Coronavirus

[John Hjorth]

WHO says 5-6 day doubling (3/6/20 sit rpt)

 

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports. ...

 

Schwab,

 

What are you specifically referring to when you mention "5-6 days doubling"?

 

2nd page 2nd question 1st paragraph of 3/6/20 report

 

Q - How are COVID-19 and influenza viruses different?

The speed of transmission is an important point of difference between the two viruses. Influenza has a shorter

median incubation period (the time from infection to appearance of symptoms) and a shorter serial interval (the

time between successive cases) than COVID-19 virus. The serial interval for COVID-19 virus is estimated to be 5-6

days, while for influenza virus, the serial interval is 3 days. This means that influenza can spread faster than COVID-

19.

 

Thank you for the reply, Schwab.

 

-Got it.

[Dalal.Holdings]

 

Well it looks like data is presenting with flu symptoms. Does not mention deaths. I would hope to god if people died they were tested for covid19. Dead people get just as much of a right to a test as living plus in this day and age a requirement I would imagine. I would imagine the data is due to.

 

1. Covid19 of course, it has flu like symptoms

2. Worries individuals/paranoid.

 

Otherwise how do you fake flu symptoms?

 

 

 

 

"Katie S

@scoville_katie

Replying to

@chrislhayes

I noticed about a month ago that we were treating a lot of patients for the flu that had negative flu tests. My mind goes back to that and I just wonder if we missed the bus even before we thought we did."

 

Maybe I work where Katie works LOL! jk. Worth a read of her thread!

 

But this is where I'm trying to reconcile.  You're saying that you're not seeing it.  But evidence suggest that flue like cases are increasing significantly, but we don't know due to what.  So I'm wondering if this is just a precursor of things to come, and you might not have seen it first hand. 

 

And I can't imagine that we are testing dead people for the virus - I would definitely save the testing capacity for those alive and potentially contained at this moment... 

 

So if that's the case, then are we undercounting BOTH deaths and people infected??

 

I never said I'm not seeing it. I currently don't have testing avail other then the protocol I just said came over from DOH. How can I diagnose someone without a positive Covid-19 test? I am seeing what you posted in that tweet. High increase in flu like symptoms with negative flu. I have made that clear I think multiple times haven't I?

 

No they are not testing bodies at the morgue. You asked about testing people who come in with flu like symptoms. I don't believe I have heard of any cases of DOA(have you?) covid-19. Today, if you have someone on life support/ventilator anywhere in America I would hope to god its known whether or not they have Covid19.

 

I don't mean to put words into your mouth, but I think you have said that a lot of people are infected and we're not seeing the deaths, so the conclusion is that CFR is lower than what's out there.  So I'm asking - is the disconnect with what other countries are seeing that both infected and deaths are undercounted (vs. just denominator being undercounted)?

 

Just another thought on this. That tweet said flu like illness spiked March 1st right? Assuming those were all new cases we are now 15 days out. If your only self quarantined for 14 days then it could be broadly assumed that your chance of dying is high in 14 days right?

 

That being said is it reasonable to assume there should have been a HUGE spike in deaths? Its been 15 days right? How many in NYC 3?

 

False. They spiked in the days leading up to March 12 as the graph clearly shows. Literally took 2 seconds to confirm.

[Dalal.Holdings]

It is only after markets crash and the economy takes a huge hit that some people will appreciate how “cheap” strong, preventative measures taken in February of 2020 to stop the spread of this would have been. Some people will never appreciate that fact.

 

Can someone explain to me the benefit of the FDA denying this Seattle ID doc way back in January the right to test patients?

 

https://www.nytimes.com/2020/03/10/us/coronavirus-testing-delays.amp.html

[Liberty]

Theorizing about sunshine-hours in various locations and lethality (based on little data, but interesting line of thought since Vitamin D supplementation is inexpensive and not-risky, so very asymmetric): https://simonsarris.com/sunlight

[StubbleJumper]

 

Why are world leaders predicting that 60-70% of the world population will contract this eventually?  What is 1% of 70% of 7.8B?  Are they full of crap?  Will we have a vaccine soon?  Hopefully you are correct; but if you are it will likely be for the wrong reasons.

 

 

My guess about the 60% numbers that have been trotted out is that it relates to the R-naught.  If you believe that R0 must be less than 1 for this virus to peter out, then you need to contemplate how that will happen.  The first option is the miracle vaccine get developed and R0 plummets.  The second option is that we keep up all of this social distancing and other restrictions indefinitely, which will drop the R0...just until the point where we let up and return to normal life, which is when wave #2 comes.  The third way that R0 could drop below 1 is if there are not enough vulnerable people for the virus to infect. 

 

If you believe that all other things being equal, the R0=3 then how much of the population needs to be immune for that R0 to drop to 1?  Roughly two-thirds of the population?  I suspect that's the rough math that the experts are doing.

