Coronavirus

[orthopa]

Houston:https://www.nbcnews.com/news/us-news/houston-hasn-t-reported-surge-coronavirus-cases-its-hospitals-tell-n1175291

 

So far, Houston, the nation’s fourth largest city, has not recorded a swell of confirmed coronavirus cases similar to those straining health care systems in New York and Detroit, giving some residents hope that stay-at-home orders issued by local officials came early enough to stop the virus from spreading too widely here. But interviews with Houston ICU doctors and nurses — as well as the daily rise in the number of critically ill patients now showing up in their hospitals — paint a more sobering picture of what’s happening in southeast Texas.

 

While limited testing has prevented officials here and across the state from getting a complete accounting of how many people have been infected with the coronavirus, hospitals in greater Houston have seen a steep increase — 40 percent over four days — in the number of patients believed to be suffering from the virus, according to a daily census of hospital admissions collected by the SouthEast Texas Regional Advisory Council, which helps coordinate emergency response efforts.

 

That's one thing we're likely to see with the uneven testing around the country... Some places may stay under the radar for a bit and then seem to come out of nowhere because suddenly they start testing more.

 

True and you will get "hotspots" but even the in the most overexagerated model Texas does not come close to available medical services.

 

All beds needed 3,682beds

 

All beds available 28,633beds

 

Bed shortage 0beds

 

ICU beds needed 712beds

 

ICU beds available 2,259beds

 

ICU bed shortage 0beds

 

Invasive ventilators needed 605 ventilators

 

https://covid19.healthdata.org/projections

[mcliu]

It seems like the transmission rate for this virus is a lot higher than expected (which corresponds to a much lower fatality rate).

Maybe because a there's a lot of asymptomatic/mild cases?

Wearing masks will help because there's more protection for non-infected (marginally) but those infected would not be spreading virus to more vulnerable people.

 

[RichardGibbons]

Ill stick my neck out again and say country is opened by 4/30.

 

I think you could be roughly right about this date, though I think it'll be on a state by state basis, with most coming after this date.

 

(That said, as far as I can see, there still isn't evidence for your "COVID-19 is widespread" theory.  I think it'll open up based on declining cases, quarantine fatigue, and the balance of pain shifting from dying people to a dying economy. So we end up in the same place, just with different explanations.)

[ERICOPOLY]

Thread on NYC morgue problem:

 

 

I posted about this a while back. I have some friends who are nurses/MDs at NYC facilities, they have replaced their morgue vans with trailers as the twitter thread mentions. I think I even posted the picture. This happened about...1.5 weeks ago?

 

Not sure where he is getting the rest of the information (burial trenches in city parks?) but it seems the most effective way to manage the bodies would be cremation,but I am no professional in this area.

 

Can they cremate bodies against the wills of the deceased/families, if they had wanted to be buried? Probably wasn't an issue in China, but here the law may prevent it. I don't know.

 

It's very touchy here particularly NY which is pretty diverse religiously. I am not sure about those laws, whether the governor can suspend them in times of crisis, and if so whether there will be fallout in the future if families decide to sue the city/state.

 

I would think in crisis situation the governor would be able to order cremations but I am guessing the logic now is, "let's spend some short-term cash, do whatever we can today to build body preservation capacity, rather than risk a slew of multi-million dollar lawsuits in the future".

 

Makes sense.  Refrigerate until capacity to do so is exhausted. 

[orthopa]

We appear to be at the top of the curve in NY and still have underwhelming trends in other states. Oregon is sending out ventilators, they are done. Looking at the data NY is the complete outlier. Again they are the exception, not the rule.

 

Interesting that Fauci sat on the sidelines during the presser yesterday. I wonder/have a feeling people within the administration are a little tired of his worst case scenario and dire predictions. Especially with signs that we are nearing/at the top and currently at 10kish deaths. This is the worst week coming up, Overall deaths in the US way down compared to the corona virus deaths. We are saving humanity indirectly.

 

The model used for all of this wildly wrong and NYC discharging way more pts then admitting. ICU need off by a factor of 10x per Cuomos previous comments. Holy shit.

 

Fauci now saying maybe 25-50% of people asymptomatic? No shit, didnt I say that a month ago?  Once more serologic testing comes out we will find that way, way, way more people have antibodies, millions of people. The death rate will plummet as I suggested back in one of my first posts and even though this "isnt the flu" we will find the death rate approaches it rapidly with serologic testing.

