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Messages - Sam

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101
Consequences / Re: COVID-19
« on: March 21, 2020, 05:23:38 AM »
Study on viability of sars cov 2 as an aerosol and on fomites. Viable for hours as an aerosol.

https://www.nejm.org/doi/full/10.1056/NEJMc2004973

Based on this, the virus remains in the air as an aerosol for hours, and infective on surfaces for 2-3 days. No wonder then why it is so bloody transmissible.

Sam

102
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.

103
Consequences / Re: COVID-19
« on: March 20, 2020, 10:11:49 PM »
Since these questions keep coming up, I am moved to share some experience and insight.

In my career I have worn many different kinds of protective gear and masks. Many were to keep things out. Many were to keep things in. Fundamentally they work the same, but with differing efficiencies.

Masks and personal protective suits are generally uncomfortable when you first start wearing them. You have to become adjusted to them. Both masks and PPE tend to be hot and sweaty (with the exception of air hats). Masks in particular cause you to breathe higher levels of carbon dioxide than you are accustomed to. This tends to make you breathe somewhat faster and harder. That is a natural response.

Masks in particular often have elastic straps. The fit is crucial. You don't want leaks. So - no facial hair. Well, unless you are willing to smear your beard with something greasy to make the seal work. That is not recommended, but can work. 

Ideally, all people wearing masks should be trained and fit tested. This isn't hard. But it is important. You have to maintain a good seal for the mask to be effective. However, if you over tighten the bands it will become uncomftable quickly. And that leads to problems both with compliance - it is uncomfortable, and it leads to fidgety touching and adjusting of the the mask, scratching, and more.

Masks should be just tight enough to seal, and not more. The bridge piece should be adjusted (usually bent) to conform tightly, but not too tightly to the nose. Bands need to go above and below the ears and be adjusted so as neither be pulled by hair or to pull hair.

Breathe steadily and regularly. Relax. Know that your breath will be warmer and wetter than you are used too. That is ok. Breathe more slowly than you think and feel like you need to. You quickly get used to that. It is important to try to breath smoothly. Strong breathing in and out will expand and collapse the mask and can break the seal.

Speak normally and clearly. Enunciate carefully. Masks make understanding harder. By practicing exaggerated speaking you can make it easier for people to understand you through the mask.

Avoid touching your face. Avoid touching anything if you can.

Practice conscious awareness. Be extremely aware of everything you touch. Mostly this means your hands. But it also means every part of you, the soles of your feet included, and you butt. Know what you touch.

Ideally, choose one hand to be "dirty" and one "clean" when you can. Anything the dirty hand touches must be thought of as contaminated by you. Anything you touch with that hand is now potentially contaminated until it is cleaned and sterilized. Though you can touch yourself with the clean hand, avoid that.

Be very aware of touching yourself, especially your face.

This is not easy to do at first. You have to fight all sorts of natural instincts to do it successfully.

You have to learn to ignore itches, droplets of sweat, hair that's out of place, clothes fitting oddly. You can do it. And in time it becomes second nature. But it is very very difficult to do at first.

For droplet control, remember that all mucous membranes (soft tissue like the mouth nose and eyes)  and all wounds are a risk. Exposed skin can be a risk but is generally a decent barrier if you wash correctly. Because your eyes are a risk, ideally you should wear sealed goggles. Fully sealed goggles fog up. So they generally have air holes to breathe. But those can allow things in. They aren't perfect.

With all of this, you are trying to maximize the probability that nothing reaches your mucous membranes - your soft tissue. Perfection is generally not possible. So do the best you can. Every step of adding protection reduces the risk of contamination. Don't get caught worrying about things not being perfect.

In most cases, it is the simple failures that lead to contamination spread, not the lack of perfection. Touching something or someone contaminated, then touching yourself before decontaminating is the biggest. Joking around us a huge risk. Interpersonal touching is another. Even usual and normal things like clasping your own hands, touching someone's arm .... are all risks.

Adding layers of protection adds to discomfort, limits vision, and limits hearing. Those limitations lead to mistakes. The mistakes can far outweigh the added protection. It is a tradeoff.

The simplest and best protection to avoid contamination is to not go where there is contamination, or the potential for contamination.

The next is to wear the most important gear, and wear it and use it correctly, while exercising strong awareness. Don't touch if you don't have to. Keep distance from people in space and time. Keeping six feet or even fifteen feet distance is useless if you blithely then walk through an area someone infected was coughing in.

Etc.... 

Also, knowing how to remove potentially contaminted protective gear and masks is as important as how you wear them. They have to be removed in a way that takes contamination or potential contamination out, away and down. If there might be loose contamination, you need to move slowly and methodically to prevent it becoming airborne again.

Sam

P.s.  One added note about filters. Air filters of all types are imperfect. They typically have a most penetrating particle size. Above that size things get through fairly easily. Less than that much less easily.  By combining two layers of filters with different size ratings, a mask can be far more efficient than the smallest size rating might suggest. This happens because of the way particles are filtered out by the media. Adding three layers each with different size ratings is even more effective.

Having the layers composed of different materials that are chemically like or dislike things also helps, as does having different chemistry that holds different static charges.

104
Consequences / Re: COVID-19
« on: March 20, 2020, 05:47:04 AM »
Map of US human temperature anomalies in this article.

https://www.tampabay.com/news/health/2020/03/19/smart-thermometer-company-may-predict-high-coronavirus-numbers-in-florida/

Wow. If they are right, Florida is in deep deep trouble. So too are Michigan, Indiana, Ohio, Tennessee, Massachusetts, Connecticut, Vermont, New Jersey, Delaware, New Hampshire, Colorado, Arizona, North and South Carolina and others.

Source
https://healthweather.us/

Sam

105
Consequences / Re: COVID-19
« on: March 20, 2020, 02:53:11 AM »
Anyone have any figures about how long this thing survives on fresh fruit and veggies.  I stupidly picked up and bought a bag of loose grapes yesterday.  I washed them when I got home but obviously not with soapy water.  Maybe I should have?  They havve now been sitting in the fridge for 24 hours next to the zucchini and tomatoes.  I am definitely going to die.

The fruit and veg section of the supermarket is mostly loose items.  People pick up and examine 2 or 3 avocados before choosing one.  The put their bare hands into the potato bin and grab what they need.  Same with most of the cheaper items that you buy in bulk.

For many foodstuffs with rinds you can safely soak them for a short time in dilute chlorine bleach. I do that routinely to assure that citrus from the store doesn’t have fungus.

For things where that might intrude into the fruit and veg, hydrogen peroxide is a safe alternative. Rinse after.

For a lot of veg, roasting is also a really safe alternative.

For shelf stable veg like squash and potatoes that can sit in the larder for a couple of weeks, time is a good solution.

I don’t know how effective it is, but vinegar rinses may also be effective. Possibly also caustic (slaked lime, sodium bicarbonate ...). I have not seen a good reference on what edible things might be good sterilants (such as these) - and for those that are, what the conditions are that work.

Mail is another quandary. Easy solutions. Handle with a glove. Junk mail never comes in - straight to the bin. Non-essential mail —> the three week isolation zone. Essential mail not including plastic —> oven roast on warm (200 F). Half an hour should do.  Mail with plastic envelopes or plasticky stuff —> spritz with greater than 60% alcohol and set aside to dry - in the sun if possible.

Then sterilize the glove after. Obviously being careful about contact transfer - what touches what.

Sam

106
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

107
Consequences / Re: COVID-19
« on: March 20, 2020, 12:07:51 AM »
I feel bad for being so scared, but I no longer know how to feel. I've read up and listened to so many things at this point...

The only way I can aptly articulate how I feel is like waiting in silence for a massive invisible monster to arrive...

Pearscot,

I have contacted Governor Inslee's office a couple of times now in regard to you and your coworkers situation. I made a particular point of highlighting their moral obligations and their legal vulnerabilities should anything adverse happen to you or your coworkers as a result of their policies.  I also pointed out their very severe PR vulnerabilities should they fail to immediately act. And yes, I have contacts in the press in Seattle, and I am not afraid to use them.

The Governor has been very proactive. This very much sounds like a disconnect between the direction the Governor and his team are giving and what is being done down the management chain.

Sam

108
Consequences / Re: COVID-19
« on: March 19, 2020, 09:26:44 PM »
Please Sam, tell them not to spread these outrageous lies!

https://www.nature.com/articles/s41591-020-0822-7

"Using public and published information, we estimate that the overall symptomatic case fatality risk (the probability of dying after developing symptoms) of COVID-19 in Wuhan was 1.4% (0.9–2.1%), which is substantially lower than both the corresponding crude or naïve confirmed case fatality risk"

Time will play out. The data will explain it to them.

Sam

109
Consequences / Re: COVID-19
« on: March 19, 2020, 10:11:37 AM »
Sam, this analysis seems to be logical and therefore extremely worrying in the short term.

I’d be really interested in what you think about the current situation in China. It  seems to be returning to some form of normality without any significant degree of herd immunity based on a relatively low number of reported infections in a total population of 1.3 Billion.

Is it simply rigorous contract tracking, Singapore style, on a grand scale or something more opaque?

My information on what is happening inside China is quite limited. I cannot read Chinese, so I have to rely on information that is mostly in English, with a smattering of other languages. A lot that I have read is from Chinese sources. However, I cannot guage either the veracity, accuracy or completeness of much of that. Neither can I judge what, if any, biases they may contain.

From my years in industry and management, the story that I think I see goes something like this (take this with a huge dose of skeptical analysis - I am not expert in any way here):

The Chinese have nearly mopped up the last of the infection chains inside the country. They continue to exercise intense internal controls with checkpoints, isolated and compartmentalized cities, blocks within cities, apartment buildings ...  They continue to use extensive testing. And those who were infected continue to be treated, monitored, isolated and controlled until they are assuredly clear of infection.

They have sanitized everything in areas with infections. Now, their focus is two fold. First is finishing that first phase of stopping the infection at home in China. More important now is stopping any infection from entering the country. That includes mandatory quarantine and testing, and obviously treatment, isolation .... for those who show symptoms or who test positive.

The Chinese are now working to restart the economy and to do so as quickly as possible. That seems to be coming with great stresses and pains. The restart isn't going as quickly as desired, so leadership have mandated things to make it happen. Some of these are apparently unreasonable or impossible, and so at lower levels they have resorted to ways to fake it. Folks above are trying to detect and counter that. Etc...

All of that is creating serious societal stresses with people making all kinds of assumptions and assertions. I have no way to tell what is real and true and what isn't, or what political, financial, or other ideological axes and grudges are at work.

Add to this the enormous social strain that the quarantine and lockdown caused and how that has emotionally and psychologically affected people. No one likes being forced. It really doesn't matter if it was the right answer or not - for how they react and respond.

