Coronavirus

[Investor20]

KCLarkin, it went up or down?

 

That's the magic of cumulative data. It can only go up!

 

According to your logic, the measles vaccine doesn't work, since every year the cumulative number of measles infections goes up.

 

--

 

0.9% tested positive on Day 0 and only 0.6% tested positive on Day 14. Seems like effective infection control, but given the 14 day incubation period, you'd need a longer study to be sure.

 

Actually it is a 4 week study

2 weeks of home quarantine

zero day: test and remove positives

Enforce supervised quarantine procedures

seventh day: test and remove positives

Enforce supervised quarantine procedures

Test on 14 day which still gave 0.6% positives.

 

The result as given by authors

 

"At the time of enrollment, after 2 weeks of home quarantine, approximately 1% of study participants had positive qPCR results, and approximately 2% subsequently became infected during the 2-week supervised quarantine period."

 

 

[Spekulatius]

^ big surprise if you live in crowded quarters m use the same bathrooms (that was one way infections were found in the study) and have roommates bunking together (I bet they do t wear mask when they sleep, how could they).

 

My only conclusion for a civilian setting is that I wouldn’t  rely on mask preventing infections in a setting like a cruise ship (the closest equivalent). As for the general conclusion of the reference (not the study ) that mask don’t work, I wouldn't agree.

 

If you refer to the often cited danish mask study, check out Taleb’s posts on Twitter. He concluded that the design and even the math of the study is incorrect and that the results actually infer that the mask cohort did show lower infection rates.

 

Edit: corrected for typos.

[Investor20]

^ big surprise if you live in crowded quarters m use the same bathrooms (that was one way infections were found in the study) and have roommates bunking together (I bet they do t wear mask when they sleep, how could they).

 

My only conclusion for a civilian setting is that I wouldn’t  rely on mask preventing infections in a setting like a cruise ship (the closes equivalent). As for the general conclusion of the reference (not the study ) that mask don’t work, I would agree.

 

If you refer to the often cot d danish mask study, check out Taleb’s posts on Twitter. He concluded that the design and even the math of the study is incorrect and that the results actually infer that mask cohort did show lower infection rates.

 

All recruits wore double-layered cloth masks at all times indoors and outdoors, except when sleeping or eating; practiced social distancing of at least 6 feet;

 

They slept in double-occupancy rooms with sinks, ate in shared dining facilities, and used shared bathrooms.

 

All recruits cleaned their rooms daily, sanitized bathrooms after each use with bleach wipes, and ate preplated meals in a dining hall that was cleaned with bleach after each platoon had eaten.

 

And Spekulatius, there is unusually high number of unasymptomatic in this study (46/51) may be because they are young and healthy.

Isnt it that asymptomatic transmit less?

 

"The viral load at diagnosis, estimated on the basis of the qPCR cycle threshold, was on average approximately 4 times as high in the 5 symptomatic participants as in the 46 participants who were asymptomatic"

[Cigarbutt]

Two days ago, I participated in an online interactive review which is relevant for this military recruits study and its interpretation. The 60-minute review was health related and the word virus was not mentioned once which may be a sign that focus may have to go back to the host at some point. The review was a discussion about tools to assess studies and include in an evidence-based framework. The discussion was made necessary and relevant due to the fact that, for that specific field in question, in North America, there is an explosion of data, an incredibly high number of unnecessary procedures (waste) and an incredibly high number of poor outcomes (harm) and people are starting to notice (trust issue). One of the underlying messages was that one can ‘massage’ the data, the analysis and the interpretation (depending on incentives). But there are ways to help sort this out. This was relevant also to the analysis of various healthcare stocks I’m following as it seems to me a natural outcome of all this will mean, eventually, a very significant downsizing of sales and a shrinking market. It is also coming down on me that the polarized approach to the virus (great aspects, ie vaccine development and inefficient policy due to failure to coordinate and collaborate) closely parallels the growing issues for US healthcare overall (great aspects combined with a growing divide in the unusual hybrid approach) explaining the overall high costs and the overall low outcomes. More to come on that front for sure.

 

There are two major problems with the interpretation of the military recruits study. First, extrapolating on the ‘intent’ of the study and second, the issue of generalization from a sample (unusual sample). 1st The questions (2) asked upon initiation of the study are: Under a standardized approach (and ideal in some ways), can spread be reduced to zero? and can asymptomatic transmission occur? These questions were reasonably answered and the answers were offered for peer review. Starting the process of retrospectively asking questions (and providing answers) after the study is complete is associated with very real and significant analytical risks. Asking questions is fine but providing answers then requires more work. That’s how blockbuster drugs for hair loss and erectile dysfunction were discovered. Companies did not start marketing a drug because they noticed unusual side effects while doing studies for a different question, they reframed the issue by asking a new question and by doing further studies and going through a systematic process. This example hides the fact that this exercise is a clear example of a survival bias as most unusual side effects and related hypothesis generation do not resist the test of time (analysis) after. To affirm that mitigation efforts for this virus “don’t work” because of this study, with some recruits coming in positive after a quarantine to start with, is a very weak assertion. 2nd The more the sample is different from a population, the more one has to be careful about generalization of specific findings.

 

The military recruits’ situation was not a ‘lockdown’, it was a situation associated with some restrictions which, fundamentally, did not change their fundamental training. Basic tools such as safe distance, masks, self-quarantine when sick or exposed etc are not “lockdowns”. These tools are like the standard practice of giving oxygen to someone coming in with what looks like a heart attack. AFAIK, there is no definitive evidence showing that it ‘works’ but it’s done because it connects a lot of dots (easy, standard, low cost, makes sense scientifically and from a common sense point of view). If somebody doubts that, they can do or support doing studies to disprove that but that somebody should be careful before suggesting to stop oxygen use while the person is having a heart attack, especially if the motivation is that a mask is a threat to his or her freedom.

