Coronavirus

[zippy1]

No one understands Japan right now

 

Yeah, I'm talking to friend in Japan right now and it's super weird.

They don't test.

There is pretty much no social isolation.

Trains are packed.

Masks are used, but not by majority and even people using masks take them off, wipe face with hands, etc.

It's just super weird that they don't have superspread.

There is a Olympic game on the line.

Some people believe that if it is decided the game is to be delayed to next year, they will do very different things.

[dwy000]

While I rarely agree with Bill Ackman he made a good point yesterday.  You cant shut things down without giving an end date.  We can argue whether 15 days is too short (probably) but you cant just lock people in their houses indefinitely and expect rational behavior or compliance.  Anyone who has been stuck in a house with a couple of kids for more than a day will tell you that months is not an option. 

 

The part they need to define is what is the criteria for reopening things up.  Do you wait for new cases to be zero?  Do you wait until there is none globally (China still has new cases although most coming from overseas now).  What is success?  Hong Kong shit down, then reopened and the cases started rising again so they shut down again.  I'm not clear from any of the medical professionals what success is here.  And until you can frame that you cant define the economic impact to measure it against.

[EliG]

Japan imposed travel restrictions, visa suspensions and mandatory quarantines for international arrivals. Some of them quite early. Is it possible that these measures alone were enough? Can't get infected if no one brings the virus into your island nation.

 

I haven't done any analysis to test this theory.

 

https://www.japan.travel/en/coronavirus/

 

 

 

 

[Jurgis]

Japan imposed travel restrictions, visa suspensions and mandatory quarantines for international arrivals. Some of them quite early. Is it possible that these measures alone were enough? Can't get infected if no one brings the virus into your island nation.

 

I haven't done any analysis to test this theory.

 

https://www.japan.travel/en/coronavirus/

 

Yeah, but there are new cases in Japan. Just few. So they have virus inside the island. And with very little testing going on it should be superspread. Unless they somehow are really lucky to get every single person early on.

[clutch]

While I rarely agree with Bill Ackman he made a good point yesterday.  You cant shut things down without giving an end date.  We can argue whether 15 days is too short (probably) but you cant just lock people in their houses indefinitely and expect rational behavior or compliance.  Anyone who has been stuck in a house with a couple of kids for more than a day will tell you that months is not an option. 

 

The part they need to define is what is the criteria for reopening things up.  Do you wait for new cases to be zero?  Do you wait until there is none globally (China still has new cases although most coming from overseas now).  What is success?  Hong Kong shit down, then reopened and the cases started rising again so they shut down again.  I'm not clear from any of the medical professionals what success is here.  And until you can frame that you cant define the economic impact to measure it against.

 

This is what concerns me. I'm not sure if these medical professionals know what success looks like or what the end game is besides slowing the outbreak NOW. I don't think they are trained to think that broadly. For sure, we should listen to them and carefully consider their suggestions since this is indeed a health crisis, but we should also think about what would be the best solution for the overall society.

 

Just imagine -- during any war situation, what would happen if you only listen to war generals for every action you take because they are the experts.

[Viking]

While I rarely agree with Bill Ackman he made a good point yesterday.  You cant shut things down without giving an end date.  We can argue whether 15 days is too short (probably) but you cant just lock people in their houses indefinitely and expect rational behavior or compliance.  Anyone who has been stuck in a house with a couple of kids for more than a day will tell you that months is not an option. 

 

The part they need to define is what is the criteria for reopening things up.  Do you wait for new cases to be zero?  Do you wait until there is none globally (China still has new cases although most coming from overseas now).  What is success?  Hong Kong shit down, then reopened and the cases started rising again so they shut down again.  I'm not clear from any of the medical professionals what success is here.  And until you can frame that you cant define the economic impact to measure it against.

 

The successful counties all have a number of things in common: robust, aggressive testing process in place. Information is communicated via their cell phone (personal freedom is secondary). Their populations are also educated and supportive of containment measures. Most everyone wears masks when they are out. 

 

Until we are able to do all these things we will need to keep everyone in lock down (very blunt instrument). Much should change in the next 8 weeks. Smart people should be able to figure this out. The sooner the better. I am least optimistic on the timing front; politicians and elected officials are often not the best and the brightest (and i say that will all due respect).

[Guest cherzeca]

"I'm not sure if these medical professionals know what success looks like..."

 

correct.  the best evidence of this is their focus on "cases".  instead the focus should be on cases involving those at risk (elderly/immunosuppressed). focusing resources on those at risk should be job 1, rather than shutting down the economy to reduce spread among those not at risk. 

