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Messages - Sam

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Consequences / Re: COVID-19
« on: April 08, 2020, 08:12:27 AM »
Interesting framework for going forward:
Lockdown Can’t Last Forever. Here’s How to Lift It.
By Gabriel Leung
Dr. Leung is an infectious disease epidemiologist and dean of medicine at the University of Hong Kong.
HONG KONG — Lockdowns, quarantines and extreme forms of physical distancing work: They are curbing the spread of Covid-19. But they cannot last indefinitely, at least not without causing enormous damage to economies and compromising peoples’ good will and emotional well-being.

When governments decide to close schools (or not), for example, they are implicitly trying to balance these various interests. One major problem, though: Their calculus about the underlying trade-offs typically is unclear, and the criteria for their policy adjustments are unknown.

A formal framework is needed, with an explicit rationale grounded in science, for determining when and how and based on what factors to relax restrictions — and how to reapply some or all of them should another epidemic wave hit again. ...

The School of Public Health at the University of Hong Kong has been estimating, and publishing, the real-time Rt for Hong Kong since early February. The chart is based on the epidemic curve corrected by established statistical methods to reduce the time lag between the onset of infection symptoms and the official reporting of new cases. (The result is called “nowcasting.”) We hope to soon be able to further enhance these estimates by incorporating location-based data from the Octopus card that many Hong Kongers use to pay for public transport or to shop.

In China, the location-based functions of the online payment platforms of Alibaba, Baidu and Tencent could be used to track people’s activity. In the West, data feeds from Facebook and Google could geo-code online searches and payments. Citymapper, a mapping and public transit app, follows people’s movements in major cities in real time. ...

That said, an Rt of 1 or below will not do in all circumstances. Context matters, too.

An Rt of 1 might be acceptable in a place with 10 million people if, say, no more than a couple of dozen new infections are confirmed every day. But it wouldn’t be if an epidemic were raging there and several hundred or thousands of new cases occurred daily. In the face of an explosive outbreak, the authorities would first need to take a sledgehammer to the Rt to knock it down to a very low level — 0.1 or 0.2 — and maintain it there for as long as it took to bring the daily case count down to a manageable figure.

In other words: Each community must determine the real-time effective reproductive number it can accept given its own circumstances, in particular the stage of the epidemic it is at.

Still, for all communities that determination essentially requires doing the same thing: Figuring out the number of new daily infections that their health system can handle without imploding.

Imagine a city that has 1,000 beds in intensive care units. It cannot have more than 1,000 people on a respirator at any given time. If the average length of a patient’s stay in the I.C.U. is 14 days, this city cannot provide intensive care for more than about 71 new patients a day (1,000 / 14 = 71.42). Assuming that about 5 percent of all newly infected cases are so severe as to require intensive care, then the city cannot afford to have more than a total of about 1,420 new infections a day (71 x 20 = 1,420). This is the true number of infections, only a fraction of which are reflected in the officially reported count.

The authorities, having established the number of new infections the city’s emergency health facilities can support, can then determine what Rt they should aim for and tune their interventions to reach it.

He refers to Figure 4 showing suppression over time on p. 12 of this Imperial College Study:

His group in Hong Kong has created a real-time Rt tracker, using location data and statistics. This would be used to arrive at an acceptable balance between health, economy and public tolerance until immunity is acquired, as described in the article.

Consequences / Re: COVID-19
« on: April 03, 2020, 08:09:27 AM »
Let's talk about where Americans can find leadership...

Consequences / Re: COVID-19
« on: March 29, 2020, 10:39:59 AM »

Clinical Pearls Covid 19 for ER practitioners

I just spent an hour typing a long post that erased when I went to change the title so I apologize to the grammar and spelling police. This one will not be proofread and much shorter.

I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know.

Clinical course is predictable.
2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.

Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.

Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours.

81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.

Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT's of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this ***** has told all other disease processes to get out of town.

China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails.

CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox.

Labs- WBC low, Lymphocytes low, platelets lower then their normal, Procalcitonin normal in 95%
CRP and Ferritin elevated most often. CPK, D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated.
Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner.

Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that.

A ratio of absolute neutrophil count to absolute lymphocyte count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation.

An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes.

Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal.

I had never discharged multifocal pneumonia before. Now I personally do it 12-15 times a shift. 2 weeks ago we were admitting anyone who needed supplemental oxygen. Now we are discharging with oxygen if the patient is comfortable and oxygenating above 92% on nasal cannula. We have contracted with a company that sends a paramedic to their home twice daily to check on them and record a pulse ox. We know many of these patients will bounce back but if it saves a bed for a day we have accomplished something. Obviously we are fearful some won't make it back.

We are a small community hospital. Our 22 bed ICU and now a 4 bed Endoscopy suite are all Covid 19. All of these patients are intubated except one. 75% of our floor beds have been cohorted into covid 19 wards and are full. We are averaging 4 rescue intubations a day on the floor. We now have 9 vented patients in our ER transferred down from the floor after intubation.

Luckily we are part of a larger hospital group. Our main teaching hospital repurposed space to open 50 new Covid 19 ICU beds this past Sunday so these numbers are with significant decompression. Today those 50 beds are full. They are opening 30 more by Friday. But even with the "lockdown", our AI models are expecting a 200-400% increase in covid 19 patients by 4/4/2020.


worldwide 86% of covid 19 patients that go on a vent die. Seattle reporting 70%. Our hospital has had 5 deaths and one patient who was extubated. Extubation happens on day 10 per the Chinese and day 11 per Seattle.

Plaquenil which has weak ACE2 blockade doesn't appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil's potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post.

We are also using Azithromycin, but are intermittently running out of IV.

Do not give these patient's standard sepsis fluid resuscitation. Be very judicious with the fluids as it hastens their respiratory decompensation. Outside the DKA and renal failure dehydration, leave them dry.

Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps.

Vent settings- Usual ARDS stuff, low volume, permissive hypercapnia, etc. Except for Peep of 5 will not do. Start at 14 and you may go up to 25 if needed.

Do not use Bipap- it does not work well and is a significant exposure risk with high levels of aerosolized virus to you and your staff. Even after a cough or sneeze this virus can aerosolize up to 3 hours.