 

In this thread, I’ve spent some time trying to disprove a fair amount of assertions of various levels of quality. So I’ll ask the following question:

Fact: When including countries of a certain size (population large enough) and with a large enough GDP per capita, you end up with about 20 countries. In this group, since last May, by far, the US has reported the highest Covid-19 death per capita (even higher that the “high mortality” countries) and trends indicate that it will remain a clear leader for the foreseeable future.

Question: Why is that? Is it because masks don’t work?

The following answers will not be accepted: the virus was here in 2015, it’s China’s fault, it is what it is, we are turning the corner, Cuomo is dumb, so and so who is ugly had a hamburger yesterday, people don’t take enough zirconium, have no access to hydroxyfuckinqueen or to Bolivia’s health-minister-approved toxic bleach.

 

My area is only a province and not a country but, if it were, it would take the #1 spot from the US for worst performer on the death per capita competition. Just a few days ago and a few kilometers (1 mile = 2.2km) from where we live, in a shopping center, there was a “demonstration” of a group (an anti-mask group) who “occupied” key walking space at the center of the shopping mall, dancing and singing unusual slogans. Why would you belong to an anti-mask group (waste of time)? Why would you participate in such a demonstration (waste of time, counter-intuitive and counter-productive)? Why would you put such a demonstration in the middle of an enclosed space at a time when it is most crowded during a period of rampant community spread in a “red zone” (dangerous on top of all the other reasons)? The most ironic part of all this was that there was this lady wearing a mask and doing her usual shopping who thought people had formed a group to show support for healthcare workers, so she entered the dance only to be told that she didn’t ‘belong’ and she was kicked out for fear of ideological contamination.

 

Apologies for the length of the post and the ranty aspect but, yesterday, I ‘visited’ the huge tent beside my regional hospital and I still have (mental) nausea. Even if nobody reads this, writing it was therapeutic. It's not the ignorants that worry me.

 

[KCLarkin]

Actually it is a 4 week study

2 weeks of home quarantine

zero day: test and remove positives

Enforce supervised quarantine procedures

seventh day: test and remove positives

Enforce supervised quarantine procedures

Test on 14 day which still gave 0.6% positives.

 

The result as given by authors

 

"At the time of enrollment, after 2 weeks of home quarantine, approximately 1% of study participants had positive qPCR results, and approximately 2% subsequently became infected during the 2-week supervised quarantine period."

 

The incubation period is 14 days. The false negative rate is extremely high in the first 4 days of infection. So it is not possible to say how many people became infected during the quarantine period. Many of those who tested positive on Day 7 were likely infected on or before Day 0.

 

Only ~half the recruits were tested on Day 0 and Day 7. Untested and tested recruits were intermixed. So a recruit could be sharing a room with an untested roommate.

 

But the main reason why your assertions are wrong is the lack of a control arm. This is an infectious disease with a doubling time of ~3 days in a general population. Doubling time is even worse in congregate settings like military camps. If you start with 16 infected people and no controls, you'd expect more than 500 infected marines by the end of two weeks. So these interventions stopped ~90% of the expected infections.

[Investor20]

Actually it is a 4 week study

2 weeks of home quarantine

zero day: test and remove positives

Enforce supervised quarantine procedures

seventh day: test and remove positives

Enforce supervised quarantine procedures

Test on 14 day which still gave 0.6% positives.

 

The result as given by authors

 

"At the time of enrollment, after 2 weeks of home quarantine, approximately 1% of study participants had positive qPCR results, and approximately 2% subsequently became infected during the 2-week supervised quarantine period."

 

The incubation period is 14 days. The false negative rate is extremely high in the first 4 days of infection. So it is not possible to say how many people became infected during the quarantine period. Many of those who tested positive on Day 7 were likely infected on or before Day 0.

 

Only ~half the recruits were tested on Day 0 and Day 7. Untested and tested recruits were intermixed. So a recruit could be sharing a room with an untested roommate.

 

But the main reason why your assertions are wrong is the lack of a control arm. This is an infectious disease with a doubling time of ~3 days in a general population. Doubling time is even worse in congregate settings like military camps. If you start with 16 infected people and no controls, you'd expect more than 500 infected marines by the end of two weeks. So these interventions stopped ~90% of the expected infections.

 

This type of quarantine is very disruptive to the society and Dr. Bhattacharya laid out the downside of such disruption. Its very difficult for everyone to be 6 feet away from each other for example.

 

For example, less vaccination for children is bad for their health.  And many other health care activities have taken back seat because of these restrictions.  The burden that these restrictions work is on the people who propose them because of the economic and health care downsides.

 

On other hand proof required for Hydroxychloroquine or Ivermectin is really high. For example a peer reviewed article below gives all the early administration HCQ studies are successful.

 

https://pubmed.ncbi.nlm.nih.gov/33042552/

Hydroxychloroquine is effective, and consistently so when provided early, for COVID-19: a systematic review

 

Another peer reviewed article written by many doctors from many well known hospitals argues about early intervention and this includes use of HCQ.

