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Messages - Sam

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1
Consequences / Re: COVID-19
« on: April 18, 2020, 01:05:20 AM »
And now we have entered that phase of the catastrophe where Grief plays an ever larger role. It mangles the responses. It distorts actions. And chaos ensues if there isn't intelligent compassionate wise leadership. We have none of those at the moment.

The data will become messy. The responses will be messier yet, with people and areas running in opposing directions.
  • Some people remain caught in shock and cannot comprehend or accept that this is real.
  • Some are deep in denial wanting the reality to be what it was and refusing to accept the reality as it is.
  • Some have moved on to anger aimed in a thousand directions.
  • Others have moved past anger to bargaining; trying to find a way back to what was, or to escape the ravages of what is.
  • Some have moved on to resignation, and depression.
  • A few have moved to acceptance.
  • And in limited locations (China, Taiwan, New Zealand, Iceland among them) people have begun to move to Testing; feeling out what the new world is like on the other side of the pandemic.
The next several months will no doubt be rugged. In those countries (the US being a prime example) where a large portion of the population remains in a cocoon of denial, anger, betrayal, shock, and worse, the course will be particularly rocky.

This will delay finally resolving the problems. It will make the outcomes vastly worse.

A part of me grieves for that. Another part wishes them well on their journey into disaster and is fine with them committing suicide in their regions, though wishing they wouldn't take innocents along for the ride. Another rages against their stupidity. No one ever said the school of hard knocks was easy, cheap, or in any way safe.

But those too are aspects of grief. And so for my own benefit and healing it is time for me to bow out. I know what I need to do to protect myself, and to aid my friends and family in protecting themselves. I cannot significantly affect or influence the course of events beyond them. All I can do at this point is cause myself injury by engaging. And as a result - I now disengage to focus on healing my own grief.

Be safe everyone, as best you can. The ride from here is going to get very bumpy. Keep your seat belts fastened and your helmets on. Keep your hands inside the car at all times until the ride has come to a complete stop.

Sam

2
Consequences / Re: COVID-19
« on: April 16, 2020, 11:52:29 PM »
The psychological effect of this disease is much more dangerous than the disease itself.

Neven,

This is a basic and common error. Our society is conditioned to think in terms that put commerce as primary. It isn’t. It is essential. It is not primary.

I think you are missing Nevens point.

Following is my reading but if you read what he wrote on Lessons form Covid-19 it is not about commerce being important. See post 182 there.

I don't think so. In #182 of Lessons Learned Never argues about the concentration of wealth and commerce. I agree with all of that. Where I have difficulty is with two points from the post #5554 in this thread.

A long ride will probably mean civilisational collapse, as fear and insecurity, incessantly pumped up by the media, will prevent people from being the consumers they were conditioned to be. Consumerism is a central pillar of our current global system. It could transition to something more resilient (if the lessons of this crisis are heeded), but it will take years, if not decades. It will collapse if everyone's eyes are glued to statistics (with no context), and fear and panic are used for ratings and to make sure people obey the installed measures.

The angle of the narrative will have to change, something along the lines of: 'Yes, this is a terrible new disease, but there are many of those. People are dying, but they are mostly very old and have comorbidities. And besides, 150 thousand people die every day. Death is a part of life. It's true that people die before their time, but on average perhaps a few months, not years, and certainly not 10 years. The only thing that really matters in all this, is that we prevent a collapse of our health care systems, and so we need to do as much as we can, but we must not be afraid, because we cannot afford to be in lockdown much longer.'

The psychological effect of this disease is much more dangerous than the disease itself.

My discussion and post go to the two comments in bold above.

Point 1. ..."we cannot afford lockdown much longer."

We cannot afford not to extend lockdown longer. It is fatal to business as well as to individuals to restart soon. Doing that causes the disease to come back and spread. That then either extends the lockdown (bad), or increases the deaths (worse) AND extends the lockdown (much worse). We must focus on the primary problem - the virus and its spread - not the secondary, tertiary and subsidiary problems. Those are important. But they are ONLY solved if we solve the first problem first.

I agree that we must make the time in lockdown as short as we can. I am firmly of the belief this has to be by making it more effective and enforced, not by lifting it. That ultimately only extends it.

Addenda: In the US the Congress did a bare minimum job of trying to help small businesses and workers. That is more notable in its failing than its success. Government/societal support for workers and small businesses is vital to their welfare and survival. That also means full healthcare without worries, something we entirely lack in the US. No one should be caught as Neven has been, needing to care for his business(es) and his workers, and having that compete with caring for himself, family, society at large, and all the rest. This is another aspect that most governments are woefully failing at.

Point 2. "The psychological effect of this disease is much more dangerous than the disease itself."

This is hugely destructive. We and our leaders can do many things to ameliorate that. Ending the quarantine prematurely isn't one of them. See point 1.

Addenda 2: What we desperately need is intelligent compassionate leaders who can and will reach out to the public to explain, as Franklin Roosevelt did with his fireside chats, precisely what is happening, what the government is doing to help, what people can do for themselves and others, and that calls on the better nature’s of everyone to work together to solve this - not just as a nation, states, communities and individuals, but also as a world- United. Instead we in the US have a conman, thief, liar, narcissist, bully who gathers everyone around to watch him beat up his perceived enemies.

Neven,

My apologies for speaking about you in the third person. I agree with the vast majority of what you have said here. It is these two points that cause me great heartburn.

Sam

3
Consequences / Re: COVID-19
« on: April 16, 2020, 09:48:43 PM »
Sam, this may be too philosophical a question for this thread, but given your view of the threat this virus poses, how are you viewing the rest of your time on this planet? How have you integrated your assessment into your goals, dreams, aspirations, hopes for your kids (if you have any), etc.?

Because if you are right, I am at a loss for how to do that.  Feel free to PM me or perhaps there's a more appropriate thread for this discussion.

For a number of reasons I elected not to have kids when I was 17. That was primarily because of a genetic linked issue that made me vulnerable to a severe form of arthritis. That caused me horrible problems for 30 years until contrary to medical wisdom I cured it. Secondarily, all the way back then in the early 1970s I saw the general outline of this coming. Not this specific virus, but climate change, pollution, wars, famine, pestilence, mass migration. That was also when the Club of Rome report came out.

So dnem, your question about how it impacts my goals and my life are in no way theoretical. They have governed my life from about age 10 onward. Everything in my life has been changed by understanding what was happening, why it was happening, where we were and are headed, and all the myriad factors that could change that.

I spent much of my life trying to change that course to no avail. I spent another large part of my life working on systems and designs. And I spent a lot of time doing emergency response and preparedness. In the course of that I identified and drove resolution of several Chernobyl scale disasters before they could become catastrophes. My name will never be associated with those. My name will never be broadly known. Solving those issues required (yes, required) working quietly behind the scenes. It was the only way to avoid the resistance and blowback that would prevent resolving the issues. Recognition is not and never has been a driver for me, nor for many of those I worked with through those years. We built things. We fixed things. We made things work well. We protected people. We were guardians and shepherds. The results are and were our reward.

I struggle with how to even suggest a solution for you to consider. I made my choices half a century ago. I lived them. Now I mourn the consequences of the things I/we could not fix.

But too I realize just as the father of the green revolution did - that all we did was to buy time for others to actually fix the structural problems. But “they” either never came along, or were not interested in solving the problems. So by buying time, we allowed the conditions to get worse before the inevitable collapse(s) arrived. We collectively made the system more able to support more people for longer, thereby making the descent into collapse harsher and faster.

Had the green revolution not occurred, population collapse and limitations would have happened decades ago. That may well have spread out the rate of change over timeframes that would have allowed civilization to come to grips with its own impacts and changed our behavior in ways that prevented catastrophic climate change. That is doubtful. The path appears to have been inevitable. The rate of changes would have been less. The hardships would have come sooner.

For me personally, I am at peace. I know my place in the universe and the grand scheme. I have the confidence of my own experiences and beliefs (knowing that that is what they are, and testing them constantly). I have lived a long and wonderful life with glorious friends and loves. All will be well.

I do not believe this marks the end even for man, though it may if we are stupid.  And a lot of mankind is truly stupid. Recent events have made that clear. It is going to be a very rough transition for the next several centuries to several millennia.

I joked with my father once when I was about 10. We were talking about these same questions, yes - all the way back in the 1960s. And he asked as you did. I replied flippantly that hey, I wasn’t around for the beginning, it might be nice to be around for the end. That off hand reply has haunted me my whole life. I am only glad that he did not live to see this.

For myself, I have a nice home. I planted a mini orchard a decade ago. It produces more fruit than I can deal with. I can garden and raise enough food for myself and friends. My health is good. So long as all that holds true, I mostly have sanctuary from this storm. In many ways this has not directly touched me. Indirectly it is devastating, as younger friends, children of friends and others suffer. I saw this coming and prepared. Most people did not. Most of them did not. They made other choices, choices that left them vulnerable, despite my protestations and cautions. Being safe while others aren’t when I spent a lifetime protecting others is wane comfort.

But then too, this forces people to face the harsh realities of life and the world. I do not mean the world as they perceived it or desired it to be, but the actual world as it really is. This is the world of scary childhood Fairy tales, where wolves and bears eat children who stray into the woods, and where goblins and monsters reside.

Truly coming face to face with reality and mortality is I think a very good thing. It is a hard and harsh thing. It is often an unwelcome thing. But it is ultimately good. Many will not survive that encounter. Many more will be grievously injured by it. Society though will be made the better for it.

I don’t know that I answered your question. But then I am still not sure I actually have an answer, even for myself. I am still searching. And I will still be searching until the day I die.

Sam



4
Consequences / Re: COVID-19
« on: April 16, 2020, 08:37:27 PM »
More and more credible sources pointing to the origin of the Wuhan coronavirus/Wuhan pneumonia/Chinese virus to the Wuhan Laboratory:

https://www.dailymail.co.uk/news/article-8223779/Coronavirus-originated-bungled-experiments-Wuhan-lab-bombshell-report-claims.html

I've been pointing out this virus came from a lab for weeks, and now we're getting closer and closer to getting that info confirmed.

This is just one more instance of the right wing nuts wanting someone to blame, preferably the Chinese, preferably communism.

There is no truth to it. There never was. This is a natural variation of a virus from nature jumping to humans from animals in a high contact zone, hybridizing with a human virus to gain capability. This happens frequently. This happens more often the higher the population density and the higher the contact rate with the wild.

This is not in any way surprising. It is and was entirely expected. It was so expected that the Chinese focused two large research groups on this very virus family AND began construction of a bio lab to study these viruses - the very lab the right wing nuts want to blame for creating it.

This is not (99+% likelihood) in any way associated with human meddling with this virus. This is nature at work weeding the herd.

Sam

5
Consequences / Re: COVID-19
« on: April 16, 2020, 08:25:27 PM »
The psychological effect of this disease is much more dangerous than the disease itself.

Neven,

This is a basic and common error. Our society is conditioned to think in terms that put commerce as primary. It isn’t. It is essential. It is not primary.

The psychological effects of this disease are terrible. The impacts of those on commerce are great. More impactful is the disease itself.  It is not in any way the messaging or narrative that is the problem. That places commerce as the priority to resolve the crisis.

To resolve the crisis requires first understanding that the disease spread is itself primary. It leads. It governs all that happens. The impacts of the disease on psychology are secondary AND important.

The impacts on commerce are tertiary. And their impacts on employment, income, work, social life ... are feedbacks from that. They are all vitally important. But they are tertiary.

Focusing on those focuses on the wrong problem.