 

Based on the data there appears to be no question that warmer climates seem to limit the spread, look at CA, FL, TX, AZ, NM.

 

I have a feeling those who were at first forecasting the most dire predictions will become disingenuous and suggest we are not counting enough dead bodies!!!

 

Ill stick my neck out again and say country is opened by 4/30. Fauci losing favor with Trump and will slide into the background. Watch for more evidence on a daily basis that this was way more wide spread then thought. 

 

We will see in the next 7-10 days but I think there is a good chance that we will find that the lockdowns did nothing as evidenced by the death rate, number of deaths and miles traveled in the Dalal's ealier post. A lot of the areas that people traveled the most have the lowest death rates!!!! How do we explain that?

 

I hope you're right Orthopa, and thanks for chiming back in this thread.  In the spirit of trying to better understand the situation I have a few points / questions:

 

1) miles traveled is likely closely correlated to population density.  If you live in Montana on a ranch, your miles traveled is irrelevant vs. miles traveled in Chicago.  Not suggesting what you're saying could not be correct - for sure it could, especially in Southern / more rural regions, but I think it conflates a few factors.

 

2) I'm unclear how you're drawing the conclusion that the lockdown isn't doing anything.  I mean, if it was effectively would you not expect it to reduce the infection rate (and the whole reason to lockdown)?  This doesn't prove that the lockdown is as effective as everyone thinks, but it certainly does not prove it to be ineffective ("did nothing").

 

3) Miami metro area seems to have ~50% of the cases.  Does this not confirm density vs. weather may be more of a factor? 

 

4) For herd immunity with R0 of 2-3 I've seen numbers between 50-70% in terms of percentage of the population that need to be immune / recovered.  It seems like we're very far from that?  I don't know that anyone really even knows the % of the population that may have had it at this point - do you have some data sources that have cited this?

 

Lastly, how do you think we emerge from this?  Youv'e cited end of the month being a demarcation line - why?  Based on immunity, or that face masks are really effective and we can bring R0 down below 0 with them, or some other factor?  Just trying to understand your line of reasoning.

 

I think population density does matter no question, NYC the best example of this. My main referencing was that the NYT picture Dalal posted a while back. The areas with the highest amount of travel, ie not staying at home have a lesser number of infections. FL just instituted a stay at home order (remember the beaches?) and Texas still does not have one!. Granted TX, FL, GA are spread out in rural areas but you there is still some significant density in Houston, Dallas, Orlando, Atlanta etc.  How much more interaction is there in large Texas cities with no stay at home order then in a locked down state? Main difference for NYC outlier maybe ultimately high reliance of subway travel in NYC compared to other cities.

 

https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html

 

 

I think what will answer a lot of our questions is serologic testing regarding herd immunity, need for masks etc. Whats a reasonable conclusion if 20-40-60% of the population has been exposed? The R value will be different for different locations and has been in multiple studies but something doesn't in vibe with a virus that is severely contagious but has only infected a small % of the population. A very small Italian study has shown that 70% of blood donors had antibodies. There is the Stanford paper and oxford paper suggesting the same. Again as I thought was possible a while back I think we are much further up the curve then we think.

 

Why end of April? I think as the month goes on deaths, new infections, admissions<discharges and there will be societal pressure to start to get back to normal. States may do what they want but I can envision many things opening up, especially for those who have antibodies. I envision serologic testing becoming much more available and that as a gateway in some function to return to a work place with others who have been exposed. Maybe restaurants limited to 1/2 capacity? Theaters limited seating etc? I would hope we would avoid an Orwellian tracking system but some may call for that.

 

I thought I read some governors discussion some return to work protocol. Certainly none of what I am postulating is scientific but honestly what data have we had that has been indisputable from a CFR, R0, chinese data, iceland data, etc etc. Its all been a mishmash learn on the go but I think things are looking up for the first time in a while.

 

https://www.mercurynews.com/2020/04/04/coronavirus-new-stanford-research-reveals-if-youve-been-exposed/

 

 

"This gives scientists a snapshot of how many people in the county have already been infected, but weren’t seriously sick and didn’t realize it. And it tells residents whether they carry potentially protective antibodies – so may be immune to future infection.

 

“This is critical information,” said principal investigator Dr. Eran Bendavid, an infectious disease specialist and professor of medicine with Stanford Health Policy.

 

“We will show the country what to do and how to do it,” he said.

