrots and potatoes. Vietnam, the world’s third biggest rice exporter, has temporarily suspended rice export contracts. Russia, the world’s biggest wheat exporter, may also threaten to restrict exports, as it has done before, and the position of the US is in doubt given Donald Trump’s eagerness for a trade war in other commodities.

“Trade barriers will create extreme volatility,” warned Torero. “[They] will make the situation worse. That’s what we observe in food crises.”

While the supply of food is functioning well in most countries at present, problems could start to be seen within weeks and intensify over the following two months as key fruit and vegetables come into season. These types of produce often have short ripening times and are highly perishable, and need skilled pickers to work quickly at the right time.

“Fruit and vegetables are also very labour intensive, if the labour force is threatened because people can’t move [due to lockdown] then you have a problem.” ...

[interstitial]

One more thing: although it is absolutely true that US authorities are in many cases truly clueless, as case numbers blow up, people will self isolate and that will reduce the spread very much.
In economics classes they often use the term "ceteris paribus" - meaning all else unchanged. But in reality all else is NOT unchanged. When people see what is happening they change their behaviour so that an uncontrolled, quick spread is very unlikely in my view. Besides, as the body count rises, politicians get their shit together and do things that were unthinkable before (see Italy). The world is not static, it adapts...

True - if we are dealing with rational actors, and if there isn't significant lag time involved, and if there aren't large exponential growth factors, and if the data is good, and if the data is rapidly reported, and if the information is well conveyed to the public. None of those are true in this case. All of those are false in this case.

There is a huge lag time, both from infection to symptoms, symptoms to testing, and testing to confirmation. The rules for testing preclude testing in most cases, simply because the tests are not available. But also because the tests produce numbers that are considered bad and that the leader does not want to hear. There is very poor data due to serious lack of testing. There is poor information sharing with the public. Often such information as there is is conveyed falsely suggesting the opposite of its true meaning. The exponential growth rate is astounding.  Decision makers in many cases compound that and make it worse. And many of the major actors are considerably less than well informed or rational. Instead, the major decision make is clearly a malignant narcissist incapable of hearing anything he considers adverse to his own interests.

This creates a perfect storm to reach a truly terrible outcome. But then, we have seen this all before. Very much the same things happened in 1918.

Sam

I think the vast majority of the problem is due to trump. Almost anyone else would at least listened to the experts on this. Not calling him out is misleading.

[pietkuip]

'That's When All Hell Broke Loose': Coronavirus Patients Start to Overwhelm US Hospitals
https://amp.cnn.com/cnn/2020/03/25/health/coronavirus-covid-hospitals/index.html

... "We don't have the machines, we don't have the beds," ... "To think that we're in New York City and this is happening," he added. "It's like a third-world country type of scenario. It's mind-blowing."

... "Last week when I went to work, we talked about the one or two patients amongst the dozens of others that might have been a Covid or coronavirus patient," Spencer told CNN's Anderson Cooper Tuesday. "In my shift yesterday, nearly every single patient that I took care of was coronavirus, and many of them extremely severe. Many were put on breathing tubes. Many decompensated quite quickly.

A new term to learn: respiratory decompensation.

I think it just means that one dies, right?

[oren]

A new term to learn: respiratory decompensation.

I think it just means that one dies, right?

No. Though my intuition said the same.

From random Google result:

Respiratory decompensation was defined as an episode of dyspnea or wheezing which:
1. was sufficiently severe to require emergency outpatient treatment or hospitalization;
2. was attributed to increased airflow obstruction by the attending ED physician and
3. was treated with nebulized bronchodilators and/or corticosteroids.

[TerryM]

The involuntary DNR Do Not Resuscitate posts were interesting.
As a mid 70s male with ongoing breathing problems I'll make sure to sign a DNR before I'm hauled off.
I'd done so in the past and survived. This time it might save my bed and ventilator for someone more likely to benefit.
...........


When adding up the possible death counts, those unable to receive life saving interventions unrelated to CV19 need to be taken into account.
I've one friend already who isn't having her cancer treated as rapidly as would have been the case if the pandemic wasn't at our door.
.............


Wikipedia has decent articles on the Black Death & The Black Death in England that speculate on the effect on politics, religion and the economy.


Stay Isolated. Stay in Touch
Terry

[Tom_Mazanec]

There is no reason to go any further than that. Surely people in the US will come to their senses before then.

Archimid, are you an American? I am. You seem to have a much more rosy view of the American mind than I do.

[Archimid]

Considering that cca. 5% of cases need hospital care that is a pretty tall order... Also need to consider that many mild cases are not even reported, and we know that there are many asymptomatic carriers (estimated variously between 20-40% AFAIK). So 12% death rate out of a realistic 2-3% hospitalization rate...wow.

realistic 2-3% hospitalization rate...wow.