The narrative in media is quaternary, not even tertiary. But it is for most people the first thing they see. And between the primacy of that flow of information and the vital importance of economics to day to day survival, it is not in the least surprising to find people believing that to be most important and hence primary. It still isn’t. It also easily lends itself to memes, and to political campaigns focused on those aspects. That still does not make it primary.

The disease and its progression are and remain primary. They drive everything else.

Solving the crisis requires solving the disease spread. Solving the crisis requires focusing on that primary problem.

And there two major aspects. First is the disease itself. Treatments, drugs, herbs, vaccines and such are the primary weapons there. Second is the spread of the disease. That is dominated by human behavior. There is as yet no suggestion even of an animal or insect vector playing any role. Stopping human to human spread is the major control. That then goes to isolation through many means, blocking transmission with masks, sanitizers, hand washing, and behavioral interventions are the major tools.

This virus is as contagious as chicken pox. That is hugely contagious. Controlling it requires actions commensurate with that. And that means lockdown.

If - and this is a huge if - we could simultaneously stop everyone from moving around for five to six weeks, we would likely end the virus. Five to six weeks in very small groups would cause the disease to run its course and die out. Even a few somewhat larger groups, or limited movement of essential people provide pathways for the virus to continue.

And even a single contagion chain is enough that when that isolation is lifted - the virus resumes its rampage. The vast majority of people don’t have five to six weeks of food and essential supplies on hand. Medical and other emergencies still happen.

So, five to six weeks isn’t enough. It requires longer - a lot longer.

That then endangers the existence of small companies. It depletes individual resources or strains them to the breaking point. Accordingly, massive societal sharing (financial bailouts being one such) become essential.

But these are not one time things. They have to last as long as the contagion persists - requiring isolation and shutdown.

And how long that lasts is decided by how tightly we are willing to lock ourselves down (all of us), and by how effective we are at it.

If we do this badly, or even moderately well. The period required is extended indefinitely. And that then drives people bonkers psychologically which causes controls to fail.

But failure means ultimately infecting about 90% of the population. And that means killing circa 3-9+% of the population in the first wave. And if this virus only provides two year immunity as it appears to, it means killing something like 2-6% in a second wave, and 1-5% in a third wave etc...  Each wave depletes the society of older and vulnerable people, presumably lessening the impact of each wave. But over a decade, this likely sums to 12-15% of the population dying, unless massive controls are put in place, or successful treatments or vaccines are developed. That then might limit the dying to 4% over the decade.

However, even a single adverse mutation in all those quadrillions of quadrillion+ copies of the virus throws all of this analysis out. Now we deal with a more lethal disease that spreads faster, and kills more and different people. It perhaps then targets the young, or young adults, or those in middle age.

In time, that too dies out. Extremely lethal viruses are self limiting. They destroy the population in the process.

Focusing on putting business recovery as primary assures that the disease spreads farther and faster and that it kills more people. That raises the decades death toll substantially. AND it destroys more businesses. Focusing on saving business and commerce as primary kills business and commerce.

The problem is not the narrative about the virus. The problem is and remains the virus.

Sam


6
Consequences / Re: COVID-19
« on: April 16, 2020, 06:32:12 AM »
Isn't COVID-19 stressful to the heart, as it needs to work harder when the lungs are less efficient? That would make (hydroxy)chloroquine even more risky and disqualifies it in severe cases.

Yes. Extremely. Though Herr Twittler assures us otherwise.

Sam

7
Consequences / Re: COVID-19
« on: April 14, 2020, 11:42:04 PM »
<snipped>
122 new death lower then 234 last week but this includes the easter effect.
<snipped>
Getting accurate fatality counts on easter weekend has proven difficult for milenia. ::)
Terry

The same holds true for all ‘major’ holidays.
<snip>
I think you missed the point Sam. Easter is the celebration of Jesus Christ being alive three days after his execution. This is not the forum to discuss who  believes that or doesn't. The comment struck me as light hearted and made me smile despite the seriousness of the subjects.

Which is precisely why I skipped it - until John The Elder decided to make a point of it - and now you. It is not I who decided to bring this here. It is several of you who elected to bring religion to a science forum followed by a mild insult. If you truly want it dropped, then simply drop it.

Sam

8
Consequences / Re: COVID-19
« on: April 14, 2020, 08:03:43 PM »
<snipped>
122 new death lower then 234 last week but this includes the easter effect.
<snipped>
Getting accurate fatality counts on easter weekend has proven difficult for milenia. ::)
Terry

The same holds true for all ‘major’ holidays.

In just the few data sets I have examined closely, what seems to help tremendously is to use a centered seven day moving average of the data. There is a lot of noise in the data that results from human variation in reporting based on the day of the week and weekend effects. Holidays and special events compound this. But they too mostly go away in a seven day average. Centering the average helps to put the impacts on the correct dates.

Also, time lagging or shifting the data by 10-11 days also makes things somewhat clearer.

The average time from infection to symptoms seems to be stable at 5-7 days, though the distribution has a broad right tailed distribution with symptoms showing in as little as 2 days and as many as 28 (or longer).

The time to seek treatment seems to average about 2 days. And the time for testing confirmation seems to be about 2-3 days.

The sum of those is 10-11 days.

The serial generation time seems to be less known. Various analyses have placed that at 4.7, 5.9, 7.2 and 7.5 days with fairly tight distributions. These are in conflict with one another due to the tightness of the assessed variations.

The R0 as a result is also variable. Add to that the population density impacts on the R0, and the result is variation from 1.5 to >20 on the R0. Even small variations in the R0 have large impacts on the models.

During the early free growing phase in the first 28 days or so, the cumulative count of cases is most informative. After that it is important to shift to the new case count. In the first fortnight, the exponential growth dominates, and there are few or no recovered cases in the population to muddy the Dara. Also, the total count rate is low making the daily counts less reliable.

After the first fortnight, and especially after social reactions (self quarantine ...) begin, the exponential changes causing muddying of the data; and the relative importance of the recovered cases (who are non infective) grows in the data set. As this happens, the new case per day data becomes more representative. Also, by that point, the rate of new cases per day is larger which also reduces the noise in that data.

What seems to be much more useful is to ignore the serial time, and R0, and to instead use the observed growth rate in daily new cases (using a seven day moving average of the data). This creates other artifacts and introduces other errors, and those must be kept in mind. Still, the daily-growth-rate-changes, in my opinion, better & more smoothly assess the impacts of all of the factors involved in the transmission with a single parameter that is more easily assessed from the data by looking at the slope of the log curves of the smoothed daily data.

Sam

9
Consequences / Re: COVID-19
« on: April 14, 2020, 07:01:09 PM »
Another bit of good news....

The one part of their solutions that all of these four share is testing, tracing and isolation...

I agree 100%. And I just can't understand why other countries do not copy them as fast as possible. Why doesn't every country (at least those able) perform mass testing and tracing???
In my country, the person responsible for the pandemic said "no testing is able to stop the virus", so they do test only for the very sick. Seriously. Unbelievable. It's like saying "no radar can stop enemy airplanes".

El CID,

That is the single best analogy I have seen or read about testing.  Thank you!

Sam

10
Consequences / Re: COVID-19
« on: April 14, 2020, 10:23:00 AM »
Sometimes those things we can least influence scare us the most.

Exactly.

It is a comforting thought to blame humans for creating this. The real scary part is that infections like this can emerge anywhere at any time.

Freakier is that they have been recurring like clockwork once a century in world spanning outbreaks.

I doubt that speaks about the viruses. I suspect it says something about humanity.

The Indian variant may be and likely is -less- virulent, based on where the mutation affected.

However it points out a grave danger. The longer this thing is extant in the world, the more copies exist in more bodies. Each reproduction is a chance for a new variation. Each variation is a chance for an even scarier disease. And with more people infected comes more co-infections and the opportunity for cross over, and the creation of some new monster.

With variation also comes the potential that the variants require distinct vaccines. And the potential for difficulties, such as occurs with the five variants of Dengue and its vaccine.

On a different note.

It appears that self isolation as done in the US is resulting in something like a -1.5% “growth” rate. I.e. a 0.985 x/day change day to day in the number of new cases. This is excellent news. However, it is - slow. At that rate, and without massive testing, contact tracing, and isolation of those infected, it means that provided this holds across much of the US (unknown) that the new case rate about May 1 will be something like 75% of the new case rate today.

And what that means is that if self isolation / quarantine is lifted on May 1 as threatened by Donald the Dumb, and people actually return to their normal lives that the case rate will begin rising at between 1.18 x/day in mostly rural areas and ~1.355 x/day in urban metro areas.

It will take 10-11 days to see that begin to show impacts on numbers.  It will take about a week of increase to persuade decision makers that they have erred. And in that time the new case rate will have grown to between 35 and 235 times the rate the day the decision was implemented. If that is 75% of the case rate now, then the case rate will have bloomed to between 25 and 175 times the new case rate today.

And in many areas, with the peak in rates being about now, now is when many areas hospitals are at or near saturation. At 25 to 175 times today’s rates, pretty much everywhere will be in saturation. But those rates will continue to rise for another 10-11 days to 130 to 5,000 times today’s rates, before the restored quarantine begins to show effects. Should that happen a whole lot of folks will die who would not have died at lesser rates. That would take the nominal 4.5% CFR for hospitalized cases much much higher.

All of this is of course guesswork, with all sorts of questionable assumptions. People are likely to be gun shy to go back to their normal lives. Many, if not most, Governors are likely to show Herr Dumkopf their middle fingers. So the reality is likely to be much less severe than these numbers might suggest.

Then again, the stacked Federal Courts courtesy of Minnie me McConnell might well trash the Constitution and the tenth amendment and decide that the Commerce Clause supersedes everything.

Still, the impact will be bad. We can only hope that he isn’t as much of an imbecile as he appears, and that he doesn’t try to “restart” the economy on May 1, or anytime in the two months after that, without dramatically changed policies that drive the infection rates to near zero before trying to gently and tentatively restart the economy.

That is of course a vain and ridiculous hope. Our dear loser of a leader has demonstrated at every turn that he is a thin-skinned, self aggrandizing, malignant narcissist, sociopathic liar, conman, bully, idiot, fool, moron, imbecile, racist, zealot, misogynist, and utterly failed business man. Everything he touches turns into a heaping fetid pile of stinking shit the likes of which no one has seen before. There is no reason to hope or believe any decision he is involved in regarding this pandemic will be any different.

And whatever happens he will of course claim to have done the most perfectest and smartetest thing any President has ever even dreamed of doing - never mind the reality. And his troglodyte troll followers will genuflect obscenely and obsequiesly to French kiss his ass as he does it, while simultaneously blaming everything on the commies and their fantasy “deep State”. All the while, our neighbors will be dying for the economy.

Sam

11
Consequences / Re: COVID-19
« on: April 09, 2020, 08:15:19 AM »
I have seen this sort of worthless data posted on line to many times already thanks.
 
Quote
NOTE: Number of deaths reported in this table are the total number of deaths received and coded as of the date of analysis and do not represent all deaths that occurred in that period.

*Data during this period are incomplete because of the lag in time between when the death occurred and when the death certificate is completed, submitted to NCHS and processed for reporting purposes. This delay can range from 1 week to 8 weeks or more, depending on the jurisdiction, age, and cause of death.

The bureaucratic delay inherent in such sources makes reference to them meaningless for a month or two yet.

Nice visualization see here >>

From here >> https://www.reddit.com/r/dataisbeautiful/comments/fxau85/the_recent_drop_in_us_pneumonia_deaths_is/

That is by far one of the best visualizations I have seen portraying the delayed reporting of data - which posts into the correct time period in the past.

