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  • #46
    Italy has > 100 cases now.

    I believe <1000 patients in the US have actually been tested. I think the CDC is not testing just to minimize panic, which is reasonable.

    Due to a high R0, infection rate, this thing scares me on a macro level. Young physicians in China have died from it.

    The flu comparisons are bunk because we have good models and a better understanding of flu and risk. We do not know much about this virus and it presents a black swan event unlike that of known entities.

    I was frustrated with the initial lackadaisical WHO response that seemed more concerned with China/World economic stability than virus control. It’s ok IMO to over react at the cost of minor economic problems because the cost of a pandemic is huge.

    I’m not panicking but this thing should be taken seriously by our institutions.

    https://en.m.wikipedia.org/wiki/Black_swan_theory

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    • #47
      Trouble is all we have is supportive care and no palpable vaccination way forward in the pipeline.

      Italy cases spiked overnight

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      • #48
        Originally posted by Zaphod View Post
        It is in china, not sure thats worth much...
        It does show that the rate of spread can be slowed by minimizing travel and keeping people from congregating (especially in large groups). That’s somewhat encouraging.

        Originally posted by Zaphod View Post
        but it does seem to be much more virulent than the flu, especially in elderly. 50% of deaths are 70 and up, 93% above 50. Given that it is so infectious, if it is successful in infecting a lot of people (no reason to think otherwise rn), than just by virtue of math a large absolute number will die around the world.

        This basically has the spreading and fatality characteristics of the Spanish Flu, hopefully being far more advanced means at some point along the treatment curve we have a breakthrough to really stomp it out.
        One of the reasons I hope we can slow the spread of this thing is to minimize the excess mortality. In Hubei, people who otherwise could have been saved are dying for lack of access to intensive medical care. What happens when more people need vents and ICU beds then there are vents and ICU beds available? (Theoretically) avoidable deaths, that’s what. Slow the spread, and we reduce the numbers of people needing ICU care at any given moment to something we may be able to handle (even if in the long run 30% of the global population ends up catching it, as happened with Spanish Flu).

        As a 57 year old with asthma, who sometimes ends up on prednisone courtesy of an ordinary URI, I am quite worried about this thing. But right now there’s nothing productive I can do apart from stocking up the pantry and possibly reconsidering my summer travel plans. Que sera, sera.

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        • #49
          From looking at the data one thing is clear, millennials made the virus.

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          • #50
            Originally posted by artemis View Post

            It does show that the rate of spread can be slowed by minimizing travel and keeping people from congregating (especially in large groups). That’s somewhat encouraging.



            One of the reasons I hope we can slow the spread of this thing is to minimize the excess mortality. In Hubei, people who otherwise could have been saved are dying for lack of access to intensive medical care. What happens when more people need vents and ICU beds then there are vents and ICU beds available? (Theoretically) avoidable deaths, that’s what. Slow the spread, and we reduce the numbers of people needing ICU care at any given moment to something we may be able to handle (even if in the long run 30% of the global population ends up catching it, as happened with Spanish Flu).

            As a 57 year old with asthma, who sometimes ends up on prednisone courtesy of an ordinary URI, I am quite worried about this thing. But right now there’s nothing productive I can do apart from stocking up the pantry and possibly reconsidering my summer travel plans. Que sera, sera.
            Except we're not measuring the rate of spread. Not knowing someone has a condition isn't the same as them not having the condition.

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            • #51
              Originally posted by WCInovice View Post
              The flu comparisons are bunk because we have good models and a better understanding of flu and risk. We do not know much about this virus and it presents a black swan event unlike that of known entities.
              The flu comparisons aren’t complete bunk if you compare COVID-19 to the right flu: 1918 Spanish or 1957A. The problem is that our last few pandemics, while they met the criteria to be called that, were low-mortality events. Now we’ve got a pandemic on our hands that has the potential to kill a lot of people even in developed countries. You don’t need a high mortality rate to produce a huge number of corpses when you’re starting with an enormous denominator (like 1/3 of the global population infected).
              Last edited by artemis; 02-23-2020, 09:59 AM.

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              • #52
                “hopefully” is a word that should never be used in any presentation or Plan. It implies a weakness and admission of not having anything to contribute.
                Hope is not a plan, merely a sentiment.
                Our healthcare system doesn’t have the capacity to “track down” exposure, let alone quarantine or isolate. Take the hit earlier. Once it’s out, it’s too late.

