Coronavirus

[stahleyp]

In case you want some real stories:

My relative who was cured 3 weeks ago now has the symptoms again and CT shows lung infections. My mom’s neighbor was recently cured and discharged from hospital and died the next night.

 

sorry to hear that. Do you know their ages?

Both in the 50s.

 

Sorry to hear about your family member, muscle. I do appreciate you giving us the lowdown and thanks for helping to alert us about how serious this thing really is.

[mloub]

So you want to start by testing states with 75 million people? Yikes.

 

The covid-19 nasal swab doesn't exist yet, you know this. Secondly. That would have been great, back in December.

Looks like they have it in WA

 

https://www.npr.org/2020/03/08/813486500/coronavirus-drive-through-testing-centers

 

Well its not available in New York. Where can we source them? NY will need about 40 million of them.

 

This is a bit of a red herring. The nasal swabs just pick up epithelial sells, mucus and whatever else is around and put them in a fixative medium - the red stuff.

 

You can run any PCR test you want on those swabs, there is nothing magical about the swabs. And we have the PCR tests ready to go. That is what Dr. Chu in Seattle did on her pre-existing Flu nasal swabs, and how she identified the 17-year old with the community acquired case that gave officials there a head start in tracking down the community spread.

 

I know we may not have an FDA approved, clinically validated nasal kit for covid-19, but we are past that aren't we? If it is scientifically sound, we should use it now.

 

And to be clear I don't advocate testing all 75 million people, just the ones with Upper respiratory tract infections not explained by another diagnosis.

 

In case of asymptomatic spread, I'm not sure we can do much about that, nor should we focus on it, until we know more about its prevelance. Current sources are conflicting on whether it plays a role at all. Hopefully, social distancing and general precautions can help deal with that.

 

M.

 

[orthopa]

Contact tracing will obviously no longer work in the US. That is an opportunity the US has missed. 

 

We must start social distancing immediately, including cancelling public events, and reducing exposures to large groups.

 

Marc Lipsitch, the Harvard Epidemiologist has a thread here:

 

 

Weren't we just arguing about this in my example of extended contact at airport ? Now because he says it, its true? LOL

 

Orthopa, do you think you can slow down a bit and try to communicate a little more clearly? I think you are making some good points, but it seems your points may not be getting across clearly or that you may even be misunderstood. This post in particular makes me think that is the case.

 

I also thought your earlier point about testing the role of testing in a diagnosis is likely a good point, but was probably too hasty to get your point across. Maybe some other medical professionals could weigh in on that, especially if you're to busy to respond.

 

I dont know how much more I can slow down. I have probably posted 50 times? Trying to get some points across. Am I completely right?, of course not but I have experience FWIW. Others have graphs,  twitter links, and or political angles which are underwhelming at best sometimes.

 

Again points that I have made that I believe are true FWIW (we are allowed an opinion right?)

 

1. The virus has been here for months, likely early January and has been seen/dealt with in the health system under other diagnoses for months.

2. The first test confirmed, was not the first test here.

3. There was nothing the government or any nation in the world could do to stop the initial spread

4. Older people and those most at risk will die. There is no cure, and viruses kill people. Elderly people should take appropriate precautions.

5. Because the virus has been here for months testing is borderline useless and your going to chase your tail the entire time. This is due to numerous contacts and the extended incubation period.

6. If you don't test everyone the virus will continue to spread quickly, again via asymptomatic people and kids. Best policy is to test everyone, but its impossible and too late.

7. Best way to prevent spread is standard precautions! This includes isolation, hand washing, yada, yada. NOT TESTING.

8. If a patient test positive and there has been minimal definite contacts say someone who is home bound with a handful of contacts testing may make sense but these are limited cases.

9. The the spring/summer will bring a reprieve in new cases and hopefully that was well as the fact that nearly everyone will have been exposed or infected this will limit virgin hosts.