It is awfully easy during an event (of many major different types), or even in industrial production, to grab data and trend it believing it is meaningful; even though it actually isn't - precisely because of this sort of information lag.

During the early months of the HIV pandemic in the 1980s I was following the data at first on a daily basis, then weekly, then monthly as CDC shifted their reporting. It was pretty easy to see that the data behaved in a mostly predictable way, with data coming in late and being posted into the correct time era in the past in a mostly repeatable manner.

The data in the graph shows similar behavior. Back in the 80's I developed a predictive algorithm in Lotus 1-2-3 to 'adjust' the reported data to estimate the likely actual data. The same appears to be possible here.

However, in the case of flu, the data is uniform enough that you can almost use the prior years as the guide to the error in the current data. By directly trending how the data changes over time, and then adjusting it based on that algorithm independent of prior years specific data, it is possible to get an early warning that things may be trending away from the prior year norms.

In the HIV case, the data always showed a rising trend (damped exponential) that turned downward at the end in the most recent reporting periods.

Perpetually the news reported that it looked like maybe we were at or near the peak. They never then went back to report that they had erred, and that no such thing had happened, and that instead that they and those who advised them had been deceived by this temporal reporting problem.

I saw this so often in my career that it is one of the first things that I look for. This especially happens when there are human reporting systems involved.

I do not believe that is what we are seeing now with COVID. It is likely that plays a role though.

It appears to me that the sheltering in place and distancing has made a serious dent in the transmission rates. This does not however mean that it will trend to zero as the models suggest. That is an artifact of errors in the assumptions in the models.

At the same time, there are clearly both unreported cases (both asymptomatic AND presymptomatic), and deaths whose causes are misassigned for any of several reasons. In some strongly rule based cultures, this is an artifact of the rules. It isn't YYY until you prove it is YYY. But absent the necessary capacity for testing, testing corpses is a low priority, so the data is corrupted; deaths assignments are recorded and reported wrongly. In those cultures, the error 'may' show up by looking at excess death rates. However, the dramatic change in human behavior from sheltering also changes the underlying statistics, so that too is not reliable.

At the same time, unattended deaths may be arbitrarily assigned any number of causes from heart disease, to pulmonary failure, uncontrolled diabetes, flu, COVID, or others based on a best assessment by a physician, or the coroner. In the US, many corners are only charitably called that. This isn't all that different from months, years, decades and centuries gone by. We just like to pretend we are better at it now than we often are. A century ago, many people died of "heart failure" who actually died of other causes. What was apparent was that the persons heart stopped beating. Absent any other cause --- heart failure.

All of that impacts the data. And as the count of cases rises, it becomes a larger and larger problem. In some ways it is akin to the "fog of war".

I don't say any of this to be critical. The reality on the ground is often different, sometimes greatly different, than we imagine or wish it to be. As a result, the data is often flawed in important and potentially deceiving ways. It is important to recognize that this is or may be happening, and not to take the data too seriously without ground truthing.

Back in the 1970s-1990s there were huge efforts at using statistical quality control, statistical process control and the like. In industrial processes, these helped. But even more than providing more and better data for controlling processes, they actually had as their purpose taking the freaking managers hands off the controls. Managers love to think they understand (when they don't) and to "prove" their worth by "fixing" things. The statistical tools forced them to take their hands off. When they finally understood that was what the tools did, they subverted the tools. This too is often a problem. Donald Trump is a prime example of that sort of stupidity, and an exemplar of how severely it can distort the data and the response; and from that the success or failure of the response.

Humans are silly creatures. We tend to believe what we want to believe, no matter the reality. The old saying "Seeing is Believing" is actually quite often precisely backward. Quite often what is seen is ONLY what is believed, and the proper saying is "Believing is Seeing", meaning that those involved not only ONLY see what they want to see and what they want to believe to be truth, but more over - they simply cannot see anything that runs contrary to their beliefs and desires. They will not even entertain the possibility that the reality is other than what they believe it to be. They can and do change the data to match their beliefs. This happens in dozens of unique ways.

It is in my experience quite rare to find people who see what is, and adjust their beliefs to match the reality, while all the while challenging whether that is the real reality, or whether the tools and systems have embedded within them preconceptions, presumptions, unstated assumptions, beliefs and biases, misunderstandings, and other failings that cause the data to portray one thing, while the reality may not be anything like that at all. And more than that - who watch for the people involved to be willfully mucking things up, even while they think they are "fixing" things.

And this doesn't even get to the willful modification of data and information to conceal things that are viewed as being contrary to the career interests of the manager(s) involved.

Sam

12
Consequences / Re: COVID-19
« on: April 09, 2020, 02:24:41 AM »
If the plasma is proven effective, as I hope it will, it is very likely worth the risks.

The risks:

Quote
Of 4857 transfusion episodes investigated, 1.1% were associated with a serious reaction. Transfusion associated circulatory overload (TACO) was the most frequent serious reaction noted, being identified in 1% of transfusion episodes. Despite clinical notes describing a potential transfusion association in 59% of these cases, only 5.1% were reported to the transfusion service. Suspected transfusion related acute lung injury (TRALI/possible TRALI), anaphylactic, and hypotensive reactions were noted in 0.08%, 0.02%, and 0.02% of transfusion episodes. Minor reactions, including febrile non-hemolytic and allergic, were noted in 0.62% and 0.29% of transfusion episodes, with 30–50% reported to the transfusion service.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5559198/

I really don't mean to be rude, but I don't think you understand this article.  The article is discussing "blood transfusions."  A plasma transfusion is *very* different.  No red blood cells, nor white blood cells, are transfused.  A plasma infusion is far, far safer.

Now, if you can find an article showing the hazards of fresh-frozen plasma, that would be relevant.

It isn’t just red cells and their proteins, or white cells and theirs that are at issue. Those are potentially very important for transfusion reaction. For the vast majority of people these do not come into play at all in terms of risks. For a small fraction of us, that is not so clear cut.

Plasma is also sterilized for pathogens. That does not assure that viruses are excluded or entirely inactivated. Neither does it always assure the all fungi and certain other organisms are eliminated. And neither does it or even can it prevent prion transmission.

These are not huge risks in the calculus for people with life threatening need for these products. And those involved have done a reasonable amount of diligence. However, that does not then translate to widespread giving it to healthy people.

Also, doing so would require a hugely expanded infrastructure to handle the added blood products. Lacking that, people who critically need these products would be denied them. More over we do not yet have very high confidence about the degree of immune protection provided. This is as yet untested.

More than this, we know that the elderly who have been exposed to more things in their lives are dying not from the virus directly, but from their own immune systems reaction to the virus as a cytokine storm damages the hearts and floods their lungs. It is not yet clear that boosting their immune response is at all the right thing to do.

Sam

13
Consequences / Re: COVID-19
« on: April 08, 2020, 02:24:40 AM »
Here is why Jacinda Ardern is one of my heroes.

New Zealand isn’t just flattening the curve. It’s squashing it.

https://www.msn.com/en-us/news/world/new-zealand-isnt-just-flattening-the-curve-its-squashing-it/ar-BB12gstI?li=BBnbfcL

It is possible to beat this virus. Doing so requires wisdom and diligence. New Zealand is now one of the few success cases.

The US due to the actions of many though not all the States has greatly reduced the growth rates. New York and Washington in particular have made great strides. These are as yet far from success. But they are better. That shows up as the current confirmed infection count now being five days behind my projection based on the rates two weeks ago. Those rates will likely slow more.

However, this is only a slowing. This is in no way success. Once the people tire enough of the restrictions and begin to venture out more, the viral transmission will again rise. This will cause the infections to continue for the long term, requiring ongoing shelter in place for month after month after month, destroying the economy in the process. And the longer this goes on, the greater the chance that the virus mutates into an even more virulent and/or an even more lethal form.

If this problem is to be solved, either solutions like those used in China, New Zealand, or possibly South Korea (though that is less successful), OR herd immunity will be required. Achieving herd immunity while not overwhelming the hospitals means that we stay under the current restrictions for at least another year, and possibly as long as two years. That means economic suicide for businesses large and small, for individuals, and for the nation.

Worse though, achieving herd immunity means that a tremendous number of our neighbors will sicken and die.

Just how long will it take our moron in chief to understand this? That’s a rhetorical question. He is entirely incapable of ever understanding or accepting that. Neither is he able or likely willing to understand the necessity of following the path Jacinda has lain out. Moreover, there is no way in hell that he will follow a woman’s lead. So we are stuck here until he is out of office. And that means an ongoing large death toll month after month until then.

Sam

.... and it begins.

A ‘Liberty’ Rebellion in Idaho Threatens to Undermine Coronavirus Orders

https://www.msn.com/en-us/news/us/a-liberty-rebellion-in-idaho-threatens-to-undermine-coronavirus-orders/ar-BB12gfO9

Stupid is as stupid does.     This is why we can’t have nice things.

But then on the success side of the ledger...

China lifts 76-day lockdown on Wuhan as city reemerges from coronavirus crisis

https://www.cnn.com/2020/04/07/asia/coronavirus-wuhan-lockdown-lifted-intl-hnk/index.html

Eleven weeks of lockdown - then recovery.

Addenda: This is not going to resolve as Dr. Fauci thinks or wants to optimistically believe. He is being foolish or self-deluded. This bug is as contagious as Chicken Pox. If we fail to eradicate it or totally contain it, it will immediately come roaring back. This is an extremely dangerous biosafety level 3 agent.

Under current strategies. Schools will not reopen in the fall. Neither will businesses.

The models are wrong in showing a peak then a decline to zero. They only go to zero, because the modelers included on-going highly effective controls in their models. You only get a decline to zero if you achieve herd immunity, or you maintain conditions that prevent transmission sufficiently to accomplish the same AND you do extensive contact tracing and isolation BEFORE releasing controls. Do anything less and it comes right back.

Worse, we do not yet know how long immunity to this bug lasts. The history from SARS1 suggests two years on average with a weak immunity in year three. But, some people exhibit a weaker immune response and can contract it again almost immediately.

This thing is not going to just “be around” as Dr. Fauci suggests, it is a violent virulent predator waiting for us to let our guard down in the least to devour people and ravage the nation - again.

14
Consequences / Re: COVID-19
« on: April 01, 2020, 01:32:26 AM »
Vox,

I won’t upstage you by posting the links to the breaking news stories. Actually I am steaming just a little too much to do it. ....

The chief turd after two months of delay and denial, deflection, insults and harangues, and a near endless stream of self serving lies now finally tells the US today to prepare for a terrible two weeks, and potentially 100k-240k deaths.

As you all here know I have been projecting far worse than that for quite literally months now. This wasn’t a surprise. This wasn’t unexpected. This wasn’t unavoidable. This is a Trumpian induced catastrophe. It took Trumpian levels of gross incompetence to kill this many Americans. Other nations have their own equivalents.

I am disgusted in the extreme. I said before that the data and numbers would ultimately tell the tale. Well, we are nearly there. And even now, finally saying the catastrophe will be enormous, they are still grossly downplaying the reality, the horror, of what is about to happen.

Worse, they are gaslighting everyone by showing their pretty (but entirely wrong) Gaussian projections of 1.5 - 2.2 million deaths (that they never shared before) flattening out to 100k-240k with the implication that they did great things to reduce the death toll. But they cannot even keep their story straight. Dr. Birx stands in front of that chart. And separately another chart with a fat right tail from the actual (but still horribly wrong) models. Those wrongly show the case counts going to zero sometime in June or early July.

What is it? Two weeks? No. 30 days? No. Two months? No. Two and a half? Still No!  They cannot even keep their gaslighting story straight.