The same goes for nebulizer treatments. Use MDI. you can give 8-10 puffs at one time of an albuterol MDI. Use only if wheezing which isn't often with covid 19. If you have to give a nebulizer must be in a negative pressure room; and if you can, instruct the patient on how to start it after you leave the room.

Do not use steroids, it makes this worse. Push out to your urgent cares to stop their usual practice of steroid shots for their URI/bronchitis.

We are currently out of Versed, Fentanyl, and intermittently Propofol. Get the dosing of Precedex and Nimbex back in your heads.

One of my colleagues who is a 31 yo old female who graduated residency last may with no health problems and normal BMI is out with the symptoms and an SaO2 of 92%. She will be the first of many.

I PPE best I have. I do wear a MaxAir PAPR the entire shift. I do not take it off to eat or drink during the shift. I undress in the garage and go straight to the shower. My wife and kids fled to her parents outside Hattiesburg. The stress and exposure at work coupled with the isolation at home is trying. But everyone is going through something right now. Everyone is scared; patients and employees. But we are the leaders of that emergency room. Be nice to your nurses and staff. Show by example how to tackle this crisis head on. Good luck to us all.


In uncertain times, we search for facts to provide comfort and clarity. Throw in the power of and I should not be so dumbfounded by the run this is getting.

My first expanded lost draft (thanks again MacBook Touch Bar) contained the appropriate hedging, disclaimers, and uncertainty the current understanding of this pandemic deserves. Some of the more concise, unproofread, hastily rewritten original post (OP) presents itself as more definitive instead of "what I think I know". For this, my apologies. I am not performing clinical trials. I am not involved in cohorting and analyzing data. The academic physicians involved in ER, Infectious Disease and Pulmonary Critical Care are likely (hopefully) way beyond my understanding of Covid 19. Furthermore, I fail to appreciate any additional benefit I could provide to Hospital Administrators who have been preparing and communicating with each other for months; or for some already combating this daily.

Basically, several state medical licensing boards are temporarily loosening their independent practice regulations on NPs, PAs, and to a lesser extent Medical Students. I wrote the OP as much for me to collect and organize my thoughts, as it was to provide a jumping-off platform for providers who may find themselves in an ER-like setting and unknowingly be treating Covid 19 patients or will be treating them soon enough. If any of it helps some of my colleagues hit the ground running then that is something too.

The OP was a summary of thoughts from being emersed in Covid 19 for weeks, reading as much as I can, and following up on my own patients. It is not my intention for this to be taken as dogma. I do not have the answers or the algorithm everyone is searching for. I was merely looking to point the handful of people I thought would read it in a clinical direction best I could. What I think I know evolves every day with the presumption it may very well end up markedly different once this pandemic is better understood. I do not know when this crisis will ultimately be arrested, however, I maintain resolute that each one of us can help make that happen. Stay home. Be safe. Find a way not to have to visit grandma.

Thank you to all the well-wishers and good luck to us all.



No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.

Consequences / Re: COVID-19
« on: March 28, 2020, 03:44:51 PM »
Eventually, there will be a growing number of people who have had this and, presumably (especially since the virus seems to be relatively stable right now), will not be able to get it again.

To the extent we can identify those people, they can be the ones that can go to work, and maybe relieve pressure on others who can stay at home. There seems to be some movement in this direction now, at least in England:

Antibody testing for all is on the horizon

Cheap, reliable antibody tests that reveal whether someone has previously had Covid-19 are viewed as crucial for managing the next phase of the pandemic. Population-level screening can gauge the overall level of immunity and can allow people to incrementally return to work. Various teams around the world are already using lab-based antibody testing, but this is challenging to scale up, partly because the tests need to be performed a few weeks after infection. In parallel, companies have been working on home-testing kits that work something like a pregnancy test. This week, the UK government signalled it thought such tests could be reliable enough, announcing it had bought 3.5m testing kits, with a view to making them available first to healthcare workers, and then to the public through high street chemists or Amazon delivery. An unnamed prototype is being validated in Oxford this week and the proposal still hinges on the tests’ performance. “The one thing that is worse than no test is a bad test,” Chris Whitty, England’s chief medical officer, said on Wednesday. In Spain, the government was forced to withdraw 9,000 Chinese-made coronavirus testing kits from use after it emerged that they had an accurate detection rate of just 30%.

By the end of the summer, the pandemic will have directly killed 2.2 million Americans, notwithstanding those who will indirectly die as hospitals are unable to care for the usual slew of heart attacks, strokes, and car accidents.

 Granted he's talking about worst case scenario...but isn't that pretty much where we are?

Consequences / Re: COVID-19
« on: March 27, 2020, 09:49:28 PM »
Coronavirus: Trump Delays Call With China’s President Xi for 90 Minutes to Phone Fox News Instead

Donald Trump postponed a planned phone call with Chinese president Xi Jinping on Thursday night so he could be interviewed by Fox News host Sean Hannity.

The president was due to discuss the ongoing coronavirus pandemic with his Chinese counterpart at 9pm, but said he delayed the call to appear on the popular Fox News programme.

Trump continued to downplay the number of ventilators he thinks New York will need.

The president told Sean Hannity on Fox News: “I have a feeling that a lot of the numbers that are being said in some areas are just bigger than they’re going to be.”

He continued:

... “I don’t believe you need 40,000 or 30,000 ventilators. You go into major hospitals sometimes they’ll have two ventilators and now, all of a sudden, they’re saying, ‘Can we order 30,000 ventilators?’”



Consequences / Re: COVID-19
« on: March 25, 2020, 11:34:54 PM »

The median age of Fox News viewers is 65.
According to Nielsen ratings, the median age of Fox’s audience was 66 in 2016. Following something of a youthful surge the following year, Adweek reported “good news” for Fox News early in 2018. Over the past year, the median age of the cable channel’s audience had dropped to 65. Looking at prime-time numbers alone, Fox viewers kicked back up to 66.

# boomer remover .

Consequences / Re: COVID-19
« on: March 23, 2020, 10:41:53 PM »
I don't think that the “flattening the curve” approach is doomed to failure.