 

https://www.sciencedirect.com/science/article/pii/S0002934320306732

Pathophysiological Basis and Rationale for Early Outpatient Treatment of SARS-CoV-2 (COVID-19) Infection

 

Written by doctors from following medical schools/hospitals:

a  Baylor University Medical Center, Dallas, Tex

 

b  Baylor Heart and Vascular Institute, Dallas, Tex

 

c  Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Tex

 

d  Cardiology Division, Regina Montis Regalis Hospital, Mondovì, Cuneo, Italy

 

e  Christ Advocate Medical Center, Chicago, Ill

 

f  Emory University School of Medicine, Atlanta, Ga

 

g  Johns Hopkins School of Medicine, Baltimore, Md

 

h  Cedars Sinai Medical Center, Los Angeles, Calif

 

i  Abrazo Arizona Heart Hospital, Abrazo Health System, Phoenix, Ariz

 

j  Carter Eye Center, Dallas, Tex

 

k Cardiorenal Society of America, Phoenix, Ariz

 

l University of Texas McGovern Medical School, Houston, Tex

 

m  Bakersfield Heart Hospital, Bakersfield, Calif

 

n  University of Siena, Le Scotte Hospital Viale Bracci, Siena, Italy

 

o  University of Torino, Torino, Italy

 

p  Henry Ford Hospital, Detroit, Mich

 

q    Yale University School of Public Health, New Haven, Conn

 

I earlier posted a meta analysis of 8 RCTs all of them showed improvement for Ivermectin.  But all this is discounted.

I posted earlier that Bangladesh has high infection rate based on seroprevalence but low death rate.  They use HCQ. But that cannot be spoken about.

 

Not a suggestion for treatment. Please consult your doctor regarding treatment.  For discussion only.

[RichardGibbons]

And, I've got to say, Trump deserves some credit for the fast vaccine. By minimizing the impact of the disease, discouraging people from wearing masks and other preventative measures, and generally helping the virus along, he's helped the number of cases to explode. Without that massive number of new infections, Phase 3 trials would've taken far longer-- to determine whether a vaccine is working, you need people to catch the disease, and he did his part to achieve that. So, credit where credit is due.

 

Lol wut. That’s the most ridiculous thing I’ve heard in a long time. Trump should be praised because his policy allowed more people to be infected and die so more studies could be done? Seriously? If ten times more people died would that be ten times better?

 

Don’t you think we could have come to the same conclusion had only half or a quarter of the people got infected and died? By your logic, Mao should be praised for reducing the population in China so there’s be enough food to eat after the cultural revolution and famines? Have a famine, millions die. Now the little food we have is enough for the smaller population. Thanks Mao! /s

 

Please tell me you’re being sarcastic? or I simply don’t know enough about vaccine development...

 

Yep, it was tongue in cheek. It's atrocious that so many people have become infected and dead in the USA as a result of this pandemic.

 

But I do get a kick out of the perverseness of the situation because it is actually true. The more people get infected, the faster you can do the Phase 3 trial, so to the extent that Trump has helped this contagion spread, he's also helped speed up the testing of a vaccine as an unintended side-effect.

 

(I know nothing about vaccine development, by my impression is that, to test efficiency, you need to split people up into 2 groups, A) those who will receive the vaccine and B) those who won't.  If nobody gets infected in either group, you can't say anything about whether the vaccine is effective. If a bunch of people get infected in group B, but none in A, you can have some confidence that the vaccine is effective. So you basically need a certain number of people infected in group B to have confidence about the efficiency of the virus. So if the virus is raging, you're going to have people infected in group B faster than you would if it weren't and therefore can complete Phase 3 trials faster.)

[RichardGibbons]

By minimizing the impact of the disease, discouraging people from wearing masks and other preventative measures, and generally helping the virus along, he's helped the number of cases to explode.

 

Richard what evidence is there regarding this statement?

 

You and I both know that you don't care at all about the answer to this question, because the answer's obvious to everyone who's followed American pandemic news even the tiniest bit for the past 9 months. One doesn't need to provide supporting evidence to say that the sky is blue, ice is cold, and the sun rises in the east.

 

So, I'm just going to save us both time, and not bother with an answer.

[Investor20]

By minimizing the impact of the disease, discouraging people from wearing masks and other preventative measures, and generally helping the virus along, he's helped the number of cases to explode.

 

Richard what evidence is there regarding this statement?

 

You and I both know that you don't care at all about the answer to this question, because the answer's obvious to everyone who's followed American pandemic news even the tiniest bit for the past 9 months. One doesn't need to provide supporting evidence to say that the sky is blue, ice is cold, and the sun rises in the east.

 

So, I'm just going to save us both time, and not bother with an answer.

 

I do care about the answer.  The answer I found is this (3 sources):

 

1)

https://www.webmd.com/lung/news/20201022/mask-use-by-americans-now-tops-90-poll-finds#1

The Harris Poll between Oct. 8 and 12.

 

More than nine in 10 U.S. adults (93%) said they sometimes, often or always wear a mask or face covering when they leave their home and are unable to socially distance,

 

including more than seven in 10 (72%) who said they always do so, the poll revealed.

 

2)

From CDC, bit outdated but latest they gave on October 30th:

https://www.cdc.gov/mmwr/volumes/69/wr/mm6943e4.htm?s_cid=mm6943e4_w

"Reported use of face masks increased from 78% in April, to 83% in May, and reached 89% in June;"

 

3)

Despite noisy no-mask protests, 92 percent of 2,200 Americans polled say they wear a face mask when leaving their home

https://www.nationalgeographic.com/history/2020/10/poll-increasing-bipartisan-majority-americans-support-mask-wearing/

Published Oct 5th.

 

I wear masks when I cannot socially distance or have good ventilation. The Trump supporters I know do the same. 

The reason is not that the belief it works, but what is there to loose unlike lockdowns.

[Investor20]

https://www.yahoo.com/lifestyle/almost-covid-transmission-happening-5-214735157.html

 

"CNN's chief medical correspondent Sanjay Gupta, MD, says not everything has to shut down because the majority of COVID transmission happens in just five places.