Fuck you Donald Trump. You did no such thing. Any reduction came from the States acting on their own independently of you and your stooges, with daily and even hourly opposition, stonewalling, deflection, and impedements from you personally and from your administration, fighting you every fucking step of the way. 

And yes, even now, at this very last moment they could save millions of lives if they would just face the truth honestly and act swiftly. They cannot do it. They cannot bring themselves to do it. All they know how to do is double down on PR and lies. Burn in hell bastards.

Be safe everyone. Keep your loved ones and friends safe, safe as you can. Duck. Duck now. The shit is beginning to hit the fan in a big bad way.

For any of you who are first responders or critical staff in any role - THANK YOU! in advance for the risks you are takling for all the rest of us.

Sam

15
Consequences / Re: COVID-19
« on: March 31, 2020, 06:52:53 PM »
Harpy,

I know this us useless and I am wasting my breath.

Please stop being a racist.

Sam

16
Consequences / Re: COVID-19
« on: March 31, 2020, 06:51:19 PM »
Covid-19 had similar symptoms to the illness that was caused by vaping.

Vitamin E acetate found to be the reason for vaping deaths

Link >> https://marketrealist.com/2019/12/vaping-deaths-caused-by-vitamin-e-acetate-cdc-says/#adnrb=900000

Not vaping per se is causing these problems, but the wrong use of Vitamin E acetate in vaping liquid.

Kari,

Blumenkraft got it exactly right. Your question is a good one. The symptoms are similar in some ways. This is because both vaping with Vitamin E acetate and the SARS-COV-2 virus cause damage to the same parts of the deep tissue of the lungs and to somewhat the sane degree. They do their damage in different ways.

We have alluded to how SARS-2 does damage, though we haven't directly talked about it. Mostly this is through the immune system itself causing the damage through interleukin 6 (IL-6) and a huge reaction with cytokines (a so-called cytokines storm). The drugs and herbs that work against SARS-2 work in a bunch of very different ways.

Some like azithromycin work by binding to the spike protein of the virus making it hard to mate to the ACE2 receptor. The ACE2 receptor is how it invades the cells.

Others like the inhaled steroid Alvesco work by locally suppressing the immune system (cytokines, interleukins, chemokines, etc...).

Others like many of the herbs and some of the drugs work by either binding to the ACE2 receptor, or by looking like the ACE2 receptor and acting as a sort of decoy for the virus.

Others yet work by interfering in various parts of the immune response (especially IL-6) to slow or stop that and in so doing to slow or stop the damage.

Etc...

For vaping, the problem was different. Vitamin E acetate has two parts. The first part, the vitamin E, is generally good for health. However, vitamin E isn't one substance. It is instead eight substances. These come in two forms tocopherols and tocotrienols. These are slightly different chemical forms that the body can use. Each of these can exist in four different orientations or configurations. Long story there, but it's not important. They are labeled alpha, beta, delta and gamma. One form of each are quite important for health. The tocotrienols are generally good and important for health. The tocopherols generally aren't, and can cause worsening health. The form that is best for each is not usually the form found in supplements.

Ok that was long, but the gist is this. Vitamin E isn't always beneficial. And the form used in vaping fluid very likely wasn't helpful, and may have been somewhat harmful. But that wasn't the key. Focusing on the vitamin E likely caused misdirection away from the real problem.

They key is the other part, the acetate. When the Vitamin E acetate enters the delicate cells deep in the lungs it separates into its two parts - Vitamin E, and acetic acid. That last part is vinegar. But this isn't vinegar like you are used too. This is concentrated. And there in lies the problem. Concentrated vinegar is a powerful corrosive destructive acid.

My personal opinion is this. And it is only my own personal opinion. This is not a medical diagnosis. I am not a doctor. Neither is it backed up by scientific research. It is born from my own personal experience having inhaled both glacial acetic acid vapors and concentrated ammonia. Do not ever do either of these. You -will be- seriously injured! That I escaped injury is equal parts luck and -extreme- experience.

What seems to have happened is that the vapers inhaled enough acetate to chemically burn the deep tissue of their lungs. That burn continues until the acid is neutralized or diluted. The obvious easy treatment that I haven't heard that anyone tried was to inhale very very low concentration ammonia. Ammonia, which is a caustic, causes lung damage as well. Intentionally inhaling that is a really bad idea. However, if you are being eaten alive by inhaled acid, you have to stop that.

Without stopping the acid or diluting it, the acid continues to chemically burn the tissues. The body responds to that by engorging the tissues with fluid (diluting it), and by recruiting every aspect to fight it as if it were a severe infection. This then acts a lot like what happens in SARS-2.

Sam

17
Consequences / Re: COVID-19
« on: March 30, 2020, 10:23:08 PM »
Is it too early to call daily peak globally (at least for this season)? I think so. There has to be at least a couple more days of a downward trend. But at least after weeks of fear, quarantines and horrible news, we are starting to see some good news, or more like a light at the end of the tunnel.

Not even close.

Sam

18
Consequences / Re: COVID-19
« on: March 28, 2020, 08:44:33 PM »
Crude, rude, blunt, and my sentiments precisely... you have been warned.
 
Stay the *$&#% at home!

https://m.youtube.com/watch?v=8BA9eTXwGIk&feature=youtu.be

Sam

19
Consequences / Re: COVID-19
« on: March 28, 2020, 12:11:31 PM »
Another thing I have yet to find is any information on is how asthma impacts on people's risks with COVID-19, or how that impacts the course of the disease.

I have several friends with asthma who are very concerned for good reason. Ditto for autoimmune diseases of various types.

If any of you have stumbled on these I would be most interested and grateful to hear what you found or heard.

Sam

20
Consequences / Re: COVID-19
« on: March 28, 2020, 11:49:35 AM »
Johnm33,

Yes - thank you for the graph. Everyone looking at it should be cautious to note the change in scales on the left for the various age groups. The differences are very large.


Sam

21
Consequences / Re: COVID-19
« on: March 28, 2020, 02:42:55 AM »
Quote
Tonight [White House coronavirus task force member] #DeborahBirx stated that models anticipating large-scale transmission of COVID-19 do not match reality on the ground.

This is simply Bullshit of the highest order. Dr. Birx has destroyed her own credibility. Hopefully her career will now shift to shit shoveler at her neighborhood sewage plant. She can rot in hell with the rest of them.

And as far as Hair Trump wanting the Governor’s to appreciate him. Kiss my ass you son of bitch. You sir desperately need to contract this virus and experience everything it has to offer to the bitter end.

The Guardian gets it right.

https://www.theguardian.com/commentisfree/2020/mar/27/trump-narcissism-american-blood-coronavirus

Sam

22
Consequences / Re: COVID-19
« on: March 27, 2020, 09:53:20 PM »
Worldometers reporting Italy posting 919 deaths today, eclipsing previous daily high of 793 six days ago.

After shutdown begins the infection chains are mostly broken except for home infection. Hopefully, this is the last wave before the quarantine yields the expected results. I pray they are using as many masks as possible and have a good plan to restart the economy while testing and quarantining like crazy.

Looking at the data — self isolation is NOT working.

Quarantine, real quarantine is required.

Sam

23
Consequences / Re: COVID-19
« on: March 27, 2020, 09:22:56 PM »
USA hits 100,000 cases
https://www.worldometers.info/coronavirus/


Woo hoo!  American exceptionalism! We’re #1, We’re #1, We’re #1!!

What do you mean that’s a bad thing?

We need some structural changes to encourage different behaviors - lots of them. One such: all unattended deaths not from homicide or attributable accident are assigned to the Hospital or medical clinic whose district it is. Period. Rate the maximum of what the administrators are allowed to be paid by that rating.

No throwing people out, curbing them, or dusting them off to other places or institutions. One instance of that as CEO or COO and you get fired and fined $500,000 personally. On a second instance, jail and barred from life from ever serving as a corporate officer AND the Board of Directors and all other corporate officers get fined $500,000 personally. Third instance, all corporate officers and members of the Board get jail sentences and are barred from ever serving as an officer or Board member in any organization of any type - for life.

Etc...

Sam

24
Consequences / Re: COVID-19
« on: March 27, 2020, 08:47:31 PM »
I heard from my friends.

Despite being at day 8 of showing symptoms, running a 102.5 F fever, being short of breath, coughing like crazy; they were told that they aren’t sick enough yet to go to the hospital!

Welcome to the once great now failed United States of America’s, where we have an illness profit system, that occasionally accidentally heals people.

Sam

25
Consequences / Re: COVID-19
« on: March 27, 2020, 07:08:28 PM »
Long time lurker, first post.

Good overview and summary of papers up to date, commenting on their strengths and weaknesses.

COVID-19: Describing a new disease (Meyerowitz & Richterman)
MGH Division of Infectious Diseases

Harvard Joint Infectious Diseases Conference
March 25, 2020



Twitter:
https://twitter.com/AaronRichterman/status/1242811276763582464

Slides: https://docs.google.com/presentation/d/1shQ8m7kX2qFyj6PByY_DxM37fcyxLjSBojmTpFJN4kU/edit#slide=id.p

Bonus to anyone who can find the HHS/Emory presentation they mention at the end.

Sigma_squared and Neven,

Thank you !!!

Huge amount of excellent information summarizing major findings from almost 2,400 preprints and papers.

My take aways:

1) Finally we may have some information to begin to assess admitted CFR versus population level FR. From one paper re: Wuhan, population level FR ~1.4%, admitted CFR known separately for this population is about 4.2%. This suggests roughly a 2/3rd to 1/3rd ratio of carrier transmission without admission (symptomatic or not) outside of admission to admission.

Separately I learned yesterday of a study in Iceland using IgG that suggested a 50%:50% ratio. But from this presentation, IgG is not a good indicator. IgM is better.

Addenda: You CANNOT use the simple deaths/confirmed ratio to get a meaningful CFR! We’ve gone over this. During the exponential phase of the disease this drastically underestimates the true CFR. Using that as the CFR is at best wishful thinking and an incredible and dangerous bias.

2) Chloroquine is not a good choice for treatment. It seems to be ineffective. Hydroxychloroquine (HCQ) appears to be slightly effective. HCQ combined with a azithromycin (tradename Zithromax) is effective. Azithromycin in addition to being an antibiotic has very positive impacts on lung function.

3) For critical patients requiring ventilator support (at least) ... tocilizumab (an IL-6 drug used for rheumatoid arthritis) in a very limited study appears to be highly effective at terminating fever and restoring the patients with ultimate release from hospital. This group tends to proceed to death. The 400 mg dose they cite if paid for out of pocket runs about $2,350 in the US. All things considered, that is a bargain.

4) There is still a great deal of uncertainty about assessing asymptomatic versus presymptomatic. So it is premature to overgeneralize the 1.4% FR. Hopefully that is correct. But we shouldn’t bet the bank on it yet.

If we apply that to the entire US population of 340 million, with 90% contracting the disease over the next many months, we are looking at 4.3 million dead. Add the hospitals going far into over-saturation which increases the CFR for that population to possibly as high as 12%, and the combined result is a terrifying 11.4 million dead - 1 person in 30. Note: this entirely excludes the compounding add-on effect of every other type of critical care patient being impacted by the ICU beds being full. A large percentage of those patients will now die as a result. Those deaths though not from COVID are directly caused by impacts from the failure to quarantine and limit this disease spread.

Addenda: Note please that the vast majority of these deaths will occur during a ~ one to two week period at the end of April and beginning of May. If there is no positive change toward massive quarantine, we are headed for an incredible blood bath in a fortnight. If instead President dumb-ass does as he suggests and directs the lifting of quarantine, AND the Governors go along with that, the number who die will double or worse.