It's a doomed approach. We must go for the full "let's make this SOB extinct" approach. That means take the "flatten the curve" approach" and crank it up to 11. Lockdown for 2 weeks minimum, 3 weeks best. In the meantime, save up all the testing capacity that you have because once the quarantine is over what should've been done from the beginning (test/trace/isolate/masks) must be done furiously.

Any country that can't get their shit together must be isolated from the rest of the world and helped. It is likely that these efforts must continue until a vaccine is deployed. It is likely that outbreaks will occur around the world, but that's ok.

Consequences / Re: COVID-19
« on: March 23, 2020, 08:16:04 AM »
I beg to differ.

2. Poor countries, i.e. all African, and most ME, have relatively young populations, on average. Population pyramids are highly skewed to the young, and with fewer of old age.

3. People in poor countries don't suffer from welfare diseases, that we know are conducive to getting the life threatening outcomes of the corona. Not too many people on blood pressure medication. Not too much of diabetes, etc.

Re 2: You can find the links yourself, but covid-19 is hitting young people very hard. 

Re 3: Many deaths are now among people with no pre-existing conditions which were feared to exacerbate their illness.

This is not like the  'flu.  Its a fast-acting killer, and in places with next to no advanced medical care facilities, like the slums of big third-world cities, the impact will be devastating.

Consequences / Re: COVID-19
« on: March 23, 2020, 02:07:09 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.....

Consequences / Re: COVID-19
« on: March 22, 2020, 04:21:34 PM »
Based on the data here the US and most European countries are following the Italy pathway.  The best fit seems to be the number of deaths doubling every 2.5 days for the first 20 days then dropping to doubling every 5.25 days after that.

No obvious departures from that pathway for the countries listed below.

Days since
first death


deaths on day


Country Status
10 2.5 18 69
11 2.5 24 93 Germany (yesterday 23, total 84)
12 2.5 31 124 Netherlands (yesterday 30, total 136)
13 2.5 42 166
14 2.5 55 221 United Kingdom (yesterday 66, total 233)
15 2.5 73 295 US (yesterday 82, total 307)
16 2.5 98 392
17 2.5 130 522 France (yesterday 207, total 562)
18 2.5 172 694
19 2.5 228 922
20 2.5 260 1,182
21 5.2 297 1,479
22 5.2 339 1,818 Spain (yesterday 345, total 1,720)
23 5.2 387 2,205
24 5.2 441 2,646
25 5.2 503 3,149
26 5.2 574 3,723
27 5.2 655 4,378
28 5.2 747 5,125 Italy (yesterday 793, total 4,825)
29 5.2 852 5,977
30 5.2 972 6,950
31 5.2 1,109 8,059
32 5.2 1,265 9,324
33 5.2 1,443 10,767
34 5.2 1,647 12,414
35 5.2 1,878 14,292

Consequences / Re: COVID-19
« on: March 21, 2020, 03:15:51 AM »
Just remember, China is still locked down.  We have absolutely no idea what's going on in China right now.  Wuhan is basically a disaster zone, who knows how many bodies they've burned at this point.

China is obviously lying, there's likely millions dead in China.

Best to refrain from this line of thinking unless there is evidence to suggest it is true.
There is enough fear mongering already..... look at Trump crossing out Corona and replacing it with Chinese.
Dont walk that path.

We need to work hard to work together.

Consequences / Re: COVID-19
« on: March 19, 2020, 06:35:30 PM »
[0% chance of anything close
    Monitor graph at bottom of CDC website. New “confirmed” cases, not oft-reported “presumptive positive” is trending to level off over next few weeks & be negligible by end of April. Same pattern as China. [/size]
Expecting the outcome of China while ignoring the steps taken in China to achieve that outcome is extremely stupid. Does he support wide lockdown, mass quarantine, severe social distancing? If not, what does he expect to happen? He is bullshitting, I've seen enough posts in the same vein to recognize the bullshit. Will he take it back when in a few weeks the outcome is different than what he expects now? Alternatively, will he ignore the fact that the outcome will have been achieved after some economic measures that he opposed (I guess) were put in place?
By the way the graph mentioned is cases by date of onset, not by date of diagnosis. As the US only tests those with severe symptoms, it does not find cases where infection occurred today or yesterday. This graph is doomed to provide very delayed and skewed information, and suggesting to base future expectations and public policy on it is crazy when during an exponential epidemic.
In an exponential situation you have to look ahead into the future as much as possible by extrapolation and modeling, rather than use week or two-week old data. It's like those in Italy that said "what's the problem, we have 2 dead people so what?"

Consequences / Re: COVID-19
« on: March 19, 2020, 06:26:55 PM »
Your last post caused me to question some of my assumptions about your situation.

While minimal, is your income at least sustainable if circumstances should require you to remain totally unproductive for months on end?

Is your income such that you will have no difficulty purchasing whatever you need without requiring communal meals or crowded waiting lines?

If you should become bedridden, are caregivers available for you without resorting to hospitalization? Do you have friends available that can pick-up & deliver needed items, do the laundry, cook meals etc?

Is your income dependent on you showing up to receive it, or is it readily available by mail or online?

It's not too late to be thinking about the strength of your personal safety net and how any of the gaping holes might be patched over.
An exciting experiment in deliberately doing without could quickly become dangerous if a debilitating illness were to intervene.

I'm sure that healthcare and medicines are available to you at no personal cost, but being told to stay home can entail some expenses and some levels of care that may not have been considered. Another friend's only contact has been via a computer at his local library. Not an ideal situation under these circumstances.

Stay Healthy - Plan for the Worst - Stay in Touch
(& Avoid those Dogs, many will lick any exposed skin.)

Consequences / Re: COVID-19
« on: March 18, 2020, 10:32:54 PM »
Meanwhile, the effectiveness of the message of social distancing and staying the fuck indoors is hardly rock solid based on the people interviewed for this news clip, who apparently live a totally selfish YOLO ethos:

Anything less than a mandatory lockdown is a disaster in the making at this late hour.

Consequences / Re: COVID-19
« on: March 17, 2020, 05:05:48 PM »
18 months of school closures and strict social distancing is simply not tenable.  I truly believe it cannot be done.

No. But 14-21 days of extremely strict isolation would reset the clock. 99.9% of all infected will run the course of the disease without passing it to others. Then testing, contact tracing and isolation can begin again.