 

While Gupta was on CNN's New Day on Dec. 3, he said, "It's really these five primary locations where 80 percent of viral transmissions are happening in our society." According to Gupta, full stay-at-home orders are likely not necessary if we target the five spots. "Much of society can still stay open and still function as long as people wear masks and things like that, it doesn't need to go into a complete lockdown," he explained."

 

The five places listed in article are cafes, restaurants, hotels, bars and places of worship.

[ERICOPOLY]

By minimizing the impact of the disease, discouraging people from wearing masks and other preventative measures, and generally helping the virus along, he's helped the number of cases to explode.

 

Richard what evidence is there regarding this statement?

 

You and I both know that you don't care at all about the answer to this question, because the answer's obvious to everyone who's followed American pandemic news even the tiniest bit for the past 9 months. One doesn't need to provide supporting evidence to say that the sky is blue, ice is cold, and the sun rises in the east.

 

So, I'm just going to save us both time, and not bother with an answer.

 

Bill Gates pointed out that he likely seeded covid-19 all over the country when he closed travel from China  and 40,000 came rushing back home to the USA and they were allowed to return without any sort of a quarantine.

[KCLarkin]

Sweden.

 

 

Given the imminent vaccine arrival, we can officially put the Sweden model onto the list of historical pandemic failures alongside GBD.

 

 

[Guest cherzeca]

PCR tests, cycling and false positives. https://www.zerohedge.com/medical/first-time-us-state-will-require-disclosure-pcr-test-cycle-data

[Gregmal]

PCR tests, cycling and false positives. https://www.zerohedge.com/medical/first-time-us-state-will-require-disclosure-pcr-test-cycle-data

 

Yup, I brought this up in the spring, and it was widely determined by the experts here not to be relevant to anything even though cycle threshold is 10000% relevant to everything regarding spread/severity of this "cold". Or that the vast majority of positives in the US would have been negatives in other countries.....

[Castanza]

PCR tests, cycling and false positives. https://www.zerohedge.com/medical/first-time-us-state-will-require-disclosure-pcr-test-cycle-data

 

Yup, I brought this up in the spring, and it was widely determined by the experts here not to be relevant to anything even though cycle threshold is 10000% relevant to everything regarding spread/severity of this "cold". Or that the vast majority of positives in the US would have been negatives in other countries.....

 

So the questions are ... if I’m reading the article correctly.

 

What CT is indicative of infection and spread?

 

What is the average CT of current test history in the US?

 

Edit: current CDC stance

 

Can cycle threshold (Ct) values be used to assess when a person with COVID-19 is no longer infectious?

 

No. Although attempts to culture virus from upper respiratory specimens have been largely unsuccessful when Ct values are in high but detectable ranges, Ct values are not a measure of viral burden, are not standardized by RT-PCR platform, and have not been approved by FDA for use in clinical management. CDC does not endorse or recommend use of Ct values to assess when a person is no longer infectious; however, serial Ct values may be useful in the context of the entire body of information available when assessing recovery and resolution of infection.

Nov 18, 2020

[Cigarbutt]

PCR tests, cycling and false positives. https://www.zerohedge.com/medical/first-time-us-state-will-require-disclosure-pcr-test-cycle-data

What do you mean by false positive?

-not contagious, no disease, no virus (true error)

-not contagious, no disease, immaterial virus

-not contagious, immaterial disease, virus+

 

As you likely know, the distribution of results along the Ct-threshold axis is different in the community vs when becoming hospitalized with Covid-19 confirmed by both clinical criteria and PCR test. Still, the trends in positive tests and test positivity in the community vs hospitalizations tend to be correlated. Do you think people who have become hospitalized with Covid-19 are falsely labeled positive as a result of the casedemic?

 

 

[Castanza]

PCR tests, cycling and false positives. https://www.zerohedge.com/medical/first-time-us-state-will-require-disclosure-pcr-test-cycle-data

What do you mean by false positive?

-not contagious, no disease, no virus (true error)

-not contagious, no disease, immaterial virus

-not contagious, immaterial disease, virus+

 

As you likely know, the distribution of results along the Ct-threshold axis is different in the community vs when becoming hospitalized with Covid-19 confirmed by both clinical criteria and PCR test. Still, the trends in positive tests and test positivity in the community vs hospitalizations tend to be correlated. Do you think people who have become hospitalized with Covid-19 are falsely labeled positive as a result of the casedemic?

 

 

I think the heart of the question is at what CT is an individuals a risk of spread? PCR is sort of rudimentary no? I mean at a CT of say 40, you have found the covid virus. But you’ve also “amplified” it way beyond the actual existing amount.

 

I guess it doesn’t really matter if the goal is to err on the side of caution. I find it interesting at the lack of standardization from a global perspective.

 

If the US is counting 40CT as positive and Portugal isn’t a positive until it’s 25 then there is clearly big discrepancies of Covid cases. I guess that’s not all that important either as the individuals who are in hospitals are there regardless.

[Cigarbutt]

I think the heart of the question is at what CT is an individuals a risk of spread? PCR is sort of rudimentary no? I mean at a CT of say 40, you have found the covid virus. But you’ve also “amplified” it way beyond the actual existing amount.

I guess it doesn’t really matter if the goal is to err on the side of caution. I find it interesting at the lack of standardization from a global perspective.

If the US is counting 40CT as positive and Portugal isn’t a positive until it’s 25 then there is clearly big discrepancies of Covid cases. I guess that’s not all that important either as the individuals who are in hospitals are there regardless.

For a long list of reasons, the Ct-threshold result is much more qualitative than quantitative.