 

The project, coordinated with the Santa Clara County Department of Health, was applauded by Gov. Gavin Newsom during a Saturday press conference in Sacramento, who called it “the first home-grown serum test in the state of California.”

 

It can guide public health measures and policies – showing where the epidemic is heading, when it is safe to lift shelter-in-place restrictions and how far away we are from “herd immunity,” when it becomes harder for a virus to spread."

 

 

The answer to your question regarding what returning to normal and herd immunity will be based on these tests. I would keep a close eye on all of these.

 

 

[KCLarkin]

I agree 100% with Gregmal's last 3 posts.

 

Wearing a mask may not that all that effective in protecting you from from catching the virus, but it may help some. However it would obviously help stop those who have the virus, weather they know it or not, from spreading it.

 

So if it is even only 10-20% effective, doesn't it make sense that everyone wear a mask when in contact with others? What's the downside as long as it doesn't deplete masks available to health care workers.

 

 

One of the studies linked in that Arstechnica article Liberty posted showed that flu-like illnesses INCREASED if health care workers wore cloth masks. And cloth masks were only 3% effective in reducing virus. So the downside is actually negative (not zero).

 

https://bmjopen.bmj.com/content/bmjopen/5/4/e006577.full.pdf

 

[orthopa]

Its rolling over big time in NY already good news!

 

https://twitter.com/bespokeinvest/status/1247194815160291328/photo/1

 

Here is latest modeling of bed usage in NYC/NY. Need to key in on the new estimate which is the purple line (kind of hard to see). Just a tincey little bit off huh? Sheesh.

 

https://twitter.com/bespokeinvest/status/1247195584643170308/photo/1

[orthopa]

Ill stick my neck out again and say country is opened by 4/30.

 

I think you could be roughly right about this date, though I think it'll be on a state by state basis, with most coming after this date.

 

(That said, as far as I can see, there still isn't evidence for your "COVID-19 is widespread" theory.  I think it'll open up based on declining cases, quarantine fatigue, and the balance of pain shifting from dying people to a dying economy. So we end up in the same place, just with different explanations.)

 

I hope 4/30 is close and I agree it will be State by State. I hope the pressure to open up will build up as fast as the pressure to close did. I will be vindicated or will look like a fool when the serology data starts coming in. Looking forward to it.

[Cigarbutt]

...

Big mistake, but the biggest mistake was to not have been ready for an epidemic with a huge stockpile and good plans for what to do, testing capability and all that, and to lose weeks to this disorganized response.

Thinking out loud here.

The comment is obviously correct, in hindsight. One could argue that the evidence was there for everyone to see but that one can always find explanations, after the 'unexpected' event, whatever it comes to be.

 

Context: I've been thinking about risk and uncertainty lately and, for instance, now think that there is excess leverage in the global financial system with the risk of correlated (financial) contamination. It feels like a voice in the wilderness and it's no way to make friends. A way to deal with black or white swans is simply to build resilience but that comes with a cost.

 

On a more relevant basis, I've been following the consequences for PG&E (California utility in bankruptcy). The evidence before the fires was obvious if you had eyes to see and an aspect which is concerning is that the diversion of attention of public authorities from the utility to the virus will likely result in PG&E coming out of bankruptcy weakly capitalized, with a poor operating culture and defective resilience planning.

 

It's hard to prepare for contingencies and the natural reflex is to fight the last war.

-----) Back to the Coronavirus

[Spekulatius]

I have been following this model all along. Yesterday predicted 94k deaths in US, now 81k.

 

This model has come under a lot of criticism. I only mention this as this was the model Dr. Birx had cited before.

 

https://covid19.healthdata.org/projections

 

81k is on par with a model I posted here a few days ago. The model that Fauci presented with 100-240k dead was an outlier compared to anything else I have seen.

[Liberty]

https://nationalpost.com/news/world/covid-19-live-updates-ontario-reporting-309-new-cases-including-13-additional-deaths

 

Ontario Premier Doug Ford on Monday said the United States had blocked the delivery of nearly three million face masks at the American border over the weekend.

 

Ford said restrictions on shipments at the U.S. border have left the province with just one more week’s worth of personal protective equipment for health-care workers fighting the coronavirus outbreak in Ontario.

[Liberty]

"UK Prime Minister Boris Johnson in intensive care after coronavirus condition ‘worsened’"

 

https://www.bbc.com/news/uk-52192604?at_custom1=%5Bpost+type%5D&at_custom4=2444197A-783B-11EA-8FE0-C319FDA12A29

[cwericb]

"Ontario Premier Doug Ford on Monday said the United States had blocked the delivery of nearly three million face masks at the American border over the weekend.