 

So, lets go one more stage on this R-naught business.  How long are we likely to be in this?  If we are dreaming about the vaccine, probably a year, but maybe we'll get lucky and it'll be quicker.  If we are thinking that we're in this until herd-immunity kicks in (ie, ~60% have already had it), do the math.  We will need to have had 60% x 350m Americans = ~200m cases of people who have already had the virus.  People are talking about flattening the curve, but if we want this to be over any time soon (ie, say in one year), we need about 4 million cases per week in the US.  If we flatten that curve too much, and if the miracle vaccine doesn't present itself any time soon, for how long will we be in this?  Years?

 

 

SJ

[KJP]

Theorizing about sunshine-hours in various locations and lethality (based on little data, but interesting line of thought since Vitamin D supplementation is inexpensive and not-risky, so very asymmetric): https://simonsarris.com/sunlight

 

Vitamin D deficiency has also long been theorized as one of the factors causing influenza seasonality.  See, for example, this paper:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2870528/

https://news.harvard.edu/gazette/story/2017/02/study-confirms-vitamin-d-protects-against-cold-and-flu/

 

On the other hand, some studies have suggested that Vitamin D supplementation doesn't do much (or anything) to prevent viral respiratory tract infections:  https://www.ncbi.nlm.nih.gov/pubmed/28719693

https://www.ncbi.nlm.nih.gov/pubmed/26951286

 

As you note, Vitamin D is very cheap.  You can also google to find recent evidence regarding the levels of supplementation that might lead to toxicity (tl;dr -- there appears to be plenty of room to supplement without causing any significant problems).

 

Based on this research, I've been supplementing with Vitamin D since last fall with good results re common cold symptoms (which are an issue with two small children in the house).  Of course, n=1 doesn't provide much evidence of anything.

 

[minten]

My guess about the 60% numbers that have been trotted out is that it relates to the R-naught.  If you believe that R0 must be less than 1 for this virus to peter out, then you need to contemplate how that will happen.  The first option is the miracle vaccine get developed and R0 plummets.  The second option is that we keep up all of this social distancing and other restrictions indefinitely, which will drop the R0...just until the point where we let up and return to normal life, which is when wave #2 comes.  The third way that R0 could drop below 1 is if there are not enough vulnerable people for the virus to infect. 

 

If you believe that all other things being equal, the R0=3 then how much of the population needs to be immune for that R0 to drop to 1?  Roughly two-thirds of the population?  I suspect that's the rough math that the experts are doing.

 

So, lets go one more stage on this R-naught business.  How long are we likely to be in this?  If we are dreaming about the vaccine, probably a year, but maybe we'll get lucky and it'll be quicker.  If we are thinking that we're in this until herd-immunity kicks in (ie, ~60% have already had it), do the math.  We will need to have had 60% x 350m Americans = ~200m cases of people who have already had the virus.  People are talking about flattening the curve, but if we want this to be over any time soon (ie, say in one year), we need about 4 million cases per week in the US.  If we flatten that curve too much, and if the miracle vaccine doesn't present itself any time soon, for how long will we be in this?  Years?

 

 

SJ

 

Good post. Just wanted to add a vaccine or no vaccine is not a binary situation.  we might develop a vaccine that offers * some * protection (like the flu vaccine), but not a watertight solution.  Also, even if we don't develop a vaccine in a year, we will likely find better ways to treat patients (with antibodies for examples) as we learn more, causing less of them to go critical and save much needed hospital resources.  Time is clearly on our side here.

 

Also just in, Lombardy reports lowest new case number in a week. Don't want to repeat myself over and over, but remember, Lombardy went in lock-down a couple of days before Italy as a whole. Could still be a one-time fluke, but if confirmed over the next few days, would be a very positive sign for what's still to come in Italy first, and the rest of Europe later.

[Jurgis]

Theorizing about sunshine-hours in various locations and lethality (based on little data, but interesting line of thought since Vitamin D supplementation is inexpensive and not-risky, so very asymmetric): https://simonsarris.com/sunlight

 

Vitamin D deficiency has also long been theorized as one of the factors causing influenza seasonality.  See, for example, this paper:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2870528/

https://news.harvard.edu/gazette/story/2017/02/study-confirms-vitamin-d-protects-against-cold-and-flu/

 

On the other hand, some studies have suggested that Vitamin D supplementation doesn't do much to present viral respiratory tract infections:  https://www.ncbi.nlm.nih.gov/pubmed/28719693

https://www.ncbi.nlm.nih.gov/pubmed/26951286

 

As you note, Vitamin D is very cheap.  You can also google to find recent evidence regarding the levels of supplementation that might lead to toxicity (tl;dr -- there appears to be plenty of room to supplement without causing any significant problems).

 

Based on this research, I've been supplementing with Vitamin D since last fall with good results re common cold symptoms (which are an issue with two small children in the house).  Of course, n=1 doesn't provide much evidence of anything.

 

Just FYI, there is some evidence that very high doses of Vitamin D can cause/contribute to kidney stones:

 

http://www.vitamindsupplement.com/vitamin-d-and-kidney-stones/

 

So, don't overdo it, don't mega dose thinking it can't have negative effects.

 

(Anecdotally, I've had kidney stone symptoms that seemed to be correlated with high Vitamin D doses. YMMV.)