10. A vaccine is useless if the virus mutates significantly.

11. The number of cases are vastly under reported, probably numbering in the millions by now in the US.

12. If someone you know or yourself had a cold/URI/flu symptoms that tested negative, and was "way worse" then the common cold there was very high chance it is/was the corona virus.

13. Every case of the virus is not severe, so don't model it as such. Corona virus dx does not = ICU and ventilator.

14. I believe eventually those in charge medically will come to the conclusion that its inevitable that this becomes a pandemic with everyone getting infected in time.

15. If your human, you will get the virus in your lifetime. Nothing you can do.

16. Flattening the curve makes sense but I question when the curve will bump as the virus again likely has been here for months.

 

 

 

[orthopa]

Where are my "this is concerning, and we are watching developments with caution" folks?

 

And be thought a fool by everyone with a strong opinion? Better to remain silent.  ;)

 

 

 

 

@orthopa

I think what folks are saying when saying testing is important is that identifying as many spreaders as possible is key to containment. You can't catch them all. Don't let perfect be the enemy of the good. Some folks spread to 1 person. Some spread disease to dozens. You want to eliminate as many spreaders as possible so that the disease population can't reach escape velocity. Basically to the point above about the number sick at any given time being semi-controllable.

 

 

 

Whats your plan for asymptomatic people/kids who don't seem to be affected and dont go to the doctor?

[muscleman]

In case you want some real stories:

My relative who was cured 3 weeks ago now has the symptoms again and CT shows lung infections. My mom’s neighbor was recently cured and discharged from hospital and died the next night.

 

sorry to hear that. Do you know their ages?

Both in the 50s.

 

Which area, if you're ok disclosing?

 

Wuhan.

 

But.... I live in the Seattle area and the Kirkland nursing center said this week that there are a few patients who has no symptoms at all, and then from onset of symptoms to death, just a few hours.

 

So we have a virus that goes on and off, and hide in stealth mode and suddenly kills people.

[Guest Schwab711]

Where are my "this is concerning, and we are watching developments with caution" folks?

 

And be thought a fool by everyone with a strong opinion? Better to remain silent.  ;)

 

 

 

 

@orthopa

I think what folks are saying when saying testing is important is that identifying as many spreaders as possible is key to containment. You can't catch them all. Don't let perfect be the enemy of the good. Some folks spread to 1 person. Some spread disease to dozens. You want to eliminate as many spreaders as possible so that the disease population can't reach escape velocity. Basically to the point above about the number sick at any given time being semi-controllable.

 

 

 

Whats your plan for asymptomatic people/kids who don't seem to be affected and dont go to the doctor?

 

I already answered. You can't catch everyone. Any additional you do catch early can moderate the number sick at any given time. You might not be able to control total number to get sick, but spreading that number out over a longer period leads to far better outcomes in aggregate. That's why people are testing.

 

Further, WHO says adult to child transmission is more common than reverse, as opposed to seasonal flu.

 

To the "it's been here for 1+ month" comment, viruses compound when no one has immunity.

 

I don't understand "why bother trying, just make fun of the try-hards" attitude just because we can't be perfect in prevention.

[alwaysdrawing]

I wonder when the market is going to wake up to the risks here.

 

Every day I think people will wake up, and every day there are only these small moves.

[orthopa]

https://www.bloomberg.com/news/articles/2020-03-11/singapore-warns-of-complacency-while-new-virus-infections-surge

 

“It was premature to perceive Singapore’s epidemic as under control, as we know there is asymptomatic transmission and that some cases may have been missed,” said Raina MacIntyre, professor of infectious diseases at the University of New South Wales. “There could have been undetected chains of transmission in the community as a result.”

 

The asymptomatic likely number in the thousands, just like all over the rest of the world.  Again you test everyone or your wasting your time.

[Dalal.Holdings]

Where are my "this is concerning, and we are watching developments with caution" folks?