If on the other hand, we instituted a truly effective mass quarantine for 6 weeks with comprehensive testing, contact tracing, and isolation - we might limit that to 25-50,000 dead. But that would have to be implemented today and be truly comprehensive.

Addenda: The above presumes that the current testing captures the current state of affairs. With the grossly inadequate and incredibly slow reporting of test results in the US, I have understated the low end risk. It is most likely that the lowest death count we could achieve with immediate mass quarantine is 10 times these numbers - a quarter to half a million dead.

With use of the two known treatments that are apparently affective, these numbers could be reduced farther saving a whole lot of lives.

Final take away: The complete and utter failure of Donald Trump, Mike Pence and their cadre of miscreants will in all likelihood cost 5 to 13 million Americans their very lives. These people have bucket loads of blood on their hands.

Addenda: IF YOU HAVE NOT ALREADY SELF-ISOLATED OR GONE INTO QUARANTINE, DO IT NOW! PLAN TO BE ISOLATED/QUARANTINED FOR NOT LESS THAN 10-12 MORE WEEKS! Do not plan to be out of isolation until Father’s Day. And that is if things go well. Good luck to us all. We are going to need it.

Sam

26
Consequences / Re: COVID-19
« on: March 27, 2020, 04:26:02 AM »
3 principal strategies to fatten the curve:

1. Propaganda. Without it Trump fanatics might lose sight of the carrot.  "it's just like the flu" and "but, but, but, the economy" does the trick. Soon you have people wanting to get it to please their emperor

2. Botched testing. testing leads to contact tracing which could have stopped the disease without much fuzz but it would have hurt the market for a bit.

3. The most important part of the plan to fatten the curve. No masks. Mask would have slowed the spread to a crawl, and even let the economy keep going.

The three things above would've saved a lot of lives but it might have lasted many months, perhaps all the way to election day. Nope, that was too slow. Fatten the curve.

Sure they are sending ventilators. Sure they'll make a hospital here or there. But keep spreading as fast as possible so that we are done by April, regardless of the body count.

What a disastrously stupid plan.

Oh I see ... fatten the curve. Trump’s always had a very short attention span (goldfish short), and he only ever hears what he wants to. That explains a lot.

He likes things to be fattened. He doesn’t like things that are flattened. So, of course he heard fatten. Wow. That really does make it so clear now. Thanks Archimid. You’ve cracked the code and solved the great mystery behind the administrations COVID policies.

Sam

27
Consequences / Re: COVID-19
« on: March 27, 2020, 02:57:01 AM »
Terry,

No down side. I am now having to advise friends who have tested positive and who are running 102.5F fevers to bloody well get to the hospital.

There are vastly more people symptomatic in the US than the confirmed numbers show. The US is in the deep end of the muck. Trump brought the swamp to DC with him, and his swamp creatures are killing us.

Sam

28
Consequences / Re: COVID-19
« on: March 26, 2020, 10:22:13 PM »
Weekly expert survey in the USA:

https://fivethirtyeight.com/features/experts-say-the-coronavirus-outlook-has-worsened-but-the-trajectory-is-still-unclear/

Quote
How many people will die in the U.S. due to COVID-19 this year?

The expert consensus is that COVID-19 will cause 246,000 deaths [in the USA] in 2020, higher than last week’s estimate of 200,000 deaths. The consensus estimate ranges, though, between 36,000 and 1.1 million. That’s quite a span

...

How many total COVID-19 infections were actually in the U.S. on March 23?

The expert consensus is that the real number of cases [in the USA] was somewhere between 83,000 and 1.8 million, with 362,000 being the most likely number.  In other words, they thought that only 9 percent of all cases had been reported

Steven,

—— for the US ——

With just two additional days of growth at the current growth rate of 1.31x/day, plus 12 days from infection to confirmed count status and a 5% death rate of those confirmed (who definitely are a part of the CFR analyzed group), and taking the yesterdays confirmed count today as 83k - the death toll is 180k.  I choose 5% not 4.5% as we are already seeing hospitals going into saturation. That is an under estimate already.

There is no way any additional controls are likely in the next two days that will mean anything. Instead Trump is trying to assert control to go the other way - to less restrictions. 12 of the 18 “experts” predict a death toll for the year of ~180k or less. So they are wrong and we can discard them from further consideration.

If we have just seven more days with current policies rather than two, so through next Thursday, then the committed death toll is at least 700k. That then exceeds the remaining six “experts” opinion. And we can discard them as well. There is zero chance that we will go into a total lockdown quarantine in the next week.

So then, just how much is this “expert” opinion worth?

Sam

Addenda. Even if the growth is actually slowed to 1.25x/day in the US, that just adds 5 days to reach 180k dead, and another 6 to get to 700k dead.

29
Consequences / Re: COVID-19
« on: March 26, 2020, 09:39:46 PM »
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/

Oren, those numbers would be correct if 70% of the population contracted the virus.  Using the same South Korea numbers, slightly less than 0.02% of the total population contracted the virus.  Total case are on the decrease in South Korea, with active cases 30% below the peak number two weeks ago.  All told, the peak number of cases occurred four weeks after the virus started spreading rapidly.  Using the South Korea infection rate would yield substantially fewer deaths.  By comparison, Italy is on pace to reach ten times the infection rate of South Korea (it currently stands at 0.12%).
Thanks for the response.
So what is your own estimate for the total infection rate expected in the US? 0.1% 1%? 10%?

Remember please that the percentages Oren cites are from reputable literature, BUT that study was based on a 2.3% CFR for the population. We know that the CFR for the hospitalized population is double that. So - double ALL of the numbers in the table.

I admit my guesstimates at the moment are very probably at the high end. Normally, I would not go there. But in this case, we have two dominant factors that make things vastly worse.

First, there is a significant portion of the science community including the epidemiologists who are under representing the hazard of the disease in terrible ways. They under-represent the CFR by a factor of 2. And the under represent the R0 by a factor of 3-5. That is a horrible combination of errors.

Second, we have leaders who take those estimates and then downplay them dramatically. They want to stay in their own mental box of beliefs. They are at best in denial. At worst they are in malignant malicious criminal denial. (e.g. let the old folks die, the economy is more important).

These combine with an understandable desire by many to believe that there is a large pool of uncounted people who have mild symptoms throughout and that because of them the fatality rate is not just less, but dramatically less than the CFR. A part of this no doubt came from early modeling estimates that suggested such things. A part is no doubt also from a natural desire for bad things to not happen. Desire is not reality. Looking away, wishing away, hoping away not only will not work, they will in point of fact make things much much much worse and very quickly so.

In emergency response, leaning toward those sorts of things is a grave danger. The reality may cover a range from there to the far other end. With exponential growth, the place to be is not at the low end, nor even at the mid point, but instead to target closer to the 95% UCL of the likely outcomes. Only by doing that can we assure that the horrible outcomes do not happen.

Doing otherwise runs grave risks of truly catastrophic outcomes.

What we have been seeing in Italy, and now Spain, and soon the US is exactly that - catastrophic outcomes.

So where is reality? We do not and cannot know that yet. The data isn't good enough. It seems to lie well above the midpoint of potential scenarios.

Another factor that many seem to forget is that in the earlier stages of the disease spread (the first 1/3rd to 1/2 - which we are still in), with exponential growth, there is a huge non-seen part of the infected population who have become infected, but who have not yet shown symptoms, let alone reported to hospital. It may well be that it is this majority of the infected population that the models suggested, not a separate infected and unseen part of the population. I.e. The problem is temporal not structural.

For the US, I suspect that the most likely death toll will be about 5 million. I cannot see it being less than 1 million. The high end is likely 25 million.

The high end comes about from presuming that there is not some large unseen portion of the population that never shows anything other than mild symptoms and is never tested; plus presuming the 4.5% CFR is accurate and representative for the hospitalized portion (who then represent everyone); and that half of those requiring intensive care die as a result of the collapse of the hospital systems when they become over run. That last part adds about 7.5% to the CFR of 4.5%, hence a 12% death rate. Italy is already seeing close to that. And they aren't through the worst of it yet.

The US continues to scream upward in the numbers infected with an average growth rate of at least 1.31x/day. That is an R0 of about 7.5 - vastly higher than the 2.4 used in most models.

That growth rate is easily understandable from human behavior. I now have friends who have tested positive and are in quasi-quarantine. One pair of them showed symptoms six days ago and tested positive yesterday. Yet it isn't until today that they have reduced going to market, stores, seeing clients, patients etc... For the last six days they have been spreading the virus. Even now, they are not in strict quarantine. They are not at all alone in behaving this way. These are intelligent people. And still...

During disasters with the potential for run away it is essential to err toward the high the end - far toward the high end. This isn't a matter of being accurate in prediction. This is a matter of saving lives. Doing anything less has a huge probability of costing lives and causing disaster. And with that comes immense economic impacts and hardships, impacts and hardships that go far beyond the short term analysis.

History is replete with examples: Bhopal, Seveso Italy, Michigan Bromine, Chernobyl, Fukushima, to name but a few. Each of these shared a common failure to understand this key tenet of emergency response, with absolutley catastrophic consequences. An infectious disease is a worst case example of this. It doesn't just run away of itself, it is infectious and contagious and exploits us to make things incredibly vastly worse and harder to control. Add to that all of the myriad of usual human weaknesses, failings, belief systems, desires, and it is a wonder these sorts of pandemics don't come around more often.

Sam

30
Consequences / Re: COVID-19
« on: March 26, 2020, 08:51:20 PM »
Social distancing and quarantine should be reducing the number of "Influenza like illnesses", car accidents and work-related deaths. 

It is sad that the world has a leadership vacuum. This is the perfect moment to irradicate influenza. If we can get away from this whole mess with influenza eliminated, whatever economic losses were incurred will be made up for a long time gains of eliminating influenza.

Unfortunately - no.  Colds from the corona virus family - Yes.

Flu is a multi-species disease. It exists in birds and pigs especially, and cycles between them and us. We learned back in the 1970s that the seasonal start of flu originates from birds defecting as they fly south down the flyways. Then it spreads among people. The birds re-aquire it, circulate it and fly north again sharing with others in the massive breeding grounds, to then fly south the following year to other parts of the world.

Large pig farms play a roll too. The pigs harbor the virus and it mutates in them along with us and the birds. With multiple strains running at all times, the strain recombine and new versions and variations develop from that and from the usual slow mutation of the viruses.

We will not be able to eradicate flu until we can find a way to eradicate it in birds. Then there is a chance. Until then - no.

Sam

31
Consequences / Re: COVID-19
« on: March 26, 2020, 08:06:42 AM »

...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

32
Consequences / Re: COVID-19
« on: March 26, 2020, 03:18:21 AM »
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

33
Consequences / Re: COVID-19
« on: March 26, 2020, 02:25:56 AM »
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 is likely pessimism speaking. What I see in the data is that even with stay home orders in place the case rate seems to be growing at 1.2x/day. That’s 3.6x/week or 10x every 12.6 days. That accounts for less than half the country.

The other half is growing at 1.3x/day; 6.3x/week; 10x every 8.8 days.

Since the Federal Government is wanting to not have limits and to get back to work; and half the States are of similar mind, we have a mixed case.

They seem unlikely to change their minds until the numbers become painfully unacceptable and then some. That might be a million cases. At current rates that is 10 days from now.

But remember that the case count is about 11 days behind the time of infection. As a result the cases will continue to growth at that rate for about 11 days before any effect is seen from the change in policies. For the parts at 1.2x/day that means an increase of 7.5 fold.  For the parts of the country at 1.3x/day that means an 18 fold increase. 