I've been hearing about this huge asymptomatic component for a while now. Sure 20% of those who get it get no symptoms and 80% of those who get it have mild symptoms, but hospitalization rate is not 2-3% when you yourself have argued the "true CFR" to be 1%.  The hospitalization rate is somewhere in the 5-20% range.


I have yet to see one study that shows convincing evidence for an asymptomatic segment so large that will make the hospitalization rate  2%.


https://covid-19.direct/US


I found this link the other day. Maybe it was in this thread? Check out the hospitalization rates in the US  and then checkout testing.

Archimid, are you an American? I am. You seem to have a much more rosy view of the American mind than I do.

I am an American. My view is not rosy. I just think that everyone will be as scared about this disease as I am once family and friends start falling ill and dying. Their failure to fear this disease and take the appropriate action emerges from ignorance and privilege.

[Tom_Mazanec]

OK, Arcimid. But by the time their friends and family have died of it the themselves will be infected and incubating. Got to figure in that time delay.

[El Cid]

.  The hospitalization rate is somewhere in the 5-20% range.

You are right.
I exagarrated a bit but no more than Sam's 12% mortality


But of those 5-20% (I would think rather 5 given the asymptomatic cases) again, "only"  a third need intensive care, so even if hospitals are totally jammed , not everyone who now gets hospital treatment would die lacking that. Far from it. That is my understanding currently.

Back-of-the-envelope:

Out of 100 infected, 30 asymptomatic, 70 shows symptoms, let's say 7 ends up in a hospital, and cca 2-3 needs intensive care, 1 dies. In my book even with zero hospitals there would not be a mortality of above 4% (which of course is also unacceptable and huge).

some breakdown of hospitalization rates / intensive care /mortality here:
https://www.statnews.com/2020/03/18/coronavirus-new-age-analysis-of-risk-confirms-young-adults-not-invincible/

[Alexander555]

In New York nurses have to use garbage bags to protect themself, one doctor died already. https://www.hln.be/nieuws/buitenland/verpleger-48-bezwijkt-aan-coronavirus-in-ziekenhuis-new-york-waar-medewerkers-vuilniszakken-moeten-dragen-als-bescherming~a150dcc7/

[dnem]

New infections and deaths in Italy peaked four days ago and are trending essentially flat to perhaps modestly lower since.

What are we to make of these numbers? The death rate in Italy of 124/1M population would correspond to about 40,000 deaths in the US at this point in the outbreak.

[Richard Rathbone]

New infections and deaths in Italy peaked four days ago and are trending essentially flat to perhaps modestly lower since.

What are we to make of these numbers? The death rate in Italy of 124/1M population would correspond to about 40,000 deaths in the US at this point in the outbreak.

China had a flat peak at about 100/day which is roughly 1/30 of their total deaths. A similar shape in Italy would lead to total deaths of 20-25000 in its outbreak.

[KiwiGriff]

https://eveningreport.nz/2020/03/24/keith-rankin-chart-analysis-covid-19-virus-exponential-growth-in-united-states-and-united-kingdom/



The USA has been on a consisted exponential growth path since day 11 (March 1). Italian Covid‑19 incidence levels – currently just over 8,000 known cases per 10 million people on 23 March – will be reached in the United States by day 39 (Sunday, March 29) if there is no decline from this path. Further death rates in the USA are likely to accelerate; there is no obvious reason why deaths as a percentage of known cases should be substantially less in the United States than in Italy.

The United Kingdom chart is on an identical grid to the USA chart. While the growth rate of known cases is on a slower exponential growth path (and projects to reach present Italian levels a day later than USA), the UK death rate is on a faster growth path. The most likely explanation here is that the UK case data has becoming increasingly divorced from the actual incidence of Covid‑19 in United Kingdom. While the UK undercount may be less than Italy’s, it is very much the death tally that has now become the key indicator in the UK (as it has in Italy and Spain). Covid‑19 deaths per 100 million people have reached 500 in the United Kingdom, but 150 in the United States.

[El Cid]

This is also relevant:

https://www.livescience.com/germany-coronavirus-deaths-so-low.html

Why is Germany's COVID-1 death rate so much lower than other countries?

"Germany has confirmed nearly 34,000 cases of COVID-19 as of Tuesday morning (March 25), but just 171 deaths total. That number — about a 0.5% death rate — suggests the death rate of the novel coronavirus causing COVID-19 is way, way lower in Germany...Germany didn't do mass testing at the highest rates — as was seen in South Korea where 10,000 tests were run a day — but Germany was meticulous about the process, the Post reported. Once an individual tested positive, officials then tracked every one of their contacts and proceeded to test and quarantine those individuals, essentially breaking "infection chains," the Post reported.