 

Ford said restrictions on shipments at the U.S. border have left the province with just one more week’s worth of personal protective equipment for health-care workers fighting the coronavirus outbreak in Ontario."

 

When you can't depend on your best friend, closest ally and largest trading partner in a time of need it is a sad situation which I fear will have consequences in the future. I know that perhaps 50% of our cottage neighbours are American and it will have an effect.

[cwericb]

Not abiding by social distancing is a $1,000 fine the first time, $2,000 the second time & $10,000 the third time. Several have been fined once.

[RichardGibbons]

When you can't depend on your best friend, closest ally and largest trading partner in a time of need it is a sad situation which I fear will have consequences in the future. I know that perhaps 50% of our cottage neighbours are American and it will have an effect.

 

Yeah, I think it will have an effect, but not that big an effect. One of the nice things about Canada is that our population isn't under the influence of propaganda networks to the extent that the USA is, which makes our politics less polarized and our populace better able to understand that the world is filled with shades of grey. So, I think most Canadians will be quick to condemn Trump, but far less quick to condemn most Americans, and continue to see them as friends and neighbours.

 

Strong Trump supporters will get contempt and derision from Canadians, but I think that's a pretty small percentage of Americans who visit up north, and even for Trump supporters, the contempt and derision often won't be that openly displayed.

[orthopa]

I have been following this model all along. Yesterday predicted 94k deaths in US, now 81k.

 

This model has come under a lot of criticism. I only mention this as this was the model Dr. Birx had cited before.

 

https://covid19.healthdata.org/projections

 

81k is on par with a model I posted here a few days ago. The model that Fauci presented with 100-240k dead was an outlier compared to anything else I have seen.

 

...and why the country has a stay at home order until 4/30. Hopefully very over estimated.

[Gregmal]

Not abiding by social distancing is a $1,000 fine the first time, $2,000 the second time & $10,000 the third time. Several have been fined once.

 

I think detaining people is a better solution than escalating fines. Outside of hugging your children and f**** your wife, what reason, ever really, but especially given the current situation, do you have for getting that close to another person? Whats wrong with people?

[orthopa]

California sending back ventilators! Who ever would have thought this was going to happen already. The most populous state in the country thinks the curve is flattening there already. 4/30 is looking better every day.

 

https://m.sfgate.com/coronavirus/article/California-to-send-500-ventilators-on-loan-15182045.php

 

Seven days ago the worst was coming in 6 weeks.In actuality its here or passed. We are way, way further up the curve then we think we are.

 

https://losangeles.cbslocal.com/2020/03/31/california-governor-newsom-covid-projection-april-may/

[minten]

on masks:

[ERICOPOLY]

Not abiding by social distancing is a $1,000 fine the first time, $2,000 the second time & $10,000 the third time. Several have been fined once.

 

I think detaining people is a better solution than escalating fines. Outside of hugging your children and f**** your wife, what reason, ever really, but especially given the current situation, do you have for getting that close to another person? Whats wrong with people?

 

Some people feel the rules don't apply to them:

 

https://www.recordnet.com/news/20200405/new-door-locks-change-defiant-lodi-congregations-plans

 

 

[mcliu]

"Ontario Premier Doug Ford on Monday said the United States had blocked the delivery of nearly three million face masks at the American border over the weekend.

 

Ford said restrictions on shipments at the U.S. border have left the province with just one more week’s worth of personal protective equipment for health-care workers fighting the coronavirus outbreak in Ontario."

 

When you can't depend on your best friend, closest ally and largest trading partner in a time of need it is a sad situation which I fear will have consequences in the future. I know that perhaps 50% of our cottage neighbours are American and it will have an effect.

 

Not a nice move by the US.

But also, Canada should have been stockpiling in Jan/Feb.

[Gregmal]

"Ontario Premier Doug Ford on Monday said the United States had blocked the delivery of nearly three million face masks at the American border over the weekend.

 

Ford said restrictions on shipments at the U.S. border have left the province with just one more week’s worth of personal protective equipment for health-care workers fighting the coronavirus outbreak in Ontario."

 

When you can't depend on your best friend, closest ally and largest trading partner in a time of need it is a sad situation which I fear will have consequences in the future. I know that perhaps 50% of our cottage neighbours are American and it will have an effect.

 

Not a nice move by the US.