There is undoubtedly a huge amount that I am missing. And I have never lived in Chinese culture of any type anywhere. So, I cannot assess, judge or evaluate most of what I am reading in those contexts.

China is today an authoritarian dictatorship. Mostly that seems to be more like a benevolent though oppressive kingdom from western history. Is that right? I cannot judge or assess. I cannot even affirm that all of this is true. I am sure it is a very incomplete picture. I am sure my own cultural and personal biases color my perceptions in ways I cannot even know. That makes me even less certain.

About all I can reasonably do is to reflect back on a few hundred situations from my own history, and the interpretations that I observed from multiple perspectives to try to make sense of the information I have. Then I temper that somewhat with the little I know from Japanese, German and British cultures and a bare snippet from Indian, Tibetan, Persian, Slovakian, Polish, and Native American cultures, as well as from a dozen or more regional cultures in the US and Canada to try to get some idea of what is going on.

But, from discussions with Chinese friends over the years, and trying to translate Chinese stories I am all too aware that the cultural jump is quite large. That makes interpreting any of this difficult. 

Side note: I clearly remember trying to translate a paragraph from a story in a Chinese paper about a nuclear incident. The translation seemed to be talking about someone living over a grandmothers garage. It was idiomatic. It didn't translate at all well.

I encourage any one of you who may have a better perspective on that to chime in. I am quite interested to hear your thoughts and speculations. However ....

Within American cultural circles there are some enormous biases in several directions about China and the Chinese, and separately the Taiwanese. A lot of that is purely racist, or dog whistle racist. A lot is purely hatred and fear frankly associated with the economic systems involved. A lot is prejudicial biases and fears about history, or government, or culture, or .... A lot is also tribal - conflict of empires stuff. Much of it is fear based. I encourage everyone to be very careful in accepting any assertions that the answer is ....xyz.... from pretty much any source. The cultural gap is large. Please exercise caution.

Sam

110
Consequences / Re: COVID-19
« on: March 18, 2020, 10:56:17 PM »
There is another thing here to think about.

Precisely because of the impacts of this damnable virus, airline flights are down dramatically. And with them, their emissions are down. As we saw from 9/11/2001 that quickly resulted in a global temperature spike.

Add to that the sudden dramatic reduction in fossil fuel use for transportation as the world comes to a temporary halt. The sulfate and particulate emissions have fallen dramatically. These are huge negative additions to global warming. Their loss means added sudden global warming impacts. 2020 may be a banner year for global warming increases, and consequently for melting of the Arctic and Antarctic ice.

The skies are noticeably clearer. The air is cleaner. The waters are cleaner too.

Sam

111
Consequences / Re: COVID-19
« on: March 18, 2020, 10:50:56 PM »
by the way, 'herd immunity' for something as contagious as this bug seems to be may require exposure of something close to 90% of the population to the virus. You've gotta kill a whole lota people to get that kind of 'herd immunity,' and no one knows how long it will last or how many people can get re-infected anyway

Astute point. The level required for herd immunity is approximately 1 minus the inverse of the contact transmission rate.

This virus has a natural growth rate of about 1.355x/day and a serial time of as much as 7.5 days.

That is an R0 of 9.76. It may be even higher. The inverse of that is 0.102. So the minimum herd immunity percentage is 89.8%. And that is just to get it to stop growing. To actually cause it to Peter out requires a higher percentage of those contracted to be immune.

And since at least some people do contract the virus again, we know that the immunity is not necessarily lasting. So the herd immunity level is well above 90%.

Said differently, well over 90% of the population has to contract this damned thing before it will fade away naturally.  That might as well be 100%.

Relying on herd immunity to stop this is nearly the ultimate in stupidity. It is only exceeded by “flattening the curve” for idiocy.

Sam

112
Consequences / Re: COVID-19
« on: March 18, 2020, 10:08:34 PM »
This is why full quarantine is required - NOW. Now imagine the hospitals are full and turning people away. ...

This disease predominantly kills those over 55. This is a healthy young person.
This disease predominantly kills men. This is a young woman.
This disease predominantly kills those with pre-existing conditions. None here.

https://twitter.com/TarzanInside/status/1240325870411186177

With hospitals at and past saturation she would not have the support that is clearly saving her life. She would in all probability be a death statistic if she contracted it later when the hospitals are full and the doctors and nurses are sick.

Full quarantine with shelter in place and absolute minimum of movement for services and supplies - with distancing and massive sanitation as the Chinese did, and massive testing as the South Koreans did is what is required right the hell NOW. This is why we need all of the meds that we know work in massive production at zero profit - NOW.

Instead we have the stupidest person ever to occupy the Whitehouse in charge using dog whistle racism, denial, insults, and pandering as his only tools. Europe’s leadership, though better in some cases and equally atrocious in others is no less effective, even in the best cases.

It is time for Trump, Pence, Johnson and all the other failed leaders to immediately resign and leave the jobs to people who actually have a clue.

Perhaps fortunately, almost all of the worlds leaders are in the high risk category: Old unhealthy males. And their policies will maximize exposure to the virus for everyone. We can then perhaps only hope that the virus does us the favor of removing them - permanently. And there is about a 30+% chance for each that it will.  But it will come too late to save the millions, nay tens of millions who will die because of their idiocy.

Sam

113
Consequences / Re: COVID-19
« on: March 18, 2020, 07:15:31 PM »
Sam: In your opinion, will a resurgence of coronavirus occur in China and South Korea?

Dnem,
in my opinion?, well....

The Chinese are still mopping up the last parts of the infection as they slowly restart their economy. There is a risk of it resurging internally, so they still have enormous and onerous controls in place.

A friend of mine is from central China. She has been in the States since early January supporting her mom. She and her boys are headed back to China next week. They know already that once they arrive they will be ushered into a 14 day quarantine.

I don't have first hand knowledge of the conditions for traveler's to China, but it appears at least that they are very aware of the threat from the rest of the world, and are working to contain it.

Even if they do that extensively, allowing any cross border traffic as the world turns to a festering pool of infected people is a probably unstoppable problem. That being the case it would not surprise me in the least for the Chinese to close all of their borders and ports to inbound traffic.

During every pandemic ports have been the major problem. Even with attempts at control, the pandemics jump the lines.

On the other hand, China is restarting its economy. They are hugely dependent on selling goods overseas. So, they are no doubt anxious to get goods moving.  But, they are an authoritarian centralized dictatorship of sorts and they are in their own minds "the Middle Kingdom", "the center of the world". They can choose to go through hardship, and simply isolate themselves until this passes.

Doing that would make perfect sense for China. However, they are so impirtant now in world trade that doing so would destroy most of the economies of the world. If they do it, I expect it will be entirely to save themselves. The rest of the world won't see it that way.

And that could lead to war. Though how such a war would play out is crazy to think about. A war to make a people make and sell you stuff. Weird.

Or they might try doing some very onerous set of controls on people and goods movement. E.g. Every ship arriving having to sit at anchor for 28 days to prove a complete lack of infection.

I think the Chinese will ultimately end up doing something entirely different. They will work like hell to prevent the SARS2 bug from returning, and to wipe out the last vestiges internally. And they will work to resume trade. But that is all an extraordinarily difficult task in a time of uncontrolled pandemic. 

I wish I understood better and had better insight.

Sam


114
Consequences / Re: COVID-19
« on: March 18, 2020, 11:20:38 AM »
What you write is reasonable and objective. But, allow me to say, it's not at all pragmatic.

Sadly true. I plead guilty.

I spent a life and career living in the -real- world. No where along the line through the decades of my life did I realize we actually live in the "real" world - no relation to the one based on physical reality, physics, chemistry, biology and the like.

Sam

115
Consequences / Re: COVID-19
« on: March 18, 2020, 10:21:19 AM »
Twitter thread >> https://mobile.twitter.com/jeremycyoung/status/1239975682643357696

Quote
We can now read the Imperial College report on COVID-19 that led to the extreme measures we've seen in the US this week. Read it; it's terrifying. I'll offer a summary in this thread; please correct me if I've gotten it wrong.

The Imperial College team plugged infection and death rates from China/Korea/Italy into epidemic modeling software and ran a simulation: what happens if the US does absolutely nothing -- if we treat COVID-19 like the flu, go about our business, and let the virus take its course?

Here's what would happen: 80% of Americans would get the disease. 0.9% of them would die. Between 4 and 8 percent of all Americans over the age of 70 would die. 2.2 million Americans would die from the virus itself.

It gets worse. People with severe COVID-19 need to be put on ventilators. 50% of those on ventilators still die, but the other 50% live. But in an unmitigated epidemic, the need for ventilators would be 30 times the number available in the US. Nearly 100% of these patients die.

So the actual death toll from the virus would be closer to 4 million Americans -- in a span of 3 months. 8-15% of all Americans over 70 would die.

How many is 4 million people? It's more Americans than have died all at once from anything, ever. It's the population of Los Angeles. It's 4 times the number of Americans who died in the Civil War...on both sides combined. It's two-thirds as many people as died in the Holocaust.

Americans make up 4.4% of the world's population. If we extrapolate these numbers to the rest of the world (warning: MOE is high here), this gives us 90 million deaths globally from COVID-19, in 3-6 months. 15 Holocausts. 1.5 times as many people as died in all of World War II.

Now, of course countries won't stand by and do nothing. So the Imperial College team ran the numbers again, this time assuming a "mitigation" strategy: all symptomatic cases in the US in isolation. Families of those cases quarantined. All Americans over 70 social distancing.

This mitigation strategy is what you've seen a lot of people talking about when they say we should "flatten the curve": try to slow the spread of the disease to the people most likely to die from it, to avoid overwhelming hospitals.

And it does flatten the curve -- but not nearly enough. The death rate from the disease is cut in half, but it still kills 1.1 million Americans all by itself. The peak need for ventilators falls by two-thirds, but it still exceeds the number of ventilators in the US by 8 times.

That leaves the actual death toll in the US at right around 2 million deaths. The population of Houston. Two Civil Wars. One-third of the Holocaust. Globally, 45 million people die: 7.5 Holocausts, 3/4 of World War II. That's what happens if we rely on mitigation & common sense.

Finally, the Imperial College team ran the numbers again, assuming a "suppression" strategy: isolate symptomatic cases, quarantine their family members, social distancing for the whole population, all public gatherings/most workplaces shut down, schools and universities close.

Suppression works! The death rate in the US peaks 3 weeks from now at a few thousand deaths, then goes down. We hit but don't exceed the number of available ventilators. The nightmarish death tolls from the rest of the study disappear.

But here's the catch: if we EVER relax suppression before a vaccine is administered to the entire population, COVID-19 comes right back and kills millions of Americans in a few months, the same as before.

After the 1st suppression period ends in July, we could probably lift restrictions for a month, followed by 2 more months of suppression, in a repeating pattern without triggering an outbreak or overwhelming the ventilator supply. Staggering breaks by city could do a bit better.