 

And be thought a fool by everyone with a strong opinion? Better to remain silent.  ;)

 

 

 

 

@orthopa

I think what folks are saying when saying testing is important is that identifying as many spreaders as possible is key to containment. You can't catch them all. Don't let perfect be the enemy of the good. Some folks spread to 1 person. Some spread disease to dozens. You want to eliminate as many spreaders as possible so that the disease population can't reach escape velocity. Basically to the point above about the number sick at any given time being semi-controllable.

 

 

 

Whats your plan for asymptomatic people/kids who don't seem to be affected and dont go to the doctor?

 

I already answered. You can't catch everyone. Any additional you do catch early can moderate the number sick at any given time. You might not be able to control total number to get sick, but spreading that number out over a longer period leads to far better outcomes in aggregate. That's why people are testing.

 

Further, WHO says adult to child transmission is more common than reverse, as opposed to seasonal flu.

 

To the "it's been here for 1+ month" comment, viruses compound when no one has immunity.

 

I don't understand "why bother trying, just make fun of the try-hards" attitude just because we can't be perfect in prevention.

 

Best not waste time arguing with brains turned to cabbage. They keep on pounding it in as Munger says. He’s not the only one with healthcare experience. Anyone who mocks those who look at graphs, reads Taleb, etc is in for a reckoning.

 

Edit: it is clear there are countries doing a good job vs not and clear which way the U.S. is headed. What we have to fight is inertia and those saying “just another flu” or “nothing can be done”. Those things are categorically false just by observing how certain countries are approaching this right now.

 

If you want to try and predict where the U.S. will be several weeks from now, the unfortunate guide seems to be Italy (except 5x the size) more and more due to pathetic response.  :-\

[Castanza]

Where are my "this is concerning, and we are watching developments with caution" folks?

 

And be thought a fool by everyone with a strong opinion? Better to remain silent.  ;)

 

 

 

 

@orthopa

I think what folks are saying when saying testing is important is that identifying as many spreaders as possible is key to containment. You can't catch them all. Don't let perfect be the enemy of the good. Some folks spread to 1 person. Some spread disease to dozens. You want to eliminate as many spreaders as possible so that the disease population can't reach escape velocity. Basically to the point above about the number sick at any given time being semi-controllable.

 

 

 

Whats your plan for asymptomatic people/kids who don't seem to be affected and dont go to the doctor?

 

I already answered. You can't catch everyone. Any additional you do catch early can moderate the number sick at any given time. You might not be able to control total number to get sick, but spreading that number out over a longer period leads to far better outcomes in aggregate. That's why people are testing.

 

Further, WHO says adult to child transmission is more common than reverse, as opposed to seasonal flu.

 

To the "it's been here for 1+ month" comment, viruses compound when no one has immunity.

 

I don't disagree with this point on spreading it out, but what exactly is the threshold (number of patients a hospital can hold)?

 

Healthcare capacity is derived and constructed off of averages and then scaled according to population. A pandemic by nature is already over-capacity right?

 

If I had to guess the threshold is quite low and I'm doubtful any solutions will be effective. The US is especially difficult to contain and isolate due to its size, efficiency and reliance on individual travel (interstate) compared to small countries like Germany (who funny enough just announced 3/4 of their citizens are likely to be infected).

 

If small countries that heavily rely on public transit can barely contain this thing how can a vast country like the US contain it? I guess scale could make quarantining sections of the country possible, but with the reliance on individual transit it feels like a bucket full of holes trying to carry water.

[opihiman2]

In case you want some real stories:

My relative who was cured 3 weeks ago now has the symptoms again and CT shows lung infections. My mom’s neighbor was recently cured and discharged from hospital and died the next night.

 

sorry to hear that. Do you know their ages?

Both in the 50s.