 

history will judge this to be epidemiologists' health care madness.  policy makers panicked and let the epidemiologists drive the national bus into an economic gutter

[ERICOPOLY]

Just imagine -- during any war situation, what would happen if you only listen to war generals for every action you take because they are the experts.

 

Just imagine if an Admiral were listened to in a particular wartime situation:

 

http://www.doug-long.com/leahy.htm

 

[drzola]

we may just be shuffling the deck faster then we can count the cards now?

 

Economic expansions are associated with increasing mortality. Suggested pathways to explain this deceleration or even reversal of the secular decline in mortality during economic expansions include both material and psychosocial effects of the economic upturns: expansion of traffic and industrial activity directly raising injury-related mortality, decreased immunity levels (owing to rising stress and reduction of sleep time, social interaction and social support), and increased consumption of tobacco, alcohol and saturated fats.

[ERICOPOLY]

1. Fauci corrected Trump in front of the cameras, causing him to lose face.

2. Fauci was not at yesterday's conference.

3. Trump now suggesting he is casting Fauci's advice aside.

 

Is it at least partly about wounded pride?

[dwy000]

While I rarely agree with Bill Ackman he made a good point yesterday.  You cant shut things down without giving an end date.  We can argue whether 15 days is too short (probably) but you cant just lock people in their houses indefinitely and expect rational behavior or compliance.  Anyone who has been stuck in a house with a couple of kids for more than a day will tell you that months is not an option. 

 

The part they need to define is what is the criteria for reopening things up.  Do you wait for new cases to be zero?  Do you wait until there is none globally (China still has new cases although most coming from overseas now).  What is success?  Hong Kong shit down, then reopened and the cases started rising again so they shut down again.  I'm not clear from any of the medical professionals what success is here.  And until you can frame that you cant define the economic impact to measure it against.

 

The successful counties all have a number of things in common: robust, aggressive testing process in place. Information is communicated via their cell phone (personal freedom is secondary). Their populations are also educated and supportive of containment measures. Most everyone wears masks when they are out. 

 

Until we are able to do all these things we will need to keep everyone in lock down (very blunt instrument). Much should change in the next 8 weeks. Smart people should be able to figure this out. The sooner the better. I am least optimistic on the timing front; politicians and elected officials are often not the best and the brightest (and i say that will all due respect).

Viking - why 8 weeks?  Not saying that's wrong but why 8 instead of 4.  Or 12.  Or 3?  And what happens at the end of that? 

 

Theres an article in NYT today from an Israeli who compares the lockdown to the lockdown from bombers in Jerusalem a couple of years ago. As he said, after a couple of days everyone got bored and stir crazy and started going out again.  Thst was bombings and days, not unseen virus and months.  There is simply no way Americans will comply for months at a time with no defined end date or measure of success while the economy melts down to irreparable.  Aren't a high proportion of Americans 2 paychecks from the street?  You cant just give them $1000 and say stay home for 6 months.

[Spekulatius]

1. Fauci corrected Trump in front of the cameras, causing him to lose face.

2. Fauci was not at yesterday's conference.

3. Trump now suggesting he is casting Fauci's advice aside.

 

Is it at least partly about wounded pride?

 

I think Fauci is going to resign very soon.

[LC]

There is simply no way Americans will comply for months at a time with no defined end date or measure of success while the economy melts down to irreparable.  Aren't a high proportion of Americans 2 paychecks from the street?  You cant just give them $1000 and say stay home for 6 months.

 

Not only that, but politicians and particularly health & safety politicians seem to have some difficulty understanding the populace.

 

One example: yesterday our mayor in Denver communicates a "stay-in-place" order; the exceptions being essential industries and going out for groceries & medicine.

 

Then he says, "oh by the way, liquor stores and recreational marijuana are not essential industries - so they will be closing tomorrow".

 

So of course, the entire damn city floods every liquor and weed store to stock up. Lines around the block, social distancing be damned. Now I'm not sure I could design a better way to transmit a virus if I tried...

 

Then of course 3 hours later he has to re-classify liquor/weed stores as essential industries. I mean, c'mon.

[no_free_lunch]

No one understands Japan right now

 

Yeah, I'm talking to friend in Japan right now and it's super weird.

They don't test.

There is pretty much no social isolation.

Trains are packed.

Masks are used, but not by majority and even people using masks take them off, wipe face with hands, etc.

It's just super weird that they don't have superspread.

 

Interesting others there see it as weird too. I was just reading something about this last night and the paper concluded they had no idea why Japan hasn't taken off. I guess it's better to be lucky than good.