But we simply cannot EVER allow the virus to spread throughout the entire population in the way other viruses do, because it is just too deadly. If lots of people we know end up getting COVID-19, it means millions of Americans are dying. It simply can't be allowed to happen.

How quickly will a vaccine be here? Last week three separate research teams announced they had developed vaccines. Yesterday, one of them (with FDA approval) injected its vaccine into a live person, without waiting for animal testing.  That's an extreme measure, but necessary.

Now, though, they have to monitor the test subject for 14 months to make sure the vaccine is safe. This part can't be rushed: if you're going to inoculate all humans, you have to make absolutely sure the vaccine itself won't kill them.  It probably won't, but you have to be sure.

Assuming the vaccine is safe and effective, it will still take several months to produce enough to inoculate the global population. For this reason, the Imperial College team estimated it will be about 18 months until the vaccine is available.

During those 18 months, things are going to be very difficult and very scary. Our economy and society will be disrupted in profound ways. And if suppression actually works, it will feel like we're doing all this for nothing, because infection and death rates will remain low.

It's easy to get people to come together in common sacrifice in the middle of a war. It's very hard to get them to do so in a pandemic that looks invisible precisely because suppression methods are working. But that's exactly what we're going to have to do. /end

There are a couple of serious problems here.

First, the model these "experts" use is based on a 6.5 day generation time and an R0 of 2.4. That then results in a mean daily growth rate of exp(ln(2.4)/6.5) = 1.144x/day

The observed actual growth rate of the unconstrained virus in populations all over the world is 1.33-1.37x/day.

Using the frequently observed value of 1.355 and their 6.5 day generation time yields an R0 of 1.355^6.5 = 7.2. !!!!!!

If they find the modeling results terrifying with their parameters, what do you call it with the real parameters? Terrifying raised to the screaming with hair on fire power?

Everything that follows from their model is invalid as a result.

Second, to get from a 1.33-1.37x/day growth to a 1.144x/day growth requires doing everything China, South Korea and others did. It requires shutting down the economy.

So what they propose actually means shutting down the economy for a month or two, then easing off for a month, cycle and repeat. That is economic suicide.

Third, this plan because it fails so badly in the modeling will utterly fail to prevent the hospitals from saturating. That drives the death rate to over 10% of those hospitalized.

Fourth, they repeat the presumption that the IFR is <1%. This is unproven. Many wish it to be true. It is not proven. At the very least, assuming it to be true and basing policy on it is a gamble with both the lives of the citizenry (literally) and of the nation. If they are even a little wrong, that's all she wrote. That is insane. 

Fifth, this plan assures that everyone in the nation will ultimately catch the virus at least once. So all of the vulnerable over 55 population will contract the virus, and the maximum lethality is assured.

So what we have then in sum is a plan that wrecks the economy repeatedly for more than a year, that destroys society, that kills and maims the maximum percentage of the population, and devastates the entire medical system, while also bankrupting everyone individually, every corporate entity, and the country.

Yeah, that's a plan. Well, it is if your plan is utter and complete disastrous failure that crushes your country into a fourth world wreck.

And this is the "flatten the curve" plan. 

An alternate to this was the "let's throw up our hands and let the virus have its way with us" plan.

That plan would also maximize deaths and maimings. The one advantage is that it would do it in one shot. That too would bankrupt everyone and utterly destroy the healthcare systems. But, it would only do that once, rather than repeatedly over a year or two as the "flattening the curve" plan does. Arguably, that is a better choice.

Vastly better is to do as the Chinese did. Institute massive draconian controls. Quarantine everyone for two months. Test the hell out of the population. And use aggressive contact tracing. Build surge capacity instantly for hospitals. And do it all three weeks ago.  Yeah, well, that isn't entirely possible anymore.

Also vastly better is to do as the South Koreans did.

Much better is to do as the Japanese and Indonesians are doing. That's not as good as China or South Korea. But compared to what the West is doing, it is genius.

For God sakes don't do what the Europeans and Americans are doing. They were and remain entirely clueless, and hell bent on killing and maiming as many people as possible, while also destroying civil society, and the entire financial basis of society.

Precisely when did idiotocracy and kakistocracy become the dominant form of Western government, and the Forest Gump's of society become the world's modeling experts?

I would also note that just as with AGW the "experts" have been woefully horribly fatally far behind the real conditions.

And ... additionally I should note that by getting the growth rate so horribly horribly wrong, combined with a near total lack of testing that the growth of the number infected will take the leaders by surprise as it did in Italy. And seemingly out of nowhere the hospitals will be in full collapse. So when the "flattening the curve" plan fails, it will fail spectacularly with huge body counts and mass graves. Welcome to a sort of replay of the US Flu of 1917-1918 (generally mislabeled as the "Spanish" Flu).

In going back and listening to the story of that last great pandemic I suppose the one heartening thing is that this bug is tame by comparison. That one clearly had an R0 far greater than measles, a generation time of about 2 days or less, and a lethality of over 20%. It makes SARS2 seem quaint and polite by comparison. But due to the stupidity of our leadership, the greater interconnectedness of the world, and just-in-time everything, this virus will do every bit as much damage. And with 7.5 billion people alive today, the death toll will no doubt exceed that of the last great pandemic of 1918.

And oh joy, "flattening the curve" will bring added pressure and time to bear for the virus to mutate into something even more terrible, and to adapt to birds so that it becomes an annual affair.

Sam

116
Consequences / Re: COVID-19
« on: March 17, 2020, 07:22:57 PM »
Latest from https://www.worldometers.info/coronavirus/

195,000 cases recorded, of which 105,000 still active.

Of the 89,000 cases now closed,
- 81,000 recovered,
- nearly 8,000, 9% dead. This is the scary statistic, the mortality of closed cases having increased from 7% to 9% in a very few days.

Remember please that the fatality rate can be calculated in two ways. When this whole thing is done, we will know rather well the number of cases (C), the number who died (D), the number of severe cases (S), and the the number who recovered (R), the fatality rate (fr), plus all sorts of other stats. The data will be perfect. There will be weirdnesses in it. But it will be close. When it is done:

C = D + R

1) FR = D / C
2) FR = D / (D + R)

While the pandemic is growing and continuing the count for C comes first, then D, then R. Each of these is incomplete, but they become closer to complete in that order. So if we use lower case for each of these, c < C, d << D, r <<< R.

1) fr(low) = d / c            ——> FR > fr(low)
2) fr(high) = d / (d + r)  ——> FR < fr(high)

1) FR estimated from fr(low) is > d / c, because d is still growing relative to c.
2) FR estimated from fr(high) is < d / (d + r), because r is growing more delayed/more slowly than d.

So, fr(low) < FR < fr(high). As a shorthand.

The 9% death rate you calculated above is the fr(high) number. As time passes and the 105,000 active cases resolve into d and r, relatively more will recover than die than have so far. This will reduce the fr(high) value. fr(high) = 8,000 / (8,000 + 81,000) ~ 9.0%

The fr(low) = 8,000 / 195,000 = 4.1%.  This will increase.

So far what the data has shown is that the fr(low) increases slowly, while the fr(high) decreases rapidly. The ultimate FR appears to always be less than the geometric mean (gm) of the two (fr(low) * fr(high))^1/2 = 6.1%.   .... excluding the early phase where there aren’t enough deaths or recoveries for the calculation to work at all.

The 9% number is concerning, but it will fall. Ultimately, the FR will be between 4.1% and 6.1% from this data.

And the most complete data suggests this is likely between 4.0% and 4.2%.

However - large caveats here.

A) the FR is highly dependent on the proportion of ages of the population, and their health. Groups with larger percentages of people over 55 years old will have much higher FRs. Conversely, groups with lower percentages of folks over 55 will have lower FRs. Similarly, health status before the virus hits will alter the FR.

B) the strategies employed to combat the spread of the virus will likewise have large effects.
1) these may skew the percentages of people in different age groups who contract the virus thereby effectively changing the age and health status effects. If more kids catch it, and less elderly catch it, the FR will go down. And conversely the reverse.
2) if the strategies fail to combat the spread enough to avoid saturation of the medical systems, patients won’t receive adequate care and the FR will rise. Because such a large percentage of those afflicted are in the (S) severe category, when the hospitals hit saturation and exceed it, an increasing number of S cases will become D’s. The FR then will increase. If half of the S’s become D’s, the FR may increase by about 7% from ~4.2% to ~11%. That would be terrifying. This also applies to regions or segments of society lacking adequate health care. The FR’s there may be quite large.

Remember too please that the preponderance of leadership in most countries is above the age cutoff where severe harm or death is much more likely to occur (~ 55 years). As a result, in countries that choose to allow the disease to run its course, whether intentionally or not, a substantial part of the leadership in government and industry will be maimed or killed. And the disease cares not one whit about a persons wealth, status or privilege.  These may buy or earn somewhat better care, but that does not guarantee survival or lack of serious injury. Since leadership meeting is essential to them taking actions required to fight the pandemic, they are placed at even greater risk. And the FR for the leadership as a group may then be substantially higher than the FR for the society at large.

Remember also please that the total injury and death count is even more important than the rates. China demonstrates that. They have all but stopped the virus with only a very small segment of society ever becoming infected. If they can prevent the viruses re-entry, and continue to squash it domestically, they stand to recover quickly. Nations that fail to do this will suffer huge losses and will economically be destroyed by their choices.

Sam

117
Consequences / Re: COVID-19
« on: March 17, 2020, 03:00:58 AM »
Edmountain,

Correction. I just saw the most recent log plot of the confirmed count in the US. It shows a 1.35-1.37x/day increase rate for the last several weeks. I had thought with the beginning of public actions that that might have dropped to 1.25x/day. It hasn’t.  At least it hasn’t yet. Beginning now it should. But now won’t show up in the data for 11 days.

Correcting for that, I suspect that we now have 135,000-150,000 people infected in the US. That should show up as confirmed numbers 11 days from now, by which time the count of infected (not the confirmed count, but the actually infected count) will be about 800,000 to 1 million. - give or take a lot due to uncertainties. 7 days later that should be counted as 160-200 thousand hospital admissions for critical care, about April 3-4. That will likely then double over the next week - reaching perhaps 700,000 by tax day - April 15. Said differently - the US may have no available ICU beds then.

I really really want to be wrong with this swag estimate.

Sam

118
Consequences / Re: COVID-19
« on: March 17, 2020, 02:21:41 AM »
TerryM:
Where the tanj do you get a mask?

If he is anything like me ....

I keep a box of N95’s and nitrile gloves in my trunk. I keep the full face respirator with everything cartridges in the basement. Along with the light duty tyvek protective suit.  Leftover habits of a lifetime getting dipped in things.

