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Messages - vox_mundi

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1
Consequences / Re: COVID-19
« on: April 05, 2020, 06:49:12 PM »
Form our beloved 'Trump criticizes Trump' series:



Quote
@realDonaldTrump

It's almost like the United States has no President - we are a rudderless ship heading for a major disaster. Good luck everyone!

3/19/14

2
Consequences / Re: COVID-19
« on: April 04, 2020, 03:36:17 PM »
Profiting from misery: How Trump Team is making money from the pandemic

Quote
Want to know how it works?

1.) Eliminate oversight of the spending of nearly a trillion dollars of tax dollars: https://thehill.com/regulation/court-battles/490737-stimulus-opens-new-front-in-trumps-oversight-fight

2.) Aquire the authority to command which businesses get which contracts:

3.) Have trusted people stand up companies through which the money can be funneled (3 week old company, founded through a loan approved via the Coronavirus Stimulus bill, is now the center of medical supply distribution): https://www.politico.com/news/2020/03/27/republican-fundraiser-company-coronavirus-152184 “I don’t want to overstate, but we probably represent the largest global supply chain for Covid-19 supplies right now,” he said. “We are getting ready to fill 100 million-unit mask orders.”

4.) Have the federal government sell, at a reduced price, it’s strategic stockpile to the new companies, run by your buddies: https://twitter.com/DavidBegnaud/status/1245841458323771393

5.) Have the states bid on the supplies, driving up the price:

6.) Have the federal government spend taxpayer dollars to ship supplies purchased from China to these brand new private companies: https://www.npr.org/sections/coronavirus-live-updates/2020/03/29/823543513/project-airbridge-to-expedite-arrival-of-needed-supplies-white-house-says

7.) Eliminate the competition. Attack any company that doesn’t play ball. https://mothership.sg/2020/04/trump-3m-10-million-masks/

Quote
As is tradition for the GOP:
https://en.wikipedia.org/wiki/The_Shock_Doctrine

Quote
...Klein argues that neoliberal free market policies (as advocated by the economist Milton Friedman) have risen to prominence in some developed countries because of a deliberate strategy of "shock therapy)". This centers on the exploitation of national crises (disasters or upheavals) to establish controversial and questionable policies, while citizens are excessively distracted (emotionally and physically) to engage and develop an adequate response, and resist effectively.

Although even in times of peace and calm, the Republican party works hard to a) make sure sure your tax dollars are going to favored individuals and companies, and b) make sure you have to spend your non-tax dollars with favored companies. Michael Lewis detailed in The Fifth Risk how AccuWeather and Sen. Rick Santorum attempted this; it's just one example out of thousands over the years.

Link >> https://www.reddit.com/r/Keep_Track/comments/fusxdh/profiting_from_misery_how_trump_team_is_making/

3
Consequences / Re: COVID-19
« on: April 03, 2020, 07:27:13 AM »
Apologies if this has been posted already (I couldn't find it here yet):

https://www.corriere.it/politica/20_marzo_26/the-real-death-toll-for-covid-19-is-at-least-4-times-the-official-numbers-b5af0edc-6eeb-11ea-925b-a0c3cdbe1130.shtml

Quote
Nembro, one of the municipalities most affected by Covid-19, should have had - under normal conditions - about 35 deaths. 158 people were registered dead this year by the municipal offices. But the number of deaths officially attributed to Covid-19 is 31 (...)

4
Consequences / Re: Hurricane Season 2020
« on: April 01, 2020, 04:28:10 AM »
Quote
Abnormally warm Gulf of Mexico could intensify the upcoming tornado and hurricane seasons

Water temperatures in the Gulf of Mexico are running more than three degrees above average, increasing the prospects for severe thunderstorms and tornadoes this spring and potentially stronger hurricane activity in the summer and fall.

The last time Gulf of Mexico waters were similarly warm in 2017, it coincided with an above-average tornado season through the spring, and then Category 4 Hurricane Harvey struck the Texas Gulf Coast at the end of summer.
Quote
The bottom line

While it is too early to predict any specific events, the presence of abnormally warm water in the Gulf of Mexico does make certain events more likely to occur and/or become more intense than they would have been otherwise. Individual events — including particular severe weather outbreaks and the specific implications for hurricane season — can’t be predicted yet.
https://www.washingtonpost.com/weather/2020/03/31/gulf-of-mexico-warm-tornadoes-hurricanes/?itid=hp_hp-more-top-stories-2_warmgulf-145pm%3Ahomepage%2Fstory-ans
By Matthew Cappucci
March 31 at 2:13 PM

5
Consequences / Re: COVID-19
« on: March 29, 2020, 10:39:59 AM »
https://texags.com/forums/84/topics/3102444

Clinical Pearls Covid 19 for ER practitioners

Quote
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.

Diagnostic
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.

Disposition
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.

Treatment
Supportive

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 Texags.com 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.

Sincerely,

NawlinsAg

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

6
Consequences / Re: COVID-19
« on: March 29, 2020, 12:53:35 AM »
Correlation between universal BCG vaccination policy and reduced morbidity and mortality for COVID-19: an epidemiological study

Source: https://www.medrxiv.org/content/10.1101/2020.03.24.20042937v1

Quote
COVID-19 has spread to most countries in the world. Puzzlingly, the impact of the disease is different in different countries. These differences are attributed to differences in cultural norms, mitigation efforts, and health infrastructure. Here we propose that national differences in COVID-19 impact could be partially explained by the different national policies respect to Bacillus Calmette-Guerin (BCG) childhood vaccination. BCG vaccination has been reported to offer broad protection to respiratory infections. We compared large number of countries BCG vaccination policies with the morbidity and mortality for COVID-19. We found that countries without universal policies of BCG vaccination (Italy, Nederland, USA) have been more severely affected compared to countries with universal and long-standing BCG policies

7
Consequences / Re: COVID-19
« on: March 29, 2020, 12:44:52 AM »
A different way to visualize covid evolution per country, and to discriminate clearly which countries have been successful so far


8
Consequences / Re: COVID-19
« on: March 28, 2020, 02:37:18 PM »
First numbers comparing normal death in this time of the year with the impact of the virus. In Spain.
Translated with Deepl from "eldiario.es"

The impact on lives and health of the coronavirus epidemic in Spain is very high and has not yet abated. Although the speed of death has slowed in all communities, this Saturday reached the 5,690 official deaths by adding 832 in 24 hours. The COVID-19 has been felt very strongly and has almost doubled the usual mortality in many areas of Spain such as Castilla y León, Castilla-La Mancha, Madrid, Aragón or Navarra. On a national level, the excess of deaths over the historical series between 21 and 25 March was 16.7%, according to the latest report published by the Carlos III Institute of Health.

On those days, the expected deaths in Spain (obtained from historical averages based on the mortality observed on 1 January 2008) were 5,661. Deaths from all causes: the observation does not distinguish between causes as it is based on data submitted by 3,900 civil registries. Those finally observed reached 6,609, an excess of 948. However, the panorama is very different according to Autonomous Community. There were "excess deaths" in Aragón, Castilla y León, Castilla-La Mancha, Catalunya, Comunitat Valenciana, Comunidad de Madrid and Navarra according to the situation report of 26 March 2020.