[KJP]

Theorizing about sunshine-hours in various locations and lethality (based on little data, but interesting line of thought since Vitamin D supplementation is inexpensive and not-risky, so very asymmetric): https://simonsarris.com/sunlight

 

Vitamin D deficiency has also long been theorized as one of the factors causing influenza seasonality.  See, for example, this paper:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2870528/

https://news.harvard.edu/gazette/story/2017/02/study-confirms-vitamin-d-protects-against-cold-and-flu/

 

On the other hand, some studies have suggested that Vitamin D supplementation doesn't do much to present viral respiratory tract infections:  https://www.ncbi.nlm.nih.gov/pubmed/28719693

https://www.ncbi.nlm.nih.gov/pubmed/26951286

 

As you note, Vitamin D is very cheap.  You can also google to find recent evidence regarding the levels of supplementation that might lead to toxicity (tl;dr -- there appears to be plenty of room to supplement without causing any significant problems).

 

Based on this research, I've been supplementing with Vitamin D since last fall with good results re common cold symptoms (which are an issue with two small children in the house).  Of course, n=1 doesn't provide much evidence of anything.

 

Just FYI, there is some evidence that very high doses of Vitamin D can cause/contribute to kidney stones:

 

http://www.vitamindsupplement.com/vitamin-d-and-kidney-stones/

 

So, don't overdo it, don't mega dose thinking it can't have negative effects.

 

(Anecdotally, I've had kidney stone symptoms that seemed to be correlated with high Vitamin D doses. YMMV.)

 

Yes -- my understanding is that Vitamin D encourages calcium formation, thus the side effect you're talking about. 

[Liberty]

Theorizing about sunshine-hours in various locations and lethality (based on little data, but interesting line of thought since Vitamin D supplementation is inexpensive and not-risky, so very asymmetric): https://simonsarris.com/sunlight

 

Vitamin D deficiency has also long been theorized as one of the factors causing influenza seasonality.  See, for example, this paper:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2870528/

https://news.harvard.edu/gazette/story/2017/02/study-confirms-vitamin-d-protects-against-cold-and-flu/

 

On the other hand, some studies have suggested that Vitamin D supplementation doesn't do much to present viral respiratory tract infections:  https://www.ncbi.nlm.nih.gov/pubmed/28719693

https://www.ncbi.nlm.nih.gov/pubmed/26951286

 

As you note, Vitamin D is very cheap.  You can also google to find recent evidence regarding the levels of supplementation that might lead to toxicity (tl;dr -- there appears to be plenty of room to supplement without causing any significant problems).

 

Based on this research, I've been supplementing with Vitamin D since last fall with good results re common cold symptoms (which are an issue with two small children in the house).  Of course, n=1 doesn't provide much evidence of anything.

 

Just FYI, there is some evidence that very high doses of Vitamin D can cause/contribute to kidney stones:

 

http://www.vitamindsupplement.com/vitamin-d-and-kidney-stones/

 

So, don't overdo it, don't mega dose thinking it can't have negative effects.

 

(Anecdotally, I've had kidney stone symptoms that seemed to be correlated with high Vitamin D doses. YMMV.)

 

What was the "high dose" that you were taking?

 

I've read that natural exposure to the sun during summer can often give you an equivalent dose to 15-20k UIs, the body seems pretty good at dealing with higher doses (better than lower doses).

 

It certainly depends where you live, but here in Canada, for someone who's inside the house most of the day, I'm probably getting little naturally so supplementation makes a lot of sense. I've been doing mostly 5k uis during summer and 8-10k uis during winter, probably for about 15 years.

[Liberty]

Scott Gottlied thread:

[StubbleJumper]

My guess about the 60% numbers that have been trotted out is that it relates to the R-naught.  If you believe that R0 must be less than 1 for this virus to peter out, then you need to contemplate how that will happen.  The first option is the miracle vaccine get developed and R0 plummets.  The second option is that we keep up all of this social distancing and other restrictions indefinitely, which will drop the R0...just until the point where we let up and return to normal life, which is when wave #2 comes.  The third way that R0 could drop below 1 is if there are not enough vulnerable people for the virus to infect. 

 

If you believe that all other things being equal, the R0=3 then how much of the population needs to be immune for that R0 to drop to 1?  Roughly two-thirds of the population?  I suspect that's the rough math that the experts are doing.

 

So, lets go one more stage on this R-naught business.  How long are we likely to be in this?  If we are dreaming about the vaccine, probably a year, but maybe we'll get lucky and it'll be quicker.  If we are thinking that we're in this until herd-immunity kicks in (ie, ~60% have already had it), do the math.  We will need to have had 60% x 350m Americans = ~200m cases of people who have already had the virus.  People are talking about flattening the curve, but if we want this to be over any time soon (ie, say in one year), we need about 4 million cases per week in the US.  If we flatten that curve too much, and if the miracle vaccine doesn't present itself any time soon, for how long will we be in this?  Years?