Sam

119
Consequences / Re: COVID-19
« on: March 17, 2020, 12:34:11 AM »
...

As he notes, the caveat is that in many places the official numbers may greatly underestimate the true number of infections, due to limited testing.

...
On that note there was a paper published online in Science today providing evidence that in China during the period January 10-23, i.e. prior to the implementation of widespread testing and travel restrictions, that more than 80% of cases went undocumented.

I think this furthers the case that there is likely substantially more infection in places where access to testing has been limited. For example, if we extrapolate these numbers to the USA could there actually be 32,000 cases in the US rather than the documented 4,600?

https://science.sciencemag.org/content/early/2020/03/13/science.abb3221

edmountain,

Based on a couple of simple thumb rules (which I explained before) from the various time lags involved and the observed growth rate - WITHOUT assuming there is some hidden reservoir - I estimate that there are currently 60,000-70,000 people infected in the United States. The beginnings of controls started now, may begin to slow the growth in about a week. By that time there will likely be between one-third and one-half a million people infected in the United States.

The models being used are often assuming a ~ 6.2 day doubling time. That is seriously wrong and leads to a gross underestimate of the coming impacts and the speed and severity with which those impacts will arrive.

They have at least begun mostly voluntary controls. The public is doing more. Those will reduce the growth rate. Just how effective they are is yet to be seen. The holes in the recommendations will seriously blunt their effectiveness. As yet, economic interests are still prevailing over health interest in the crafting of the guidelines and rules. That creates a hole large enough to fly a Jumbo Jet through.  Expect the supply of hospital beds to be exhausted well before the end of the month with triage then starting.

Good luck everyone. Isolate if you can - for as long as you can. The great ugliness is now beginning in earnest.

Sam

120
Consequences / Re: COVID-19
« on: March 16, 2020, 01:49:15 AM »
Note: Dr. Fauci and many others have been citing a doubling time of one week. That is grossly in error. It is much much faster than that. And that has enormous impacts on decision making.

Maybe you misheard? "Tenfold in a week" is correct, but maybe you heard "twofold"?

See the semilogarithmic curves of the cumulative numbers of deaths here: https://observablehq.com/@neelance/corvid-19-trends?collection=@observablehq/coronavirus

He said ten times the death rate of flu (which is less than real by a factor for 4-5) and doubling every week.

Sam

121
Consequences / Re: COVID-19
« on: March 16, 2020, 12:51:32 AM »
I am hearing reports of very long lines at "coffee shops" in the Netherlands, as they are about to be closed. Can anyone here confirm or otherwise (or are you standing in one now??  :) :o 8) )

Meanwhile, official numbers so cases outside China set to pass 100,000 in the next couple days, and still doubling every 4-5 days.

Guessing (conservatively imvho) that this under-represents the actual number of infected by an order of magnitude, there are probably a million people (at least) with this thing worldwide outside China. 

And (conservatively again) rounding up to a five day doubling time, that gives a projection (not prediction) of about a billion infected outside China by about the beginning of May.

One way or the other, of course, it will be leveling off shortly thereafter.

https://www.worldometers.info/coronavirus/coronavirus-cases/#case-tot-outchina

Public Radio just now:

Quote
The governor of Illinois on Sunday ordered all bars and restaurants in his state to close amid the threat of the new coronavirus, and officials elsewhere in the country said they were considering similar restrictions after revelers ignored warnings against attending large gatherings

The unconstrained doubling time has often been as little as 1.5 days in the span from about 10 cases to about 100 cases. This comes from a daily growth of 1.60x/day. Wuhan continued at the high rate for somewhat longer.

From 100 to about 5,000 cases the daily growth often slows to about 1.33 - 1.35x/day. This has been repeated in country after country. This corresponds to a doubling time of 2.33 days (8x/week). Note: Dr. Fauci and many others have been citing a doubling time of one week. That is grossly in error. It is much much faster than that. And that has enormous impacts on decision making.

From about 5,000 cases to 10,000 cases the doubling time often slows. It finally seems to stabilize at 1.15 - 1.20x/day in many cases. That corresponds to a doubling time of ~4 - 5 days.

It might be possible to put some sort of relation to that. But the individual variation by location is no doubt important. And once massive quarantines are imposed the relationship falls apart - as it should.

The slow down from 1.33 - 1.35x/day seems to very much be associated with societal changes - distancing, hand washing, self-isolation and ultimately quarantines. I suspect that is precisely what it is. It may also be partly influenced by the statistics of human to human contact. This can occur as the infection moves from the most mobile and contacted part of the population into more isolated segments with less contact. At even higher infection counts, it can also happen with statistical reduction in the population pool available of those who have not yet been infected.

This latter effect is where herd immunity comes in. If the R0 is small enough (near 1), when a significant part of the population is infected the statistical chance of infected people infecting others drops taking the R0 under 1. At that point the infection chains peter out and die. The most you can expect from that is a ratio of 0.6. That means that when the R0 is greater than the inverse of this, i.e. > 1.66, that herd immunity will not stop the chains.

When the R0 is substantial this does not happen. The effective R0 still drops due to the reduced probability of finding uninfected people to infect. However, with a high R0, there are still enough people to keep the effective R0 above unity, so the chains continue.

With an extremely infective virus, herd immunity has much less importance. This is where Boris is making a huge mistake in Great Britain. He reportedly wants to rely on herd immunity to end the chains. I do not know this first, second or even third hand. So treat that as rumor until someone links a story. Whether true or not it provides backdrop for explaining why this will not work.

This virus has been reported to have a serial time (the average time it takes one person to infect another in a chain) of 5.9, 7.2, and 7.5 days.  These are not significantly different evaluations. They are all long. Also, the virus seems to be contagious for at least several of the days before symptoms show at day 5-7 on average.

If we know or can estimate the serial time, and we know the slope of the growth curve of infections (plotted logarithmically), we can calculate the effective R0 = (growth rate/day)^(serial time in days). the growth rate itself is the exponential of the slope of the curve on the logarithmic plot (to the same base as the plot was made).

So for the typical growth rate of 1.35x/day and a serial time of 5.9 days we get an R0 of 5.87.  With the same growth rate and a serial time of 7.5 days the R0 is 7.50.

These are in the same range as Chicken Pox. It is highly communicable!

During the early phase with growth at ~1.6x/day, the equivalent R0 is then 16 - 34 !!!  That is Measles territory and worse.

This is what Edmountain was referring to. The major factors involved in this pandemic involve this infectivity, not the CFR. The CFR gets to consequences. It doesn't tell the whole story.

For disaster planning, both of these and the ratios for various morbidities are all important. For disaster management in an ER, the focus is on the specifics of the disease as it affects treatment and as it affects infection control.

The issues for decision makers and emergency managers is mostly about trying to stop the spread, and about logistics issues related to impacts on health care and societal functions. So long as those do not exceed the capacity of the emergency services, the details of what they have to deal with though important, are a second level concern. The first level concern is in minimizing the catastrophes growth so that they do not become overwhelmed. Then next, if they will be, figuring out any ways to reduce those impacts to levels that can be dealt with. 

In China that meant doing the mass quarantines, ... as first level response; then rapidly building hospitals and moving in equipment and personnel (doctors and nurses, plus support equipment and supplies) to handle the surge as it occurred. Italy failed there. The hospitals were and remain overwhelmed. At that point, the hospital emergency staff are in triage mode. They are having to decide who lives and who dies. This will traumatize them for the rest of their lives.

Within the medical establishments the focus is different. There the focus is on infection control both for all of the patients AND for all of the doctors, nurses, and staff, while being able to rapidly assess and handle all of the casualties and their specific needs without exhausting everyone, or consuming all available supplies. Slightly lower in priority is efforts to find the most effective and expeditious treatments with the best outcomes. Those are all a delicate dance with conflicting priorities and resource needs.

Back to your specific question. Since the time to display symptoms is generally about 5-7 days, this means that under the expected conditions with a growth rate of 1.35x/day, The number infected is about 6 times the number exhibiting symptoms. And since it often takes a day or two for those to present, thats 1.8 times more yet. And if the systems require that they be "confirmed" through testing to be counted, and the tests take 2 days to return answers, that is yet another 1.8x multiplier. For that case, the number infected is something like 20 times the confirmed count (give or take - a lot).

If there are no test kits available (US case) and the policy is to not test unless certain very constrained conditions exist (again - the US case), then the true population infected count may be staggeringly higher than the confirmed case count. In that case, deaths from causes that look like COVID may be a better indicator. And those occur something like 17 days on average following confirmed infection - 23 days in total. So death count times 1,000 may be a crude estimate of the likely count of those infected. That presumes of course that all those dying of the disease get counted as that, even if they were never tested for it.  Otherwise, the number is higher. Using these ratios for the United States this would suggest somewhere between 48,000 and 59,000 people infected a day ago. (Remember too that the data ia almost always a day late). That converts to 65-80,000 today.

Note also that as time passes, the counts smear together current and past counts, and these ratios break down. Do not rely on them other than as extremely crude thumb rules. Even then - do not rely on them.

If the controls began to go in place less than a week ago (true), then the growth is the same for the next few days at least. Remember that people are infected for almost a week before showing symptoms - so that week delay is baked into the problem.

If we use a growth rate of 1.25x/day for the next week (given how much people are beginning to do), then a week from today we should expect that there are 300-400 thousand people infected in the US.

BUT, if the numbers are suppressed due to under counting, these may dramatically underestimate the total infected at every stage.

Continue that same growth for one more week (i.e. no significant national actions for the next week, just haphazard State and individual actions that cause the rate of growth to remain at 1.25x/day for another week), then before anything changes, the number of infected people in the US reaches 1.4 - 1.8 million.

That is a likely minimum case BEFORE significant national controls take force. It only takes 24 more days (31 from now - one month) of inaction for those numbers to grow to involve every injectable person in the United States. And the first 6 of those are already baked in. Each passing moment dramatically lessens the effectiveness of any action taken.

That is the nature and problem with exponential growth. By the time you see you have a problem it has already eaten your lunch.

Sam

122
Consequences / Re: COVID-19
« on: March 15, 2020, 09:19:48 PM »
There are now more cases outside of China than inside of China. Within days there will be more who died outside of China than inside of China as well.

The world got lucky with SARS1. We have been mostly lucky with MERS and Ebola. Our luck ran out with SARS2.

So now we face the next difficult series of questions.

1) Will we globally pull our collective heads out of our asses and stop this thing? That was rhetorical. We failed. People have generally done more than governments to slow the spread (except for China, South Korean, and possibly Japan, Singapore and Indonesia). Italy, Spain, France and Germany have come late to the table in exerting controls. The US gas done bupkis as a nation. A handful of US States have done minor things. Major things are required. The US now has one week before the shit hits the fan. The shit is already hitting the Dan in Europe.