I think (but I obviously do not know!) that extreme measures to prevent an early swamping of health care capacity makes sense, but at some point we might just have to take our lumps, absorb a cull of human numbers and develop herd immunity.

If testing, contact tracing and isolation is performed with extreme diligence a culling is completely unnecessary. infections would be kept to a minimum, especially if technology is leveraged.

The entire global finance system and economy cannot possibly survive 18 months of shut downs and at some point the cure is worse than the disease.

Yes, the cure is worse than the disease if not done correctly. Half measures and lack of testing only prolongs the pain. What the UK is proposing is half measures, similar to what Trump is delivering in the US. It's like they want to convince the people that no solution is possible and just die.

I am not putting "the economy" above human life. I am saying that a collapse of the global economy will have more dire impacts on human health and welfare than letting this disease sweep through the human family.

Am I wrong?

Yes, you are wrong. Letting this run through or taking weak measures will be worse for the global economy no matter what. It is not an option to let it run through. Look at Iran, look at Italy. LEaders are the vulnerable population.

All countries that slacked off in testing must shut down until they can control the disease within their borders. To control the disease they must test in mass, trace contacts and isolate. If done rigth the numbers can be kept to a minimum for decades at a relatively constant cost.

Consequences / Re: COVID-19
« on: March 17, 2020, 10:38:55 AM »
Rodius wrote:
I think the increase death toll as a percentage is a reflection of how many uncounted cases there are.
It isnt the death rate is worsening, it is likely the same, but the number of deaths compared to counted cases when not much counting is happening will increase the percentage.

Well, that makes sense in my head anyway

Interesting. I hadn't thought of that.

But I think these are raw numbers, not ratios

If I understand this correctly, epidemics in general follow a Gompertz curve.

There is an inflection point that is of importance, where increasing exp. growth is taken over by the second exp. function that defines the Gompertz, which has a decreasing exp. growth.
It seems that the US hasn't reached the inflection point yet. To little testing to tell. And the latest data show no inflection point reached:

Compare the time line with S korea, which is the case of a well managed situation. 60 days until maximum and inflection point:

Another helpful model is the SIR model

Consequences / Re: COVID-19
« on: March 15, 2020, 05:10:27 PM »
What I would like to see, is how much this pandemic shortens average global life expectancy. For instance, I recently read that air pollution reduces average life expectancy for the entire global population by three years (see here).

In a worst case scenario where lots of old people die from COVID-19, how much are the lives of all people on the planet shortened on average?


Another point: Even though I think that measures currently taken in Europe are justified, it depresses me that there doesn't seem to be a willingness to do the same for other, potentially much larger catastrophes, like AGW, industrial agriculture, air pollution, unhealthy food, etc. COVID-19 is a warning, a lesson, that teaches us how unresilient and unprepared our current globalized, turbocapitalist system is. I fear that no lessons will be learned, no matter how many old people die.

A lot of what we are doing during these quarantines, should be normal practice. Less travelling, less buying, less entertainment, less addiction, less distraction. But that drives people nuts, as they don't know who they are if they have to let go of their conditioning. Which is why it seems that nothing else in the world but COVID-19 exists right now. Everybody is talking about it non-stop.


This hardly gets any media attention, or else I'm sure it would've been posted here. From a couple of days ago:

Mr Di Maio told the BBC the measures imposed in the first area of the outbreak were proving effective.

Two weeks after the first 10 towns in northern Italy were declared a "red zone" and put under lockdown, he said they had no new infections.

I think that if everyone follows the process that China and Italy have gone through, it could be under control by summer, and then hopefully not come back next winter.

Consequences / Re: COVID-19
« on: March 15, 2020, 12:35:29 PM »
Over at reddit

Consequences / Re: COVID-19
« on: March 15, 2020, 11:10:08 AM »
Yes, this is a WOW moment. Still, i think they are doing the right thing.

It's either our govs become more authoritarian in order to solve this crisis or it will drive the death count up.

To be clear, i'm not supporting authoritarianism per se. I'm supporting the right tool for the right issue.

We all have mixed societies. Some are more on the socialist side, some more on the capitalist side. I support socialism when it comes to infrastructure. I support capitalism when it comes to goods and services. And i support authoritarianism when it comes to catastrophes like this. I'm only pragmatic here.

I hope governments don't fear becoming more authoritarian in a false understanding of freedom. After all, having your life saved is the ultimate freedom.

Consequences / Re: COVID-19
« on: March 15, 2020, 10:27:22 AM »
Our government has released a very helpful video

Warning don't watch this if you don't like bad language.

Consequences / Re: COVID-19
« on: March 11, 2020, 10:52:44 PM »

The above is data supplied and updated by Chinese students residing in Canada and the States.
I'm assured that it's more accurate than other sources and that it's constantly updated by a large number of student volunteers.
It breaks things down to at least a county level allowing many to access the risk close to home.

Stay Isolated, Stay Healthy, Stay in Touch.

Consequences / Re: COVID-19
« on: March 11, 2020, 09:20:58 PM »
White House Classifies Top-Level COVID-19 Meetings 2:51 p.m.:

Reuters: “The White House has ordered federal health officials to treat top-level coronavirus meetings as classified, an unusual step that has restricted information and hampered the U.S. government’s response to the contagion, according to four Trump administration officials.”

The officials said that dozens of classified discussions about such topics as the scope of infections, quarantines and travel restrictions have been held since mid-January in a high-security meeting room at the Department of Health & Human Services (HHS), a key player in the fight against the coronavirus.

Staffers without security clearances, including government experts, were excluded from the interagency meetings, which included video conference calls, the sources said.

... “We had some very critical people who did not have security clearances who could not go,” ... “These should not be classified meetings. It was unnecessary.”

The White House insistence on secrecy at the nation’s premier public health organization, which has not been previously disclosed, has put a lid on certain information - and potentially delayed the response to the crisis.