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                • #53
                  The WHO tends to be conservative and rather slow when it comes to epidemics/pandemics. Their hand almost has to be forced. Political and not just medical considerations are at play.
                  My Youtube channel: https://www.youtube.com/channel/UCFF...MwBiAAKd5N8qPg

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                  • #54
                    Originally posted by Antares View Post
                    He was 34. What a coincidence that one of the youngest to die also embarrassed the powers that be in a country known for disappearing those who are inconvenient.
                    I’m in the pandemic/recession camp. Since I am constitutionally wired to to expect the apocalypse, I try to take my view with a grain of salt. . Not that this is the coming apocalypse, but fwiw I see this as probably disruptive to the global economy with a small percentage but large real number of deaths. An overwhelmed health system in the US is possible and would be nightmarish. I expect the impact to be relatively short term, on the order of months. A scary time for the world. Not entirely predictable. It’s not hard to imagine worse than what I just said. Is that the deep-seated fear of infectious illness speaking, the limitless human capacity for envisioning possibilities? Or reality? I tend to look at what the markets are saying as a predictor of risk. But virologists are the experts on this, and they can only say “we don’t know “. And they are at the very least concerned. I am sleeping better having made a long-contemplated adjustment to my asset allocation with retirement anticipated in the next few years.
                    Update: a 29 year old doctor, a woman who had been sick for 33 days, died in China yesterday, so the first doctor fatality is no longer the youngest. And a 42 year old doctor died today.
                    My Youtube channel: https://www.youtube.com/channel/UCFF...MwBiAAKd5N8qPg

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                    • #55
                      Originally posted by Antares View Post

                      Update: a 29 year old doctor, a woman who had been sick for 33 days, died in China yesterday, so the first doctor fatality is no longer the youngest. And a 42 year old doctor died today.
                      Antares, you are scaring me again. I was trying to hold onto that graph that shows that COVID-19 only has significant mortality for old folks. Who is going to take care of all of those patients on vents?

                      I would very much like to know if PPE is highly effective, or not. DId the health care workers in China get sick before they knew what they were dealing with, meaning before they took measures to protect themselves? Or is COVID-19 so contagious that the PPE does not effectively protect you?

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                      • #56
                        Originally posted by White.Beard.Doc View Post

                        Antares, you are scaring me again. I was trying to hold onto that graph that shows that COVID-19 only has significant mortality for old folks. Who is going to take care of all of those patients on vents?

                        I would very much like to know if PPE is highly effective, or not. DId the health care workers in China get sick before they knew what they were dealing with, meaning before they took measures to protect themselves? Or is COVID-19 so contagious that the PPE does not effectively protect you?
                        I can't answer the PPE question, but Iran has 8 deaths out of 43 cases reported, and South Korea, which has ballooned to 603 cases over the last two days, is reporting only 3 deaths. The fatality rate numbers are all suspect though, because we don't really have accurate numbers for total infected, and probably can't as many are mildly ill and are never evaluated or tested. Is medicine in S Korea better than in Iran? Anyway, it seems we all have to keep repeating that we don't have enough information yet. You would expect decent data from S Korea and Italy (which suddenly has 155 cases), but maybe inherently limited by asymptomatic/mildly ill/unknown/untested cases.

                        edited to note that there’s a corrected figure of 6 deaths in South Korea out of 603 confirmed cases
                        Last edited by Antares; 02-23-2020, 05:12 PM.
                        My Youtube channel: https://www.youtube.com/channel/UCFF...MwBiAAKd5N8qPg

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                        • #57
                          One problem they are running into in China in the Hubei Provence is a shortage of PPE. So medical staff are being forced to improvise, making homemade versions. That’s probably playing a role in the deaths of younger medical personnel.

                          But even garden-variety seasonal flu kills a few young, healthy adults with no known pre-existing conditions every year. There are just no guarantees when it comes to death via an infectious disease. A mortality rate of 0.0001% is cold comfort to your grieving family if you end up as one of that 0.0001%. Coincidentally I just finished a book tonight on the history of influenza research; the opening chapter features the story of an otherwise healthy 30 year old woman who caught a seasonal influenza and wound up on ECMO. (Fortunately she survived, but it was touch-and-go for a while.)

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                          • #58
                            For the complacent I suggest reading The Great Influenza, by John Barry; and the Great Mortality, by John Kelley.

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                            • #59
                              Originally posted by FIREshrink View Post
                              For the complacent I suggest reading The Great Influenza, by John Barry; and the Great Mortality, by John Kelley.
                              Didn’t read the second, but agree The Great Influenza was excellent and eye-opening.
                              My Youtube channel: https://www.youtube.com/channel/UCFF...MwBiAAKd5N8qPg

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                              • #60
                                South Korea is now reporting 763 case. Wow. Under 200 2 days ago.
                                My Youtube channel: https://www.youtube.com/channel/UCFF...MwBiAAKd5N8qPg

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