2) Whether nations do what is needed to stem this pandemic or not, once the first wave passes, will the nations of the world maintain stringent controls and education, and then aggressively work to eradicate this thing everywhere? Yes, that too is rhetorical. They won’t. That is my prediction. Economic pressures will win. As a result there will almost certainly be a second and third wave.

3) Presuming governments fail to do what is needed to totally eradicate this bug this summer:
A) will the virus mutate into one or more even more virulent or lethal forms?
B) will the virus mutate into less lethal forms in some areas? This leads to huge complications. This may have already happened in South Korea and parts of China.
C) will the virus become endemic?
D) will the virus take up residence in birds, specifically ducks and geese? If so, welcome to the more lethal version of the flu and a dramatic lessening of global life expectancy, as the great bird migrations shit the disease on us year after year, with genetic changes making previous treatments ineffective.
E) will the virus take up residence in other natural reservoirs making it impossible to eliminate?

4) Will the new genetic created vaccines work? Will they have nasty unexpected side effects?

5) Will some asshole somewhere decide to weaponize this bug? Will that be a high school student, or a college student, or some radicalized yahoo from God knows what background angry at someone or some group - using the Crspr and related tools that are now freely available to anyone?

6) As the world is tightly focused on SARS2, will MERS burst forth to show us just how lethal lethal can be? Ebola? Brazilian hemorrhagic fever? A variant of Hanta? Something unknown?

7) Will anyone learn anything from this? Or once it passes, or settles into the annual sequence of diseases or the diseases of youth, will we just go back to sleep only to be slapped in the face by the next emerging pandemic - whether that is Ebola or some other terrible disease almost no one has ever heard of?

Sam

123
Consequences / Re: COVID-19
« on: March 15, 2020, 07:11:50 PM »
Also - back to Neven’s points.

AGW is in the end vastly vastly vastly more important, bigger, and more critical than this damned stupid virus. Failing to respond massively to stop or now - slow - AGW will ultimately far far outweigh anything this virus does.

With AGW the maths are similar. The scope is greater. And the timeframes are vastly slower with much longer lag times. The human failings and stupidities are identical.

These are similar types of problems. And the very human failings that are causing us globally to fail with COVID are the self same failings that are destroying everything with AGW.

And that is I believe where the lesson with this virus most strongly strikes home.

If we cannot individually and collectively deal with this virus, how can we ever even begin to hope to solve AGW.

Sam

124
Consequences / Re: COVID-19
« on: March 15, 2020, 07:02:32 PM »
Edmountain,

The difference in 1-4% fatal isn’t with medical folks. They get it. They focus on what is right before them and what is important.

The importance is with the political leaders. When they fall into the threshold belief that this is just another flu, that is when they fail to act and fail to act quickly enough or massively enough. That is when a simple disease outbreak becomes an epidemic and when an epidemic becomes a pandemic.

In the end, the CFR will be a footnote. Unfortunately it will be a footnote to a paragraph that explains how leaders were so stupid as to allow a pandemic to ravage the world killing untold millions, and about how unnecessary those deaths were, and where it was that they got this idea from.

That is why and where the CFR argument has any importance at all. That - and the lives destroyed by all of those individual unnecessary deaths.

Sam

125
Consequences / Re: COVID-19
« on: March 15, 2020, 06:51:59 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:

Quote
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.

Amen Neven.

126
Consequences / Re: COVID-19
« on: March 15, 2020, 06:46:30 PM »

You are correct. Substitute IFR. Everything else remains exactly the same. Please stop arguing that this disease is anything less than 4% fatal to the general population, and devastating to another 6-11%. Unless of course it is your intent and desire for massive numbers of people to be killed and maimed. In that case I have no use for you, and I certainly cannot help you.

Sam

Considering the shortness of test kits and the testing of only the severe cases, I would say your numbers are too high - possibly by a lot.  After the initial onslaught, the cfr in China has fallen to under 1.  I find your claims of omnipotence recording this virus to be rather egotistical.  Why do you think are right and those who disagree are wrong?

The Diamond Princess controlled experiment demonstrated that, even with a population that skewed older than the general population and thus more vulnerable, the CFR and IFR are around 1% if the patients can get exceptional medical care. This is the lower bound for what we can expect worldwide. In this experiment, the IFR and CFR are the same as all infected persons were identified.

Wuhan, Italy, Iran and soon other nations will provide us with evidence regarding the CFR we can expect when the health care system is overwhelmed and large numbers of desperately ill people are essentially left to their own devices. The problem with these CFR numbers is we will never understand fully the IFR in these countries as their failed heath care system can't possibly identify all that are infected.

Last I checked, the CFR in Italy is around 7%.

SH

Unfortunately it didn’t demonstrate a damned thing. The cases were scattered to the wind.

The focus in belief that this disease is less fatal than it has demonstrated that is, and less transmissibility than it is is simply plain stupidity. The video above posted by NevB explained it quite clearly and correctly.

A handful of you though perhaps meaning well are arguing for things that will get people killed. And you are taking no personal responsibility for that stupidity.

Stupidity kills.

Sam

127
Consequences / Re: COVID-19
« on: March 15, 2020, 04:58:57 AM »
  I find your claims of omnipotence recording this virus to be rather egotistical.  Why do you think are right and those who disagree are wrong?

Number 1. I don’t claim omnipotence. I follow the data where it leads. I show my math, and I explain my reasoning. I am very open to information that conflicts with anything I write. You can believe what you like. It won’t hurt my feelings. My skin is far thicker than that.

As to why I think I am right? Well, because I can read, and I can do simple math. There are nearly 6,000 people dead already. We have a rapidly exploding pandemic shutting down the whole freaking world’s economy. And we are on course now to kill over 100 million people.

Beyond that, I have spent a lifetime in emergency management and response. I have lived with exponential growth problems my whole career and I know just how fast they get out of control. I have run nuclear reactors in crisis conditions. I have been bathed in corrosive chemicals and breathed toxic gases. I have literally had my skin turned to soap in a gas spray release. I have been in 175F environments, and high rad fields. I have been inside a biosafety level 2 facility. And I have personally worn nearly every kind of protective gear you can imagine, save BSL4, and loose plutonium surface contamination bubble suits and gear. i was invited to tour through the destroyed unit 4 reactor core at Chernobyl and I was invited to tour Fukushima. I declined both.

I have done engineering forensic analyses of many types. And I have worked with, and yes argued with, some of the finest scientists on earth in dozens of fields.

The problem here is straight forward. Choosing to cherry pick low data assures disaster. Choosing disaster is blitheringly stupid. This is not a linear problem. This isn’t even a problem of low-risk, high-consequence. This is a much more straight forward problem. It is a highly lethal pandemic spreading like chicken pox with a lethality that is high, perhaps half that of the Spanish flu. And if we screw up even a little and overwhelm our hospitals, it may equal the lethality of Spanish flu.

Treating it with any less respect than that deserves is the pinnacle of arrogance and stupidity. And no, I do not care one whit if that hurts your feelings. That is not ever a goal. But if one consequence is that I bruise your ego, so be it. The data speaks for itself. Peoples lives are at immediate risk. And I ignore fools in a crisis, unless they need to be dealt with because they are making the problem worse. You are making the problem worse. Stop doing that. Peoples lives are at stake.

Sam

128
Consequences / Re: COVID-19
« on: March 15, 2020, 03:16:41 AM »
I was just looking through the nextstrain data.

There may be another difference that ties South Korea and China ex Hubei together.

Both are part of the B Clade.  We know that the strain in Washington State is lethal. That’s the B1 Clade.

Hubei is in A clade. That is lethal.

Much of the rest of China seems to be B clade. South Korea is also mostly B clade.

I cannot easily tell from the data, but it may be that most or all of the B clade group, sans B1 may be less fatal than the A clade groups (and B1 - US).

So who here can make sense of that and plot out the lethality of the various clade strains?

Sam

129
Consequences / Re: COVID-19
« on: March 15, 2020, 12:20:12 AM »
Germany has now closed their public venues.

The United States is less than a week behind Italy, France, Spain and Germany. A handful of States have begun responding. The National response is to hand it over to business to deal with.

Businesses response has been less than stellar. And in Google's case, they handed it back.

The US from the Federal level is sleep walking into catastrophe. With each passing day without massive actions to curtail the spread the ultimate death toll rises exponentially.

The collapse of a once great nation.

Sam

130
Consequences / Re: COVID-19
« on: March 14, 2020, 11:29:06 PM »

I know you want this to be less devastating than it is. I believe you are also earnest in your arguments. But you are flatly wrong. There is no sound reason to believe that there is a large silent portion of this pandemic that magically makes the whole population CFR less. There is instead the early phase of infection before symptoms are apparent, and the later phase where they are apparent.

If we're going to argue about fatality rates, it might be good to stick to accurate terminology.  CFR is, by definition, a case fatality rate.  A "case" is a person who comes to medical attention, by test or otherwise.  We have decent data on this.

Infected but untested people are not "cases."  These fall into an "infection fatality rate," or IFR.

The IFR is simply unknown.  We won't know the IFR until antibody tests are available.  Even if such a test gets rolled out tomorrow, it would be a challenge to interpret while the pandemic is growing in size.

In a year or two, we'll have a solid understanding of the IFR.  Until then, it's all speculative.

You are correct. Substitute IFR. Everything else remains exactly the same. Please stop arguing that this disease is anything less than 4% fatal to the general population, and devastating to another 6-11%. Unless of course it is your intent and desire for massive numbers of people to be killed and maimed. In that case I have no use for you, and I certainly cannot help you.

Sam

131
Consequences / Re: COVID-1
« on: March 14, 2020, 11:16:27 PM »
So far 700 people have been tested in New-York, 500 of them tested positive.
That is an insane number of positive results for what is at this point essentially a screening test. Contrast this with where I work in Alberta where as of this morning there have been 7,108 tests done with 39 positives (source; accessed March 14).

In practice in New York this means the pre-test probability at the time the test is exceptionally high; in this setting it's impossible to conclude that a negative result is a true negative (barring a test with 100% sensitivity--and we know that's not the case).

On the flip side... if the tests are correct, we will know in about a week as a large percentage of those 500 become hospital patients.

However, if that is true, by then the case numbers in the population will have completely exploded.

Sam

132
Consequences / Re: COVID-19
« on: March 14, 2020, 10:49:30 PM »
Italy is approaching a 7% CFR. The next rising CFR's will be Spain and France as their medical services get overwhelmed.

I think Seattle and California are about to become hotspots. Testing will not tell us that, like in other countries. It will be news of overwhelmed hospitals. We have a week for that,

No masks yet.

We don’t know how high the death rate is when the population goes untreated. We know that 15-20% or more need critical care. Lacking that care a significant fraction will die. But how many?  If we guess half of those who wouldn’t have died anyway, then we need to add ~8% to the CFR. That puts the CFR at ~10-12% when severe controls are not implemented early and comprehensively.