But also, Canada should have been stockpiling in Jan/Feb.

 

Yea, its an interesting narrative and application of responsibility from some here. The US/Trump should have foreseen everything months ago and had massive stockpiles of everything one would be able to think of after the fact. Everyone else who is unprepared is the victim of Trump being an asshole.

[ERICOPOLY]

"Ontario Premier Doug Ford on Monday said the United States had blocked the delivery of nearly three million face masks at the American border over the weekend.

 

Ford said restrictions on shipments at the U.S. border have left the province with just one more week’s worth of personal protective equipment for health-care workers fighting the coronavirus outbreak in Ontario."

 

When you can't depend on your best friend, closest ally and largest trading partner in a time of need it is a sad situation which I fear will have consequences in the future. I know that perhaps 50% of our cottage neighbours are American and it will have an effect.

 

Not a nice move by the US.

But also, Canada should have been stockpiling in Jan/Feb.

 

Yea, its an interesting narrative and application of responsibility from some here. The US/Trump should have foreseen everything months ago and had massive stockpiles of everything one would be able to think of after the fact. Everyone else who is unprepared is the victim of Trump being an asshole.

 

I think we could negotiate an exchange for toilet paper if we were smarter.

[Liberty]

The Strategic National Stockpile was amassed for 22 years, and those involved in both the Bush and Obama administrations say its sole purpose is to be deployed to states in a moment like this.

 

“The idea the stockpile is ours and the governors have got to have their own stockpile, they are changing the narrative,” said Lt. Gen. Russel Honoré, who served as the Joint Taskforce Commander during Hurricane Katrina. “That is bulls--- and Jared Kushner doesn’t know what he is talking about.”

 

In 1998, President Bill Clinton, growing increasingly concerned about how the U.S. would respond to a bioterrorism attack, signed a law allocating $51 million for the stockpiling of drugs and vaccines.

 

Subsequent administrations have built up the stockpile to respond to a range of medical emergencies the country could face, from a terrorist attack to a natural disaster, like a hurricane or tornado. In addition to drugs and vaccines to treat known pathogens, the stockpile has been expanded under each previous administration to include additional medical supplies and even the ability to set up a 250 bed hospital in a disaster zone. [...]

 

Under the Trump administration, the management of the stockpile was moved out of CDC and into the Department of Health and Human Services, something former CDC director Thomas Frieden warned at the start of the coronavirus pandemic could make it more difficult for resources to be quickly and effectively allocated.

 

The Trump administration went so far as to change the website description for the stockpile to downplay its use by the states, removing language saying that it was intended to be used by state, local, tribal, and territorial responders who "request federal assistance” following Kushner's comments last week.

 

Under the Obama administration, when a state needed something, like during the H1N1 pandemic, they would put in a formal request to the federal government, which would review it and allocate what was needed to the states to then distribute to their local hospitals.

 

https://www.nbcnews.com/politics/white-house/trump-s-use-medical-stockpile-veers-past-administrations-leaving-state-n1177786

[Viking]

"Ontario Premier Doug Ford on Monday said the United States had blocked the delivery of nearly three million face masks at the American border over the weekend.

 

Ford said restrictions on shipments at the U.S. border have left the province with just one more week’s worth of personal protective equipment for health-care workers fighting the coronavirus outbreak in Ontario."

 

When you can't depend on your best friend, closest ally and largest trading partner in a time of need it is a sad situation which I fear will have consequences in the future. I know that perhaps 50% of our cottage neighbours are American and it will have an effect.

 

Not a nice move by the US.

But also, Canada should have been stockpiling in Jan/Feb.

 

Yea, its an interesting narrative and application of responsibility from some here. The US/Trump should have foreseen everything months ago and had massive stockpiles of everything one would be able to think of after the fact. Everyone else who is unprepared is the victim of Trump being an asshole.

 

US standing in the world continues to fall to new lows. Disgusting behaviour. It is in times of crisis that you learn about the true character of people and nations.

 

Premier of Newfoundland and Labrador takes aim at Trump over medical supplies

- https://www.theglobeandmail.com/politics/article-premier-of-newfoundland-and-labrador-takes-aim-at-trump-over-medical/

 

Dwight Ball told a news conference today that the province gained international acclaim for the way its residents helped thousands of stranded airline passengers after the 9/11 terrorist attacks on the United States in 2001.

 

Ball says that when the United States was in crisis, Newfoundlanders and Labradorians “acted fast and did what was necessary.”