 

There are 120 m people in Japan.  I don't know the numbers but there is a lot of business with China.  You can't just throw that massive dataset away as "luck" because it doesn't agree with your hypothesis.  What this suggests is the virus is not quite as contagious as we want to believe.

[Spekulatius]

There is simply no way Americans will comply for months at a time with no defined end date or measure of success while the economy melts down to irreparable.  Aren't a high proportion of Americans 2 paychecks from the street?  You cant just give them $1000 and say stay home for 6 months.

 

Not only that, but politicians and particularly health & safety politicians seem to have some difficulty understanding the populace.

 

One example: yesterday our mayor in Denver communicates a "stay-in-place" order; the exceptions being essential industries and going out for groceries & medicine.

 

Then he says, "oh by the way, liquor stores and recreational marijuana are not essential industries - so they will be closing tomorrow".

 

So of course, the entire damn city floods every liquor and weed store to stock up. Lines around the block, social distancing be damned. Now I'm not sure I could design a better way to transmit a virus if I tried...

 

Then of course 3 hours later he has to re-classify liquor/weed stores as essential industries. I mean, c'mon.

 

LOL, the public clearly demonstrated what they consider essential. Liquor stores are open where I live too.

[Pelagic]

There is simply no way Americans will comply for months at a time with no defined end date or measure of success while the economy melts down to irreparable.  Aren't a high proportion of Americans 2 paychecks from the street?  You cant just give them $1000 and say stay home for 6 months.

 

Not only that, but politicians and particularly health & safety politicians seem to have some difficulty understanding the populace.

 

One example: yesterday our mayor in Denver communicates a "stay-in-place" order; the exceptions being essential industries and going out for groceries & medicine.

 

Then he says, "oh by the way, liquor stores and recreational marijuana are not essential industries - so they will be closing tomorrow".

 

So of course, the entire damn city floods every liquor and weed store to stock up. Lines around the block, social distancing be damned. Now I'm not sure I could design a better way to transmit a virus if I tried...

 

Then of course 3 hours later he has to re-classify liquor/weed stores as essential industries. I mean, c'mon.

 

The rationale I've heard from medical professionals for liquor stores staying open as "essential" is basically that they don't want alcoholics going through withdrawals straining medical resources, easier to just keep them open and not have that to worry about.

[PatOfThePig]

 

The rationale I've heard from medical professionals for liquor stores staying open as "essential" is basically that they don't want alcoholics going through withdrawals straining medical resources, easier to just keep them open and not have that to worry about.

 

You dont want that all alcoholics do a "delirium tremens" at the same time if they stop drinking.  The hospital will be full for that reason.

[krazeenyc]

Japan imposed travel restrictions, visa suspensions and mandatory quarantines for international arrivals. Some of them quite early. Is it possible that these measures alone were enough? Can't get infected if no one brings the virus into your island nation.

 

I haven't done any analysis to test this theory.

 

https://www.japan.travel/en/coronavirus/

 

Yeah, but there are new cases in Japan. Just few. So they have virus inside the island. And with very little testing going on it should be superspread. Unless they somehow are really lucky to get every single person early on.

 

I spent 2 weeks in Japan in the middle of February. I think their numbers are almost certainly artificially low for lack of testing... but it's way different than it was here. While they didn't cut off flights from china, here are some factors i think contribute to there being a  slower rate of spread there:

 

1) Government preparedness

Every building in Tokyo and Kyoto that i visited had gallons and gallons of alcohol hand sanitizer.

Everywhere I went they warned of the Coronavirus and to take precautions. The warning about the virus were everywhere from on the trains to the metro, to the airport.

Schools closed much earlier than here.

For employees who could work at home, that started earlier than here.

they had screening at the airport, when I returned to JFK we did not.

 

2) Cultural Differences.

it seems that in Taiwan and Japan, the spread of the common flu was already declining -- leading one to think people are already aware of not spreading their germs.

People, generally speaking, seem more willing to sacrifice for the whole... and seem to accept recommendations from the government.

masks - while they may not keep  from getting the virus, if a big % of the population is wearing them, those who are sick are likely to spread it to less people.

 

Also, I think when your friend mentioned people taking off masks and touching their face, etc. i noticed that a lot too... but i think that's due to our paranoia... and being very aware of who's doing what!

 

 

[Investor20]

Japan imposed travel restrictions, visa suspensions and mandatory quarantines for international arrivals. Some of them quite early. Is it possible that these measures alone were enough? Can't get infected if no one brings the virus into your island nation.