Countries which have been highly effective at containment could certainly wonder if they did too much to contain by, for example, wondering if using a lower Ct-threshold value would have resulted in the same level of containment with less restrictive measures. It is ironic that the same question is being asked where spread (contagious transmission) has been so rampant. In areas of high and persistent spread (high and rising positive rates), the additional value of more robust standardization of Ct-threshold value is like having the possibility to drive a Ferrari in dirt track racing.

[patience_and_focus]

I think the heart of the question is at what CT is an individuals a risk of spread? PCR is sort of rudimentary no? I mean at a CT of say 40, you have found the covid virus. But you’ve also “amplified” it way beyond the actual existing amount.

I guess it doesn’t really matter if the goal is to err on the side of caution. I find it interesting at the lack of standardization from a global perspective.

If the US is counting 40CT as positive and Portugal isn’t a positive until it’s 25 then there is clearly big discrepancies of Covid cases. I guess that’s not all that important either as the individuals who are in hospitals are there regardless.

For a long list of reasons, the Ct-threshold result is much more qualitative than quantitative.

Countries which have been highly effective at containment could certainly wonder if they did too much to contain by, for example, wondering if using a lower Ct-threshold value would have resulted in the same level of containment with less restrictive measures. It is ironic that the same question is being asked where spread (contagious transmission) has been so rampant. In areas of high and persistent spread (high and rising positive rates), the additional value of more robust standardization of Ct-threshold value is like having the possibility to drive a Ferrari in dirt track racing.

 

First of thank you Cigarbutt for trying to shed some light on this. Actually its even more fundamental than that. Here is an excerpt from CDC but any biochemistry book covering PCR test will clarify -

 

Question: Can Ct values from different RT-PCR tests be compared?

"No. For a given RT-PCR diagnostic test, the genetic material from a patient sample must be processed using a specific series of steps to produce a valid test result. However, the steps used to process the genetic material, the specific genetic target being measured, and the amount of the patient sample used varies among RT-PCR tests.  Because the nucleic acid target (the pathogen of interest), platform and format differ, Ct values from different RT-PCR tests cannot be compared."

 

What that means is that a test deployed in Portugal may be the same amount of "amplified" viral genetic material as a test from some other country with a different Ct. Ct is just # of cycles. Even if you have different cycles but you start with different initial state you may end up with the same result. It gets even more complicated. Not every PCR test is equally "efficient" meaning they do not have the same exponential curves. They also don't start with the same amount of patient sample (the specification for that test) because of how tests are configured with different technologies. Yet another important factor is the end goal which also matters. If the goal is to catch every potential case then the test is "tuned" for more cycles.

 

I mean this is an investment forum, I would have assumed some literacy and/or curiosity about these things instead of bias. So here is a very rough analogy and gross simplification of the PCR process -

 

exponential process = compounding with a rate of return,

initial state = amount of starting capital,

number of cycles = # of years.

ending capital = amount of viral dna after amplification

 

Just talking about how may years it took for two different investors to reach the same amount of ending capital is useless in comparing them if one doesn't know starting capital, rate of returns, different strategies employed, the goal of each investor (capital preservation vs capital growth vs steady income), etc etc.

 

If a biochemist came to an investment forum or conference and started talking about various investment strategies/options/metrics in an unsophisticated way, all "savvy" investors will eat him/her alive. And yet here we are, talking about an equally complex thing at the intersection of medicine/biochemistry/epidemiology, that needs expertise, in a casual way as if its so easy. The best (*sarcasm) articles come from zero hedge, with reference to truely original sources and insights from "JustTheNews".

 

 

[RichardGibbons]

By minimizing the impact of the disease, discouraging people from wearing masks and other preventative measures, and generally helping the virus along, he's helped the number of cases to explode.

 

Richard what evidence is there regarding this statement?

 

You and I both know that you don't care at all about the answer to this question, because the answer's obvious to everyone who's followed American pandemic news even the tiniest bit for the past 9 months. One doesn't need to provide supporting evidence to say that the sky is blue, ice is cold, and the sun rises in the east.

 

So, I'm just going to save us both time, and not bother with an answer.

 

I do care about the answer. 

 

Ok, fine. I don't believe you but here's 3.5 months.  (Source)

 

Jan 8 - First CDC warning on Novel Coronavirus (COVID-19)

 

Jan 9 - Trump campaign rally

 

Jan 14 - Trump campaign rally

 

Jan 16 - House sends impeachment articles to Senate

 

Jan 18 - Trump golfs

 

Jan 19 - Trump golfs

 

Jan 20 - first case of COVID-19 in the US, Washington State.

 

Jan 22 - “We have it totally under control. It’s one person coming in from China. It’s going to be just fine.”

 

Jan 28 - Trump campaign rally

 

Jan 30 - Trump campaign rally

 

Jan 30 - WHO declares Public Health Emergency of International Concern (PHEIC).

 

https://www.medscape.com/viewarticle/924596

 

Jan 31 - Trump announces China travel restrictions.

 

Feb 1 - Trump golfs

 

Feb 2 - Starts China travel restrictions

 

Feb 2 - “We pretty much shut it down coming in from China."

 

Feb 5 - Senate votes to acquit. Then takes a five-day weekend.

 

Feb 5 - HHS Secretary Azar requested $2 billion to buy respirator masks & other supplies for the national stockpile. Trump cut request by 75%

 

Feb 10 - Trump campaign rally

 

Feb 11 - At a rally, Trump says the virus will 'miraculously go away' with warmer weather. Meanwhile, the white house releases fiscal budget plan which proposes large budget cuts to the CDC and NIH

 

https://www.medscape.com/viewarticle/925130 Feb 12 - Dow Jones closes at an all time high of 29,551.42

 

Feb 15 - Trump golfs

 

Feb 19 - Trump campaign rally

 

Feb 20 - Trump campaign rally

 

Feb 21 - Trump campaign rally

 

Feb 24 - “The Coronavirus is very much under control in the USA… Stock Market starting to look very good to me!”