The US in particular is very late to do anything meaningful. If those efforts don’t happen in the next few days, then there is a high likelihood that the hospitals become overwhelmed and the worst case happens. If 60% of the population is infected, and the 12% CFR results, the US may see as many as 24 million killed in April.

If massive controls and quarantines begin immediately, the US might limit the death toll to 1 million. All of those deaths, whether 1 million or 25+ million are the responsibility of one person - Donald Trump and his failings.

El Cid,

I know you want this to be less devastating than it is. I believe you are also earnest in your arguments. But you are flatly wrong. There is no sound reason to believe that there is a large silent portion of this pandemic that magically makes the whole population CFR less. There is instead the early phase of infection before symptoms are apparent, and the later phase where they are apparent.

Arguments such as yours, writ large, have contributed greatly to this catastrophe. I do not believe you have made any significant difference personally in the outcome, other than possibly to a few members of this forum, who might to their detriment have listened to you.

It is clear at this point that in general the CFR with working hospitals and advanced health care is about 4.2-4.4%. When those fail, the CFR rises. We have yet to see just how high. At the least - it doubles. With extremely good decision making and massive early actions, it is lessened. China demonstrated that. Italy, France and Spain are way late in learning from that example, but they are at least trying. South Korea and China ex Hubei showed a different and effective approach with emphasis on massive early testing. Others appear to have also made major inroads with early education and campaigns to reduce contact through social distancing, combined with widespread use of masks, and extensive sanitation (hand washing ...).

South Korea and China ex Hubei remain open questions as to why their reported CFRs are lower. Age distributions appear to play an important role. Reporting may as well (I.e. assignment of deaths to causes other than COVID for various reasons). Delays in reporting may too. The choice to use Chloroquine and other drugs/herbs may also play a central role. I sincerely hope they do. We do not know with any certainty what the causes are, or even that they are actually real. To assign that cause based on pure speculation as you have misleads decision makers and expands the magnitude of the catastrophe. Please stop.

It will be of academic interest later, and of importance for future SARSx pandemics. But now, it is important that decision makers bluntly face the high death rate as they make decisions, and that they not be distracted even for a moment by arguments or assertions that the CFR is anything less than 4%. Doing so will get people killed. I would hope that you do not want that.

Sam

133
Consequences / Re: COVID-19
« on: March 14, 2020, 07:56:21 AM »
Blumenkraft,

Sadly - that time is all but past. It is vital to do as you suggest. The government leaders won’t do it though. They demand proof first. Not just any proof either; proof that satisfies their personal preconceptions and limits, and that credits them or profits them in some way. And they don’t want to open their wallets, unless it is to enrich themselves personally.

Waiting for governments to act at this point is a form of suicide, or at the least - Russian Roulette. Self isolation is far from perfect. But it is what we have - at least for a few of us who are able to do so.

Sam

134
Consequences / Re: COVID-19
« on: March 14, 2020, 07:44:31 AM »
Vox and everyone,

Remember, always remember, when you look at those graphs - that is the people showing symptoms AND confirmed. Symptoms take 5-7 days to appear. People generally don’t seek assistance for the first day of symptoms, sometimes 2. Testing takes 2-3 days to confirm, sometimes longer. So those curves are 9 to 11 days AFTER people were infected. To prevent those infections, control efforts had to be fully in place 10-12 days earlier.

Since we are looking at 40 days to the absolute peak in the United States (~11 days earlier for Italy, 8 for France and Germany), that means to avoid those peaks full control actions must be in place four weeks earlier than the absolute peak. That’s 38-40 days from the peak in the US. And that is now. I mean right now. That isn’t to start controlling. That is to have full controls in place. That isn’t to start testing. That had to have happened four weeks earlier.

All of us have blown it in testing. Badly!  France and Germany will be in the same boat as Italy. That’s a done deal. The U.K. and Switzerland. Just barely have a chance if they begin massive actions instantly to avoid some of the worst.

People think immediately and linearly. Even then they generally far under estimate the needed response.

People almost never are able to think exponentially and to plan accordingly.

For the vast majority of people that will simply appear grossly alarmist. But that is what is required. After the fact, they will always be shocked, hurt and surprised, then angry that xxxx didn’t protect them. Yet they will never support or agree to the actions required to actually be ready.

And yes, this is a sort of parable about climate change too. Same song, different verses, same meaning.

Rodius,

Don’t lose heart. Even those who can think exponentially, and who do get all they ask for to avert calamity, will never ask for enough. The harms will still be great. And if they are in charge, they will still get blasted for not doing enough. But the true measure of a person isn’t in the accolades or acknowledgement. It is in the accomplishing of great deeds - especially if no one ever knows those deeds were done. Equally important are the myriad voices pushing them to action.

If through some miracle the leaders/experts do everything right, the hazard will never seem to have appeared and they will be looked on as foolish and alarmist and wasteful in the most extreme ways.

On the other hand - egotistical morons will never accept any blame. They and their sycophants will blame everyone but themselves for their failures. They will in fact demand credit - though God only knows for what. They can never imagine they are anything less than the most magnificent thing ever. May they all rot in hell.

Sam

P.s. Some long while ago I commented in frustration that the numbers didn’t matter anymore. The reason I said that was that the clock ran out for the United States and the World.  The pandemic was out of control in a dozen countries in the wild. The genie could no longer be put back in the bottle. Massive testing had to be in place then everywhere, AND massive controls needed to begin then, or the rest would play out as it has.

135
Consequences / Re: COVID-19
« on: March 14, 2020, 05:31:36 AM »
They used an R0 that is far too low.

The total of those who have been infected is growing in nearly every nation at 1.33 to 1.35 fold per day. That is an R0 of 6-8.

They then limit the infections to ~50% of the population in their models and assume a low CFR - for all of the reasons I have pointed out here. The real CFR looks to be 4.2-4.4%.

But, that assumes an infection rate low enough that the hospitals do not saturate, that physicians, nurses, ventilators and all the other gear is available. 15% of the population requires ICU level support.

Even with the grossly wrong parameters, they project (not predict) 20 million needing hospitalization at the same time, when there are less than 1 million beds for them.  The actual numbers will likely be much  higher unless massive action is taken immediately to slow the spread of the disease. The peak will be reached otherwise in 40 days or less. Worst case, that’s tens of millions becoming sick on the 39th day. (>60 million).

I cannot imagine that unconstrained growth and crash happening. People will self isolate.

About 6-9 days later that projects as 2.7 million deaths on the same day. That too won’t happen.

More than this though, even cutting these numbers dramatically the hospitals will be overwhelmed far before the peak. As China did, now is the crisis time to be building short term hospitals for this crush of people. Without the beds a large percentage of the 15% requiring serious support will instead - die.  The true CFR will then likely exceed 10% in the US, and in many places in Europe. In the most impacted areas during the worst week, the CFR May exceed 15%.

It will be remembered as the spring of the great dying.

And that is the true and hideous cost of having a Moron in Charge.

We are six to eight weeks from the worst of it. And it will be the worst in living memory. Then we will forget within a generation, only to be reminded again.

Perhaps the only saving ‘grace’ or poetic justice is that the leadership is old and in less than wonderful health. They will get to experience this tragedy first hand. Many will not survive. We might even lose as many as 20-35% of senior elected leaders. Their own policies, choices and actions will directly impact them.

Sam

136
Consequences / Re: COVID-19
« on: March 13, 2020, 04:05:04 PM »
Thank you Bruce.

I hope you are correct.

Sam

137
Consequences / Re: COVID-19
« on: March 13, 2020, 06:02:36 AM »
I just learned from a friend that the State of Washington has been ordered by The Federal Government to stop using their COVID test because it is not CDC/FDA approved. 

I can not verify this information personally.

If true, and I have every reason to believe it is, then:

1) It is utterly insane
2) I believe Washington State should immediately release a copy of that order to the press
3) I believe Washington State in the person of Governor Inslee should immediately hold a press conference detailing all of this and delivering Washington’s response: Go to hell. We will continue testing using our State developed tests until we have sufficient complete tests from CDC to fill our entire need, and have verified they work, or until ordered by a Federal Judge to stop. And our need for tests will not be limited to CDC guidance. Mass testing is needed now to identify who in the community may be infected.

We know CDC has utterly and completely failed. Washington State and New York State stepped up and began their own tests due directly to CDCs failures.

Massive public testing is needed - now!

CDC direction only allows testing under limited conditions:
https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html

Mass testing is essential to stop this virus’ spread. That must begin immediately.

Instead the U.S. Federal Governments response seems to rely on the three monkeys:
See no evil, Hear no evil, Speak no evil.

That policy is truly insane and recklessly irresponsible in a pandemic - in this pandemic!

Sam

138
Consequences / Re: COVID-19
« on: March 12, 2020, 10:17:50 PM »

My phlebotomist came this morning to take blood samples. She wasn't masked or gloved and we were not prepared either. I think I'll insist on her being better equipped on her next visit.
Still, it's much better than waiting in line at a lab.

Terry


Do remember please the oral and nasal swabs detect the virus. Blood typically does not!  Fecal samples do confirm it as well.

Sam

139
Consequences / Re: COVID-19
« on: March 11, 2020, 11:22:17 PM »
https://coronavirus.1point3acres.com/en


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.
Terry

Fantastic!

Thank you Terry.

Also - people should note an excellent source that these five students list...

https://github.com/CSSEGISandData/COVID-19

As well as all of the individual sources for their data.

Current best estimate of the CFR:
3. 91% < CFR < 4.88%. ==> CFR ~ 4.4%
Somewhat dependent on population age demographics and health.

Current best estimate of the growth rate:
1.33 / day - based on current infections
All succeeding numbers are derived from this and are very sensitive to it.

Current best estimate of R0 based on 5.9 or 7.2 day serial time:
5.4 and 7.8 respectively


Current best estimate of the average doubling time across many countries (varies by region):
2.44 days

Current best estimate of the weekly ./. monthly growth rate of those infected:
7.4 fold growth per week ./. 5,700 fold growth per month
Until quarantines and restrictions are imposed, or mass self-isolation occurs.

Sam

”Be the change you want to see.”

140
Consequences / Re: COVID-19
« on: March 11, 2020, 09:17:00 PM »
Excellent analysis!! Highly recommend!!
https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca

Fantastic analysis. The South Korea case makes sense when you look at the young age demographic and the effects of the expanded testing. That is reflected in the bounds analysis of the CFR. Just do NOT get hung up on the low bound CFR. It is misleading.

The fatality rate is 4-5% on a population level  - almost all over age 55 in the specifics, with tragic exceptions.

Lost too though is the immense harm to three times this many people with heart, lung and kidney damage, and the crushing weight on the health care system.