The two castes are the ones that have suffered an acceleration in mortality. Both exceed 93% excess. In Castile and Leon, the statistics estimated that 498 deaths could be expected from 18 to 25 March and 964 were observed. In Castile-La Mancha (between the 15th and 25th of this month) there were 1,137 real deaths compared to the average of 558. Another aspect that points to the effect of the COVID-19 is that the groups most affected by the increase in mortality were men (with more than 100% excess) and the ages of over 74 in Castile and Leon and 65 to 74 in Castile-La Mancha, which more than doubled the volume of deaths. According to studies carried out since the first outbreak in Wuhan (China), men and the elderly are the group with the worst diagnosis of infection.

In Aragon, from March 23rd to 25th, according to the Carlos III Institute of Health, the excess reached 75% and the group with the worst unemployment was that of 65 to 74 years of age, which long doubled its mortality: from 12 estimated to 25 reais. In the Autonomous Community of Navarre, it jumped from a historical estimate of 48 deaths to the 90 recorded. Once again, the age between 65-74 years saw a rise of 133% (from 6 to 14) and that of over 74 years of 97%: 70 deaths as opposed to the average of 36.

However, in the epicenter of the epidemic in Spain, the Community of Madrid, the data are much more behind. The system has detected an excess mortality between 10 and 17 March of 71%: 1,548 deaths compared to the 904 expected.

The Daily Mortality Surveillance (MoMo) system applies to all causes of death and in providing the results it does not specify whether the deceased had been included in the official coronavirus count, which only feeds into records where a case has been confirmed by a test as positive for COVID-19. That is, there may be deaths of patients with coronavirus that are not officially attributed to that statistic.

In addition, the report details that "at present we observe a delay in the notification of deaths in the civil registries of several autonomous communities, being notable in Galicia, Community of Madrid and La Rioja".

9
Consequences / Re: COVID-19
« on: March 25, 2020, 07:56:06 AM »
As to the "mystery" of the comparatively low death rate in Germany, this source maintains that a good part of that is due to deficiencies in the German system of issuing death certificates. Translated with Google Translate:

Quote
Since the doctors who issue the death certificates do not have a coronavirus test to check whether the virus is the cause of death, the number of victims of the coronavirus is systematically underestimated in Germany. Contradictions with the data from other countries, the poor quality of the death certificates and the reports of doctors from the coronavirus hotspots in North Rhine-Westphalia suggest that the German data on deaths are systematically distorted. There is reason to believe that the actual death toll is higher and the true extent worse than reported. It cannot be excluded that the number of unreported cases is several times higher than the figures reported by the authorities.

Signs of these errors result in part from the comparison of international statistics, in which the proportion of deaths among the diagnosed cases is many times higher in all other countries than in Germany, the well-documented errors in the issue of death certificates in Germany and the absence of post mortem tests in some or all of the German federal states.

(...)

The head of the Robert Koch Institute, Lothar Wieler said today in a press conference on March 20: "We are at the beginning of an epidemic. We count as corona dead people who have been diagnosed with a corona infection." However, the proof of a corona infection requires the collection of evidence. In Germany, the deceased are not tested for corona. In Italy, since February 20, there has been a requirement to test every deceased person. A doctor on call from a focal point in North Rhine-Westphalia, who currently issues death certificates every day, reports that he has no test kits, would not receive them and could not make any compromises. Therefore, he could only deduce whether someone had died of the virus, which would not be possible. Despite all the relevant symptoms that the caregiver would report upon request, no one would have considered the possibility that the virus would have caused death. Neither the body nor the caregivers would have been tested. Unfortunately, the case would be typical. As long as the deceased are not tested in Germany, we have to assume that there will be significant numbers. Accordingly, the statistics confuse the population and decision-makers, who have been late in making the necessary decisions for three months. In addition, there are the problems with death certificates, which should document and document the causes of death.

The quality of death certificates is a notorious weak point in the German health care system. The Bonn General Anzeiger reported in 2017 a study by the Institute of Forensic Medicine at the University of Rostock in which 10,000 death certificates were examined. Only 223 death certificates were issued without errors. There were over 3,000 serious and 35,000 minor errors. A natural cause of death was erroneously found in 44 cases. So the fact is that doctors in Germany are unable to correctly document the causes of death. (...)

http://www.politplag.de/?fbclid=IwAR1hxNVX1yO63FD_eZF_g0SFZIT6QNJt6Ti7lnbDsvE5b9XpeyfI3GXtFAc

10
Consequences / Re: COVID-19
« on: March 24, 2020, 02:04:21 AM »
Maybe not necessarily infectious at 17 days, but honestly, not a development I want to see.

https://www.cnbc.com/amp/2020/03/23/cdc-coronavirus-survived-in-princess-cruise-cabins-up-to-17-days-after-passengers-left.html?__twitter_impression=true


CDC says coronavirus survived in Princess Cruise ship cabins for up to 17 days after passengers left

The coronavirus survived for up to 17 days aboard the Diamond Princess cruise ship, living far longer on surfaces than previous research has shown, according to new data published Monday by the Centers for Disease Control and Prevention.

...

The virus "was identified on a variety of surfaces in cabins of both symptomatic and asymptomatic infected passengers up to 17 days after cabins were vacated on the Diamond Princess but before disinfection procedures had been conducted," the researchers wrote, adding that the finding doesn't necessarily mean the virus spread by surface.

11
Consequences / Re: COVID-19
« on: March 23, 2020, 06:31:26 PM »
“All of humanity's problems stem from man's inability to sit quietly in a room alone.”
~ Blaise Pascal

https://twitter.com/holdengraber/status/1238983089805651974

12
Consequences / Re: COVID-19
« on: March 23, 2020, 03:41:37 PM »
Dear Neven, Maybe it’s not specifically addressed to me but I would like to offer some protest to the pandemic porn label. I didn’t much like the doomer porn label that was thrown around in the past as some of us here talked about radical independence, simplicity , frugality and walking back from the eternal promises made by civilization and green BAU advocates.
 I don’t throw insults around the Tesla tread and those enamored with perpetual technological progress at any price . But I believe that progress has resulted in many of the shitty food options, the unaffordable medical system ( here in US ), inequity , endless motoring and collapse of independent farms. Some things you fight directly and other things you can best fight by disengagement . When  the doomer porn label was applied I tried to argue that all of the small is beautiful options also result in less CO2 emissions. I can’t argue the the pandemic will result in less CO2 because it sounds callus but at this point disease, hunger, war , and death are the time tested mechanisms nature has to deal with one species consumed with it’s importance.  I would prefer to bet on what nature has to offer rather than with those options that separate us from it. And yes accept the results as earth trying it’s best to survive us. 
 When my opinion detracts from this forum please disinvite me. Insulting each other does make the forum more typical of other online conversations. Pandemic porn, or doomer porn are insults .