 

 

SJ

 

Good post. Just wanted to add a vaccine or no vaccine is not a binary situation.  we might develop a vaccine that offers * some * protection (like the flu vaccine), but not a watertight solution.  Also, even if we don't develop a vaccine in a year, we will likely find better ways to treat patients (with antibodies for examples) as we learn more, causing less of them to go critical and save much needed hospital resources.  Time is clearly on our side here.

 

Also just in, Lombardy reports lowest new case number in a week. Don't want to repeat myself over and over, but remember, Lombardy went in lock-down a couple of days before Italy as a whole. Could still be a one-time fluke, but if confirmed over the next few days, would be a very positive sign for what's still to come in Italy first, and the rest of Europe later.

 

 

 

Well, go one step further.  If there is much uncertainty about the likelihood of developing a vaccine or the timeline for developing a vaccine, is the "general lockdown" the correct management strategy?  If you are in the camp where you believe that herd immunity will be our avenue out, then you want to achieve that as fast as you can without drastically overwhelming medical resources.  There is an argument that the optimal approach would be mandatory quarantine of the healthy older population (70+ years) and those who are otherwise immunocompromised, and then re-open all of the schools and workplaces so that the virus runs through the young population reasonably quickly.

 

We don't want to be in a situation of social distancing for all of the next 5 years....

 

 

SJ

[RichardGibbons]

You said I didnt think I was ignorant. Liar! I like you how strictly adhere to statistics though! That takes a lot of confidence in medicine! I would never want to operate on you. Imagine going through the complication rates with you. Whoo!

 

I try to be evidence-based (don't always succeed), and since that post I've got substantially more evidence. Cobafdek's explanation makes sense to me.  Essentially, when it comes to math, until I have evidence to the contrary, it sounds like I should assume that a typical doctor is roughly as knowledgeable as someone who's never taken a math course in college.

 

And that's fine. If you're a surgeon, I imagine I as a patient gain more from you doing another medical course than a statistics course. It just means that, I should have little confidence in your analysis of math things like statistical sampling and exponential growth, just like you have no confidence in me for medical things.

 

(I have a math degree and a couple computer science degrees. I'm completely ignorant of how to operate on people, and basically trust my doctor 98% for anything medical.  So you're welcome to call me ignorant too.)

 

Maybe you can reconcile this questions for me since you guys are way better at the crunching the numbers then I am.

 

Can we all agree Italy is a shit show right? Many have used it as an example of worst case scenario.

 

1. First case in Washington Jan 20th, First case in Italy Jan 31st. Cant argue that right?

 

2. Italy has 1809 deaths I think? Washington State 50, ~27 from infirmed elderly.

 

3. You guys have pounded the table about exponential growth. I clearly don't get it or calculate it. As as many have said for days, it is coming. No doubt, it is coming.

 

4. You guys are data driven guys. Whats up here?

 

Sure. While people talk about average rate to double of about 6 days, there's high variance in the number of people infected by any given person. The typical infected person infects 2 others, but one person in South Korea seemed to have infected a thousand people.

 

So extrapolating doubling from tiny numbers doesn't work.  Once you get a bunch of cases (say, 40), the infection rate converges on the average, and you can start to play the 6 day doubling game.  (Which, as a percentage of the population starts to take social distancing seriously, should increase, decreasing infection rate.)

 

For the USA, it's also worth noting that deciding who to test based on different criteria than other countries will affect the results of tests, and that seems to be true in the USA. (e.g. suppose you test one person, and find them positive, and then never test anyone again, identifying no more positive people. Is it reasonable to conclude that the virus has stopped spreading?  USA isn't quite this extreme, but it's doing way fewer tests, particularly per capita, than pretty well every other developed country.)

 

Also FWIW I dont believe your name is Richard Gibbons. Who would name their kid Dick Gibbons? j/k ;)

 

LOL, for a few years in middle school, one of my nicknames was Gibble Dick.  That was unfortunate. :)

[minten]

Well, go one step further.  If there is much uncertainty about the likelihood of developing a vaccine or the timeline for developing a vaccine, is the "general lockdown" the correct management strategy?  If you are in the camp where you believe that herd immunity will be our avenue out, then you want to achieve that as fast as you can without drastically overwhelming medical resources.  There is an argument that the optimal approach would be mandatory quarantine of the healthy older population (70+ years) and those who are otherwise immunocompromised, and then re-open all of the schools and workplaces so that the virus runs through the young population reasonably quickly.

 

We don't want to be in a situation of social distancing for all of the next 5 years....

SJ

 

Assuming spring will take the numbers down, and assuming fall would cause an upflare, it seems reasonable to me to practice social distancing (or lockdown, if need be) for everybody to keep the numbers down until spring, which shouldn't be more than a couple of weeks. And then use spring and summer to develop better treatment options, produce more of what we are currently short on, and much, much better and more testing. So when it does come back, everybody will be better prepared and informed, cases on average will be much less severe, this thing won't have such an enormous impact and, most of all, won't create such a ridiculous panic in the economy. So herd immunity, yes, but only when we're ready. But what do I know.