 

I haven't done any analysis to test this theory.

 

https://www.japan.travel/en/coronavirus/

 

Yeah, but there are new cases in Japan. Just few. So they have virus inside the island. And with very little testing going on it should be superspread. Unless they somehow are really lucky to get every single person early on.

 

I spent 2 weeks in Japan in the middle of February. I think their numbers are almost certainly artificially low for lack of testing... but it's way different than it was here. While they didn't cut off flights from china, here are some factors i think contribute to there being a  slower rate of spread there:

 

1) Government preparedness

Every building in Tokyo and Kyoto that i visited had gallons and gallons of alcohol hand sanitizer.

Everywhere I went they warned of the Coronavirus and to take precautions. The warning about the virus were everywhere from on the trains to the metro, to the airport.

Schools closed much earlier than here.

For employees who could work at home, that started earlier than here.

they had screening at the airport, when I returned to JFK we did not.

 

2) Cultural Differences.

it seems that in Taiwan and Japan, the spread of the common flu was already declining -- leading one to think people are already aware of not spreading their germs.

People, generally speaking, seem more willing to sacrifice for the whole... and seem to accept recommendations from the government.

masks - while they may not keep  from getting the virus, if a big % of the population is wearing them, those who are sick are likely to spread it to less people.

 

Also, I think when your friend mentioned people taking off masks and touching their face, etc. i noticed that a lot too... but i think that's due to our paranoia... and being very aware of who's doing what!

 

Whatever they did, for sure they are reducing virus transmission rates

 

https://www.wsj.com/articles/japan-sees-silver-lining-to-coronavirus-as-flu-cases-drop-11583073526

 

"If there is a positive impact of the coronavirus epidemic, look for it in Japan, where people are observing better hygiene and the number of influenza cases is far below a typical year.'

 

[Liberty]

https://peterattiamd.com/samharris2/

 

New podcast by Peter Attia with Sam Harris about the COVID19 situation.

[StubbleJumper]

There is simply no way Americans will comply for months at a time with no defined end date or measure of success while the economy melts down to irreparable.  Aren't a high proportion of Americans 2 paychecks from the street?  You cant just give them $1000 and say stay home for 6 months.

 

Not only that, but politicians and particularly health & safety politicians seem to have some difficulty understanding the populace.

 

One example: yesterday our mayor in Denver communicates a "stay-in-place" order; the exceptions being essential industries and going out for groceries & medicine.

 

Then he says, "oh by the way, liquor stores and recreational marijuana are not essential industries - so they will be closing tomorrow".

 

So of course, the entire damn city floods every liquor and weed store to stock up. Lines around the block, social distancing be damned. Now I'm not sure I could design a better way to transmit a virus if I tried...

 

Then of course 3 hours later he has to re-classify liquor/weed stores as essential industries. I mean, c'mon.

 

The rationale I've heard from medical professionals for liquor stores staying open as "essential" is basically that they don't want alcoholics going through withdrawals straining medical resources, easier to just keep them open and not have that to worry about.

 

 

Yes, and there is also a fairly well-known history in the US about what happens during alcohol prohibition.  If the government insists that all of the bars close and all of the liquor stores close, how long will it take for people to start opening up underground clubs (ie, a speakeasy).  Booze can always be bought tax free from certain Indian reserves, and I doubt that those stores would ever close.  After sourcing the booze, the next step for an enterprising person would be to open that underground club, which would not be helpful for the social distancing effort.  Better to leave the booze stores open so that people can buy their supply.

 

 

SJ

[Liberty]

More than 20% of Italians between the ages of 30 and 49 live with their parents, according to Bonn University economists Christian Bayer and Moritz Kuhn. That’s more than double the rate for Germans in that age bracket.

 

https://www.bloomberg.com/news/articles/2020-03-24/coronavirus-less-deadly-in-germany-because-of-youthful-patients

[DocSnowball]

While I rarely agree with Bill Ackman he made a good point yesterday.  You cant shut things down without giving an end date.  We can argue whether 15 days is too short (probably) but you cant just lock people in their houses indefinitely and expect rational behavior or compliance.  Anyone who has been stuck in a house with a couple of kids for more than a day will tell you that months is not an option. 

 

The part they need to define is what is the criteria for reopening things up.  Do you wait for new cases to be zero?  Do you wait until there is none globally (China still has new cases although most coming from overseas now).  What is success?  Hong Kong shit down, then reopened and the cases started rising again so they shut down again.  I'm not clear from any of the medical professionals what success is here.  And until you can frame that you cant define the economic impact to measure it against.