That then jumps the counts to about 12-13 million. Thereafter things slow a bit. But at least two more weeks growth at 1.12x/day everywhere seems likely.  And that is another five fold taking us to 60-65 million. Then things slow again and we get perhaps another doubling. So 120-130 million. With the hospitals saturated, death rates go to ~12%. 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.

Anywhere along the line changes in policy could substantially cut those numbers. What we have seen is that at almost every instance they have done the opposite. Hoping they do something different at this point seems a futile hope. On the other hand pushing for people to go back to work and to get together to celebrate Easter seems almost designed to maximize illness and death.

I am just not at all optimistic that the nation will do anything other than to take the worst possible path.

Sam

Addenda:  and that is just for this first wave. If we don’t do a hard lock down with massive testing and contact tracing to extinguish the virus, successive waves will take us to ~90% of the population infected = 300 million. Even at 8% death rates with only partial saturation of the hospitals (first wave), that puts us at ~24 million dead before years end.

Also, where the five weeks comes from is that if we stop sheltering a la the Presidents desire, and then go to 1.3x/day or greater, we easily reach the whole population in five weeks.

34
Consequences / Re: COVID-19
« on: March 25, 2020, 11:43:07 PM »
Sam
We've been lucky in the past & may get lucky this time around.
All we can and should do as individuals is stay at home.


We're not being asked to defend Stalingrad, just to sit quietly at home.


Group meetings of 3 or more have been banned at McMasters University. A wise edict that precludes group activities of any kind.


Stay out of the Streets! Stay in Isolation. Stay in Touch.
Terry

Terry,

Thank you. I have been in total isolation for two weeks. I am planning a minimum of 12 more and can easily stay isolated for 40 weeks. My many friends are not so fortunate. Many are still having to work. Many are now out of work and do not know how they will survive financially. Safety for me is not my concern. My decades of experience will protect me. My worry is for the safety, health, and welfare of others, not just in my community and nation, but in the world. Alas, the world does not want to be helped. Neither apparently does my nation.

Sam

35
Consequences / Re: COVID-19
« on: March 25, 2020, 11:13:29 PM »
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

36
Consequences / Re: COVID-19
« on: March 25, 2020, 10:01:59 AM »
The rate of growth in confirmed infections has begun to slow in the United States. This slowing is a reflection of actions about 11-13 days ago. That is before the State wide stay home orders. It is about right in timing to see impacts from the first “level the curve” pronouncements.

Where the growth had been 1.323x/day. For the last four days it averages about 1.30x/day. This should continue to come down as the stay home orders begin to be apparent in about a week. Until then I suspect that the rate will drift down to about 1.25x/day.

The individual rates in different States are astoundingly different. New York has been running about 1.45x.day. New Orleans infection case count growth rate was running at eye popping early Wuhan rates of 1.67x/day. New York is now trying to cut their rate. But the next week will be brutal as the increase is likely to be 5 to 6 times today’s case total. So about 140k cases at the end of next Tuesday.

Louisiana is hard to project. It looks likely to explode at a rate of 1.65x/day in NOLA, and 1.35x/day in the rest of the State. If that comes to pass, by the end of next Tuesday they may have 25k-30k cases in the State.

The nation as a whole is slowing down the rate of increase. But it is very uneven. Some areas will see horrible increases not just in numbers, but in the rate of growth of the numbers. Others who started earlier will also have large numbers, but slower rates of growth.

Trying to smear all of those into one growth parameter is unworkable. They each now need to be assessed individually.

Collectively though, the condition in areas of the United States will begin to become catastrophic by a week from now. Large areas will be in saturation and catastrophic two weeks from now.

By then no one will seriously consider ending the stay home orders. Before then more comprehensive quarantines will be ordered. And those will cover most of the States. Those States that fail to do that will see Kansas Flu levels of destruction. The rest will only be God-awful-horrible. No State will escape the ravages. All of them waited too long to act.

No matter what the idiot in the White House may want, the answer - comprehensive quarantine for six weeks (likely more), and four weeks of slightly looser quarantine with aggressive testing and contact tracing beginning in a week or two, will be obvious to anyone with a functioning brain.

With a dearth of testing, the actual situation in the US is unknowable. What is knowable is that it is vastly worse than what the confirmed numbers say.

Everything is about to get very ugly both in the US and in Europe.

Sam

37
Consequences / Re: COVID-19
« on: March 24, 2020, 05:23:10 PM »
gerontocrat,

The data you posted is astonishing and terrifying. Italy now has a higher death rate from SARS2 than SARS1 caused, possibly very much higher. Spain is close behind. And America close behind them.

That is a cautionary tale for every nation, most especially to the United States.

The President and members of his party are so focused on money that they have entirely lost site of reality and reason.  Dr. Fauci is missing in action for two days now, a clear sign that dear leader is displeased with him. So far Dr. Fauci has not taken the principled step of stepping out on his own and saying the truth plainly to the nation and the world, that the United States is being run by a mad man. A mad man who appears ready through his arrogance and ignorance to commit gentescide - national suicide; however that is spelled in Latin (gentescide, gentecide, natiocide ??).

Days of inaction matter. At this point hours of inaction matter. Dr. Fauci - where are you? Dr. Fauci: your duty to the people of the nation far exceeds your duty to one man.

Come to think of it, as a medical doctor working closely with dear leader, can he order that he be placed on a 72 hour psychiatric hold for being an imminent danger to himself and others, and then be evaluated by a team of psychologists to determine whether his malignant narcissism and sociopathy warrant his permanent referral to a psychiatric establishment for treatment and care?

Sam

38
Consequences / Re: COVID-19
« on: March 24, 2020, 05:59:57 AM »
WTF?

Quote
Remuzzi says he is now hearing information about it from general practitioners. "They remember having seen very strange pneumonia, very severe, particularly in old people in December and even November," he says. "This means that the virus was circulating, at least in [the northern region of] Lombardy and before we were aware of this outbreak occurring in China."

Link >> https://www.npr.org/2020/03/19/817974987/every-single-individual-must-stay-home-italy-s-coronavirus-deaths-pass-china-s

That's interesting. I was in Bergamo twice in November and December. I had reduced resistance because of little sleep and lots of driving. It caused me to be quite ill for three days in December, but mostly fever and aches. Was that COVID-19 or just a cold?

I wish I could do a rapid test that measures antibodies, but they're hard to find online and just for professionals.

Do you remember if you lost your sense of smelling before the onset of fever?
Then it was likely the covid, as that seems to be a leading indicator.

We are most certain we had it in our family in Sweden around Christmas/New year. All symptoms fit perfectly, at least one of us complained of not feeling smells before falling ill. For myself, i had fever for a few days, and then this awful dry coughing that just wouldn't go away for weeks.

This could also be one of at least three variants of adenovirus, especially 3, 4 and 14. These cause a truly horrible dry cough. I cracked ribs coughing from one of them, then ripped my lung away from my chest wall two years later with a second one. Common child hood bug. Nasty ass bug when you are older. Immunity fades over time.

Sam

39
Consequences / Re: COVID-19
« on: March 24, 2020, 05:27:58 AM »
What Are The Best Materials for Making DIY Masks?

https://smartairfilters.com/en/blog/best-materials-make-diy-face-mask-virus/

Quote
Data shows that DIY and homemade masks are effective at capturing viruses. But if forced to make our own mask, what material is best suited to make a mask?



Layer two or more of these together. The differing tightness of the materials and the differing nature of them makes the combination far more effective than the simple sum would suggest. This is due to each having a most penetrating particle size. When those are different, each layer removes much of what the other(s) doesn’t. Also, different materials have both differing surface charges and differing chemical affinities. Each of these increases the effectiveness of the layered mask over what the efficiencies of the separate layers would be by a simple sum.

The more different they are (within reason), the better. Adding a layer of cotton battling or yarn creates more tortuousity which also helps, though it does make the mask more bulky.

Sam

40
Consequences / Re: COVID-19
« on: March 24, 2020, 03:14:59 AM »
Doesn't a virus need water? How can a droplet stay humid for 17 days?

They are more stable in moisture. The longer the virus is “dry” the greater the chance that it chemically degrades and ceases to be effective.

How long they last varies based on a lot of factors. On cardboard the virus is typically degraded in about 48 hours. On plastic it tends to last another day. 

Sam

41
Consequences / Re: COVID-19
« on: March 24, 2020, 03:12:40 AM »
Sam
Your prognostications are particularly alarming, yet they also seem particularly probable. :P

.............

Neven
I hope like all hell that you were one of the very early cases & that you've developed an immunity that will last your (natural) lifetime.
Acting as if this is true could sign your, and your families death warrant.

Stay Isolated, Stay Calm, Stay in Touch.

You might have won the lottery, and you may never find out that you have won, if it happens to be true.
Terry

Mine aren’t meant to be alarming at all. They are projections not predictions based on the current trends. Those change possibly dramatically based on choices made by various leaders.

The point of them is not alarm. Though if they aren’t alarming, then you aren’t reading them right.

The point is to highlight where we are, where we are headed, and what is possible from here given a range of choices.

For a lot of people unfortunately that future look is not something they are used to or know how to deal with. Instead they view it as either now, or as desire. There is no desire here at all. If there were it would be to slam on the brakes as hard and as fast as possible!

These are simply tools. They portend great ugly terrible things. We should I would hope want to avoid those terrible paths. However, the decisions required to do that often conflict with certain beliefs and desires, or with human nature and human limitations.  In those cases, the answers though they might result in vastly better outcomes may simply not be available or achievable.

Often too we encounter the limitation that people want or need to see these numbers become facts before they are willing to act. They want to believe that somehow these will not come to pass thereby spaing them from having to make difficult decisions.

But rather than help, due to the inherent delays and lag times involved, that delay assures disaster. Sigh.

Sam

42
Consequences / Re: COVID-19
« on: March 24, 2020, 12:45:34 AM »
Freegrass,

Well, it appears that you are about to be proven right in a big way. Donald John Trump is apparently on the verge of deciding that short-term economics trumps human life and to then on the national level end restrictions. That idiocy has no effect on State decisions.

Should he do this, he will de facto be deciding to kill huge numbers of folks from so-called “Red States” that will doubtless follow his lead. If they do, over the next three to four weeks the case count will explode in those States growing at 1.55-1.65x/day or there abouts. They will be able to see the folly of that decision about 9-13 days later. By that time the infection count will explode by several hundred fold. The hospitals will collapse under the burden between the second and third weeks. If they fail to instantly reverse course with a comprehensive quarantine, there will be no second chance. The death toll will be astounding - exceeding the deaths from the Kansas Flu a century ago.

This will adversely affect the States under quarantine themselves, unless they attempt to go into hard lockdown against the entry of people from other States. That will no doubt be over ruled by Judges, so folks fleeing the disaster to States under quarantine will bring the disease with them. The impact might be tempered by the quarantines. But the infection will be everywhere.

Should he do this, he may very likely be signing the death certificate for the nation. The economic injury alone will take a lifetime to recover from.

The count of US cases for today is incomplete and stands at 43,776. My projection from several days ago was for 44,302 today. Tomorrow:58,307.  The actual growth rate appears to be just slightly less than the one I used for projection. So tomorrow seems likely to record 57-58k. The day after is likely ~75k

Deaths so far today are 546. That is also just shy of my projection of 1/73rd of the count: 599.

I hope the President is not so stupid as to follow through on his suggestion. If he is, I sincerely hope his cabinet is willing to invoke the 25th amendment to remove him from office for mental defect.