 

Damn, that's fucked.  I watched a video on Youtube the other day where they interviewed this young English bloke in Wuhan that had coronavirus.  If you end up with the severe symptoms, it sounds effing horrible.  He said it started out like a regular cold, then you start to feel better, and then for him it turned into like the worst case of the flu.  The shortness of breath symptom, apparently, is from pneumonia, which he ended up getting.  No wonder a lot of old people and people with health issues are dying from coronavirus.  It's the pneumonia that's likely killing them.  Pheumonia is no joke.  You need to go to the hospital for that.

 

Also, people need to watch this:

 

 

I think what he said struck a chord with me.  This is going to be a marathon and not a sprint.  People are making idiotic assumptions like they usually do on this dumb forum that this will be like the flu.  We have vaccines for the flu, which likely makes the course shorter.  But, we have no vaccine for this.  Hell, we don't even have a vaccine for the common cold. 

 

[orthopa]

Where are my "this is concerning, and we are watching developments with caution" folks?

 

And be thought a fool by everyone with a strong opinion? Better to remain silent.  ;)

 

 

 

 

@orthopa

I think what folks are saying when saying testing is important is that identifying as many spreaders as possible is key to containment. You can't catch them all. Don't let perfect be the enemy of the good. Some folks spread to 1 person. Some spread disease to dozens. You want to eliminate as many spreaders as possible so that the disease population can't reach escape velocity. Basically to the point above about the number sick at any given time being semi-controllable.

 

 

 

Whats your plan for asymptomatic people/kids who don't seem to be affected and dont go to the doctor?

 

I already answered. You can't catch everyone. Any additional you do catch early can moderate the number sick at any given time. You might not be able to control total number to get sick, but spreading that number out over a longer period leads to far better outcomes in aggregate. That's why people are testing.

 

Further, WHO says adult to child transmission is more common than reverse, as opposed to seasonal flu.

 

To the "it's been here for 1+ month" comment, viruses compound when no one has immunity.

 

I don't understand "why bother trying, just make fun of the try-hards" attitude just because we can't be perfect in prevention.

 

So your ok with catching 50 for every 50 that run free? Looks like your in cahoots with those in charge in Singapore.

[orthopa]

Where are my "this is concerning, and we are watching developments with caution" folks?

 

And be thought a fool by everyone with a strong opinion? Better to remain silent.  ;)

 

 

 

 

@orthopa

I think what folks are saying when saying testing is important is that identifying as many spreaders as possible is key to containment. You can't catch them all. Don't let perfect be the enemy of the good. Some folks spread to 1 person. Some spread disease to dozens. You want to eliminate as many spreaders as possible so that the disease population can't reach escape velocity. Basically to the point above about the number sick at any given time being semi-controllable.

 

 

 

Whats your plan for asymptomatic people/kids who don't seem to be affected and dont go to the doctor?

 

I already answered. You can't catch everyone. Any additional you do catch early can moderate the number sick at any given time. You might not be able to control total number to get sick, but spreading that number out over a longer period leads to far better outcomes in aggregate. That's why people are testing.

 

Further, WHO says adult to child transmission is more common than reverse, as opposed to seasonal flu.

 

To the "it's been here for 1+ month" comment, viruses compound when no one has immunity.

 

I don't understand "why bother trying, just make fun of the try-hards" attitude just because we can't be perfect in prevention.

 

Best not waste time arguing with brains turned to cabbage. They keep on pounding it in as Munger says. He’s not the only one with healthcare experience. Anyone who mocks those who look at graphs, reads Taleb, etc is in for a reckoning.

 

Edit: it is clear there are countries doing a good job vs not and clear which way the U.S. is headed. What we have to fight is inertia and those saying “just another flu” or “nothing can be done”. Those things are categorically false just by observing how certain countries are approaching this right now.

 

Hi Dalal, you couldnt go a whole month again could you???  Where are we supposed to be case wise on your graph again?