[Read the Footnotes]

 

Sure. While people talk about average rate to double of about 6 days, there's high variance in the number of people infected by any given person. The typical infected person infects 2 others, but one person in South Korea seemed to have infected a thousand people.

 

So extrapolating doubling from tiny numbers doesn't work.  Once you get a bunch of cases (say, 40), the infection rate converges on the average, and you can start to play the 6 day doubling game.  (Which, as a percentage of the population starts to take social distancing seriously, should increase, decreasing infection rate.)

 

For the USA, it's also worth noting that deciding who to test based on different criteria than other countries will affect the results of tests, and that seems to be true in the USA.

 

Several real important statistical/mathematics points here.

 

Most importantly the USA has just announced that they will focus the new testing capacity on the elderly and medical professionals. Medical professionals makes sense, but the elderly may not be a very good plan. The elderly typically get sick quickly and acts as a giant red flag. In S. Korea and China they believed 50% of cases were caused by asymptomatic  by 20-29 year olds. S. Korea has focused on this age group to prevent asymptomatic spreaders.

 

The USA plans to do the complete opposite process of what may be the most successful program in the world.

 

https://www.forbes.com/sites/sciencebiz/2020/03/15/covid-19-who-is-infectious/#3dedb7a44d89

[EliG]

It certainly depends where you live, but here in Canada, for someone who's inside the house most of the day, I'm probably getting little naturally so supplementation makes a lot of sense. I've been doing mostly 5k uis during summer and 8-10k uis during winter, probably for about 15 years.

 

Liberty, where do you buy 5K-10K doses in Canada? I checked local stores and amazon.ca. Reputable brands don't go higher than 1K. I can buy 5K-10K on amazon.com but I'd rather not pay international shipping fee.

[Jurgis]

Theorizing about sunshine-hours in various locations and lethality (based on little data, but interesting line of thought since Vitamin D supplementation is inexpensive and not-risky, so very asymmetric): https://simonsarris.com/sunlight

 

Vitamin D deficiency has also long been theorized as one of the factors causing influenza seasonality.  See, for example, this paper:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2870528/

https://news.harvard.edu/gazette/story/2017/02/study-confirms-vitamin-d-protects-against-cold-and-flu/

 

On the other hand, some studies have suggested that Vitamin D supplementation doesn't do much to present viral respiratory tract infections:  https://www.ncbi.nlm.nih.gov/pubmed/28719693

https://www.ncbi.nlm.nih.gov/pubmed/26951286

 

As you note, Vitamin D is very cheap.  You can also google to find recent evidence regarding the levels of supplementation that might lead to toxicity (tl;dr -- there appears to be plenty of room to supplement without causing any significant problems).

 

Based on this research, I've been supplementing with Vitamin D since last fall with good results re common cold symptoms (which are an issue with two small children in the house).  Of course, n=1 doesn't provide much evidence of anything.

 

Just FYI, there is some evidence that very high doses of Vitamin D can cause/contribute to kidney stones:

 

http://www.vitamindsupplement.com/vitamin-d-and-kidney-stones/

 

So, don't overdo it, don't mega dose thinking it can't have negative effects.

 

(Anecdotally, I've had kidney stone symptoms that seemed to be correlated with high Vitamin D doses. YMMV.)

 

What was the "high dose" that you were taking?

 

I've read that natural exposure to the sun during summer can often give you an equivalent dose to 15-20k UIs, the body seems pretty good at dealing with higher doses (better than lower doses).

 

It certainly depends where you live, but here in Canada, for someone who's inside the house most of the day, I'm probably getting little naturally so supplementation makes a lot of sense. I've been doing mostly 5k uis during summer and 8-10k uis during winter, probably for about 15 years.

 

It clearly depends on a person.

 

I was taking 5K IUs close to daily. Now I am taking 5K IUs twice a week with no kidney stone symptoms.

[Read the Footnotes]

Well, go one step further.  If there is much uncertainty about the likelihood of developing a vaccine or the timeline for developing a vaccine, is the "general lockdown" the correct management strategy?  If you are in the camp where you believe that herd immunity will be our avenue out, then you want to achieve that as fast as you can without drastically overwhelming medical resources.  There is an argument that the optimal approach would be mandatory quarantine of the healthy older population (70+ years) and those who are otherwise immunocompromised, and then re-open all of the schools and workplaces so that the virus runs through the young population reasonably quickly.

 

We don't want to be in a situation of social distancing for all of the next 5 years....

SJ

 

Assuming spring will take the numbers down, and assuming fall would cause an upflare, it seems reasonable to me to practice social distancing (or lockdown, if need be) for everybody to keep the numbers down until spring, which shouldn't be more than a couple of weeks. And then use spring and summer to develop better treatment options, produce more of what we are currently short on, and much, much better and more testing. So when it does come back, everybody will be better prepared and informed, cases on average will be much less severe, this thing won't have such an enormous impact and, most of all, won't create such a ridiculous panic in the economy. So herd immunity, yes, but only when we're ready. But what do I know.