13
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.....

https://covidactnow.org/

14
Consequences / Re: COVID-19
« on: March 22, 2020, 12:58:29 PM »
Should this post be titled..

"nature abhors a vacuum...."
or
"when we are not there....."
or
"“life tends will find a way.”


https://www.theguardian.com/world/2020/mar/22/animals-cities-coronavirus-lockdowns-deer-raccoons
Emboldened wild animals venture into locked-down cities worldwide

15
Consequences / Re: Global recession
« on: March 21, 2020, 07:48:38 PM »
Maybe it is insensitive to point out that the 2008 economic fiasco was the only downturn in CO2 emissions we have collectively contributed to. Maybe the people flying to Italy to go skiing isn’t an
expense / luxury that we should rationalize because it “helps the economy” ? There are lots of other examples of wanton waste we call our economy and yes it keeps the wheels turning and we can afford healthcare, a big military, and massive government infrastructure because living large, and betting the market  are all we got to maintain BAU. Betting that the world actually fixes it’s CO2 issues while maintaining our extravagant lifestyles is fantasy thinking.
 I know Ed mountain means well and everyone else in society who performs anything as critical as healthcare deserves lots and lots of respect right now . I also think the third world  already suffers under the problems edmountain is trying to save the rest of us from. The poor weren’t flying viruses around the world to spread them, they largely haven’t been responsible  for the CO2 habit we promote and their lives will not change as much as ours in the aftermath of this pandemic. So maybe being poor is better in some ways ?  That is somethings may be good for you even if they don’t feel that way.

16
Consequences / Re: COVID-19
« on: March 21, 2020, 01:54:59 AM »
Over the past 20 days, the growth rate in the confirmed case count in the United States has been steady at 1.323x/day.

That equates to a 2.47 day doubling time, and an R0 of about 8.16.

Several States locked down (somewhat) in the last two days. It takes 5-7 days for symptoms to show. It takes 1-3 days to decide to seek help. It takes 2-4 days to get a test (if you can get one). And it takes 1-2 days to get the results. That is a lead time from infection to counting of about 9-16 days - most likely 12-13 days.

So, we will not see the growth slow down at all for at least 9-10 days, probably a bit more. That may reduce the growth to 1.25x/day for the next week. In 4-5 days as the counts rise we should see a national quarantine.

The blob in office said today he cannot foresee any case that would justify that. Usually when he says something like that he has to reverse himself within 4-5 days, then claim he saw it coming long ago.

So with counts today at 19,302 (provisional - they will go 7.5% higher). Using the above scenario then, we are likely to see: (increase all of these by a factor of 1.075 to account for the undercounting for today.)

3/20   19,032
3/21   25,179
3/22   33,312
3/23   44,072
3/24   58,307
3/25   77,141
3/26  102,057
3/27  135,022
3/28  178,634
3/29  236,332
3/30  312,668
3/31  390,834
4/1    488,543
4/2    610,679
4/3    763,349
4/4    954,186

That puts the likely confirmed count in the US over 1,000,000 on April 4, and over half a million on April Fool's day.

It is pointless to speculate at all beyond this as the count changes over the next week will result in life altering changes in the body politic of the United States. None of these numbers are meaningful. They are a foreboding of what may come based on the inaction or grossly inadequate actions taken to date.

I understand from friends in California that there is wide spread violation of the stay home rule there. When the count exceeds the magic 50k number in about 4 days, there should be major changes in people's thinking. But with a 10 day lag between infection and the confirmed numbers, that is meaningless in its impact for a week and a half. So the 1,000,000 person confirmed infection milestone is probably baked in already sometime between April 1 to April 11.

By then all hospital beds will have long ago been filled and the hospitals will be overrun.

Sam

Post script: In 5-6 days we will pass China in total confirmed infected persons and we won't even slow down as we go screaming past. 

Also, using current numbers - divide the above by about 72 to get an idea of the deaths. Using the Chinese experience, divide by 43 to get the estimatd death count.

17
Consequences / Re: COVID-19
« on: March 21, 2020, 12:09:36 AM »
I am stuck at home for the duration with a phone & a laptop that are only sometimes talking to the internet. So what to do? Start with looking at the damn thing that has imprisoned me  -  Covid-19.

Source of data - https://www.worldometers.info/coronavirus/
Overall world totals only to begin with.  3 graphs & one table attached.

Notes
- When looking at the data perhaps one should say February is mainly China, and March is Rest of World, especially Europe now.
- About a week ago the scientists told us in the UK that the recorded data was probably an rder of magnitude more than the identified cases. A lot to do with a lack of testing. Testing has increased by a lot everywhere, but so has the spread.
So how many times more than the current recorded cases of 274,600 is the true figure ?
- the percentage of deaths has risen in March ***
        -  from 6% to 11% of cases discharged,
        -  from 3.4% to 4.1% of all cases recorded.
- the trend lines suggest a minimum of recorded cases of at least 500,000  and of deaths at least 30,000 by the end of this month. Even I don't dare look further than that.
- UK testing, though greatly deficient has increased greatly. Unfortunately the number of cases found is increasing at a greater rate than the increase in testing. This may apply elsewhere.

- For a second day China has said no new homegrown cases. The scientists say that as there is no immunity to this new virus, the entire population is vulnerable. How can China have wiped out the virus?

18
Consequences / Re: COVID-19
« on: March 20, 2020, 12:29:15 AM »
Big news story today.

https://www.cnn.com/2020/03/19/us/fastest-supercomputer-coronavirus-scn-trnd/index.html

DOE ran the COVID spike protein against existing drugs and substances to see what might best bind it. The thing that popped out to me was three natural substances - all easily available at local health stores. Luteolin, Quercitin and Yerba Santa may be effective against COVID. There are also a wide array of existing pharmaceuticals that might ligate it as well.

Here is the paper: Rev. 4
https://s3-eu-west-1.amazonaws.com/itempdf74155353254prod/11871402/Repurposing_Therapeutics_for_COVID-19__Supercomputer-Based_Docking_to_the_SARS-CoV-2_Viral_Spike_Protein_and_Viral_Spike_v4.pdf

Here is the main entry for updated versions:
https://chemrxiv.org/articles/Repurposing_Therapeutics_for_the_Wuhan_Coronavirus_nCov-2019_Supercomputer-Based_Docking_to_the_Viral_S_Protein_and_Human_ACE2_Interface/11871402/4

Sam

19
Consequences / Re: COVID-19
« on: March 18, 2020, 12:30:51 PM »
Here’s some very close to home anecdotal evidence of how the current UK strategy is playing out on the ground.

One of my nine year old granddaughter’s classmates went skiing with her family over half term in Northern Italy though not near the Covid-19 hotspots.

On return she developed mild symptoms of an upper respiratory infection, went back to school for a day and was subsequently withdrawn by her parents - her mother is a doctor.

Since then a number of the poorly child’s classmates have suffered from similar symptoms. As of yesterday a total of 8 were absent from school plus a teacher whose daughter is in the affected class. This morning the teacher of the affected class reported sick.

This outbreak commenced very shortly after completion of a 14 day period from when the family flew back from Italy but the folk involved are understandably very nervous.

The medically qualified mother requested that Coronavirus tests should be carried out but this was denied because the 14 day period had elapsed which is unbelievable given the potential of this cluster to spread. The test anyway would have taken up to 4 days to complete.

We’re told that our current strategy should be science led. In this case, the science clearly indicates that virus shedding beyond 14 days is rare but it has been observed.

My fingers are firmly crossed that this is simply a standard school-related infection but if that should prove not to be the case then we will shortly be facing a major outbreak of coronavirus in a small semi-rural village where the school is at the heart of the community.

This situation illustrates exactly why the WHO’s mantra is Test, test, test. In the U.K. we currently have absolutely no idea how many people are self isolating with symptoms (or not!), having first established new disease clusters in just this way.

We really are getting this very, very wrong on testing and we’ll pay a high price for our failure to follow the WHO advice.

Keep safe all!

20
Consequences / Re: COVID-19
« on: March 16, 2020, 05:06:21 PM »

...