[hyten1]

lets hope remdesivir works

[KCLarkin]

11. The number of cases are vastly under reported, probably numbering in the millions by now in the US.

 

Everything you are saying is based on this assumption, which has no proof! Obviously the lack of testing in the US means this could be true. But extremely unlikely based on what we are seeing in other countries.

 

In Ontario, we have tested just under 3000 people and 36 were positive. That is just over 1% positive from people deemed high risk of the virus. This is not a virus that has been silently going around for months.

 

You are just wrong on this. And repeating it 50 times does not add value.

[Dalal.Holdings]

11. The number of cases are vastly under reported, probably numbering in the millions by now in the US.

 

Everything you are saying is based on this assumption, which has no proof! Obviously the lack of testing in the US means this could be true. But extremely unlikely based on what we are seeing in other countries.

 

In Ontario, we have tested just under 3000 people and 36 were positive. That is just over 1% positive from people deemed high risk of the virus. This is not a virus that has been silently going around for months.

 

You are just wrong on this. And repeating it 50 times does not add value.

 

The danger of loudmouth cabbage brains is they convince people in charge and that leads to danger for all of us. This is not an extinction event, but it sure makes you realize exactly how we would approach a real extinction threat—in the same way.

 

This thread is toxic.

[orthopa]

11. The number of cases are vastly under reported, probably numbering in the millions by now in the US.

 

Everything you are saying is based on this assumption, which has no proof! Obviously the lack of testing in the US means this could be true. But extremely unlikely based on what we are seeing in other countries.

 

In Ontario, we have tested just under 3000 people and 36 were positive. That is just over 1% positive from people deemed high risk of the virus. This is not a virus that has been silently going around for months.

 

You are just wrong on this. And repeating it 50 times does not add value.

 

How many asymptomatic people were tested? Have you been tested?

 

Secondly whats your read on the bloomberg singapore article?

[orthopa]

11. The number of cases are vastly under reported, probably numbering in the millions by now in the US.

 

Everything you are saying is based on this assumption, which has no proof! Obviously the lack of testing in the US means this could be true. But extremely unlikely based on what we are seeing in other countries.

 

In Ontario, we have tested just under 3000 people and 36 were positive. That is just over 1% positive from people deemed high risk of the virus. This is not a virus that has been silently going around for months.

 

You are just wrong on this. And repeating it 50 times does not add value.

 

The danger of loudmouth cabbage brains is they convince people in charge and that leads to danger for all of us. This is not an extinction event, but it sure makes you realize exactly how we would approach a real extinction threat—in the same way.

 

This thread is toxic.

 

Why do you keep replying and reading if this thread is toxic?

[Read the Footnotes]

https://www.bloomberg.com/news/articles/2020-03-11/singapore-warns-of-complacency-while-new-virus-infections-surge

 

“It was premature to perceive Singapore’s epidemic as under control, as we know there is asymptomatic transmission and that some cases may have been missed,” said Raina MacIntyre, professor of infectious diseases at the University of New South Wales. “There could have been undetected chains of transmission in the community as a result.”

 

The asymptomatic likely number in the thousands, just like all over the rest of the world.  Again you test everyone or your wasting your time.

 

It's not clear what you mean by asymptomatic, but WHO and many others say they believe asymptomatic cases are extremely rare. China for example went back and retested old samples that were collected and tested only for influenza A and B, or for other tests. They found almost 0% in the general population. That would indicate that there are not people running around China who have it and don't know.

 

On the other hand, it is believed that asymptomatic transmission can happen early before symptoms present. It is important to note that though everything MacIntyre said is accurate, it is believed that as in other viral infections newly infected patients who are asymptomatic are believed to shed the virus much less than patients whose disease has progressed. For example, viral loads could be expected to be higher later, and coughing and sneezing would increase the risk of droplet infection. Asymptomatic people would be less likely to be coughing and sneezing, and the viral load per droplet likely lower too. These are just a few of the reasons recently innoculated asymptomatic people are believed to be less infectious.