 

The successful counties all have a number of things in common: robust, aggressive testing process in place. Information is communicated via their cell phone (personal freedom is secondary). Their populations are also educated and supportive of containment measures. Most everyone wears masks when they are out. 

 

Until we are able to do all these things we will need to keep everyone in lock down (very blunt instrument). Much should change in the next 8 weeks. Smart people should be able to figure this out. The sooner the better. I am least optimistic on the timing front; politicians and elected officials are often not the best and the brightest (and i say that will all due respect).

 

FDA has now approved the routine nasal swab for COVID testing. Removes another bottleneck. Expect testing to be widespread and easily available. 45-60 minutes turnaround time for inside the hospital, a day or at the most two for drive through testing.

https://www.fda.gov/emergency-preparedness-and-response/mcm-issues/coronavirus-disease-2019-covid-19

 

CMS did a nationwide conference call with physicians today (Seema Verma and Deborah Birx were on it) - what is notable is how quickly this administration is removing roadblocks to Telehealth, and to COVID testing. FDA has also set up numerous clinical trials for treatment and prophylaxis, so that we find out what works and what doesn't. While the planning phase was an obvious botch up, it's been more than a decade since anyone in administration has been even bothered to talk with or listen to physicians in this country.

 

On the downside, if we open too soon, while the economy may or may not improve quicker (don't know enough to comment), what is certain is COVID clusters will show up in hospitals uninvited and be a healthcare transmitted infection (plenty of precedent with MERS-CoV in Middle East). I shudder to think of the safety of our healthcare workforce in the coming months.

 

What's not clear from the decision makers isn't "what we will do", rather "how we will decide". I'd think the data about daily cases and deaths will drive this decision, as well as lessons learned from European countries a few days ahead of the US.

[Viking]

While I rarely agree with Bill Ackman he made a good point yesterday.  You cant shut things down without giving an end date.  We can argue whether 15 days is too short (probably) but you cant just lock people in their houses indefinitely and expect rational behavior or compliance.  Anyone who has been stuck in a house with a couple of kids for more than a day will tell you that months is not an option. 

 

The part they need to define is what is the criteria for reopening things up.  Do you wait for new cases to be zero?  Do you wait until there is none globally (China still has new cases although most coming from overseas now).  What is success?  Hong Kong shit down, then reopened and the cases started rising again so they shut down again.  I'm not clear from any of the medical professionals what success is here.  And until you can frame that you cant define the economic impact to measure it against.

 

The successful counties all have a number of things in common: robust, aggressive testing process in place. Information is communicated via their cell phone (personal freedom is secondary). Their populations are also educated and supportive of containment measures. Most everyone wears masks when they are out. 

 

Until we are able to do all these things we will need to keep everyone in lock down (very blunt instrument). Much should change in the next 8 weeks. Smart people should be able to figure this out. The sooner the better. I am least optimistic on the timing front; politicians and elected officials are often not the best and the brightest (and i say that will all due respect).

 

FDA has now approved the routine nasal swab for COVID testing. Removes another bottleneck. Expect testing to be widespread and easily available. 45-60 minutes turnaround time for inside the hospital, a day or at the most two for drive through testing.

https://www.fda.gov/emergency-preparedness-and-response/mcm-issues/coronavirus-disease-2019-covid-19

 

CMS did a nationwide conference call with physicians today (Seema Verma and Deborah Birx were on it) - what is notable is how quickly this administration is removing roadblocks to Telehealth, and to COVID testing. FDA has also set up numerous clinical trials for treatment and prophylaxis, so that we find out what works and what doesn't. While the planning phase was an obvious botch up, it's been more than a decade since anyone in administration has been even bothered to talk with or listen to physicians in this country.

 

On the downside, if we open too soon, while the economy may or may not improve quicker (don't know enough to comment), what is certain is COVID clusters will show up in hospitals uninvited and be a healthcare transmitted infection (plenty of precedent with MERS-CoV in Middle East). I shudder to think of the safety of our healthcare workforce in the coming months.

 

What's not clear from the decision makers isn't "what we will do", rather "how we will decide". I'd think the data about daily cases and deaths will drive this decision, as well as lessons learned from European countries a few days ahead of the US.

 

Doc, i do see some green shoots starting to come up. The news on the testing front is very encouraging. So much still to learn. Fortunately, lots of very smart people are highly motivated and working overtime on finding solutions. And yes, “how we will decide” will be very important in the coming weeks.

[Liberty]

https://brontecapital.blogspot.com/2020/03/coronavirus-getting-angry.html