In addition, the virus is known to have more severe impacts on the elderly, and to date, most of the diagnosed cases in Germany are in younger individuals: The median age for confirmed cases of COVID-19 is 47 in Germany, compared with 63 years old in Italy"

[pileus]

The United States has apparently decided to try the most egregious solution. Let the maximum number of people die, while also passing legislation to rob the poor and give to the rich.

On the current course, expect in excess of 25 million American dead over the next five weeks, and a wrecked economy.

Spain just overtook China with the most cases. Tomorrow the US will overtake Spain. Within about 10 days, the US will have more than half of all cases globally and all hospitals will be in saturation then or shortly after. Expect the fatality rate to go well over 10% in the US.

The impacts will be very uneven. There is virtually no time left to do meaningful things. Instead, the moron in chief is whimpering at not being able to play with his friends, and trying to go precisely the opposite direction from that which is useful.

The catastrophe in the US won't have been bad luck. America will have been killed through gross incompetence and willful malice by its President, the Congress, many State governors, a Republican political party that is corrupt stupid arrogant and ignorant, Trumps followers who are a cult, and the corrupt media that supports their beliefs. They are committing joint suicide, while injuring and killing millions of their brethren, while never understanding a single thing.

America will be shattered and changed by this experience in wholly unpredictable ways. Welcome to hell.

Sam

While this and your subsequent post are an interesting exercise in speculation and maths it has no basis in reality or fact.  There is no legitimate modeling that forecasts this level of impact, even with a complete lack of preventative measures.

Beyond that, a primary flaw in your assumptions is that somehow all states and the entire US populace will blindly follow the directives of Trump to return to normal.  He has no control over state governors and localities, nor businesses and other organizations.  Red state governments may indeed follow his commands, but most states and organizations will ignore him and take measures to protect their people.

I unfortunately live in Florida, a state that is under the control of a Trump sycophant and the lords of big business.  The governor is making timid and terrible decisions, and it will contribute to horrific impacts on the 22M residents, a high portion of whom are elderly.  But even within the state larger cities and population centers have taken aggressive measures to implement closures and social distancing, so it will help offset the potential high end impacts.

Will certainly check back on this in five weeks.  I do not expect the US body count to be as you predict.

[dnem]

While this and your subsequent post are an interesting exercise in speculation and maths it has no basis in reality or fact.  There is no legitimate modeling that forecasts this level of impact, even with a complete lack of preventative measures.

Beyond that, a primary flaw in your assumptions is that somehow all states and the entire US populace will blindly follow the directives of Trump to return to normal.  He has no control over state governors and localities, nor businesses and other organizations.  Red state governments may indeed follow his commands, but most states and organizations will ignore him and take measures to protect their people.

Will certainly check back on this in five weeks.  I do not expect the US body count to be as you predict.

I tend to agree with this, at least for this first go round.  What I can't get my head around is what is going to happen after the numbers start to improve, and Americans, weary of isolation and broke, begin to come out and mingle. Will the virus re-surge? Will the next bump be smaller? Will we be caught in cycles of this? These are all unclear to me, but I don't think we will see cataclysmic death tolls over the next weeks. I hope.

[blumenkraft]

Look at trumps approval ratings.

Half of US citizens are fanatic members of this GOP death cult. Half! But you need >80% of the population to dismiss the president's message.

Where is this optimism coming from?

[Alexander555]

Look at trumps approval ratings.

Half of US citizens are fanatic members of this GOP death cult. Half! But you need >80% of the population to dismiss the president's message.

Where is this optimism coming from?

And you are a supporter of a communist party that puts millions in a concentration kamp without trial. And there are many here that like these communists. And this are the same kind that always cry about human rights, animal rights......No wonder this planet is fucked-up.

[gandul]

New infections and deaths in Italy peaked four days ago and are trending essentially flat to perhaps modestly lower since.

What are we to make of these numbers? The death rate in Italy of 124/1M population would correspond to about 40,000 deaths in the US at this point in the outbreak.

Perhaps they are reaching a constantly increasing number of hospital patients, instead of exponentially increasing. Especially in the tragically affected Bergamo. That would be great news. The hospitals maxed out but coping... as many people recover by now.

[SteveMDFP]

Look at trumps approval ratings.

Half of US citizens are fanatic members of this GOP death cult. Half! But you need >80% of the population to dismiss the president's message.

Where is this optimism coming from?

Exactly right.  Unless there is *very* high compliance with isolation procedures, there's very limited benefit.  With Hair Furor undermining the public health message, compliance simply won't happen adequately.  The US, then, gets the worst of both worlds--a crashed economy and an unchecked epidemic.  Within a few weeks, many may envy the comparatively mild problems of northern Italy and Spain. 