 

So while what MacIntyre said is accurate, extrapolating that there are thousands of asymptomatic spreaders who will have no illness or mild illness does not reflect the current scientific conventional wisdom at this point as far as I know.

[KCLarkin]

How many asymptomatic people were tested? Have you been tested?

 

Ontario is testing people with flu symptoms and known COVID-19 contacts. If there was widespread community spread, it would be detected. Almost every case so far is travel related.

 

Unfortunately, we share a border with a country that completely botched their response and now we will import community spread from the US.

[alwaysdrawing]

This is a thread which translates a note from Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care:

 

 

"It may be necessary to establish criteria of access to intensive care not just on the basis of clinical appropriateness but inspired by the most consensual criteria regarding distributive justice and the appropriate allocation of limited health resources."

 

"This scenario is substantially comparable to the field of 'catastrophe medicine,' for which ethical reflection has over time stipulated many concrete guidelines for doctors and nurses facing difficult choices."

 

"In a context of grave shortage of medical resources, the allocation criteria need to guarantee that those patients with the highest chance of therapeutic success will retain access to intensive care.

 

It's a matter of giving priority to 'the highest hope of life and survival.'"

 

Recommendations:

 

1) The extraordinary criteria of admission and discharge are flexible and can be adapted in accordance with the local availability of resources.

 

These criteria apply to all patients in intensive care, not just those infected with CoVid-19.

 

2)"Allocation is a very complex and delicate choice. […]

 

The foreseeable increase in mortality for clinical conditions not linked to the current epidemic due to the reduction of chirurgical activity and the scarcity of resources needs to be taken into consideration."

 

3)"It may become necessary to establish an age limit for access to intensive care.

 

This is not a value judgments but a way to provide extremely scarce resources to those who have the highest likelihood of survival and could enjoy the largest number of life-years saved."

 

"This is informed by the principle of maximizing benefits for the largest number.

 

In case of a total saturation of resources, maintaining the criterion of 'first come, first served' would amount to a decision to exclude late-arriving patients from access to intensive care."

 

4)"In addition to age, the presence of comorbidities needs to be carefully evaluated. It is conceivable that what might be a relatively short treatment course in healthier people could be longer and more resource-consuming in the case of older or more fragile patients."

 

"For patients for whom access to intensive care is judged inappropriate, the decision to posit a ceiling of care nevertheless needs to be explained, communicated, and documented."

 

My opinion, which echoes what epidemiologists are saying:  The US must quickly adopt Non-Pharmaceutical Interventions (NPIs) like closing schools, churches, cancelling concerts and sports games, and more to prevent our hospital system from getting overwhelmed like this.

 

It does not have to be this bad if we can slow down the spread to keep hospitalizations within (or as close as possible) the hospital capacity.

 

This is vital because if the CFR is 1% in normal times, it will be much much higher if hospitals have to triage patients like this.  More people will die if we do not adopt these measures.

 

These are not normal times, and this is NOT the flu!!!

[Guest Schwab711]

So your ok with catching 50 for every 50 that run free? Looks like your in cahoots with those in charge in Singapore.

 

You obviously aren't going to change your opinion because you've made it clear where you stand (at last for today), so this is as far as we go. I've posted citations I think are worth readers' time. I can understand all sorts of opinions in life, but this is one I think is plainly ignorant. You may have a lot of healthcare experience, but most every doctor and organization with on-the-ground experience or oversight of this disease contradicts you. You want people on this board to respect your experience but you refuse to acknowledge the more relevant experience of others saying you are wrong. It's hubris.

Where are my "this is concerning, and we are watching developments with caution" folks?

 

And be thought a fool by everyone with a strong opinion? Better to remain silent.  ;)

 

 

 

 

@orthopa

I think what folks are saying when saying testing is important is that identifying as many spreaders as possible is key to containment. You can't catch them all. Don't let perfect be the enemy of the good. Some folks spread to 1 person. Some spread disease to dozens. You want to eliminate as many spreaders as possible so that the disease population can't reach escape velocity. Basically to the point above about the number sick at any given time being semi-controllable.