 

Feb 25 - “CDC and my Administration are doing a GREAT job of handling Coronavirus.”

 

Feb 25 - “I think that's a problem that’s going to go away… They have studied it. They know very much. In fact, we’re very close to a vaccine.”

 

Feb 26 - “The 15 (cases in the US) within a couple of days is going to be down to close to zero.”

 

Feb 26 - “We're going very substantially down, not up.”

 

Feb 26 - "This is a flu. This is like a flu"; "Now, you treat this like a flu"; "It's a little like the regular flu that we have flu shots for. And we'll essentially have a flu shot for this in a fairly quick manner."

 

Feb 27 - “One day it’s like a miracle, it will disappear.”

 

Feb 28 - “We're ordering a lot of supplies. We're ordering a lot of, uh, elements that frankly we wouldn't be ordering unless it was something like this. But we're ordering a lot of different elements of medical.”

 

Feb 28 - "The press is in Hysteria mode!" Over covid19

 

Feb 28 - Trump campaign rally

 

Feb 29 - First COVID-19 death in US

 

Mar 2 - “You take a solid flu vaccine, you don't think that could have an impact, or much of an impact, on corona?”

 

Mar 2 - “A lot of things are happening, a lot of very exciting things are happening and they’re happening very rapidly.”

 

Mar 4 - “If we have thousands or hundreds of thousands of people that get better just by, you know, sitting around and even going to work — some of them go to work, but they get better.”

 

Mar 5 - “I NEVER said people that are feeling sick should go to work.”

 

Mar 5 - “The United States… has, as of now, only 129 cases… and 11 deaths. We are working very hard to keep these numbers as low as possible!”

 

Mar 6 - “I think we’re doing a really good job in this country at keeping it down… a tremendous job at keeping it down.”

 

Mar 6 - “Anybody right now, and yesterday, anybody that needs a test gets a test. They’re there. And the tests are beautiful…. the tests are all perfect like the letter was perfect. The transcription was perfect. Right? This was not as perfect as that but pretty good.”

 

Mar 6 - “I like this stuff. I really get it. People are surprised that I understand it… Every one of these doctors said, ‘How do you know so much about this?’ Maybe I have a natural ability. Maybe I should have done that instead of running for president.”

 

Mar 6 - “I don't need to have the numbers double because of one ship that wasn't our fault.”

 

Mar 6 -"It came out of China... we closed it down, we stopped it."

 

Mar 7 - Trump golfs

 

Mar 8 - Trump golfs

 

Mar 8 - “We have a perfectly coordinated and fine tuned plan at the White House for our attack on CoronaVirus.”

 

Mar 9 - "The Fake News Media and their partner, the Democrat Party, is doing everything within its semi-considerable power (it used to be greater!) to inflame the CoronaVirus situation, far beyond what the facts would warrant.”

 

Mar 9 - “This blindsided the world.”

 

Mar 9 - "The Fake News Media and their partner, the Democrat Party, is doing everything within its semi-considerable power (it used to be greater!) to inflame the CoronaVirus situation, far beyond what the facts would warrant.

 

https://thehill.com/homenews/administration/486559-trump-fake-news-media-democrats-working-to-inflame-the-coronavirus

 

Apr 13 - "The media minimized the risk from the start."

 

Mar 10 - "It will go away. Just stay calm. It will go away."

 

Mar10 - Trump Addresses the Nation - closes travel to 26 countries in Europe, exempting those that contain Trump Resorts.

 

Mar 11 - Trump corrects multiple major misstatements in his national address.

 

https://www.salon.com/2020/03/12/officials-walk-back-numerous-inaccurate-claims-made-by-trump-during-bungled-coronavirus-address/

 

Mar 12 - Finally ordered N95masks

 

Mar 13 - [Declared state of emergency]

 

Mar 13 - " I dont take responsibility at all."

 

Mar 14 - Young Asian-American family of 4 stabbed in TX Sam's Club by man who thinks they're responsible for COVID.

 

Mar 15 - "It's a very contagious virus. It's incredible. But it's something we have tremendous control of."

 

Mar 15 - 3,613 COVID-19 cases, 69 deaths

 

Mar 17 - “This is a pandemic,” Mr. Trump told reporters. “I felt it was a pandemic long before it was called a pandemic.”

 

Mar 18 - "It’s not racist at all. No. Not at all. It comes from China. That’s why. It comes from China. I want to be accurate."

 

Mar 19 - "And we’re going to be able to make that drug available almost immediately, and that’s where the FDA has been so great. They — they’ve gone through the approval process. It’s been approved."

 

Mar 19 - FDA "Chrloroquine has not been approved for use against COVID-19."

 

Mar 20 - Trump says he is going to enact the Defense Production Act

 

Mar 23 - Dow Jones closes at 18,591.93

 

Mar 23 - "You look at automobile accidents, which are far greater than any numbers we're talking about. That doesn't mean we're going to tell everybody no more driving of cars. So we have to do things to get our country open."

 

Mar 25 - 3.3 million Americans file for unemployment.

 

Mar 26 - “You call it a germ, you can call it a flu, you can call it a virus. You know, you can call it many different names. I'm not sure anybody even knows what it is...”

 

Mar 27 - Activates Defense Production Act

 

Mar 30 - Dow Jones closes at 21,917.16

 

Apr 1 - "Did you know I was number one on Facebook?"

 

Apr 2 - 6.6 million Americans file for unemployment.