Sam

43
Consequences / Re: COVID-19
« on: March 23, 2020, 10:42:10 PM »
I don't think that the “flattening the curve” approach is doomed to failure. I think it's perfectly reasonable to presume that once the hospitals get some breathing room, that at that time the government will loosen its grip. School will start again, and young people with children will resume their life. Yes, some will get sick, but the hospitals will be able to handle it then like a normal flu season.

The only problem that remains is what to do with the most vulnerable. I guess that after the young are stable, that the elderly will be allowed to go outside at their own risk. If you want to live, stay in quarantine. If you really want to live, go outside and throw the dice...

I think that's what "flattening the curve" means, no?

Quote
The Chinese showed the best answer. But can we in the west listen and learn from that. It appears that the short answer to that is - no.

And so, in the great economic battle - the Chinese win.
Let's see... When they open up to the world again, the virus will come back to them as well. So a gradual herd immunity, or a vaccine is what's needed... No other way forward I think...

No. Immediately after the first round of flattening the curve, if economic activity resumes and people resume their lives, the infection chains come roaring back. Within two weeks the quarantine must then be reimposed. Rinse and repeat until 90% of the population has been infected and either recovered or died. The modeled estimate of that says 12-18 months.  So - perhaps four to six weeks of quarantine with no activity followed by two weeks of activity for a year and a half. That amounts to a 65-75% curtailment of economic activity for a year and a half!  No nation or society survives that.

And also - no. The Chinese have imposed 14 day minimum quarantines for everyone entering China. They are not allowing it back in. They also are maintaining district level isolation. If the virus jumps the fence so to speak, it will be limited to a pocket where it can be dealt with. The harder problem is in handling container traffic, specifically the people. That means no shore leave at all. It also means isolation zones and quarantine boundaries there. The Chinese have thought this through

One woman decided she was better than everyone else. She took fever reducing drugs and flew to China for treatment. She got that, plus quarantine, plus a seven year prison sentence. The Chinese are serious.

Sam

44
Consequences / Re: COVID-19
« on: March 23, 2020, 09:05:57 PM »
I just heard that The Netherlands has extended their lockdown there to at least June 1. How are the Dutch folks on here taking that news?

Well, I'm Dutch, though living in Austria. I think it's insane to extend this lockdown or any lockdown by two months. This is something that should be evaluated every week or so. So much can change in just one week! For instance, the numbers are slightly improving (and not just in the Netherlands). If this keeps up for a few more days, do they really think people are just going to accept a 2-month extension?

The situation is serious, but there's a lot of inflated panic, and lots of symbolic policies being exaggerated. Things better get more serious in more places where the air is clean and the population is generally more healthy, or there will be hell to pay.

Ending quarantine before the infection is eradicated in an area ensures that it resurges. This is why the “flattening the curve” approach is doomed to failure. It never attempts to eradicate the infection. It only attempts to keep hospitals from going into saturation. That then means resurgence of the virus as it more slowly burns through the population. That then requires the reimposition of tighter quarantine - time after time - until a sufficient portion of the population has been infected and either recovered and become at least temporarily immune, or died.

Once herd immunity levels are reached, the virus is unable to maintain itself and it peters out - unless it mutates sufficiently to once again burn through the population.For this virus, herd immunity requires more than 90% of the population to become infected.

This approach maximizes the total time of quarantine which in turn maximizes economic destruction, as well as assuring the maximum part of the population suffers the maximum harm shy of hospitals going into saturation.

But this tailored approach requires accurately modeling the virus to avoid the hospitals going into saturation. So far, the models used by governments have used a 6 day doubling time. The actual doubling time is 2.3 to 4 day’s depending on conditions. With the long lead time of about a week from infection to symptoms, failing to get this right assures that the hospitals go into saturation. That in turn increases the death rate, and leads to greater infection rates among doctors and nurses, reducing the available staff and hospital capacity, further increasing the death rate.

Focusing on the near term economic impacts and missing the fundamental nature of the problem assures exactly the reverse outcome of that intended. It maximizes harms.

You are right that the public will not like it. They need to be shown precisely what the hazards are. That is where leaders can best help people. If they fail in that, which they currently are in the vast majority of countries, they increase the likely consequences and the probability that the worst case is realized.

In a way this is akin to the monkey trap. Put fruit into jugs that monkeys like such that if they grab it, their hand and fruit cannot be pulled through the hole in the jug. The monkeys love the fruit so much that they will not let it go, even when extreme danger - hunters - approach. They are captured or killed precisely because they cannot think the problem through to the end. They have to let go of the fruit and flee. But their desires won’t let them do that.

Similarly here, humans want and believe certain things. They have enormous difficulty in seeing that the route to maximizing what they want and minimizing the damage lies in precisely the opposite direction.

For this, we have to entirely shutdown the economic engine for a time to squash the infection chain. Any weakness in that control extends how long the controls must remain in place to work. Any significant failing in that makes the solution fail.

In that case, if the population and government are unwilling or unable to do what they must, the least harm comes from maximizing the infection rate. This maximizes deaths, but then allows the economy to recover. That is a disastrous and tragic path. It is in point if fact willful murder.

The Chinese showed the best answer. But can we in the west listen and learn from that. It appears that the short answer to that is - no.

And so, in the great economic battle - the Chinese win.

Sam

45
Consequences / Re: COVID-19
« on: March 23, 2020, 06:48:12 PM »
This is a most sad and difficult time.

It could have been less sad and less difficult - a lot less. Unfortunately, all of the things required to do that require foresight and planning. We humans are not very good at that. More than this it required learning from the past. We are generally really bad at that. And most of all it required understanding and believing in acting on warnings, using the precautionary principle and variations on that, and on understanding math, particularly exponential math. And the vast majority of humans are absolutely terrible at that.

Add to this, it required actually understanding what is truly most important in how things work, as well as what is truly important personally, socially and spirititually. We are generally bad at all of those as well.

I don't say these things to make anyone feel badly. They are simple truths.

Virus growth in a population works under a few simple rules. They are extremely simple in their behavior. They don't think. They don't plan. They simply act in accord with their genetics. Those genetics constantly drift and change as mutations occur. But mostly they stay fairly constant for periods of months. As a result, they can be predicted. The consequences in the human body can be predicted. There are variations dependent on age, gender, health, genetics and luck. But the generalities can be predicted.

Yes, for this virus, some young people's bodies will be decimated. Some will die. The proportions are small for the young. They are immense for the old. They are no less terrible. For those that are severely impacted of any age, but who modern medicine can help, that help relies on the availability of space in care facilities, high tech equipment and very highly skilled staff. If any of those are missing, what was a manageable though terrible life threatening emergency stays just that - life threatening. If any of those things are missing, the proportion at all ages who die increases - dramatically.

The viral growth and spread in a population is dependent in population density, behavior, wisdom or actually the lack of that, hygiene controls - again more the lack than the controls, and a few other factors. Mostly it is simple science. Again something most humans are bad at.

The rules of how the virus multiplies and spreads are simple. It commandeers cells to make more of itself. It forces various body responses that encourage coughing and other actions that expell massive quantities of virus. And by its nature it hangs around in tiny droplets in the air for many hours wafting here and there with the air to be breathed in by others not wearing protective masks, or wearing them but not assuring their adequacy or proper fit. Once in, the cycle begins again.

The math of how the virus spreads is easy. It is a damped exponential function in a limited probability pool. At first, in the most connected and mobile parts of the densist unprotected populations the number infected multiplies rapidly following a simple exponential function. As the most connected and most mobile aspects are infected, the virus seems to move to less connected less mobile parts. In truth it was always moving in all parts. It just seems like it changes because of the interaction rates among people. And then the replication slows - a bit.  Later this seems to change again as even less connected and less mobile parts of society are involved, as as the pool of people becomes more saturated with those infected. Probability begins to enter into the equation.

As a practical matter what this looks like is a super rapid spread at first with (for this version of this virus) a 55-65% per day growth rate. As it moves into a broader part it slows slightly to ~33-37% per day growth. As it spreads farther, other parts of less connected less mobile society become involved and the spread slows to ~15-25% per day. 

Then when finally severe controls are put in place, the growth ceases to be growth. The viral chains of infection are interrupted and peter out. Occasional pockets remain to be squashed, but the virus for the most part is gone having run as far as it could. This happened in China. Massive onerous controls stopped it, and stopped it fairly early in its run. South Korea has done almost as well using massive testing, less onerous controls, contact tracing ...  but they have not as yet gotten the virus fully stopped as China has. China chose more wisely. Taiwan in their anti-China zeal imposed controls even sooner and did even better.

Alternately, without adequate suppression through onerous quarantines, the infection spread continues. With no controls it runs its own course. That course spreads so rapidly that all hospitals and care facilities are rapidly overrun. At that point, about half of all those who could have been saved with intensive care die instead in a miserable choking death of from organ failure. It isn't pleasant in the least. It is in point of fact a terrible way to die. Most medical staff themselves are infected in this case as their supplies run out. And those who needed care but didn't get it, but that who do recover go through hell to live and then suffer life long injury as a result.

If instead moderate controls are put in place, a semi-quarantine, the hospitals are still over run, many if not most doctors and nurses again succumb, though over a longer time frame. A lower proportion of people die, but not by much.

With even stricter controls and successful efforts made to "flatten the curve", the hospitals never saturate. Many doctors and nurses succumb as they again exhaust supplies. But the number of deaths are limited.

In all of the cases where anything less than onerous massive quarantine is used, the maximum proportion of the population that can be infected is ultimately infected. The baseline deaths remain the same - upwards of 4-5%. Deaths are added when the hospitals are over run, as much as 3-9% more.

But each of these requires severely suppressing activity at the least with terrible economic consequences. Flattening the curve results in the fewest deaths among the less than full quarantine options. But it also maximizes the economic disruption for 12-18 months or longer. And in doing that it drives society back more than a century. The government likely fails. What replaces it is unpredictable. In prior pandemics invasions were one result as a weakened nation could no longer defend itself. Even without that famines and other depredations cause the death rate to rise as the society collapses, a delayed impact of the virus never accounted for by the planners and never counted in the death tolls.

The only option that prevents these harms is full and massive quarantine. And that is most effective the earlier it is applied. In later stages, it doesn't limit deaths, that becomes a done deal. But then it does squash the ongoing infection propagation ending the spread.

However, intentionally shutting down an economy runs precisely counter to the religion of profit and growth that is western society. Making that decision runs afoul of the basic tenants of the religion of money. And so, it is opposed. This is where we are now.

At the highest levels of government they are deciding the economic value of life, putting money above life. What they cannot see is that money is not a fundamentally valuable thing. People are. It is the people's labor that create the wealth they value and that society itself depends on. Money and wealth are not Fundamental. But that idea is heresay in the religion of money.

As a result, led by worship of a false God, the leaders make decisions that maximize the damage and harms to everyone, and maximize the deaths in the process.

Sam

Addenda. Oddly too, the inability to understand the basic math involves lead to many absurd things. One of those is evident today. The head of the WHO was quoted today as saying the pandemic is "accelerating". This appears to be the case when you think linearly. The counts of those infected and those killed are increasing exponentially. Yet in truth, the pandemic is slowly decelerating. The rate of growth caused by the exponential is slowing. In math terms he is factually wrong and has it backwards. Still, in human terms it is a true statement.

One of the difficulties with exponential problems is that they look very much like nothing is happening for a very long time. Then seemingly suddenly and out of no where they seem to explode. They were exploding all along. The time to have gotten excited was long ago. Now comes the time for reflection and repentance at our collective failings and the harms those caused.