U.S. May Need 6-8 Weeks to Get Over the Worst (7:30 a.m. NY)
https://www.msn.com/en-us/finance/markets/health-agency-hit-by-cyber-attack-airline-warning-virus-update/ar-BB11e57K

U.S. Surgeon General Jerome Adams says the nation may need six to eight weeks to get over the majority of coronavirus-related pain, if the situation develops as it did in China and South Korea.

Adams, speaking on Fox News, acknowledged there is a chance the U.S. does worse than South Korea, and that the situation could get as bad as in Italy.

...
Given that testing in the US has been so badly botched they will be extremely lucky to get an outcome anywhere near that of China or South Korea. Based on deaths, which are presumably easier to track than cases, it seems likely that the current number of cases in the US is at least the same as South Korea, i.e. around 8,000. Frankly, even that may be an underestimate: it's possible people have died in the US without having been tested so the actual number of deaths could be even higher.

21
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.

23
Consequences / Re: COVID-19
« on: March 13, 2020, 11:14:56 PM »
I believe it because I've read it in many places and it makes sense.


24
Consequences / Re: COVID-19
« on: March 13, 2020, 09:29:40 PM »
I would like to give a bump to the article A-Team posted , a blog from a Wuhan Dr.   beautiful, sad,
and the good fight.

https://scienceintegritydigest.com/2020/03/11/dr-ai-fen-the-wuhan-whistle/
 
We have one grandson, an EMT in San Jose. He caught something a couple weeks ago and ran a fever, negative for strep and flu. Sent home , no Covid test. Recovered , back to work , and has transported a Cov-19 patient this week. Santa Clara county where he works is the hot spot for Calif.  It would be good to have an antibody test for Covid-19 so that those on the tip of the spear might know their personal risk, even if only for some peace of mind.

because, I went to visit the doctor today. I wore a mask. I had isopropyl handwipes in the car.
When I got home I put the r-95 mask in a bag and dated it so after a couple weeks I can reuse it. I washed my hands and changed clothes . Bagged clothes also.  If there were cases locally I would shower and will add that to my regimen when ever I leave the farm and return home.  Re. arrhythmia. Luckily after thirty years of occasional bouts I have a drug that gets me “reset” quickly.   

25
Consequences / Re: COVID-19
« on: March 10, 2020, 11:46:04 PM »
US of A

A study (not yet peer-reviewed) that suggests the number of cases in the US are probably many more than those being recorded.

All the US needs now is a President and Vice-President willing to be led by the science & act accordingly.

https://www.sciencedaily.com/releases/2020/03/200309110456.htm
COVID-19 infections in U.S. may be much higher, new estimates show
Quote
But even moderate interventions can help reduce spread, according to study
Date:
March 9, 2020
Source:
Cedars-Sinai Medical Center

Summary:
By March 1, 2020, thousands of people in the U.S. may have already been infected by the COVID-19 coronavirus, far more than the number that had been publicly reported, according to a new study. However, the findings also suggest that even moderately effective interventions to reduce transmission can have a significant impact on the scale of the epidemic, the authors say.


By March 1, 2020, between 1,043 and 9,484 people in the U.S. may have already been infected by the COVID-19 coronavirus, far more than the number that had been publicly reported, according to a new Cedars-Sinai study.

"This suggests that the opportunity window to contain the epidemic of COVID-19 in its early stage is closing," the researchers stated in their paper, which is posted online on a forum where physicians and researchers share information.

The range of possible patients is significantly higher than the number of confirmed and presumptive U.S. cases reported by the federal Centers for Disease Control and Prevention, which stood at 164 as of March 7. Some news media on March 8 were reporting more than 500 total cases. [Editor's note: as of its March 9 update, the CDC put the total number of COVID-19 cases in the U.S. at 423, including both confirmed and presumptive positive cases.]

Cedars-Sinai investigators, who led the study, said they chose "very conservative" methods to estimate the number of coronavirus cases. "This makes our current estimation likely to be an underestimation of the true number of infected individuals in the U.S.," they wrote.

Shlomo Melmed, MB, ChB, executive vice president of Academic Affairs and dean of the medical faculty at Cedars-Sinai, added: "Cedars-Sinai is committed to the global efforts to combat COVID-19 and we believe that early dissemination of this study and the free sharing of the code that underlies the model will help in those efforts."

To arrive at infection estimates for their new study, the researchers modeled only COVID-19 coronavirus cases "imported" directly to the U.S. from the area of Wuhan, China, before Jan. 23, when the Chinese government locked down the city, and they assumed the lockdown stopped all outbound traffic. Potential cases arriving in the U.S. from other parts of China, or other heavily affected countries such as South Korea, Italy or Iran, were not included in the estimate.

The scale of the COVID-19 epidemic in the U.S. was calculated based on: air traffic data between Wuhan and the U.S., totals of confirmed cases publicly released by the CDC and transmission dynamics as estimated from previous research. The study took into account the identification and quarantine of individual domestic cases in the U.S. Among other considerations, the research team assumed the imported cases were no longer spreading infection.

Based on all these assumptions and methods, the investigators estimated the total number of people in the U.S. infected with coronavirus as of March 1 to be between 1,043 and 9,484. The first figure assumed current preventive procedures -- such as quarantines and screening international travelers at airports -- had reduced as much as 25% of the transmissibility in unidentified cases. The second figure assumed no intervention procedures had been undertaken to reduce the transmissibility.

The disparity between the lowest and highest estimates has important implications for controlling the COVID-19 epidemic, said Dermot P. McGovern, MD, PhD, professor of Medicine and Biomedical Sciences at Cedars-Sinai and senior author of the new study.

"Our model suggests that even moderately effective population interventions to reduce transmission can have a profound impact on the scale of the epidemic," McGovern explained. "This finding supports the role of public health interventions in controlling this disease."

But slowing transmission is not an easy task, given that most COVID-19 cases appear to be mild or even asymptomatic, the researchers noted, which can make it difficult to identify infected individuals who may be spreading the virus.

Dalin Li, PhD, the new study's first author and co-corresponding author with McGovern, said the research team is releasing the just-completed study data online before the full study has been accepted in a journal due to the urgency of the COVID-19 outbreak.

"We are making the results public before peer review as it will be important for timely and informed public health decision-making. We are also making the model available to the research community so that others can build upon it." said Li, a research scientist in the Inflammatory Bowel and Immunobiology Research Institute.

The other co-authors of the study were Jonathan Braun, MD, PhD, professor of Medicine, and research operations associate Gregory Botwin from the Inflammatory Bowel and Immunobiology Research Institute at Cedars-Sinai; and Jun Lv, Weihua Cao and Liming Li, all from Peking University Health Science Center in Beijing.

Funding: Research reported in this publication was supported by the National Institutes of Health, the Helmsley Charitable Trust and the F. Widjaja Foundation.

26
Consequences / Re: COVID-19
« on: March 10, 2020, 11:11:08 PM »
According to the liar mike Pence there are a million tests available. At the same time, the healthcare workers are the Life Care facilities with symptoms are still waiting for tests.

They will keep the ruse going. They will keep not testing. At this point, I'm convinced they are somehow botching post mortems to hide coronavirus deaths as unknown deaths.