 

Apr 3 - 270,062 COVID-19 cases, 6,927 deaths.

 

Apr 4 - “Maybe we could allow special, for churches, maybe we could talk about it. Maybe we could allow them, with great separation outside, on Easter Sunday. I don’t know, it's something we should talk about,” he said.

 

“We have to get this country open. This country was not designed to be closed...we're paying people to stay home...and they want to go to work.”

 

Apr 5 - More then 9000 deaths in US from Covid-19. More than active service members killed in Iraq and Afghanistan combined.

 

Apr 6 - "I answered this 15 times. You don't have to answer." -- Trump prevents Dr Fauci from answering a question about hydroxychloroquine

 

Apr 7 - Trump threatens to pull funding from WHO

 

The whole Hannity interview. Just a couple snippets. https://www.cnn.com/2020/04/08/politics/donald-trump-sean-hannity-coronavirus/index.html

 

Apr 10 - Trump administration announces employers dont have to report corona virus cases unless you are in the health care industry. https://www.commondreams.org/news/2020/04/12/former-osha-officials-voice-alarm-trump-tells-corporations-they-dont-have-record

 

“This is a very brilliant enemy. You know, it’s a brilliant enemy. They develop drugs like the antibiotics. You see it. Antibiotics used to solve every problem. Now one of the biggest problems the world has is the germ has gotten so brilliant that the antibiotic can’t keep up with it."

 

He added: “We’re fighting – not only is it hidden, but it’s very smart. Okay? It’s invisible and it’s hidden, but it’s – it’s very smart.”

 

Apr 11 - Trump asked White House coronavirus task force member Dr. Anthony Fauci, “Why don’t we let this wash over the country?”

 

Apr 13 - Trump claims absolute authority over states governors

 

Apr 13 - "The media minimized the risk from the start."

 

Apr 14 - Trump announces USA will stop funding WHO

 

Tests still not available for most people.

 

And see? You don't care about any of this. That's what I mean by it being as obvious as the sky is blue. And it's equally as obvious that you don't actually care to have an accurate view of how the actions of the President of the United States may have contributed to the explosion of cases during the worse pandemic in the USA in 100 years.

 

That's why it's a waste of both our time.

 

[Cigarbutt]

...for trying to shed some light on this...

i guess that's the idea and it does get pretty dark sometimes.

On top of what you describe,

-It would be plausible for someone to go for the test in the AM and get a Ct of 22, in the PM the same day at 35 and the next day at 26. How can this be useful from an individual perspective, at this point? And this variability does not even include the basic fact that viral loads are dynamic in nature, it only includes the embedded statistical margins of error.. Taken at the population level, the statistical errors tend to cancel each other and may help more but the Ct-threshold value remains a qualitative input that needs contextual interpretation.

-The quantitative aspect can be improved with context. If disease prevalence is high (ie virus % more than 5% in population tested), the false negatives are much less of an issue (this is a simple mathematical fact if you spend 4 minutes on this). Let's say you test for gonorrhea in an at-risk population with 'community' spread, the positive predictive value will be high (number of false positives will be low even with less than 100% specificity). However, if you test for the same disease in a low-risk population in an area where community spread is absent, the positive predictive value will be low, ie if you test positive, there will be a high chance that it is false. The false positive issue where coronavirus spread is wide is an irrelevant one.

-----

The false positive rate is a reasonable concern and the issue arises because of uncertainty. It's too bad some quarters exploit the uncertainty to seed doubt theories. This is an investment board and the interesting aspects are the potential impact on investments and the analytical challenge. Last June, when this Ct-threshold issue was raised, the associated working assumptions (underpinnings of various doubt theories) were changing from the deaths will be counted on one hand to: it doesn't matter if hundreds of thousands die because they're dead-weight anyways and won't impact my portfolio, i would sell a family member for a profit if i could and to be involved in the market meant that you should be a socio-path.

To better understand the spread phenomenon going on right now (not the virus spread) and to avoid clogging this site, i've exchanged elsewhere on the topic. Recently, someone blabbed out a post on the false positive doubt theory. During the exchange, it became clear that the person had shallow understanding and used tribal-type of analysis. The point of the person what that the CV story was fake news and the virus did not really exist. When confronted and cornered with counterfactual analysis, the person spontaneously switched to another theory and suggested that the virus landed in America in 2019 and had become widespread. When i suggested that it was hard to reconcile that the virus was nowhere and everywhere simultaneously, the person reverted to ad hominem attacks.  ::)

[Castanza]

By minimizing the impact of the disease, discouraging people from wearing masks and other preventative measures, and generally helping the virus along, he's helped the number of cases to explode.

 

Richard what evidence is there regarding this statement?

 

You and I both know that you don't care at all about the answer to this question, because the answer's obvious to everyone who's followed American pandemic news even the tiniest bit for the past 9 months. One doesn't need to provide supporting evidence to say that the sky is blue, ice is cold, and the sun rises in the east.

 

So, I'm just going to save us both time, and not bother with an answer.

 

I do care about the answer. 

 

And see? You don't care about any of this. That's what I mean by it being as obvious as the sky is blue. And it's equally as obvious that you don't actually care to have an accurate view of how the actions of the President of the United States may have contributed to the explosion of cases during the worse pandemic in the USA in 100 years.

 

That's why it's a waste of both our time.

 

By the end of JULY there was 26 million people who attended BLM rallies and protests crossing state lines. Since then that number is likely about 50%+ more. It was the largest event in US history. You can take all of Trumps rallies and its population total is a drop in the bucket compared to GLM rallies, protests and riots.

 

Rule for thee, but not for me.

 

The fact is all of these behaviors likely influenced the spread rate....plenty of foolishness to go around.