... That follows this 1 p.m. tweet from DOD’s official twitter feed: “’The way that you control public health outbreak is not to hide data, it’s to be transparent to the public & to your partners going forward so that we have a clear understanding of the risk and then we can take appropriate measures to mitigate.’ — Brig. Gen. (Dr.) Paul Friedrichs”



Top Armed Services Lawmaker Scoffs at Coronavirus Precautions 12:42 p.m.:

Asked what precautions he is taking to protect himself from COVID-19, octogenarian Sen. Jim Inhofe, R-Okla., the chairman of the Senate Armed Services Committee, told reporters “none” — and then offered his hand. “Wanna shake hands?” he said, according to The New York Times. The cavalier response from the Pentagon’s senior overseer on Capitol Hill comes as the Pentagon has implemented so-called “social distancing” practices per CDC guidelines that recommend people stand six feet away from one another. Pressure is mounting on lawmakers to cancel votes and curtail other activities in the Capitol to prevent an outbreak.

Consequences / Re: COVID-19
« on: March 11, 2020, 07:59:29 PM »

Consequences / Re: COVID-19
« on: March 01, 2020, 08:41:02 PM »
The coronavirus' estimated fatality rate appears to have risen to 3.4%

That number was also referred to in France. And two young children infected:

The director general of France’s health service, Jérôme Salomon, has given the latest figures and there’s another leap on Sunday. The number of confirmed cases has risen to 130, from 100. Of that, 116 people are in hospital – nine of them in a serious condition – and 12 people recovered. There have been two deaths

New cases include two children, a one-year-old and a five-year-old, who have been hospitalised in Strasbourg in eastern France along with their 27-year-old mother who also tested positive. Their condition has been described as not worrying.

Salomon says French travellers should avoid journeys abroad outside the European Union “unless strictly necessary”. Nevertheless, he pointed out the death rate worldwide is 3.4% of confirmed cases.

Consequences / Re: COVID-19
« on: March 01, 2020, 08:16:55 PM »
The coronavirus' estimated fatality rate appears to have risen to 3.4%

Consequences / Re: COVID-19
« on: March 01, 2020, 06:49:37 PM »
All bets are off if we do see a high 'R0' leading to a 'peak infection', in developed nations, that crashes health services (via swamping them but also leaving many staff suffering the virus with the rest of us?)

Symptoms that we can 'treat', in normal times, will lead to unnecessary death as will a plethora of other 'run of the mill', easily cured ailments, over that period? ....... drive safe over peak infection eh?.... nobody's coming to pull you out of your wreck nor will there be a bed in Hospital waiting for your mangled self.......

Can some of our posters just read up on the 1918 'Spanish Flu' and just how it impacted their health service over peak infection purlease!

As we , here in the UK, had said to us from our telly's (in the early 80's) 'Don't die of ignorance'

Be Well people!

Consequences / Re: COVID-19
« on: March 01, 2020, 10:48:09 AM »

However, I refuse to think that the US does not have the capacity to trace and isolate cases once they appear.  So unless the trump administration actively suspended tracking of patients and just let this killer flu into the ecosystem, I think the US got this. If Trump thinks this is just flu and orchestrated the response to just let into the ecosystem as to not affect the markets, then we are truly Fd. Is he evil/stupid enough to do that? yes. But I don't think people that value their lives would let him.
A cautionary tale from the guardian....
Millions of uninsured Americans like me are a coronavirus timebomb
by Carl Gibson
I haven’t gone to the doctor since 2013. When you multiply my situation by 27.5 million, that’s a scary prospect

Like 27.5 million other Americans, I don’t have health insurance. It’s not for a lack of trying – I make too much to qualify for Medicaid, but not enough to buy a private health insurance plan on the Affordable Care Act exchanges. Since I can’t afford to see a doctor, my healthcare strategy as a 32-year-old uninsured American has been simply to sleep eight hours, eat vegetables, and get daily exercise. But now that there are confirmed coronavirus cases in the United States, the deadly virus could spread rapidly, thanks to others like me who have no feasible way to get the care we need if we start exhibiting symptoms.......

.......Earlier this week, the Department of Health and Human Services secretary, Alex Azar, (a former senior executive at pharmaceutical manufacturer Eli Lilly) refused to commit to implementing price controls on a coronavirus vaccine “because we need the private sector to invest … price controls won’t get us there”. Even the House speaker, Nancy Pelosi, notably didn’t use the word “free” when referring to a coronavirus vaccine, and instead used the word “affordable”. What may be considered affordable for the third-most powerful person in the US government with an estimated net worth of $16m may not be affordable for someone who can’t afford a basic private health insurance plan that still requires a patient to pay thousands of dollars out of pocket.

Given the high cost of healthcare in the US, I haven’t seen a doctor since 2013, when I visited an emergency room after being run off the road while riding my bike. After waiting for four hours, the doctor put my arm in a sling, prescribed pain medication and sent me home. That visit cost more than $4,000, and the unpaid balance eventually went to collections and still haunts my credit to this day, making it needlessly difficult to rent an apartment or buy a car. But even a low-premium bronze plan on the exchange comes with a sky-high deductible in the thousands of dollars, meaning even if I was insured, I’d have still paid for that ER visit entirely out of pocket.

When you multiply my situation by 27.5 million, you end up with a country full of people who won’t see a doctor unless they’re extremely sick. This system is exactly why a 2018 West Health Institute/NORC at the University of Chicago national poll found that 44% of Americans declined to see a doctor due to cost, and why nearly a third of Americans polled said they didn’t get their prescriptions filled due to the high cost of their medicine. This is the same system that killed 38-year-old Texas public school teacher Heather Holland, who couldn’t afford the $116 co-pay for her flu medication and later died from flu complications. It’s the same system that Guardian contributor Luke O’Neil refers to as “Go viral or die trying”, in which Americans who can’t afford life-saving healthcare procedures are forced to become their own advocate and PR agency by launching a viral GoFundMe campaign to ask strangers on the internet to save their lives.

When you multiply my situation by 27.5 million, you end up with a country full of people who won’t see a doctor unless they’re extremely sick. And when you combine a for-profit healthcare system – in which only those wealthy enough to get care actually receive it – with a global pandemic, the only outcome will be unmitigated disaster. This could be somewhat remedied if the US had a single-payer, universal healthcare system, like every other industrialized nation. And as a team of Yale epidemiologists discovered in a study recently published in the Lancet, a single-payer healthcare system in the US could simultaneously save 68,000 lives and $450bn in taxpayer dollars each year.