27
Consequences / Re: COVID-19
« on: March 09, 2020, 09:34:32 PM »
Talk about very quick KARMA

Quote
Florida congressman says he came into contact with coronavirus patient
From CNN White House team

Rep. Matt Gaetz, who just returned to Washington from Florida traveling aboard Air Force One with President Trump, just tweeted that he "was informed today that he came into contact with a CPAC attendee 11 days ago who tested positive for COVID-19."

In a series of tweets, Gaetz's official account said, "While the Congressman is not experiencing symptoms, he received testing today and expects results soon. Under doctor's usual precautionary recommendations, he'll remain self-quarantined until the 14-day period expires this week."

And Gaetz's accounted also noted that his Washington office will be closed during this time. His Pensacola office will stay open.

Pool reporters also traveling aboard the presidential aircraft said they saw Gaetz disembarking from a separate entrance to the plane than the President, which is customary for most travelers aside from the President and his tight entourage. 

CNN has asked the White House for reaction to the announcement. 

This was the same congressman that wore a gas mask to the voting of the COVID-19 funding bill.


28
Consequences / Re: COVID-19
« on: March 09, 2020, 09:18:59 PM »
Archimid, I saw this article in reddit that reminded me of the Dr. Christian Salaroli quoted in the Brussels Times article you linked . Also in Corriera Della Serra newspaper.

https://www.reddit.com/r/medicine/comments/ff8hns/testimony_of_a_surgeon_working_in_bergamo_in_the/





29
Consequences / Re: COVID-19
« on: March 08, 2020, 11:45:36 AM »
Here in the UK that 'lower 1/3rd of society (that aided in securing us Brexshyte and johnson?) are now abroad without the MSM shrieking at them as to how best to progress so we now appear likely to see them at their 'Dunning/Kruger' best?

When they are no longer of use to'The Establishment' then the very folk that should be taking their time with them to make sure 'The Penny Drops' for them (and that they know how to act as 'Team Players' over the crisis?) will just desert them and leave them to their own designs........

Every 'rumour' of shortages will see them out and about 'hoovering up' every last item of said 'scarcity' leaving nothing for the rest....

They will, of course, forget who has been handling those products prior to them grabbing them....or to wash up B4 they next 'Face Touch'....

Keep well clear of 'Wetherspoons' for the next period eh?

30
Consequences / Re: COVID-19
« on: March 07, 2020, 09:53:37 PM »
Saw this on reddit, with a source. Seems like a plausible explanation for the low South Korean CFR.

Quote
Absolutely. Demographics are critical when discussing the fatality rate. If you're interested, here's a comment I made about the outbreak in South Korea:

The current fatality rate in Korea is 0.65%. Some important information to better understand why this may be:

The below applies to Daegu (the epicenter of the outbreak, representing about 4/5 of all cases in SK) only.

Of those infected, 38.0% are in their 20s. This is a reflection of the younger demographic of the Shincheonji cult.

13.7% are in their 40s, and 18.3% are in their 50s

only 6% of the infected are 70+

for reference, here is the age distribution of South Korea

2/3 of the infected are women

3/4 of the infected in Daegu are from the Shincheonji cult.

1760 are hospitalized

Over 90% of cases are unresolved at this time.

Overall, this provides a possible explanation for the relatively low mortality rate we've seen from Korea thus far. According to worldometers, women are less likely to die from COVID-19, likely correlating with a lower prevalence of vascular conditions and smoking history.

https://blog.naver.com/daegu_news/221840129905

31
Consequences / Re: COVID-19
« on: March 05, 2020, 10:38:23 PM »
It seems the two variant thing might not be relevant.

Response to “On the origin and continuing evolution of SARS-CoV-2”


http://virological.org/t/response-to-on-the-origin-and-continuing-evolution-of-sars-cov-2/418

Quote
An analysis of genetic data from the ongoing COVID-19 outbreak was recently published in the journal National Science Review by Tang et al. (2020) 35. Two of the key claims made by this paper appear to have been reached by misunderstanding and over-interpretation of the SARS-CoV-2 data, with an additional analysis suffering from methodological limitations.

32
Consequences / Re: COVID-19
« on: March 05, 2020, 05:12:34 PM »
Not sure this resource has been mentioned yet, re. the discussion of different strains. Too many posts to follow them all.

https://nextstrain.org/ncov?

The site provides an interactive phylogenetic tree which can be filtered by date/location.

"This phylogeny shows evolutionary relationships of HCoV-19 viruses from the ongoing novel coronavirus COVID-19 pandemic. All samples are still closely related with few mutations relative to a common ancestor, suggesting a shared common ancestor some time in Nov-Dec 2019. This indicates an initial human infection in Nov-Dec 2019 followed by sustained human-to-human transmission leading to sampled infections."

As I write, 166 different genomes have been sampled ...

33
Consequences / Re: COVID-19
« on: March 05, 2020, 01:54:55 PM »
Continued a bit....leaving out some of the things talked here and elsewhere.

While CoV-2 isn't the only virus capable of inducing viral pneumonia, that is, a lysis of epithelial cells with associated leaks of bodily fluids into lungs, it is the most severe widely spread causative agent. Being a member of Coronaviruses, it can and will surf on the cell membranes until it finds it's entry point to the cells on mucous membranes likely undetected by the immune system. Normally, the body learns to attack these sorts of viruses early with immunization. Being a completely new virus on widespread areas CoV-2 gets past most of early defenses in a body. The widespread breach of the membrane by the virus generates a general alarm of the immune system, which may result in a septic shock and death. Pneumonias are usually more hazardous to older people, their body has fought against so many respiratory infections the response of their immune system is large.
Treatment of viral pneumonias is largely symptomatic in later stages, some antivirals work on specific viruses, the death rates have been steadily dropping f.e. in influenza-induced viral pneumonia.

However, reports of successfully treating CoV-2 pneumonia with antivirals are few. Pneumonic patients may find it easier to lie face down, however air ducts must not be obstructed, as one effect of the destruction of lung epithelial cells is reduced air intake. On mild cases, pain killers off the shelf and medication dropping the patients temperature, are possibly sufficient. Survivors state the 2-3 weeks it takes for a properly functioning immune system to combat this have been "the worst of their life". To be sure of not passing this spreading it's probably wise to self-isolate even after getting out of the sickbed, there's been talk of relapses back to sickness.

Nasty stuff. Expecting pretty sickly spring and summer here as well, though there's been (yet) only 7 confirmed cases in the country.

34
Consequences / Re: COVID-19
« on: March 03, 2020, 03:28:11 PM »

35
Consequences / Re: COVID-19
« on: March 03, 2020, 07:59:00 AM »
Coronavirus: just eight out of 1,600 doctors in poll say NHS is ready

Doctors raise concern over already high demand and lack of resources in health service

https://www.theguardian.com/society/2020/mar/02/coronavirus-just-eight-out-of-1600-doctors-in-poll-say-nhs-is-ready
  by Denis Campbell, Health policy editor


More than 99% of 1,618 NHS medics questioned appear not to agree with the assurances given by Boris Johnson that the service will cope if it is hit by a surge in the number of people falling ill.

“The truth is the NHS has already been brought to its knees and many doctors fear that our health system simply won’t cope in the event of influx of coronavirus patients.

“With nearly 10,000 doctor vacancies and 43,000 nurse vacancies [in the NHS in England] the NHS is already understaffed to deal with demand. A&E waiting times are the worst on record. Intensive care units are at capacity and are even struggling to admit patients who are critically unwell or awaiting cancer surgery.”