 

Unfortunately, seasonality is likely overstated. The real benefit is that though COVID-19 will increase through the summer, cold and flu season will decrease and offset some of the demand from COVID-19.

 

https://ccdd.hsph.harvard.edu/will-covid-19-go-away-on-its-own-in-warmer-weather/

[Liberty]

It certainly depends where you live, but here in Canada, for someone who's inside the house most of the day, I'm probably getting little naturally so supplementation makes a lot of sense. I've been doing mostly 5k uis during summer and 8-10k uis during winter, probably for about 15 years.

 

Liberty, where do you buy 5K-10K doses in Canada? I checked local stores and amazon.ca. Reputable brands don't go higher than 1K. I can buy 5K-10K on amazon.com but I'd rather not pay international shipping fee.

 

You can just take multiple 1Ks, that does fine too. But if I want 5ks, I get them from the US, shipping fee's pretty low for such small items.

[orthopa]

 

Well it looks like data is presenting with flu symptoms. Does not mention deaths. I would hope to god if people died they were tested for covid19. Dead people get just as much of a right to a test as living plus in this day and age a requirement I would imagine. I would imagine the data is due to.

 

1. Covid19 of course, it has flu like symptoms

2. Worries individuals/paranoid.

 

Otherwise how do you fake flu symptoms?

 

 

 

 

"Katie S

@scoville_katie

Replying to

@chrislhayes

I noticed about a month ago that we were treating a lot of patients for the flu that had negative flu tests. My mind goes back to that and I just wonder if we missed the bus even before we thought we did."

 

Maybe I work where Katie works LOL! jk. Worth a read of her thread!

 

But this is where I'm trying to reconcile.  You're saying that you're not seeing it.  But evidence suggest that flue like cases are increasing significantly, but we don't know due to what.  So I'm wondering if this is just a precursor of things to come, and you might not have seen it first hand. 

 

And I can't imagine that we are testing dead people for the virus - I would definitely save the testing capacity for those alive and potentially contained at this moment... 

 

So if that's the case, then are we undercounting BOTH deaths and people infected??

 

I never said I'm not seeing it. I currently don't have testing avail other then the protocol I just said came over from DOH. How can I diagnose someone without a positive Covid-19 test? I am seeing what you posted in that tweet. High increase in flu like symptoms with negative flu. I have made that clear I think multiple times haven't I?

 

No they are not testing bodies at the morgue. You asked about testing people who come in with flu like symptoms. I don't believe I have heard of any cases of DOA(have you?) covid-19. Today, if you have someone on life support/ventilator anywhere in America I would hope to god its known whether or not they have Covid19.

 

I don't mean to put words into your mouth, but I think you have said that a lot of people are infected and we're not seeing the deaths, so the conclusion is that CFR is lower than what's out there.  So I'm asking - is the disconnect with what other countries are seeing that both infected and deaths are undercounted (vs. just denominator being undercounted)?

 

Just another thought on this. That tweet said flu like illness spiked March 1st right? Assuming those were all new cases we are now 15 days out. If your only self quarantined for 14 days then it could be broadly assumed that your chance of dying is high in 14 days right?

 

That being said is it reasonable to assume there should have been a HUGE spike in deaths? Its been 15 days right? How many in NYC 3?

 

False. They spiked in the days leading up to March 12 as the graph clearly shows. Literally took 2 seconds to confirm.

 

No it starts to increase March 1st, now that is giving a generous 14 day time to death! So we still have to wait some more?

[orthopa]

Is it really possible to become and MD without a basic understanding of exponential growth and no understanding of statistics/sampling theory? (This is a serious question, not rhetorical, because I don't know the answer and I'm curious if such big holes are normal in doctors' education.)

 

Since I'm an MD, I can answer your question.  The answer is yes.  Probability/statistics is hard.  Furthermore, it's probably the worst taught class in medical school, with the least interest for most med students, who are understandably more interested in anatomy, physiology, biochemistry, pathology, etc.  The average doctor is no more proficient in formal probability and statistical concepts than the average layman, i.e., CoBF member.

 

That said, and in defense of us MDs, ordinary clinical decisions are based on intuitive probability judgments that are made implicitly, and without the need for any tricky mathematics.  Mathematical probability comes into play only on those rare occasions when the right answer turns out to be counterintuitive.  It's not really relevant in everyday clinical practice.

 

After completing my residency, I did a research fellowship which involved getting an MPH degree in biostatistics.  But even if an MD has a good understanding of statistics, a medical opinion is nearly useless in this current coronavirus situation.  Clinical decision making is based on statistical inference, whether it's explicit or intuitive.  Statistical inference is based on well-designed experiments, clean data, and a well-understood scenario, none of which characterize this pandemic.  Statistical thinking is retrospective, based on past data.  With coronovirus, we have a whopping 4 months of chaotic short-term data.

 

Probability judgments are prospective.  They can be based on relative frequencies over time, relative frequencies in an actual group of patients, relative frequencies in an imaginary group of patients, or they can be subjective belief.  Most of the speculation in this thread is based on the latter two.  We're all guessing.  Orthopa is clear on that.  He is also self-aware because he admits he may be subject to the anchoring bias, having committed to a relatively controversial opinion.