Yes, countries with single-payer systems still have coronavirus cases, Italy and Japan. But the spread of the virus in those countries would likely pale in comparison to the potential spread of coronavirus in the US, in which a significant portion of the population simply won’t go to the doctor if they’re sick. Coronavirus is a worldwide public health emergency, and massive profits for health insurers and pharmaceutical manufacturers shouldn’t come before the basic health and safety of human beings.

Carl Gibson is an independent journalist whose work has been published in CNN, the Guardian, the Washington Post, the Houston Chronicle and NPR, among others

by Andrew Rawnsley
I am going to put the choice more bluntly than he does – or any politician is ever likely to be brave enough to spell out. Should we take every measure available to try to counter the virus and at whatever economic and social cost? Or are we better advised to take less stringent steps to minimise the impact on society, at the price of increasing the risk of infection and, for those most vulnerable to the virus, elevating the risk of death?

This is the critical dilemma that is lurking behind many of the calculations and pronouncements by politicians and their advisers. The debate needs to be had honestly and openly. It is a conversation that will need to be led. To govern is to choose. One choice no leader can make at a time of crisis is to hide.

Consequences / Re: Chinese coronavirus
« on: February 14, 2020, 06:41:29 PM »
I believe what Archimid and dnem and Sam may be trying to refer to is how racial/ethnic differences apply in the Medical context And in this case especially as it refers to drug metabolism.

One of the things I learned in Pharmacokinetics, and Phamacogenomics was the impact of an enzyme system in the body called the Cytochrome P450 on drug metabolism. There are many variant of this enzyme (called polymorphisms) within humans. These variants are often linked to racial or ethnic categories.

A drug may work for one population and fail completely for another. This is why race and ethnicity are important in medicine.


The Effect of Cytochrome P450 Metabolism on Drug Response, Interactions, and Adverse Effects

Cytochrome P450 enzymes are essential for the metabolism of many medications. Although this class has more than 50 enzymes, six of them metabolize 90 percent of drugs, with the two most significant enzymes being CYP3A4 and CYP2D6. Genetic variability (polymorphism) in these enzymes may influence a patient's response to commonly prescribed drug class.

Cytochrome P450s are the major enzymes involved in drug metabolism, accounting for about 75% of the total metabolism. Most drugs undergo deactivation by CYPs, either directly or by facilitated excretion from the body. Also, many substances are bioactivated by CYPs to form their active compounds.

One out of every 15 white or black persons may have an exaggerated response to standard doses of beta blockers (e.g., metoprolol [Lopressor]), or no response to the analgesic tramadol (Ultram). This is because drug metabolism via CYP450 enzymes exhibits genetic variability (polymorphism) that influences a patient's response to a particular drug.3

A specific gene encodes each CYP450 enzyme. Every person inherits one genetic allele from each parent. Alleles are referred to as “wild type” or “variant,” with wild type occurring most commonly in the general population. An “extensive” (i.e., normal) metabolizer has received two copies of wild-type alleles. Polymorphism occurs when a variant allele replaces one or both wild-type alleles. Variant alleles usually encode a CYP450 enzyme that has reduced or no activity.1 Persons with two copies of variant alleles are “poor” metabolizers, whereas those with one wild-type and one variant allele have reduced enzyme activity. Finally, some persons inherit multiple copies of wild-type alleles, which results in excess enzyme activity. This phenotype is termed an “ultrarapid” metabolizer.4

CYP450 enzyme polymorphism is responsible for observed variations in drug response among patients of differing ethnic origins.4–6 For example, 7 percent of white persons and 2 to 7 percent of black persons are poor metabolizers of drugs dependent on CYP2D6, which metabolizes many beta blockers, antidepressants, and opioids.7,8 One in five Asian persons is a poor metabolizer of drugs dependent on CYP2C19, which metabolizes phenytoin (Dilantin), phenobarbital, omeprazole (Prilosec), and other drugs.9 Variance in drug response among persons of different ethnic origins also can be caused by genetic variations in other drug-metabolizing enzymes, drug transporters, and drug receptors.3


There are over 32 peer-reviewed articles on the implication of racial/ethnic differences as they apply to drug metabolism



Pharmacogenomics of CYP3A: considerations for HIV treatment

In both the U.S. and Global geographic settings, drug interactions contribute to clinical dilemmas making successful antiretroviral therapy, as well as the management of long-term complications, a formidable challenge.

... The CYP3A4*1B allelic frequency varies among different ethnic groups: 0% in Chinese and Taiwanese [38,39], 2–9.6% in Caucasians [36,38,40,41], 9.3–11% in Hispanic Americans, and 35–67% in African–Americans [28,42,43].


Cytochrome P450 variations in different ethnic populations.

Consequences / Re: Chinese coronavirus
« on: February 08, 2020, 05:31:36 AM »
It is important to remember that these numbers are hospital admissions. It is also important to note that the confirmed numbers may be limited by the testing delays. And it is especially important to remember that temporarily, each of these numbers represents populations (cohorts) that start at differing points in time. We have crude estimates of what those are. We do not have confirmation of that. And to further complicate issues, the timeframes are not fixed, but rather each are instead distributions. We do not have good data on what those distributions look like. They are likely to be close to log normal in character. But we do not know what they actually look like.

We have estimates that it takes 1-3 days from admission on average to be tested and hence confirmed. We have estimates that the average time to death from confirmation is about 5.9 days. But, that has a brand distribution. We also have estimates that it takes an additional 3-9 days to confirm a person as recovered. That number is much less certain.

Since the growth is exponential in the number of patients, it is essential to know these parameters to estimate the lethality of the disease. But that isn't enough. We need to know how that works in terms of age, gender and other factors.

Alternatively and better, we need a case study of a broad cross section of people to identify what the ultimate outcomes are.

At the moment, it appears (and -only- appears) that there are a large number of people who have limited symptoms and do not report to hospital. As a result, it appears that the lethality of the virus is likely about 4% as measured on the whole population infected. It may be more. It may be less. It is clear that the disease predominantly kills people over 55 years of age, and predominantly males (70%). ...

Excellent analysis Sam

The visual analogy of what your describing brings to mind an aggregate depletion curve of a field of fracking wells. Each individual has a fast rise (an acute phase) followed by a long tail (a convalescent phase). When summed together you get something like this ...