[Prime Minister] Johnson said: “I think the crucial thing for the public to understand is coronavirus is of concern, it is a novel illness, but it’s something this country really amply has the resources to deal with.

“We have state-of-the-art testing facilities, we have a fantastic NHS. We will have to get through this, but believe me we are going to beat it.”


The main concerns doctors highlighted in the survey were:

  • The NHS is already struggling to meet the existing need for care and so would not be able to cope with a sudden large increase in demand linked to Covid-19.
  • Hospitals have too few intensive care and high-dependency care beds, those units are understaffed and there are no plans to expand such facilities.
  • GP practices do not have enough appointments to ensure that patients can be seen quickly.
  • Some hospitals are lacking basic equipment including face masks.
  • NHS 111 is still telling some people who appear to have symptoms o Covid-19 to go to A&E or an urgent care centre, even though official advice warns against anyone with suspected coronavirus going to A&E or a GP practice.
Parmar said doctors had been “shouting this from the rooftops for some time”.

36
Consequences / Re: COVID-19
« on: March 03, 2020, 07:50:37 AM »
Wealthy turning to private jets to escape coronavirus outbreak

Firm reports rise in rich families and multinationals booking flights to lower risks

https://www.theguardian.com/business/2020/mar/02/wealthy-private-jets-escape-coronavirus-outbreak
  by Rupert Neate, Wealth correspondent


Big businesses and wealthy people are chartering private jets for “evacuation flights” out of countries hit by the coronavirus outbreak.

Twidell said rich families were also chartering private jets to reduce the risk of exposing their families to the virus by avoiding commercial flights and busy airports.

“Over the past few weeks, there’s undoubtedly been a rise in demand for short notice on-demand charter relating to the coronavirus Covid-19,” he said. “We’ve had a very significant number of inquiries for group evacuations and from corporates and individuals.

“Initially, inquiries were focused on evacuations from south-east Asia and other affected areas. But, increasingly, we are now seeing clients looking to take a private flight between a variety of global destinations, to avoid exposure to crowds in [commercial] cabins and airport terminals.

“In many cases, these are passengers who don’t usually fly by private aviation but are looking to protect themselves, their families and employees.”

The number of private jet flights from Hong Kong to Australia and North America in January jumped 214%, compared with the previous year, according to data from the business aviation monitoring company WingX.

37
Consequences / Re: Global recession
« on: March 01, 2020, 03:13:01 AM »
Just an update of anecdotal evidence from my wife who admins a warehouse for a large retail company in Australia.
They have had no incoming containers from China for ten days.
The supplies in the large warehouse have basically come to a standstill which means the stores will be running out of stock in the coming few weeks..... there is no sign of containers coming into the warehouse in the coming week.
I got bored so I went shopping in the retail store and they look light on stock (I use to manage large format retail stores so I see these things easier than most).
I then walked the competitors and saw similar results.
Australia clearly relies on China a lot for retail stock.
I went to the supermarket and see slight signs of stocks getting low, but nothing drastic there.

Anyway, since my old computer decided to die today, I had to buy a new one (this is coming from my brand spanking new comp). The first one I wanted had no stock, same with the second one and I finally got a stocked item on the fourth attempt.
I felt for the sales person as he was dancing around the supply situation..... just for fun I asked for other computers just to get a gauge on supplies in general and found that over half the computers they sell are out of stock company wide.

While this is anecdotal, I am not surprised.
It also means that there are several companies in the coming months that are going to become bankrupt because of no stock unless something fast happens concerning supply chains.

I am not personally over-stressed about the virus (barring my wife who is extremely susceptible to lung infections) but this supply chain breakdown is a concern and rates as my thing to worry about the most this year.

This year is going to become historically significant.

38
Consequences / Re: COVID-19
« on: February 29, 2020, 02:16:28 PM »
...
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.

State-level responses in the US will be good in many cases, poor in others.  The Federal level response has been anemic to date, except for promptly making military bases available for quarantine.  Rolling out testing capacity has been a fustercluck.  Fauci at NIH is a great communicator for guiding a national response, but he's been muzzled.  The CDC badly stumbled on basics when Ebola came to these shores, and it's stumbling badly now.

The CDC has had weeks to get testing capacity ramped up, and it's shown an inability to act boldly and quickly.

There's no indication that any agency is acting to mass produce antiviral medications that have shown efficacy in China.  There's talk of starting up a clinical trial that will take months to complete, for a patented investigational drug.  Moronic.  Exponential spread will make that timeline nearly useless.  They're planning to build a barn door as the cow is walking out of sight.

With contact tracing and standard quarantine rapidly becoming useless, the next major strategy  to use is for everyone to stay home, if they don't have a compelling need to go out.  The US doesn't have the necessary safety nets to allow very many people to stay home.

People simply staying home means an instant economic recession.  Sadly, our Dear Leader fears a bad economy more than he fears a million deaths.  Things will not go well here in the US.

39
Consequences / Re: COVID-19
« on: February 27, 2020, 10:20:46 PM »
The remainder based on the data we have suggests a ~5.5% death rate.
Sam
Where does this ~5.5% death rate come from?

Let's take the most recent data from China (mostly - yesterday's data).

As of 2020-02-27 07:11 National Statistics
the data shows
Change data from yesterday: data to be released by the National Health Commission

42,968 Existing Diagnosis
  2,358 Suspected
  8,346 Existing Severe
78,631 Cumulative Diagnosis
  2,747 Cumulative Deaths
32,916 Cumulative Healing

Particularly look at the last three numbers Cumulative Diagnoses, Deaths and Healing. We know that it takes time from confirmation to death and longer from death to recovery. In the cumulative data, much of that cycle is now complete. Those cohorts in time were confirmed and either died or recovered.

The cohorts closer to the present in time are as yet incomplete. The death count is incomplete. And the recovery count is even more incomplete.

Let's now look at two ratios.

1) The ratio of deaths to confirmed cases. These are the numbers that epidemiologists use to calculate the case fatality rate. And so long as the recent cohorts represent a small fraction of the total cases, the CFR calculated will be close to the real rate. It will underestimate it to the degree that the newer cases dominate. As such, it sets a lower likely bound on the case fatality rate.

2) The ratio of deaths to deaths plus recoveries. As with the first case, this will be an estimate of the case fatality rate. It will be correct when all of the confirmed cases resolve as either deaths or recoveries. During an outbreak this will always be incomplete. As the data accumulates and the cohorts that have not fully resolved dwindle to being less important than the rest, the calculated case fatality rate will approach the true case fatality rate. However, since recoveries take longer than deaths, this will overstate the CFR.

We now have two ratios that in their limit will both equal the case fatality rate (unless there are errors in the data - which there almost always are). So the rate will be imprecise. Beyond that, the case fatality rate calculated is dependent on the population assessed and their peculiarities in age distribution, gender, health status, nutritional status, access to health care, quality of heath care, happenstance, genetics (both of the population and of the organism) and other issues. So the final rate though accurate for that population is only accurate for that population. It is just an indicator for others.

It gives us an indication about the disease that we can then use to begin to project (with care) to other circumstances.

In the case of the Chinese non-Hubei population, the genetics, health status, smoking rates, ... are likely comparable. And as a first order estimate can be taken as such. However, as others have pointed out, if there are demographic shifts, such as young people being recruited to an area (especially from other places), or the sick coming for care to central facilities, or ... these can be misleading. A second order estimate is needed that takes these and other factors into account. Mostly, a sanity check of the data may suggest when factors might exist that need to be found and resolved.