 

 

 

Whats your plan for asymptomatic people/kids who don't seem to be affected and dont go to the doctor?

 

I already answered. You can't catch everyone. Any additional you do catch early can moderate the number sick at any given time. You might not be able to control total number to get sick, but spreading that number out over a longer period leads to far better outcomes in aggregate. That's why people are testing.

 

Further, WHO says adult to child transmission is more common than reverse, as opposed to seasonal flu.

 

To the "it's been here for 1+ month" comment, viruses compound when no one has immunity.

 

I don't disagree with this point on spreading it out, but what exactly is the threshold (number of patients a hospital can hold)?

 

Healthcare capacity is derived and constructed off of averages and then scaled according to population. A pandemic by nature is already over-capacity right?

 

If I had to guess the threshold is quite low and I'm doubtful any solutions will be effective. The US is especially difficult to contain and isolate due to its size, efficiency and reliance on individual travel (interstate) compared to small countries like Germany (who funny enough just announced 3/4 of their citizens are likely to be infected).

 

If small countries that heavily rely on public transit can barely contain this thing how can a vast country like the US contain it? I guess scale could make quarantining sections of the country possible, but with the reliance on individual transit it feels like a bucket full of holes trying to carry water.

 

For some reason I have it in my head you are an engineer. Recall the concept of load factor. In theory, it is what you say, a planned amount that is certain to be overwhelmed in situations like this. In practice, pop-up hospitals/clinics/designated testing areas can absorb certain types of healthcare traffic that provide additional capacity. The military is capable of providing healthcare that is highly scalable and I'm sure they have procedures the broader population could copy. We can already see the pop-up additional capacity concept being used in WA.

 

So yes, there is some threshold that I can't rigorously define for you (and probably isn't definable). However, there's a larger gray area than I believe you are considering. Similar with containment area size. Containing MSAs and advising limited inter-state (or inter-community) travel greatly reduces node-to-node contact (from the higher-level POV of community nodes, not individual people). At any point, governments could feasibly shut down highways. Similar to Orthopa, just because we can imagine a way someone can escape quarantine/testing/containment doesn't mean we throw the solution out entirely. Back to engineering, every system has a planned failure rate and that's fine.

 

You just need that R0 rate to fall below 1. If it does, you can see the light at the end of the tunnel. If not, the tunnel is still dark.

[Kaegi2011]

There appears to be several points that are being debated, so I’m putting this down as much for me to clear my thinking as much as anything else.  My thinking has evolved so I appreciate those who have contributed to the topic (sometimes in a passionate way). 

 

Points of agreement (I believe):

1) Initial R0 and CFR are significantly higher for COVID19 vs. “normal” flu

2) CFR significantly higher for older / immune compromised individuals

3) The dormant period for the virus is potentially up to two weeks or more

4) There are no cures or vaccines

 

 

Points of debate:

1) Is testing useful?  If so, when?  If not, why not?

2) What methods could stop or slow down the spread of the virus, and their effectiveness & cost?

3) What resources do we have to cope with the disease?

4) What are the economic implications, and indirectly the impact on security prices?

 

On the points of debate:

1) I think there’s probably a stage when testing would have been helpful.  I’m increasingly coming around to the view that that time has passed.  Regardless if you think there are 5mm people infected in the US or 50k or 5k, it seems like there are more than enough cases out there given the dormant period to start the epidemic.  All the data is backward looking, and we won’t know the number of cases anyway since we didn’t test, so if you disagree with this conclusion, could you outline why you disagree? 