Consequences / Re: Chinese coronavirus
« on: February 04, 2020, 09:36:36 PM »
Xenophobia has no place in this discussion.

China, and the Chinese are making huge sacrifices in an effort to buy the rest of the world some time to prepare for a horror that is almost certainly coming our way.

I know of no other country, or people, that would attempt such a Sisyphean task. To harass them for errors they may make as they face the real possibility of annihilation is the most ungrateful response I can imagine.

It's like chiding Horatius for not leading an orderly retreat, or chastising him for his unfashionable choice of armor.

Policy and solutions / Re: Nuclear Power
« on: June 26, 2019, 05:25:19 AM »
a lot of pessimistic assumption

By all means, there was nothing pessimistic in Sams post. It's pure realism. It's an accurate description of the things happened. No doom, only truth.

Some people have use for the updated regional data files:


The rest / Re: SpaceX
« on: June 05, 2019, 09:04:50 AM »
Transporting soil to Mars...  :D :P

Arctic sea ice / Re: Latest PIOMAS update (June 2019)
« on: June 05, 2019, 08:45:45 AM »
The volume and volume-anomaly graphs.

Arctic sea ice / Re: Latest PIOMAS update (June 2019)
« on: June 05, 2019, 08:43:23 AM »
The new PIOMAS data is in, both the gridded thickness as the official volume data. On 31 May the volume was 19.111 [1000 km3], second lowest after 2017.

Attached is the animation.

The rest / Re: SpaceX
« on: June 05, 2019, 05:19:24 AM »
Collapse of human civilization (which I expect to happen by mid-century) is not the same as human extinction on Earth, which I don't expect to happen. But in any case, the risk of extinction on Mars is much higher than on Earth, once there is no supporting civilization to launch more needed stuff and send new immigrants.

The rest / Re: SpaceX
« on: June 05, 2019, 04:43:55 AM »

Great point. Perchlorate is a severe hazard. It is a powerful oxidizer and toxin. Even in trace concentrations it is a huge health problem. Perchlorate and pertechnetate (radioactive waste) substitute in the body for iodate (iodine’s active form in the thyroid). In doing that, they wreck havoc on thyroid and pineal gland function and with other organs and tissues to a lesser degree.


The soil can be cleaned or brought from Earth. Do you really think that life on Earth in the next 10-20 years will be better and safer than on Mars?  :)

Read the latest news from the next branch.,2728.msg203412.html#msg203412

Human Civilization Faces "Existential Risk" by 2050 According to New Australian Climate Change Report 

Strange logic.

If, as has been pointed out, the ability to inhabit Mars is practically nil, for the myriad of reasons just explained ... deterioration of civilization, or even the entire earth system, does not increase those possibilities of inhabiting Mars up from nil.

The report you presented doesn't magically make Mars more inhabitable.

The rest / Re: SpaceX
« on: June 05, 2019, 12:14:32 AM »
Plus ... perchlorate in all the soil. What? Can't use the soil? Can't even come into contact with it? Can't even be exposed to the dust that would be impossible to keep out of the protective bubble habitat you'd have to exist in, permanently, forever? What, science fiction fans didn't know about the actual chemical makeup of the deadly martian soil?

Pffft. What a waste of resources all this living on Mars bullshit is. People tried to live in a sealed habitat right here on earth, spent tons of money trying, and it failed miserably. Look that up too.

The high levels of perchlorate found on Mars would be toxic to humans, Smith said.

"Anybody who is saying they want to go live on the surface of Mars better think about the interaction of perchlorate with the human body," he warned. "At one-half percent, that's a huge amount. Very small amounts are considered toxic. So you'd better have a plan to deal with the poisons on the surface."

Any humans exploring Mars, Smith said, will find it hard to avoid the finest of dust particles. "It'll get into everything…certainly into your habitat."

It's all just so stupid.  Why not just stop killing the planet you've got? :o

Policy and solutions / Re: Carbon Capture and Storage (CCS)
« on: June 03, 2019, 05:37:26 PM »
Sorry Tom, but their efficiency claim is BS!

As long as there are CO2 producing energy sources the efficiency is always net-negative and will produce more CO2 than if you replace the original CO2 source.

Unless we have eliminated all CO2 producing energy sources, CCS adds to global CO2 consumption. It's that easy.

The day we've stopped burning fossil fuel entirely on this planet is the day this technology is useful. Not a day before.

The rest / Re: SpaceX
« on: May 28, 2019, 01:47:05 PM »
Satellite Internet will be much cheaper than laying thousands of kilometers of cables along the ocean floor.

Just gotta hope there's not a big solar flare anytime soon!

Policy and solutions / Re: Nuclear Power
« on: May 23, 2019, 07:18:12 AM »
Great podcast on fusion, how nuclear radiation is not a real problem here, and how far they really are:

The Wendelstein 7-X Fusion Experiment

In our never-ending quest to understand fusion and its potential use in energy production, I visited the Wendelstein 7-X fusion experiment in Greifswald run by the Max-Planck-Institut für Plasmaphysik. We started out with a visit to the experiment hall, while experimentalist Matthias Hirsch gave us an overview over the machine. Next we discussed theory and modeling with Ralf Kleiber. Finally, I returned to Matthias Hirsch, and we chatted about more experimental aspects of Wendelstein. It is probably best to listen to our previous fusion episodes (22, 157 and 304) before listening to this one.

Link >>

Arctic sea ice / Re: Latest PIOMAS update (November)
« on: November 06, 2018, 12:32:52 PM »
Thickness map, compared with previous years and the differences.
What I find most disturbing here is the complete absence of 4M+ ice.  We are inching closer to the end of freeze season volume matching annual heat uptake.

Time to show my PIOMAS thickness distribution. As some may remember, ice in each gridcell in the PIOMAS model is specified as a discrete distribution: there exist 12 categories of ice thickness (m):
[0.00, 0.26, 0.71, 1.46, 2.61, 4.23, 6.39, 9.10, 12.39, 16.24, 20.62, 25.49]
gice specifies the percentage less or equal to the thickness of each category.

The attached graph shows the area of ice that is thicker than each thickness cat.