The Chinese acted correctly and massively with oppressive quarantines. AND by immediately building the hospitals required to care for people. No other country is doing this. The consequence of that failure of vision, leadership, and action will be devestating all over the world outside of China.

And that is likely to be most especially true in the United States, where the crushing failure of leadership is the most pronounced. In the United States, rather than leadership we have the proverbial three monkeys - see no evil, hear no evil, speak no evil. The consequences of that failure will be tragic and fatal for many. Given the advanced age of much of the leadership, it will be entirely unsurprising to see a 20% death rate of those in high office and positions of power. It will be a fascinating and horribly sad case study for the future of how not to run a country.

Sam

141
Consequences / Re: COVID-19
« on: March 11, 2020, 12:42:49 PM »
Though there has been suggestion that there are two broad groups of strains of the virus L and S, these seem not to have different properties. The suggestion that this distinction existed was made to try to explain the different apparent CFRs.

The explanations for these in most locations are straight forward and appear to be artifacts of the behavior of the virus and the populations involved.

This virus is extremely communicable. In high population density zones it transmits with an R0 of 10-18 comparable to measles. In zones with less population density it shows R0s of 6-12. And in smaller more discrete conditions with quarantine and other factors it transmits with lower R0s.

These are all simply conditions of human interaction rates and distances affecting the R0. These point to strategies to slow and even stop the virus, as the Chinese did.

Epidemiologists routinely assess the CFR by dividing current total deaths by current known infected population counts. With slow moving viruses, this number is reasonably close to the ultimate CFR when the infections have run their course.

However in pandemic conditions where the virus has a long latency, a large R0, and high lethality that takes another week to two to kill the patients, the deaths far trail the infections. In those conditions, the count of dead is always far behind the count of infected people. With time the ratio of total dead to total infected begins to catch up with reality as the spread of the virus slows. Even then, the ratio is still far low compared to reality.

This then causes the disease experts and decision makers to vastly underestimate the scale of the disaster. This too leads to a failure to recognize early the damage that will occur to the medical systems as they become overwhelmed.

To China's great credit, they saw this early and acted forcefully to shut down the pandemic in China. Unfortunately, this happened during lunar new year celebrations. That slightly delayed the first recognition of the problem. And the mass movement of people into and out of China during that time sent infected people all over the world. The seeds of a pandemic were sown.

Other nations had an opportunity to learn from the Chinese experience. But the same errors in assessing the CFR and communicability were repeated everywhere. This is not surprising. Experts the world over are ready for the flu. They aren't ready for the Spanish flu. Though they may fear pandemics like it, none of the tools are well built to truly spot it and respond in time. Scientists fears for credibility also delay their responses and cause them to err on the "conservative" side - the low side for both CFRs and R0s. This can be disastrous, as it has been with COVID-19.

The CFR as normally evaluated fails to identify the lethality of a virus like COVID-19 early in its propagation, precisely because of its properties. And it's properties are what makes it pandemic. Without serious changes in the numerical methods, pandemic viruses will always escape in this way.

The CFR must be evaluated better. One crude method to do that is by assessing it from its lower bound using the normal approach (total dead/total known infected). To that must be added the upper bound calculated by dividing total dead divided by the total dead plus total recovered. In the earliest days, this value can be nonsensical. Soon however it stabilizes. The true CFR lies between these (with corrections). When these are widely divergent, they point to inadequacy in the data for making conclusions. That avoids making false conclusions.

As the epidemic turns to pandemic and the counts increase, both numbers will come closer to the actual ultimate CFR. However, as now, even three months in there will be some spread between them. Currently those point to a CFR bounded between 4% and 5%.

With better data, better data gathering, and better analysis examining the exponential growth curves and the time lags from infection to confirmation to severe conditions to death and to recovery, with all of the variation of each, it is posible to better estimate the true CFR within the first weeks and months.

I did that here with not so good data and did narrow the CFR range to about 6-15% in that time period. That wasn't quite right. But it was close. Better knowledge about the time lags early in the epidemic would have gotten it closer.

Even now, the wants, desires and wishes that this not be so severe create enormous problems in assessing the severity of this pandemic. These come about for a number of different reasons. Some seem to be for the simple desire for bad things not to happen. Some seem to come from a misplaced reasoning that places financial and business analysis first and that seem to presume that not getting in the way of commerce is the primary priority.

The latter of course gets it entirely backwards. Health must come first. Failing to get that right maximizes the injury to commerce. This is a bitter lesson the United States and the European Union are in the process of learning the hard way.

Some of the error also appears to have had as its source emotion in general. People desire positive outcomes. People fear and loathe negative outcomes. And as with the economic error, this too leads to biases that cause maximum harm. Trying to minimize the apparent harm by stating it to be less than it is perversely maximizes the actual harm, pain and suffering. That is a very hard lesson.

With this virus in particular, the demographics effects are particularly acute. As this disease is most lethal to one age group, the elderly, any changes in age demographic of the initially affected population strongly skews the calculated CFR. This is most acute in the data from South Korea. The initial group impacted there had a very young age demographic. South Korea then began wide spread testing. This identified people as infected far sooner than would otherwise be the case. Doing this is good. But, doing so adds an even longer time lag between being counted as infected and dying. That skews the CFR decidedly low until the pandemic levels out. And that in turn leads to bad decisions as people rely on the low CFR as if it had real meaning.

Other population cases are less clear. There is not yet a good explanation for why the China data, ex Hubei shows a lower CFR than the total data set for China.  This may be a similar combination of factors. Or, it may be something else. It may also be impacted by small numbers.

For many nations, early in the pandemic phase, small numbers lead to problems in assessing the CFR.

But what we do know is that this virus behaves fairly uniformly. The CFR is likely not significantly different from one population to another. And lacking good evidence that there is a real difference for other reasons, it is foolish to presume they exist. It is prudent to use the higher CFR from the large population samples for decision making.

Now it may be that for this virus that there are genetic differences in ACE2 receptors from one group to another. And these could theoretically cause a difference in lethality among populations. But, there is as yet no evidence to support such an effect occurring.

Mostly what we seem to see is affects based on the age demographics and the comorbidities in the populations.

This virus is extremely communicable. In populations not exercising controls, quarantines, an end to gatherings and the like, the growth rate is generally about 1.33 per day in the cumulative count of those infected in the range from 100 to 10,000 infected. The curve heals over and slows a bit to about 1.20 over 10,000 infected. This is no doubt simply a reflection that the growth isn't dependent on the total ever infected, but rather on the Total population currently infected. The metric chosen for reporting isn't ideal. And again, better data and tools would make that clear.

Either way, this is an extremely communicable disease. With a serial time of 5.9 days, a 1.33/day growth implies an R0 of 5. A serial time of 7.2 days implies an R0 of 8. And when the growth is 1.6/day as it is early in the growth curve, these R0s are much higher at 16 and 30 respectively.

Said differently, in the early growth phase this virus is as communicable as the measles. Later during much of the growth phase it is as communicable as Chicken Pox. Both are extremely communicable.

We know now that the CFR is between 4% and 5%. 4.5% is a good average. That number will vary somewhat with the age demographics of the population involved. So too will the timing. But for planning purposes this close enough.

Then too there is the other very human problem of demanding proof before action, I.e. Test confirmation before counting. This once again places potential economic harm at priority over public health. And it perversely maximizes harms to both people's health and the economy.

It is already too late to learn these lessons with this first wave of COVID-19. All of the key decisions about quarantines, banning of gatherings, and other actions will cease to have any significance within two to three weeks. After that, the medical systems globally will face the same collapse Italy is now seeing. Many nations will see that rather sooner even than that. But, we can learn from this for the future.

Sam


142
Consequences / Re: COVID-19
« on: March 09, 2020, 11:28:00 PM »
The WHO has as much choice about this as you or me. They must remain civil while trying to convince the tyrant of his foolishness.

I agree with the WHO that this is not a pandemic yet, not even close to a pandemic. The potential for a pandemic is most certainly there especially with the US doing I don't know what, but we can still stop this before another Wuhan.

Get real. We passed Pandemic a long time ago.

This is a rapidly spreading (1.2-1.6 fold per day) highly lethal (mean 4.4%, almost all over age 60) disease with a long incubation period (5.9-7.2 days mean with a range of 2-28 days). It also severely injures a large percentage of those who need care with heart damage, lung damage, or kidney damage causing immense strain on the medical systems and causing Hospitals to have to triage which patients get care.

This disease spreads like chicken pox or measles in terms of speed, and kills nearly as effectively as SARS, Polio or the Spanish Flu in the second wave.

If this were flu, pandemic would have been declared long long ago.  This is worse and vastly more lethal.

This is a pandemic. Delaying recognition of that kills people and maims others. Massive actions are required everywhere to stop it. Those don't happen when it isn't recognized for what it is. Italy now recognizes that - far too late. And they have now placed the entire country under loose quarantine. Loose quarantine isn't nearly enough, as they will very soon realize.

Say the words.

COVID-19 is a fast spreading, highly lethal, global pandemic.

And ---- it may get worse. Like the Spanish flu, this may mutate into other forms with worse characteristics. In the midst of a pandemic those are often slow to be recognized.

Sam

143
Consequences / Re: COVID-19
« on: March 08, 2020, 09:21:52 PM »
I wonder how this is going to end. Vietnam had 8 new infections today, all tourists from Europe. The same for India, many european tourists. European tourists are infecting people across the entire planet.

It will likely end badly.

I am reminded of a quote from a TV program no one remembers (Crusade). The Actor Andreas Katsulas (great actor, no longer with us sadly) delivered the line as the Narnian Ambassador G'Kar (actually a bit more complicated) to a group of leaders and dignitaries. They were on a spaceship fleeing the dark forces. The leaders wanted the captain to set the ship down on a planet to let them off, then fly on with the dark forces in pursuit leaving them safely behind.

G'Kar explains to them ever so politely that they cannot land as the ship is being held together by bailing wire and bubble gum, and that were they to attempt to do so that they would likely have a most unfortunate encounter with the ground.

We are about to have that most unfortunate encounter. It will end badly.

Sam

144
Consequences / Re: COVID-19
« on: March 07, 2020, 09:26:13 PM »
Vox,

In the graphic you shared the red box for SARS-COV-2 is shown about where the early epidemiological work suggested it should be. In an exponential rapid growth condition this early evaluation severely understates both the infectivity and lethality of the virus.

Based on current data the red box should properly be located where the words “People infected by each sick person” are in the graph with lethality between 1 and 5% (with 4-4.5% being most likely), and infectivity (R0) being between 6 and 18 with the most likely range being 9-14, barring mass quarantine. 

That puts its infectivity between Chicken Pox and Measles, and its lethality at about half that of SARS, Polio, and Spanish Flu.