 

My local experience parallels Orthopa's so far (except for no cases of positive coronovirus tests yet, which is because there has been hardly any testing done around here as of this weekend).  I'm in Orange County, California.  My hospital's ER has a tent outside for overflow cases.  It went up last week and hasn't been utilized.  The hospital and ICU census is the usual at this time of year. (I know it's early.)  My flow of office patients has actually slowed in the past week, possibly because patients are now thinking twice about coming to the doctor or hospital.  (I know it's early.)

 

(Cobafdek: this is why I'm at the 2% rather than the 70% number for orthopa's theory.  If someone doesn't understanding even the most basic concepts of exponential growth or statistics--ideas you'd learn in your first year courses--them, when it comes to a pandemic, their hypotheses about the meaning of anything they observe are likely to be worthless.)

 

My opinion that Orthopa's theory has a 70% probability of being correct is pure subjective belief, partly based on my local anecdotal scene.  It's just a feeling.  I don't think it's any more or less valid than any of the counter-opinions in this thread.  We're all fooled by randomness.  And I have not expressed my opinion in my community because I think people would misinterpret it and not do the right thing, which is to use the precautionary principle. 

 

In fact, I think it is a major mistake and dangerous to think that heavy speculative computation - seen on this thread - is at all helpful in these cases.  For unknown unknowns like this novel coronovirus, the worst case scenario is bad enough.  Put down the calculator and run like hell.

 

Thanks for increasing my confirmation bias. That being said I also find it interesting no comments on your contribution. How can everyone else blame me/you I guess. Seeing is believing until it changes.

 

Question for the math guys as Im learning a great deal. Ill leave the computation up to you guys.

 

Again we know first infection Jan 20th, whether it was here before is up for debate and unknowable. At what date in the future do you start to say, wait a minute. This death rate is way over blown, maybe this isn't as bad as we thought it was. We should be looking at a significant exponential increase here soon right? Its been almost 2 months, lots of untested people and asymptomatic walking around.

 

Social distancing and shut down just started. Going by quarantine guidelines that train left the station 14 days ago. The snowball is still growing for 14 more days. Increased death should follow.

 

What are you guys looking at?

[KJP]

Is it really possible to become and MD without a basic understanding of exponential growth and no understanding of statistics/sampling theory? (This is a serious question, not rhetorical, because I don't know the answer and I'm curious if such big holes are normal in doctors' education.)

 

Since I'm an MD, I can answer your question.  The answer is yes.  Probability/statistics is hard.  Furthermore, it's probably the worst taught class in medical school, with the least interest for most med students, who are understandably more interested in anatomy, physiology, biochemistry, pathology, etc.  The average doctor is no more proficient in formal probability and statistical concepts than the average layman, i.e., CoBF member.

 

That said, and in defense of us MDs, ordinary clinical decisions are based on intuitive probability judgments that are made implicitly, and without the need for any tricky mathematics.  Mathematical probability comes into play only on those rare occasions when the right answer turns out to be counterintuitive.  It's not really relevant in everyday clinical practice.

 

After completing my residency, I did a research fellowship which involved getting an MPH degree in biostatistics.  But even if an MD has a good understanding of statistics, a medical opinion is nearly useless in this current coronavirus situation.  Clinical decision making is based on statistical inference, whether it's explicit or intuitive.  Statistical inference is based on well-designed experiments, clean data, and a well-understood scenario, none of which characterize this pandemic.  Statistical thinking is retrospective, based on past data.  With coronovirus, we have a whopping 4 months of chaotic short-term data.

 

Probability judgments are prospective.  They can be based on relative frequencies over time, relative frequencies in an actual group of patients, relative frequencies in an imaginary group of patients, or they can be subjective belief.  Most of the speculation in this thread is based on the latter two.  We're all guessing.  Orthopa is clear on that.  He is also self-aware because he admits he may be subject to the anchoring bias, having committed to a relatively controversial opinion.

 

My local experience parallels Orthopa's so far (except for no cases of positive coronovirus tests yet, which is because there has been hardly any testing done around here as of this weekend).  I'm in Orange County, California.  My hospital's ER has a tent outside for overflow cases.  It went up last week and hasn't been utilized.  The hospital and ICU census is the usual at this time of year. (I know it's early.)  My flow of office patients has actually slowed in the past week, possibly because patients are now thinking twice about coming to the doctor or hospital.  (I know it's early.)

 

(Cobafdek: this is why I'm at the 2% rather than the 70% number for orthopa's theory.  If someone doesn't understanding even the most basic concepts of exponential growth or statistics--ideas you'd learn in your first year courses--them, when it comes to a pandemic, their hypotheses about the meaning of anything they observe are likely to be worthless.)

 

My opinion that Orthopa's theory has a 70% probability of being correct is pure subjective belief, partly based on my local anecdotal scene.  It's just a feeling.  I don't think it's any more or less valid than any of the counter-opinions in this thread.  We're all fooled by randomness.  And I have not expressed my opinion in my community because I think people would misinterpret it and not do the right thing, which is to use the precautionary principle. 