The non-Hubei data presents a conflict where the first order analysis would suggest that the CFRs should be the same as the Hubei rates. Yet, they are not. Why? Why not? This is where my description of other possible factors comes in to play.

For non-Chinese populations (non-Han Chinese even), this becomes more important. Whether Korean, Thai, Italian, Japanese or any other group, significant demographic factors are likely to be different. We cannot rely then on the CFR being the same.

In this case, age and gender are particularly important factors. So too are lifestyle conditions related to health status, diet, and other issues. As a zeroth order estimate we can use the Chinese data to suggest what we might expect to see in France for example. As a first order estimate, the data in France will tell us more. A second order estimate will refine that even further. In the data, France now shows to have a first order estimate of the CFR of about 11%. For small numbers, that is reasonably close to the Chinese experience. But it might not be. Caution is in order.

Using the Chinese data above, now let's see what they say about the CFR.

Case 1) deaths to confirmed cases.

2,747/78,631 = 3.49%

This is the low bound. The death count is not yet complete for those confirmed as infected. This under-estimates the CFR for this population.

Case 2) deaths to deaths plus recoveries.

2,747/(2,747 + 32,916) = 7.70%

This is the high bound. The death count is incomplete. The Recovery count is even more incomplete. This over-estimates the CFR for this population.

So, now we have 3.49% < CFR < 7.70%

We have no data to decide on which of these two bounds may be closer to the final value when the cases all resolve. And we may yet be missing data and populations. So there are caveats we have to consider. In particular, the population as a whole may and is even likely to self select that only those sufficiently ill seek health. Conversely, in other populations, we could have a case where those significantly ill avoid care believing that they will be ill treated or harmed. That should not be the case here.

Having no idea which bound is closer, we can 'guess' that these are both asymptotically approaching the final value. That might be the mean. It might also be a skewed distribution tending toward one bound or the other. A plot over time of both calculations and trending on those might clarify that and point to a better choice for the likely final value.

Lacking any of that, let's start with a simple arithmetic mean.

(3.49% + 7.70%) /2 = 5.6%

As a crude first order estimate it appears that the likely CFR for the population in China that goes to the hospital is about 5.6% +/- who knows how much error.

This was the origin of my previous 5.3%-5.5% band. It is looking to be a skosh or smidgeon higher. That might be simple meander in the data for a variety of reasons. It might also mean that the correct bound is skewed toward the high bound.  It might also be simple randomness. Only time will tell.

For now, and until we have more data, I am presuming that the CFR for those hospitalized is about 5.5%

Sam

40
Consequences / Re: COVID-19
« on: February 26, 2020, 06:34:36 AM »
This site has been mentioned previously, but this thread has grown quite a bit since then.  With the outbreak breaking to so many different countries, this page gives a great overview, with highlighted changes.  I believe it is updated 2x per day, might be more.
https://www.worldometers.info/coronavirus/#countries

41
Consequences / Re: COVID-19
« on: February 26, 2020, 12:59:49 AM »
How would my government respond if this virus spread across my country?

“For the United States, the answers are especially worrying because the government has intentionally rendered itself incapable. In 2018, the Trump administration fired the government’s entire pandemic response chain of command, including the White House management infrastructure.”


And has not replaced them.  Recently, the administration appointed a “coronavirus task force” — with members like climate-change denier Ken Cuccinelli, who had to turn to Twitter to try to obtain the most basic information on the outbreak.

Trump Has Sabotaged America’s Coronavirus Response
As it improvises its way through a public health crisis, the United States has never been less prepared for a pandemic.
https://foreignpolicy.com/2020/01/31/coronavirus-china-trump-united-states-public-health-emergency-response/

42
Consequences / Re: COVID-19
« on: February 25, 2020, 08:24:26 PM »
Dnem, Ten years directly and Indirectly
I have watched as aquatic plagues crashed multiple invertebrate stocks. The one thing that seems to be shared by these crashes has been stress. For the invertebrates it is heat and environmental stress that leads to disease outbreaks. Stress is what Iran has to deal with as we embargo the medicines and hospital equipment they need to fight this disease.  Stress on food resources is what the Horn of Africa has to deal with as the locusts swarm. Food shortages are an issue that will change the lethality of this disease even for the youth not now considered at risk. War is stress on Syrian populations that will have Covid -19 soon enough. There are tens of thousands of refuges in tent camps with terrible sanitation problems. Asymmetric  war is what will happen if whole populations starve as we Americans refuse to send them relief aid. How hard is it to ship this problem to your enemies?
 I have a pig farm and pigs can also get coronaviruses. There is one called SADS. I deliver my pigs to the one and only slaughter house in Calif. south of San Francisco. Every time I go there I immediately wash the trailer with detergent and Clorox the truck and trailer tires before I return home.  I wear disposal plastic boots  and gloves that are either thrown away or sprayed with Clorox.  There are multiple diseases that could destroy my herd if I were to track them back home. I quarantine every new breeding pig I purchase before it is introduced to the herd.
 I don’t know what other stress multipliers will come along over the next ten years but I am guessing there will be more and more of them as planet earth begins to cook. Air conditioning systems may be a potential way to spread this disease. I don’t trust technology , mass transportation , instant worldwide
airfreight , or biotech but combined with asymmetric war we are in for lots of more trouble.

I farm by myself, if I get sick I worry about who can take care of my herd. In general if I keep working when I get sick I run the risk of making my pigs sick also. If visitors visit my farm they can pass disease on to my pigs. My situation isn’t unique and there are farmers in China who are dealing with how to feed their pigs during a quarantine , who can take care of their pigs while they sweat out a month in a hospital and whether they will have the strength to deal with the farm when they get home.
If they remain healthy but the grain truck can’t deliver when do they euthanize their starving animals?
My grandfather farmed a dairy , got sick ,kept working, got pneumonia , died. I carry his name.
 
 

43
Consequences / Re: COVID-19
« on: February 25, 2020, 03:42:05 PM »
It's a great lower bound with Wuhan providing the higher bounds.

44
Consequences / Re: COVID-19
« on: February 25, 2020, 01:40:44 PM »
A very interesting narration of the cases. This is not the flu, this is much worse in both infectiveness and severity.  This can not be let out in the wild.

3 COVID-19 Cases As Described By Doctors In China





45
Consequences / Re: Chinese coronavirus
« on: February 25, 2020, 02:04:19 AM »
we cannot trust the early info from local officials who were obviously downplaying things . Even if this has changed it is likely that we are still playing a gradual catch-up to the truth , or exactly the opposite .. an ever growing cover-up .
  This is far more contagious than SARS . I anticipate a minimum of 25 million dead worldwide and a collapse of health services . If I was in govt anywhere i would be urging doctors and nurses out of retirement and preparing for disaster . Even if my fears are overblown it would be a valuable exercise as the mess that is China's wildlife markets and meat production makes future epidemics a near certainty .
  World economy may well shrink unless it really is killing only the old and ill but this seems doubtful . If survival is dependent on intensive care then .. oops . b.c.



update ..

and survival for a considerable proportion is dependent on intensive care and assistance in breathing . Anywhere without the capacity of China to create facilities and throw thousands of medical staff at the problem has a problem .. how to get rid of all the bodies .

our county hospital in Omagh has completed it's preparations for the impending pandemic . One room containing one bed has been set aside . So the NHS is ready for action !
 
today was really the first day the virus infected the financial markets . As the Dumb bald rump waved in India , I was reminded it once said any president presiding over a Dow fall of 1000 pts should be fired at the sun .. good call , small fall . But depressions don't shout their presence too loudly until you realise you are in one .