 

2) So far it looks like several methods are being advocated for, and nobody is disagreeing on the what could be done (e.g., hygiene, social distancing, etc.), but rather what is practical.  For example, could travel be limited in a country like US?  It’s possible, but we’d have to get way worse before we see that.  However, if everyone worked from home (I think a non-controversial method to deal with the spread) a large swath of the economy goes into a tailspin.  Google is already asking everyone North America to work from home for a month. 

 

a. I’m also coming around to the view that we will all get this at some point.  The Singapore resurgence example is instructive.  If there are sufficient carriers in the wild, I don’t think containment is going to work.  So the question then becomes how long can we spread out the transmission and “bending the curve” vs. eliminating the virus forever. 

b. Also, buying time allows for potential defenses like vaccines to be developed and commercialized.

 

3) I was under the impression that there was potentially more to be done for folks who are sick from the disease (and flu), but from the conversation here it appears that after a certain point, those who are older / immune compromised will have a hard time recovering period.  However, some could be treated, and the question then goes back to how do we maximize the resources available for the largest amount of people (e.g., spreading out the transmission over a longer period.

 

4) As far as the economic impact my opinion is worth just as much as the next guy’s, and I’m not even sure so who knows…

 

Did I misinterpret or misrepresent anything here? 

 

[orthopa]

https://www.bloomberg.com/news/articles/2020-03-11/singapore-warns-of-complacency-while-new-virus-infections-surge

 

“It was premature to perceive Singapore’s epidemic as under control, as we know there is asymptomatic transmission and that some cases may have been missed,” said Raina MacIntyre, professor of infectious diseases at the University of New South Wales. “There could have been undetected chains of transmission in the community as a result.”

 

The asymptomatic likely number in the thousands, just like all over the rest of the world.  Again you test everyone or your wasting your time.

 

It's not clear what you mean by asymptomatic, but WHO and many others say they believe asymptomatic cases are extremely rare. China for example went back and retested old samples that were collected and tested only for influenza A and B, or for other tests. They found almost 0% in the general population. That would indicate that there are not people running around China who have it and don't know.

 

On the other hand, it is believed that asymptomatic transmission can happen early before symptoms present. It is important to note that though everything MacIntyre said is accurate, it is believed that as in other viral infections newly infected patients who are asymptomatic are believed to shed the virus much less than patients whose disease has progressed. For example, viral loads could be expected to be higher later, and coughing and sneezing would increase the risk of droplet infection. Asymptomatic people would be less likely to be coughing and sneezing, and the viral load per droplet likely lower too. These are just a few of the reasons recently innoculated asymptomatic people are believed to be less infectious.

 

So while what MacIntyre said is accurate, extrapolating that there are thousands of asymptomatic spreaders who will have no illness or mild illness does not reflect the current scientific conventional wisdom at this point as far as I know.

 

 

https://newyork.cbslocal.com/2020/03/09/coronavirus-update-new-jersey-patient-speaks-out/

 

"Cuomo also made a surprise announcement. One of the latest cases is a top transportation official in charge of the airports: Rick Cotton, executive director of the Port Authority. Cotton is in his mid-70s and is asymptomatic."

 

 

“He’ll be working from home and the senior team that work with Rick will also be tested,” Cuomo said.

 

Maybe its just in Singapore and New Jersey there are asymptomatic people? No way it could be in Ontairo like KC said. They tested all 3000 people.

 

Your shedding the disease regardless, even if less. Still no bueno, and undetected, untested.

[KCLarkin]

Maybe its just in Singapore and New Jersey there are asymptomatic people? No way it could be in Ontairo like KC said. They tested all 3000 people.

 

Singapore and New Jersey have known community spread, so there are of course asymptomatic people. The median time for symptoms to develop is 5 days! Which means in an outbreak, most people will be asymptomatic. That is why this is so dangerous! But you are extrapolating true facts in ways that are completely wrong.

 

Unfortunately, large parts of the US will find out in the next three weeks that you are spewing B.S. And it is a waste of time arguing with you. The time for testing was a month ago.