That is a really bad combination. It leads to bad decisions, delayed response, rapid spread, and high morbidity and mortality. It also leads to huge numbers of people being sick and dying almost simultaneously.

Sam

145
Consequences / Re: COVID-19
« on: March 07, 2020, 04:09:13 AM »
    The US CDC is now recommending that those over 60 or with serious health conditions stay home.

https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html

Quote
People at Higher Risk for COVID-19 Complications
What to do if you are at higher risk:
  • Stay at home as much as possible.
  • Make sure you have access to several weeks of medications and supplies in case you need to stay home for prolonged periods of time.
  • When you go out in public, keep away from others who are sick, limit close contact and wash your hands often.
  • Avoid crowds.
Stay up to date on CDC Travel Health Notices.
On This Page

Who is at Higher Risk
Get Ready for COVID-19 Now
What to Do if You Get Sick
What Others can do to Support Older Adults
Who is at Higher Risk

Older adults and people who have severe chronic medical conditions like heart, lung or kidney disease seem to be at higher risk for more serious COVID-19 illness. Early data suggest older people are twice as likely to have serious COVID-19 illness. This may be because:
  • As people age, their immune systems change, making it harder for their body to fight off diseases and infection.
  • Many older adults are also more likely to have underlying health conditions that make it harder to cope with and recover from illness.
  • If a COVID-19 outbreak happens in your community, it could last for a long time. Depending on the severity of the outbreak, public health officials may recommend community actions to reduce exposures to COVID-19. These actions can slow the spread and reduce the impact of disease.
  • If you are at increased risk for COVID-19 complications due to age or because you have a severe underlying medical condition, it is especially important for you to take actions to reduce your risk of exposure.

Get Ready for COVID-19 Now
  • Consult with your health care provider for more information about monitoring your health for symptoms suggestive of COVID-19.

Have supplies on hand
  • Contact your healthcare provider to ask about obtaining extra necessary medications to have on hand in case there is an outbreak of COVID-19 in your community and you need to stay home for a prolonged period of time.
  • If you cannot get extra medications, consider using mail-order for medications.
  • Be sure you have over-the-counter medicines and medical supplies (tissues, etc.) to treat fever and other symptoms. Most people will be able to recover from COVID-19 at home.
  • Have enough household items and groceries on hand so that you will be prepared to stay at home for a period of time.
  • Avoid close contact with people who are sick
If COVID-19 is spreading in your community, take extra measures to put distance between yourself and other people
  • Stay home as much as possible.
  • Consider ways of getting food brought to your house through family, social, or commercial networks
  • Avoid crowds, especially in poorly ventilated spaces
  • Make a plan for what to do if you get sick
  • Stay in touch with others by phone or email. You may need to ask for help from friends, family, neighbors, community health workers, etc. if you become sick.
  • Determine who can provide you with care if your caregiver gets sick.
  • Take everyday preventive actions
  • Clean your hands often
  • Wash your hands often with soap and water for at least 20 seconds, especially after blowing your nose, coughing, or sneezing, or having been in a public place.
  • If soap and water are not available, use a hand sanitizer that contains at least 60% alcohol.
  • To the extent possible, avoid touching high-touch surfaces in public places – elevator buttons, door handles, handrails, handshaking with people, etc. Use a tissue or your sleeve to cover your hand or finger if you must touch something.
  • Wash your hands after touching surfaces in public places.
  • Avoid touching your face, nose, eyes, etc.
  • Clean and disinfect your home to remove germs: practice routine cleaning of frequently touched surfaces (for example: tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks & cell phones)
  • Watch for symptoms and emergency warning signs
  • Pay attention for potential COVID-19 symptoms including, fever, cough, and shortness of breath. If you feel like you are developing symptoms, call your doctor.
If you develop emergency warning signs for COVID-19 get medical attention immediately. In adults, emergency warning signs*:
  • Difficulty breathing or shortness of breath
  • Persistent pain or pressure in the chest
  • New confusion or inability to arouse
  • Bluish lips or face
*This list is not all inclusive. Please consult your medical provider for any other symptom that is severe or concerning.

What to Do if You Get Sick
  • Stay home and call your doctor
  • Call your healthcare provider and let them know about your symptoms. Tell them that you have or may have COVID-19. This will help them take care of you and keep other people from getting infected or exposed.
  • If you are not sick enough to be hospitalized, you can recover at home. Follow CDC instructions for how to take care of yourself at home.
  • Know when to get emergency help
  • Get medical attention immediately if you have any of the emergency warning signs listed above.

Sam

146
Consequences / Re: COVID-19
« on: March 06, 2020, 06:21:01 AM »
With doubling time of confirmed cases outside China currently at about three days, we can be sure of one thing--that rate cannot continue for more than three months, since by then everyone on earth would have had it at least once! (Of course, with stories of re-infection...who knows  :o )

Whether imposed by governments, or self imposed by people, the rate will no doubt drop as quarantines and isolation begins. The Chinese imposed it. Western countries have not embraced it - yet; except Italy - who has begun doing so. When the governments abrogate their roles in protecting people’s health, the people will react in fear and do so themselves.

Sam

147
Consequences / Re: COVID-19
« on: March 06, 2020, 05:41:04 AM »
Washington State, King County Health recommendation. Expect similar recommendations across the US over the next two weeks. Also, expect these to change rapidly as the pandemic spreads.

https://www.kingcounty.gov/depts/health/news/2020/March/4-covid-recommendations.aspx

Quote
State and local officials announced today new recommendations to King County residents aimed at reducing their risk of exposure to COVID-19. We understand these actions will have a tremendous impact on the lives of people in our community. We are making these recommendations in consultation with CDC based on the best information we have currently to protect the public's health.

This is a critical moment in the growing outbreak of COVID-19 in King County and these measures can potentially impact the spread of the disease.

Public Health is recommending, but not requiring, the following steps:
People at higher risk of severe illness should stay home and away from large groups of people as much as possible, including public places with lots of people and large gatherings where there will be close contact with others. People at higher risk include:
People 60 and older
People with underlying health conditions including heart disease, lung disease, or diabetes
People who have weakened immune systems
People who are pregnant


Workplaces should enact measures that allow people who can work from home to do so. Taking these measures can help reduce the number of workers who come into contact with COVID-19 and help minimize absenteeism due to illness

If you can feasibly avoid bringing large groups of people together, consider postponing events and gatherings.

Public Health is not recommending closing schools at this time. If there is a confirmed case of COVID-19, Public Health will work with the school and the district to determine the best measures including potential closure of the school.

All people should not go out when they are sick.

Avoid visiting hospitals, long term care facilities, or nursing homes to the extent possible. If you need to go, limit your time there and keep six feet away from patients.


More detail on these measures will be available at www.kingcounty.gov/covid

The decision on school closure will likely change when the first student is infected. Highlighting in the above is mine, not theirs.

Sam

3.77% < CFR < 5.36%

There are two types of people; the living, and the dead. Choose which group you would like to be part of.

148
Consequences / Re: COVID-
« on: March 03, 2020, 11:02:39 PM »
That is perhaps true if you are a health care worker who will be repeatedly exposed thousands of times, and who doesn’t mind risking ultimate exposure, illness, heart damage, lung damage, kidney damage, and death.

Yes sure, in that case, by all means use the piss poor protective recommendations from CDC. While you are at it, rely on their seemingly mostly ineffective test. 

Sam
What a strangely angry response. If the CDC IPC guidelines are "piss poor" I am curious what you think of the guidelines from the WHO, Health Canada, and other jurisdictions which are actually less strict than those from the CDC.

From his posts, Sam has to be a medical professional with infectious disease knowledge as he questions many of the statements made by the experts and almost all of the data is suspect due to efforts to conceal the seriousness of the pandemic. We know how doctors can have poor bedside manner and this must be the reason for the tone of some of his comments.

SH

Think. Think for yourself self. Stand on your own two feet. Do the math. Read the reports. Reach the obvious conclusions. CDC and frankly WHO, Canada and many others have missed the boat. The data from Wuhan initially, then from China at large, then Italy and others are abundantly clear.

This is a BSL 3, extremely contagious, high lethal virus. It cares not one whit about degrees, or anything like that. It respects cost-benefit analysis as much as it does starquakes on proxima - not at all.

The various organizations recommendations are based on outmoded ideas of infection control that are useful for seasonal flu and that fail utterly to recognize the consequences already seen from using even more stringent protocols in China. Hundreds perhaps thousands of medical staff there have fallen prey to this virus with many being critically injured or dying as a result. Using lesser controls will inevitably result in disaster here for medical and nursing staffs.

I fail to understand why so many people fall to their knees bowing to authority.

This is NOT the seasonal flu. This is an out of control pandemic killer. Treat it as such. Treat it with the respect it deserves. People should rightly be afraid. Priorities need serious realignment. COVID is a killer.

And as the data suggested for some time now, the CFR is in the 4-5% range.

Sam

149
Consequences / Re: COVID-19
« on: March 03, 2020, 10:50:00 PM »
Quote
the American system cannot possibly test all who need testing.

It most certainly can. It chooses not to.

Like with most diseases, the earlier these cases are caught, the better the likely outcome. Lack of testing means that people will not get adequate treatment in time. The US will have a very high fatality, thanks to Trump.

I pray summer limits this gross mishandling of the situation.

It's the democrat states that bring in almost all the cases, the open border states. Just look to Europe, they left all the borders open. Italy is already a disaster. Cases are going up fast in France and Germany. Today we had our first case of local transmission here in Belgium. It's the same lobbyists that you had from the anti-brexit camp. This is there next disaster.

Oh please. Infectious diseases do not care about such bilge.

150
Consequences / Re: COVID-19
« on: March 03, 2020, 07:48:22 AM »
There’s a high likelihood that community spread of coronavirus has been going on for weeks "at least": Outbreak expert

Quote
“How did we end up with major surveillance failure on par with Italy and Iran? Let’s talk about how that happens.”

He said that it would likely get spun as a flaw in the test kits, but it isn’t.

“It’s an interconnected communications, strategy, process, and execution failure, reflecting a serious breakdown of crisis management”...

... The key question is not ‘why didn’t CDC’s test kits work?’ It’s ‘why were flawed CDC test kits allowed to bottleneck all US testing capacity when alternatives were available?'”

Other nations have managed to make it work, and tens of thousands have been tested. In fact, the province of British Columbia in Canada has tested more people than all of the United States.

https://www.rawstory.com/2020/03/theres-a-high-likelihood-that-community-spread-of-coronavirus-has-been-going-on-for-weeks-outbreak-expert/

We got here by relying on the terrible idea that we don’t want to scare people, or inconvenience them, so we rely only on PROVEN positive tests. And we do that knowing the very high false negative test rates and the known defective nature of many of the tests.

Proof in science is fine when you are trying to prove a theory. It can be a real killer when applied in real time in pandemics.

Sam

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