46
Consequences / Re: Chinese coronavirus
« on: February 23, 2020, 08:59:00 AM »
Thanks for that link, Bruce.

Besides hygiene, getting ahead of the curve on meds and staples seems like a good idea.

Here are more experts saying we should expect this virus to continue to spread and should be making plans accordingly:

Quote
“The infectious-disease epidemiology community and policymakers have come to the conclusion that it’s very likely that this virus is going to continue spreading throughout the world over time,” said Michael Mina, assistant professor of epidemiology at the Harvard T.H. Chan School of Public Health.

 “Things have really shifted a little bit from trying to stop its spread in China to now saying, ‘What can we, as a global community, as individual nations, and even as individual hospitals, do to prepare for what seems more and more potentially inevitable that we will start seeing cases locally throughout the world?’”

https://news.harvard.edu/gazette/story/2020/02/health-officials-expect-coronavirus-to-spread-worldwide/

47
Consequences / Re: Chinese coronavirus
« on: February 21, 2020, 03:00:10 AM »
https://ncov.dxy.cn/ncovh5/view/pneumonia?from=groupmessage&isappinstalled=0

截至 2020-02-20 17:28 全国数据统计
数据说明

55,051 现存确诊  -1,335 较昨日
  5,206 现存疑似 +1,614 较昨日
11,633 现存重症     -231较昨日
75,567 累计确诊    +892 较昨日
  2,239 累计死亡    +118 较昨日
18,277 累计治愈 +2,109 较昨日

As of 2020-02-20 17:28 National Statistics
the data shows

54,051 Existing confirmed diagnosis -1,335 since yesterday
  5,206 Suspected                          +1,614 since yesterday
11,633 Existing severe illness              -231 since yesterday
75,567 Cumulative diagnoses             +892 since yesterday
  2,239 Cumulative deaths                 +118 since yesterday
18,277 Cumulative Healing              +2,109 since yesterday

https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

Johns Hopkins
76,243 Confirmed
  2,247 Deaths
18,424 Recovered

https://nextstrain.org/ncov?l=unrooted&m=div
Next Strain
103 analyzed strains

We can bound the case fatality rate. We know it takes longer to recover from the disease than to die from it. As a result, the CFR cannot be higher than the total deaths/total recovered and is likely much less. That puts an upper bound on the CFR at 12.2%

A similar naive calculation (one not taking account of the actual dynamics) based on the Deaths/Confirmed and Deaths/Recovered puts those at 3.0% and 24.2%. The total of those should be 100%. Clearly it is far from it, so the dynamics are still very much at work (i.e. it takes time to die or recover). But that does set a lower bound on the CFR at 3.0%.

Do remember though that these bounds are for those who report to hospital. And since we lack any data at all about those who do not report to hospital, and how that population compares in size to the hospitalized portion, we cannot assess what that means about the actual population wide CFR.

Also, the age distribution issue still applies. This disease kills people over 60 and few under 60. So the utility of a simple all-age CFR at all is dubious.

The same cautions still apply. The changing case definition and other issues make it very difficult to compare these numbers day to day or week to week, let alone to use them to infer things about the communities at large.

Oren,

The reports out of the four countries (Japan, South Korea, Iran and Singapore) are indeed concerning, as are the movement of the infected folks off the cruise ship(s). These all greatly increase the chance that this evades control and becomes an international pandemic.

The markets are just now beginning to take note. Goldman Sachs is now cautioning about a potential 10% correction soon. That is likely just the beginning.

Markets and suppliers are also now beginning to realize the implications for supply chain disruptions. I suspect there are a whole lot of corporate heads and corporate board members reconsidering the wisdom of a highly diversified and interdependent supply chain.

This is nothing new. Centralization and decentralization in all its many forms feels an awful lot like a perpetual motion machine.

Sam

Addenda

Something I wonder about from this data.

Note that the existing confirmed diagnosis tally is declining. If we subtract that from the Cumulative Diagnoses, we get 21,516. That is pretty close to the total cumulative tally of deaths and recoveries (2,239 and 18, 277, total = 20,516). I do not like that these numbers are precisely 1,000 apart.

However, if we can assume that the long early tail of diagnoses, deaths and recoveries is large compared to the current count of those ill, then the deaths/diagnosed ratio might set a low bound on the CFR. (2,239/21,516 = 10.9%). That is very close to the reported value for the original SARS at 10%.

It is tempting to think this is meaningful. Not knowing the pedigree of the data, I really can't even speculate on that.

If true, this also suggest that we should expect (or fear) an additional ~6,000 deaths from those already confirmed infected and in treatment.

48
Consequences / Re: Chinese coronavirus
« on: February 20, 2020, 06:37:54 PM »
I think the mortality rate in Wuhan already proves that the response was not nearly enough, even when I believe a great commendable effort was made. Live and learn, but we only learn if we admit mistakes and improve. If we hide the mistakes then we will repeat them.


49
Consequences / Re: Chinese coronavirus
« on: February 20, 2020, 11:33:39 AM »
I certainly hope Vox doesn't deliver the vital snippet that would have kept you alive , blumenkraft ..

 Looks like every block of flats in Wuhan has similar virus incubating capabilities to the Diamond Princess .
'Bring out your dead' was a common plague refrain . With unrecorded dead lining streets and yet more obvious manipulation of the numbers ; will it again be the cry of the C21 ? b.c.


50
Consequences / Re: Chinese coronavirus
« on: February 15, 2020, 01:10:58 AM »
Update: US Will Test People With Flu Symptoms, In Significant Expansion of Government Response
https://www.scmp.com/news/world/united-states-canada/article/3050759/coronavirus-us-will-test-people-flu-symptoms

The US will begin testing people identified by local health authorities as having flu-like symptoms for the novel coronavirus, a senior official said Friday, a significant expansion of the government’s response to the epidemic....

Thanks, vox, for bringing this update.  I thought I'd share another source for this information:

CDC: Flu surveillance system enlisted in hunt for COVID-19 cases
http://www.cidrap.umn.edu/news-perspective/2020/02/cdc-flu-surveillance-system-enlisted-hunt-covid-19-cases

"As a way to spot any community COVID-19 activity early, federal health officials will use the nation's flu surveillance system to look for people who may be infected with the disease.

US Health and Human Services Secretary Alex Azar first unveiled the plan yesterday. Its first phase will be launched at public health labs that are part of the flu surveillance system in Los Angeles, San Francisco, Seattle, Chicago, and New York City...."

_____________________________

It appears these labs will automatically test specimens (taken from patents presenting with flu-like symptoms) and test those negative for influenza for Covid-19.  This should give much better data for finding and tracking cases other than from known contacts and quarantine persons. 

Within a couple of weeks, we should start to get an indication as to whether the epidemic is spreading among otherwise unrecognized populations.  A major management question will be what to do with those individuals who are infected but not sick enough to need hospitalization.

It's been decades since mandatory home quarantines have been used in the US.  We may see them again.  I'm a bit concerned that many modern Americans will refuse to be confined in this way.  Throwing violators in jail would obviously be problematic.  What to do with non-compliant patients?

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