4m+ ice is indeed declining dramatically,  but that is not a recent development.

Consequences / Re: Limits To Growth Predicts Collapse in 2015
« on: April 09, 2015, 06:36:23 PM »
Please keep in mind that the Limits to Growth studies never predicted anything.  They extrapolate trends to indicate what will likely happen should BAU continue along its trajectories measured at the time of the studies. 

The reason they have hit the trends so precisely is that their warnings of what the extrapolations of BAU would lead to were ignored.  BAU is suicide is what the studies indicated was likely and after 40 years of BAU it sure looks accurate.

The biggest thing to keep in mind about discussions related to the Limits to Growth works and our current emphasis on climate change is that they are two different mechanisms and processes.  The Limits to Growth works do not take climate change into account.  This is a huge point.  The Limits to Growth work is almost totally related to the global carrying capacity issues and subjects.  Leaving climate change completely out of the analysis those studies which are now seen as incredibly accurate point to a civilizational collapse.

Thus we are left in this situation.

Civilization will collapse over the next few decades due to our exceeding the globes carrying capacity if we continue to pursue BAU scenarios (black or green does not matter) detailed in LTG.

Civilization will collapse over the next 30-40 years due to climate change regardless of whether we pursue BAU or not (that is ignoring carrying capacity realities).

In combination the effects of exceeding the globes carrying capacity and worsening climate change present a death sentence to our complex civilization but they also present an existential threat to the survival of large numbers of our species.

The only path forward which satisfies a rational risk/benefit analysis is to pursue a vigorous program of global degrowth (or managed collapse for those who prefer frank language).  And let's get started in 2005 at the latest.

There is an interesting quote in the paper that is almost identical to one I have made many times ..and got beat up for making.

This suggests, from a rational risk based perspective, that we have squandered the past decades, and that preparing for a collapsing global system could be even more important than trying to avoid collapse.

BAU won't work.  Get over it.

As to the 2015 projected peak in per capita industrial production being the prime metric for determining when collapse starts I an not sure I agree with using that metric.   I think one can make a good argument collapse started some time ago or one could make a fair argument that we are on sort of a plateau at peak and have not really started measurable decline.  But those arguments are not really important as we can clearly see the freight train coming at us at this point.  You can jump in the river and try and swim for it, or you can stay on the tracks and try and stop the train.  Your choice. 

Policy and solutions / Re: James Hansen loves nuclear power
« on: March 25, 2014, 05:44:49 PM »
EROEI of nuclear and solar

Above we see a claim

EROEI of nuclear is somewhere between 20 and 40

EROEI of Solar is between 6 and 8 and will be much higher in a few years time.

If one considers a carbon-weighted EROEI (say, carbon-free Energy Return on Energy Invested) then the value of the energy returned vs that expended in the emission goes up to 40-80 and 12-16 (normalizing to appropriate Social cost of Carbon values).

If you wander over to the Renewables thread you can find the only large scale real world analysis ever performed for solar power plants (in Spain) done be Charles Hall one of the world's preeminent experts on calculating EROEI.  His numbers for actual performance are 2.45 yes 2.45.  In an ideal location.  He estimates that the German average is less than 2.00

What does he say about nuclear?

We have found the information about the EROI of nuclear power to be mostly as disparate, widespread, idiosyncratic, prejudiced and poorly documented as information about the nuclear power industry itself. Much, perhaps most, of the information that is available seems to have been prepared by someone who has made up his or her mind one-way or another (i.e. a large or trivial supplier of net energy) before the analysis is given. As is usually the case, the largest issue is often what the appropriate boundaries of analysis should be.

The seemingly most reliable information on EROI is quite old and is summarized in chapter 12 of Hall et al. (1986). Newer information tends to fall into the wildly optimistic camp (high EROI, e.g. 10:1 or more, sometimes wildly more) or the extremely pessimistic (low or even negative EROI) camp (Tyner et al. 1998, Tyner 2002, Fleay 2006 and Caldicamp 2006). One recent PhD analysis from Sweden undertook an emergy analysis (a kind of comprehensive energy analysis including all environmental inputs and quality corrections as per Howard Odum) and found an emergy return on emergy invested of 11:1 (with a high quality factor for electricity) but it was not possible to undertake an energy analysis from the data presented (Kindburg, 2007). Nevertheless that final number is similar to many of the older analyses when a quality correction is included.

Note the above quoted numbers obviously fall into the wildly optimistic camp.

Tyner was the author (or co-author) on the 1988 and 1997 reports which are examples of the lower EROI numbers -- less than 5:1. Tyner’s 1997 paper reported an “optimistic value” of 3.84 and a “less-optimistic” value of 1.86 and may be based on “pessimistic” cost estimates. For example capital monetary costs were 2.5 times higher than those reported for Generation III and III+ plants (Bruce Power 2007, see below). Fleay’s 2006 on line paper at least gives very detailed numerical analyses of costs and gains and hence probably can be checked explicitly. Different boundaries are used for these “low EROI” studies than most other recent studies that effect the results. For example Tyner takes interest (with a 4-5x larger energy cost magnitude than capital energy costs) into account in EROI (Tyner 1997). The two large EROI values reported here were for nuclear lifecycles which used centrifuge fuel enrichment as opposed to diffusion-based enrichment. Centrifuge enrichment uses much less electricity than other methods (Global Security 2007). We do not know how to interpret these analyses because centrifugal separation is an old technology. Newer rotor materials allow more rapid rotor spin which might influence results. At present much of the enriched uranium used for nuclear power is coming from dismantled nuclear warheads from the US-Russian agreement to decrease nuclear warheads but, apparently, that program will soon come to an end and we will have to contemplate again generating nuclear power from mined uranium. Much of the arguments about the great or small potential of future nuclear power comes from those who argue about the importance of technology vs. those who focus on depletion. As usual, however, technology is in a race with depletion and the winner can be determined only from empirical analysis, of which there seems to be far too little.

The most knowledgeable people looking at the  cradle to grave EROEI of existing nuclear put the EROEI numbers around 5.  Not 20 and certainly not 40-80.

The above link contains about 20 additional links to back up the numbers.  It also leads to very extensive EROEI discussions which can be used to learn about this subject.

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