 

In fact, I think it is a major mistake and dangerous to think that heavy speculative computation - seen on this thread - is at all helpful in these cases.  For unknown unknowns like this novel coronovirus, the worst case scenario is bad enough.  Put down the calculator and run like hell.

 

Thanks for increasing my confirmation bias. That being said I also find it interesting no comments on your contribution. How can everyone else blame me/you I guess. Seeing is believing until it changes.

 

Question for the math guys as Im learning a great deal. Ill leave the computation up to you guys.

 

Again we know first infection Jan 20th, whether it was here before is up for debate and unknowable. At what date in the future do you start to say, wait a minute. This death rate is way over blown, maybe this isn't as bad as we thought it was. We should be looking at a significant exponential increase here soon right? Its been almost 2 months, lots of untested people and asymptomatic walking around.

 

Social distancing and shut down just started. Going by quarantine guidelines that train left the station 14 days ago. The snowball is still growing for 14 more days. Increased death should follow.

 

What are you guys looking at?

 

I'm also interested in orthopa's point:  For those who believe the US response was "too little, too late" to avoid overloading hospitals a la Italy, by what date (or range of dates) should we start to see overloaded ICUs in the apparently most troubled areas, e.g., Seattle and NYC? 

[alwaysdrawing]

I'm also interested in orthopa's point:  For those who believe the US response was "too little, too late" to avoid overloading hospitals a la Italy, by what date (or range of dates) should we start to see overloaded ICUs in the apparently most troubled areas, e.g., Seattle and NYC? 

 

Approx every week cases double, and it takes about a week until people are hospitalized, so once you reach a large enough threshold of cases, each week gets progressively worse.  Going from 1 case to 100 takes around the same amount of time as going from 100 to 100,000 (unmitigated), and the problems become much large in that 100 > 100,000 progression.

 

If the estimates I've seen hold, that threshold is hitting right about now with around 20,000 estimated US cases as of a few days ago. Clusters will become large enough to impact large city health systems once you have a few thousand cases in the area, and I'd expect in less than 7 days you'll start seeing a crush of patients in Seattle and NYC, and the situation will likely get worse each week from there.

[KJP]

I'm also interested in orthopa's point:  For those who believe the US response was "too little, too late" to avoid overloading hospitals a la Italy, by what date (or range of dates) should we start to see overloaded ICUs in the apparently most troubled areas, e.g., Seattle and NYC? 

 

Approx every week cases double, and it takes about a week until people are hospitalized, so once you reach a large enough threshold of cases, each week gets progressively worse.  Going from 1 case to 100 takes around the same amount of time as going from 100 to 100,000 (unmitigated), and the problems become much large in that 100 > 100,000 progression.

 

If the estimates I've seen hold, that threshold is hitting right about now with around 20,000 estimated US cases as of a few days ago. Clusters will become large enough to impact large city health systems once you have a few thousand cases in the area, and I'd expect in less than 7 days you'll start seeing a crush of patients in Seattle and NYC, and the situation will likely get worse each week from there.

 

Thanks for the quick and precise response.  What contrary data over the next 7-21 days would cause you to change your opinion?

 

Note that I'm using ICU overload in an attempt to find an objective measure in light of the lack of testing in the US (though I understand that an ICU visit could be 14-28 days days after infection, so if you see ICU overload, then you likely have even bigger problems in the near future unless significant containment measures were instituted weeks earlier.)

[alwaysdrawing]

I'm also interested in orthopa's point:  For those who believe the US response was "too little, too late" to avoid overloading hospitals a la Italy, by what date (or range of dates) should we start to see overloaded ICUs in the apparently most troubled areas, e.g., Seattle and NYC? 

 

Approx every week cases double, and it takes about a week until people are hospitalized, so once you reach a large enough threshold of cases, each week gets progressively worse.  Going from 1 case to 100 takes around the same amount of time as going from 100 to 100,000 (unmitigated), and the problems become much large in that 100 > 100,000 progression.

 

If the estimates I've seen hold, that threshold is hitting right about now with around 20,000 estimated US cases as of a few days ago. Clusters will become large enough to impact large city health systems once you have a few thousand cases in the area, and I'd expect in less than 7 days you'll start seeing a crush of patients in Seattle and NYC, and the situation will likely get worse each week from there.

 

Thanks for the quick and precise response.  What contrary data over the next 7-21 days would cause you to change your opinion?

 

Note that I'm using ICU overload in an attempt to find an objective measure in light of the lack of testing in the US (though I understand that an ICU visit could be 14-28 days days after infection, so if you see ICU overload, then you likely have even bigger problems in the near future unless significant containment measures were instituted weeks earlier.)

 

If we don't start seeing deaths spike soon, I'd be surprised and would re-assess.  Every country hit has been following similar trajectories, so it's within my 90% confidence interval that we will start to see an increase of cases along that trajectory (which is likely a significant undercount), and because the most serious cases will be the ones identified, I'd expect to see a high mortality rate.