[Gregmal]

Perhaps now, perhaps in 6 months, perhaps in a year or two we can revisit. When it comes to being in the market, the only thing that matters is putting yourself in position to being on the side of the trade that makes money. If folks were too distracted, or filled with fear, or grief stricken to invest, thats ok. As I always say, we all answer to our own P&L's. Perhaps down the line, when one is back in the office, or with their colleagues, bosses, patients, clients or whoever they answer to, they can take some time on their allotted lunch break to come back here and lecture me on trading family members for dollars....at which time I'll probably be at home, happily, with the wife and kids...mid 30s and all. Time is money. Who's really trading family for dollars? Whats spending the next 2 two decades doing a 9-5 worth? 80% of your kids lives as kids? Tisk, tisk.

[samwise]

The market seems to be seeing through the coming months of viral pain, just as it looks through any natural disaster which has high human costs but lower long term economic costs. So the following questions are more out of curiosity than investment impact. Many doctors have posted here, so maybe someone knows more about whats happening.

 

1. NM hit 102% ICU capacity. What does this mean? Are staff working 1.02 shifts? Could they work 2 shifts? 100% doesn't seem to be a real hard limit. https://news.yahoo.com/intensive-care-units-hospitals-coronavirus-pandemic-health-human-services-report-202137966.html?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAAMIvCKGM_DZzdARm4PBZQPw9v5c7skbhTqwAHGTo0B3B0dN_VoKnBoa82VuexpuEVdS_KAgn6jc7SIiDRt0WLkiEb9mNqlc0TiO9Em4bhpMNUYLq0jxqYAsbQXlfPtzuzESS8d54JBy17r2WUKoQOPF7Gc5Weg00nILQDJPoFbzw

 

 

2. Assuming there is a real limit somewhere, and demand and supply of ICU beds needs to be cleared, what approach do US hospitals take? Who gets the limited supply of ICU beds

a) The one who has the money , aka free market solution?

b) The one who knows the governor, aka corruption, nepotism...

c) Some triage, aka the one most likely to survive and live many years? Who makes this judgement and sentences people to death?

 

3. IF the capacity/supply constraint is not physical beds but staff, can't that be imported from areas in the world where the pandemic is more controlled? e.g. Aus, NZ, S Korea, China. Staff can be flown in from there. You'd need to ask nicely and give the right incentives, but not sure if there are any other constraints. Hospitals can't take the medical malpractice legal risk perhaps? Still seems better to me than letting people die in the corridors.

[Cigarbutt]

Before moving to the 'curiosity' part, on a net basis and perhaps in addition to short term opportunities that may be spotted based on short term issues, the coronavirus impact will end up being positive for markets. You also have to assess the host but that's another story.

 

On 1.

Bed capacity is based on the physical beds (assumed to be available and functional (equipment and personnel)). There's always the possibility to work over 100% capacity, even in ICUs, simply by redesigning the space, redeploying available equipment and re-allocating human resources. Adaptive potential can be very significant. i remember specifically being involved a long time ago when a never ending string of ambulances were bringing women serially shot by somebody who thought he knew better. Capacity to adapt is one of the great qualities of humans. But this adaptation plays out on a daily basis, to various degrees. In my area, it's not unusual for emergency rooms to often function at around 120% of capacity for long and recurrent periods. This is more difficult to achieve acutely in ICUs and pressure build-up there will tend to cause major surgical procedures flow to be slowed down or stopped. The US is not used to that but it's not that unusual in Canada. An interesting aspect is that smaller hospitals in the US are seeing unusual activity levels due to Covid and, typically for these smaller operations, the 'capacity' is partly theoretical and when, in practice, the capacity is needed, they are meeting resistance along the supply chain, especially for specialized and dedicated personnel. Ordinarily, these smaller hospitals can transfer excess and unexpected surges in demand to neighboring hospitals but, these days, the capacity issues are widespread and people may have to be transferred far away, out of state etc. In some places, they built temporary 'field' hospitals but it's hard to ventilate somebody in the parking lot.

 

On 2.

This is a tough question. There may be some of a) and b) but it's mostly c). Last spring, there were some discussions between folks in my area and people on the ground in the NY area. This is not a discussion for this board perhaps but to help with perspective you may want to think of what you would do if in charge of a hospital near where a plane crashes. There would be a demand-supply mismatch and this is covered in training ie who to attend to and who to provide terminal assistance to. Those who work in war settings are also familiar with this. There are accepted triage criteria based on severity of injury, chance of survival etc. It's a situation you want to avoid but, if forced to, there are reasonable (but painful) ways to approach this. Specifically for Covid, i've seen protocols that were prepared, but not used on a large scale. The protocol 'works' for the majority of cases and for the debatable scenarios, there is usually a team of three or more people recognized by peers who can take the decisions.

 

On 3.

You may have heard that nurses from the mid-west went to the NY area at some point and there was some return in favors recently but this is not typically a cost-effective solution. If the help is coming from a different area, there are differences in equipment, protocols, rules and customs. The training and adaptation period likely negates most of the positive value that could be eventually obtained. In my area, there were attempts (mostly failed) at disparate resource re-allocation but it was discovered that brain surgeons are not that effective at elderly diaper changes.

 

It would be interesting to read a diversity of opinions. i'm 90-95% retired but have some experience ranging from on-the-ground to decisional, and just finished a conference call. In my area, media will announce later on today that 50% of regular hospital activity will be curtailed across the board until further notice which means likely well into 2021..This too shall pass and all this is no big deal for investments but it is a true humanitarian crisis. At the end of the call, it was announced that the topic next Monday would be a review of end of life care decisions..