46
Consequences / Re: COVID-19
« on: March 23, 2020, 02:17:43 AM »
I bumped into this site that measures provides estimated dates for hospitals being overwhelmed by CV.

I did a check, it seems to be good so.....

https://covidactnow.org/

Thank you!  That is a great site.

Also, so far my projection from several days ago is right on track. Tomorrow - US - 44k+ confirmed.

Sam

47
Consequences / Re: COVID-19
« on: March 21, 2020, 06:22:50 PM »
LA County Shifts From Containing Coronavirus, Advises Doctors to Skip Testing of Some Patients: Report
https://www.latimes.com/california/story/2020-03-20/coronavirus-county-doctors-containment-testing?_amp=true

A surge in coronavirus cases has Los Angeles County health officials telling doctors to give up on testing patients in the hope of containing the outbreak and instructing them to test patients only if a positive result could change how they would be treated, according to a new report.

...
In the USA the window of opportunity for when large-scale testing would have been beneficial in containing the outbreak has long since closed. Large scale testing makes sense if the strategy is containment; it's less helpful and probably wasteful if the strategy is based on mitigation.

There's an old maxim in medicine that states one should not perform a test unless the results of that test are going to change management. Now that containment has failed, the way in which testing affects management has changed and whence the indications for testing are changing. It should come as no surprise that these revised guidelines are quite similar to the guidelines for when testing for influenza should be performed during times of high influenza activity.

edmountain,

You are of course right. It has lost meaning in terms of stopping the pandemic from exploding. That is a done deal. Now it is being used by offcialdom in ways that suppress reporting the severity of the pandemic. That is vastly worse.

Where testing might still have played a role is in helping to separate those infected from those not infected as part of a massive lockdown quarantine. But, that would require an effective and heavily enforced quarantine to have meaning. The US isn't going to do that. So, again I am forced to agree. It has become meaningless. Go by symptoms instead.

And the test kits don't exist anyway. The virus moves on, and so must we.

The numbers are now so large that they swamp any confusion with flu, colds and other cases. Simply start counting and reporting all respiratory infections that match the symptoms of this virus.

Sam

48
Consequences / Re: COVID-19
« on: March 21, 2020, 11:49:24 AM »
Archimid,

Note the design differences. Surgical masks are intended to greatly reduce contamination from the wearer to the patient.

N95, R95, P95 and their N,R,& P 99 and 100 cousins are designed to protect the wearer from particulate in the outside world. They usually have an exhaust check valve designed to allow easy expulsion of air from the wearer and to minimize CO2 buildup. They do not protect others from the wearer. The videos show that.

The same is generally true as well for half and full face respirators. They too are designed with a check valve allowing easier breathing.

The video of the Italian hospital shows the other case - of a hooded containment to keep the patient from contaminating the room.

For something like this infection ideally you want the mask to filter both ways. However, those are harder to breathe in, more uncomfortable generally, and result in higher breathed CO2 levels, which has its own problems and hazards for the wearers health.

Sam

49
Consequences / Re: COVID-19
« on: March 21, 2020, 11:23:42 AM »
There have been a lot of comments about various countries not having as many deaths as expected, Germany and Sweden among them..

But please notice and compare how many cases each country is reporting. Then, how many deaths they are reporting, AND how many recoveries they are reporting.

Many of the countries with the unusually low death reports also have unusually low recovery rates. In essence - it appears that they simply aren't reporting. As a result, the statistics are meaningless.

Globally the death rate is now exceeding what was observed in China.

The growth rate globally is averaging about 1.20x/day. That looks a touch more promising than what is happening in the US and some other countries. But that too may be an artifact of low testing rates and low reporting rates. And even that is a terrifying 3.8 day doubling time and an R0 of 4.

The comments by the head of the Chinese Red Cross are very concerning. Italy despite their quarantine is failing in its quarantine efforts. The quarantine needs to be vastly tighter. This also applies to the US and elsewhere in Europe. The quarantines need to be massive and strongly enforced. Civil society as we know it has to stop, with only essential work continuing. And that work must be under strict quarantine control and decontamination rules and practices.

Otherwise - the next three weeks will grow rapidly more dystopian. The US is rapidly exhausting its entire stock of PPE and masks. When those are gone there are no more. Then we return to infection control from a century or two ago. Then it gets truly ugly.

All the while we have a nearly complete abrogation of leadership, other than by a small number of Governors and professionals. I personally expected failures. I have seen them my entire professional career. But I never expected such a comprehensive and all encompassing set of simultaneous failures of leadership, or failures on such a colossal scale.

Sam

Addenda: here is a link to the Newsweek article on the comments by the head of the Chinese Red Cross. There are many other variations of this story on other services.

https://www.newsweek.com/vp-chinese-red-cross-says-coronavirus-striken-italy-not-doing-nearly-enough-slow-spread-we-must-1493476

50
Consequences / Re: COVID-19
« on: March 21, 2020, 07:14:26 AM »
Not exponential ?

https://www.zdnet.com/article/graph-theory-suggests-covid-19-might-be-a-small-world-after-all/
https://www.medrxiv.org/content/10.1101/2020.02.16.20023820v2

sidd

Well, sort of. Humans behave in a networked fashion. That can show this sort of behavior. People also are not uniform and homogeneous in behavior. The simplest example of this is the distinction between extroverts and introverts.

Some people have lots and lots of contacts with others. Other people have less. Others yet have vastly less. And some are effectively shut ins.

Urban versus suburban versus rural versus isolated is another aspect of this.

When an infection starts to spread, it spreads most easily in the groups with the highest contact rates. In dense urban areas. As it spreads into lower density areas and to people with fewer and least frequent contacts with others it is natural that the R0 falls.

You can see this in the Chinese data especially. At first the virus grew with an effective growth rate of about 1,65x/day. That then transitioned to a long period at ~1.35x.day. When the total count exceeded about 4,000-5,000 it again slowed. By 10,000 it was about 1.20x/day.

However, about that time the Chinese had recognized how dangerous this virus was and they imposed draconian quarantines. So, what actually changed the rate? Virus interaction with human behavior, or human behavior instituting controls?  I.e, is this natural or imposed?

With the Chinese data - it was both, but the imposed quarantines were hugely important and dominated the data.

This difference is crucial in considering application of the Chinese experience to anywhere else. It can easily lead to a false belief that the virus spread will limit itself. It won’t.

The spread of HIV most clearly showed some of these aspects. The difference in sexual contact rates between gays in big cities, the young adult population, the older population, and others shows a dramatic shift in contact rates across an astounding four orders of magnitude. The explosion of that pandemic can’t be understood or modeled without understanding the human behavior and the various segments of society involved. Add to that drug users, economics and things get really complex. Also add the dual vector nature of the disease in converting HIV to AIDS and things get even more complex.

For this virus the behavior is much easier to understand. Until the virus involves more than a few to ten percent of the population, the exponential laws work - well, right up to the point where people begin responding to the pandemic.

The Chinese responded early and aggressively. The US and Western Europe didn’t. They mostly just ignored it until it was far too late to make a difference.

With a ~1.35x/day growth rate and a 10 day lag from infection to count, the warning properties for leaders and the public are atrocious. That lag is the difference of a factor of 20 or so in the count. And since human actions tend to be tentative and slow as the leaders are reluctant to act, those actions easily take another week or two - another factor of 10 to 20 to have significance.

So by the time the numbers trigger concern a 200 to 400 fold growth is all but baked in. Note, that isn’t 200% to 400% that is 200 to 400 times!

Just now that takes us from about 8,000 a few days ago to several hundred thousand less than two weeks later - about 10 days from now. The longer the delay, the higher the count.

Here we have the perfect storm with Trump in charge. He is the slowest to act, the least intellectually capable of understanding, the most emotionally incapable and unstable, and the most resistant. He acts only when he has been forced and then with a several day delay. He reacts to anything he doesn’t like or want as an insult. And like a petulant five year old he then refuses to do what is needed until someone can sufficiently massage his extremely fragile ego and he can find someone to blame.

So it is that we will exceed a million infected by April 11. Depending on what happens in the next week, the count may rise dramatically and quickly after that, though at much less than the 1.35x rate.

What we need to do is to drive the rate down to below 1 for new cases. To do that requires draconian quarantine, massive testing, isolation and controls. Yet we lack the will for the quarantine, and the materials for the tests. We also lack the massive amounts of PPE required.

Plus - we will now drive all of the hospitals into saturation. At that point the truly ugly begins as it has in Italy.  The death rate will soar as people who might have been saved are left to die agonizing deaths. And yes this is Trumps fault. Yes it is also the various Governor's fault with some exceptions. And it is the “experts” fault who miserably failed in so very many ways.

But again, we lack the wise leadership to do anything reasonable to prevent these things. And the time to do anything meaningful is very rapidly running out.

The old poem rings loudly true:

For Whom the Bell Tolls
by John Donne (1572 - 1631)

No man is an island,
Entire of itself.
Each is a piece of the continent,
A part of the main.
If a clod be washed away by the sea,
Europe is the less.
As well as if a promontory were.
As well as if a manor of thine own
Or of thine friend's were.
Each man's death diminishes me,
For I am involved in mankind.
Therefore, send not to know
For whom the bell tolls,
It tolls for thee.


We had a chance. We let it pass. Now we suffer the righteously terrible and terrifying consequences of that error.

The model approaches such as this are likely well intended. And they might be useful in the future. They are not useful now. They instead serve to mislead, distract, and to dissuade critical action as researchers and leaders get trapped in the calf paths of their minds. They are nothing more than a sophisticated form of back-fitting or curve fitting.

We have made these errors before. We will make them again. And people will die as a result.

The Calf-Path
by Sam Walter Foss (1858-1911)

One day, through the primeval wood,
A calf walked home, as good calves should;
But made a trail all bent askew,
A crooked trail, as all calves do.

Since then three hundred years have fled,
And, I infer, the calf is dead.
But still he left behind his trail,
And thereby hangs my moral tale.

The trail was taken up next day
By a lone dog that passed that way;
And then a wise bellwether sheep
Pursued the trail o’er vale and steep,
And drew the flock behind him, too,
As good bellwethers always do.

And from that day, o’er hill and glade,
Through those old woods a path was made,
And many men wound in and out,
And dodged and turned and bent about,
And uttered words of righteous wrath
Because ’twas such a crooked path;
But still they followed — do not laugh —
The first migrations of that calf,
And through this winding wood-way stalked
Because he wobbled when he walked.

This forest path became a lane,
That bent, and turned, and turned again.
This crooked lane became a road,
Where many a poor horse with his load
Toiled on beneath the burning sun,
And traveled some three miles in one.
And thus a century and a half
They trod the footsteps of that calf.

The years passed on in swiftness fleet.
The road became a village street,
And this, before men were aware,
A city’s crowded thoroughfare,
And soon the central street was this
Of a renowned metropolis;
And men two centuries and a half
Trod in the footsteps of that calf.

Each day a hundred thousand rout
Followed that zigzag calf about,
And o’er his crooked journey went
The traffic of a continent.
A hundred thousand men were led
By one calf near three centuries dead.
They follow still his crooked way,
And lose one hundred years a day,
For thus such reverence is lent
To well-established precedent.

A moral lesson this might teach
Were I ordained and called to preach;
For men are prone to go it blind
Along the calf-paths of the mind,
And work away from sun to sun
To do what other men have done.
They follow in the beaten track,
And out and in, and forth and back,
And still their devious course pursue,
To keep the path that others do.

They keep the path a sacred groove,
Along which all their lives they move;
But how the wise old wood-gods laugh,
Who saw the first primeval calf!
Ah, many things this tale might teach —
But I am not ordained to preach.


Sam

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