[gandul]

Great comparison KiwiGriff which shows that Boris Johnson  is perhaps a sociopath, and perhaps worse than the Narcissistic In Chief. Although this last one is also convinced that at some point economy trumps people. He risks losing both battles.

[blumenkraft]

And you are a supporter of a communist party

No, i'm not.

that puts millions in a concentration kamp without trial.

Do they? I've not seen proof of that. And no, US cable-news propaganda is no proof.

Second, the EU and the US maintain concentration camps despite breaking international laws doing so. And this is indeed provable.

No wonder this planet is fucked-up.

Mental gymnastics for 500, please.

[El Cid]

Let's get back to COVID19 after this nice distraction of narcissistic chiefs, communist parties and a fucked up planet

[vox_mundi]

Road Not Taken: Trump Administration Didn't Use Pandemic "Playbook" for Coronavirus
https://www.axios.com/trump-coronavirus-pandemic-playbook-7da0cf5b-1d83-438f-8111-57f955675dbc.html

'Pandemic Playbook' in .pdf format: https://assets.documentcloud.org/documents/6819268/Pandemic-Playbook.pdf

[Tom_Mazanec]

How the Pandemic Will End
https://www.theatlantic.com/health/archive/2020/03/how-will-coronavirus-end/608719/

The U.S. may end up with the worst COVID-19 outbreak in the industrialized world. This is how it’s going to play out.

[gandul]

I gotta say, I always found Bill Gates unbearable in interviews, but he has a strong position in favor of preserving lives and enduring, severe lock down, very much against the two-way, lose-lose solution of Trump.

https://www.cnbc.com/2020/03/25/what-bill-gates-would-do-to-fight-covid-19-if-he-were-us-president.html

[Alexander555]

40 more infections in Tokyo, subways still full with people. https://the-japan-news.com/news/article/0006449651

[pileus]

While this and your subsequent post are an interesting exercise in speculation and maths it has no basis in reality or fact.  There is no legitimate modeling that forecasts this level of impact, even with a complete lack of preventative measures.

Beyond that, a primary flaw in your assumptions is that somehow all states and the entire US populace will blindly follow the directives of Trump to return to normal.  He has no control over state governors and localities, nor businesses and other organizations.  Red state governments may indeed follow his commands, but most states and organizations will ignore him and take measures to protect their people.

Will certainly check back on this in five weeks.  I do not expect the US body count to be as you predict.

I tend to agree with this, at least for this first go round.  What I can't get my head around is what is going to happen after the numbers start to improve, and Americans, weary of isolation and broke, begin to come out and mingle. Will the virus re-surge? Will the next bump be smaller? Will we be caught in cycles of this? These are all unclear to me, but I don't think we will see cataclysmic death tolls over the next weeks. I hope.

The modeling appears to indicate that even with comprehensive physical distancing and other measures, the embers will be there and flare up as soon as restrictions are relaxed, until there is a vaccine in distribution (~18 months) and/or there is a large part of the population with antibodies from exposure and survival.  Neither extreme measures nor the stop/start approach are frameworks that work well with the “American way,” so that presents challenges and risks beyond the obvious.

The US seems to have lost its chance to get in front of this due to systemic failures, primarily at the federal level.  No leadership on physical distancing and closures, and no comprehensive testing and tracing program.

Still, these projections of 25 million deaths in five weeks are absurd and not grounded in any type of real data or science.  But the death toll will likely still be terrible, and more than it should have been had there been different leaders in place with more acceptance of science and expertise.

[Pmt111500]

Finnish situation is pretty clear, the province with the capital (most tourists and other travels abroad) is the clear leader like Paris was earlier (and still is?) in France. In the middle of the country there are higher incidence areas, these could be either returning tourist from Helsinki or capital region people going to Lapland. There is one province that has no cases, this is because it's not really a tourist destination (some cross-country marathon skiers might like it here, but few others.)

Discussions are on-going how to close the borders of the province of the capital. Any tourists landing by happenstance to Helsinki-Vantaa airport are not allowed further in the country. Two other airports are kept open for returning Finnish tourists (some evacuation flights planned). If you by happenstance end up on these expect to get familiar with Finnish military personnel.

[pileus]

Look at trumps approval ratings.

Half of US citizens are fanatic members of this GOP death cult. Half! But you need >80% of the population to dismiss the president's message.

Where is this optimism coming from?

A US president by default tends to get benefit of the doubt and majority support in times of crisis/war/disaster.  See Bush after 9/11, elder Bush at the beginning of Desert Storm, etc.

Some of this support will erode as the recession/depression deepens and more people are directly impacted, but Trump is unique that he is indeed a cult figure, and 90% of his support (about 40% of US adults), will never abandon him.

[Archimid]

Masks can be seen as temporary vaccines. With good mask use, most social tasks can resume with minimal risk.