Some numbers discussion of Coronavirus pandemic

[formerly_cn]

So, looking at CDC website I’m getting this (https://www.cdc.gov/coronavirus/2019...ses-in-us.html):
Total cases: 3,487; Total deaths: 68

Thats a 2% fatality rate.

Where we are in the dark is how many of true/hidden cases of coronavirus is going around

Some background before some math:
There is this excellent image in what we should learn from China paper (https://jamanetwork.com/journals/jam...rticle/2762130)




Basically, there is lag of cases floating around in population vs when we diagnose it. So confirmed cases vs. actual cases. So Jan 21st they are diagnosing 100 but saying that there are actually 1500 cases (you can’t find it NOW, but they are there). Now go back to the CDC website https://www.cdc.gov/coronavirus/2019...ses-in-us.html and see the diagnosed corona virus cases bar graph on the bottom you can draw similar analogy of ACTUAL cases being an order magnitude higher (specially how poorly USA is testing).

fatlittlepig posted (and other sources https://www.statnews.com/2020/03/10/...wers-covid-19/)


- Doubling time is 6 days.
- Time to death - from catching virus to dying is variable (2 to 8 weeks ) source:https://ourworldindata.org/coronavirus . For analysis lets say 4 weeks (28 days)
- Now imagine 1st death happening from coronavirus, it took around 4 weeks to get to this point so 4 weeks prior to this death there were 200 cases already (using 2% mortality number above per CDC website).

What that means: death today with above numbers 2^(28/6) =~ 25x the original case load of 200 which is 5000 "true" cases.

So CDC is saying 3500 cases with 68 deaths, then with these calculations we got ~86,000 "true" cases out there. Today.

Disclaimer: I am not epidemiologist, but just thinking about all of this based on lead time, symptoms vs diagnosis and current CDC numbers. Obviously this is not scientific study or regression analysis to control for any cofactors.



Business effect/After all a finance forum:
Personally, this has affected my businesses (few here know I dabble in a bunch) and the most affected is service business I help wife with that is getting hammered (social distancing - absolutely the right thing to do btw). Real estate (commercial) also will surffer as tenants are seeing decreased foot traffic. So I am stuck. Stock market - enough said. Ecommerce hasn't suffered (thankfully, but I believe it will as well) . Unlike EntrepreneurMD I am leveraged so this may take me sometime to recover from. Don't regret anything.

But more than that I am thankful that we are all coming together and following social distancing (as well as other measures).

Anyways, I am exhausted. Good night all.

[adventure]

~86,000 "true" cases out there. Today.

I think the real numbers are so much higher for who has/had COVID-19.

[Dont_know_mind]

I think this has been covered by Bruce Aylward in the last month.
Basically he thinks there is a false narrative that :
a) assumes higher rate of asymptomatic cases - if you look at China - few
b) assumes China mortality rate is higher than the west - if you listen to people who visited China - very possible that west may do worse and so false sense of security from extrapolation of China mortality - that it will be lower in the west.

My base case is that figures are accurate, but that a bomb will still explode. US may be about 3 weeks behind Italy. US has younger population than Italy. Feom
what I can find (but maybe inaccurate) similar number of ventilators per 1000 population (? 2) which is low from a world standard.

A problem is US healthcare. In China one of the first things they did was tell the population that they would be covered by getting treatment and testing for Covid-19 and that no one would go broke from coming forward to get tested and treated. Then population education and getting the population behind the surveillance and case finding. Then ramping up facilities in a very short period of time to reduce mortality:

https://youtu.be/PfR2pECJoeY

from 2 weeks ago

[formerly_cn]

I think the real numbers are so much higher for who has/had COVID-19.

Very possible. I'm just using mortality rate and time to death to predict case load. Btw it'll be 180k in a week. That is exploding. Not sure how much more we want...

You can do this using just community spread vs travel based and make your own model. Numbers will probably be higher then

Btw if you look at the china figure above, when they thoguht before lockdown that they had 440 cases, the true cases were 22k ; Yea, lots around than actual test #s

[formerly_cn]

I just typed out a long response in another thread.

I see these numbers and am very concerned by them.

I think the flip side of this is to focus on what we know; we do not know future states. We don't know if we are Italy, China, S. Korea (admittedly unlikely).

At this point basically everyone is assuming that the worst case scenario is going to play out everywhere. I'm not quite there.

I also think FWIW a little bit of stoicism is helpful here. Our path for the next month or so is probably kind of already set. All that you can control is your own response to it. Personally I'm currently on the train of tipping grocery store clerks random $20 bills and paying people for services they aren't giving me (cleaning lady, barber, etc).

I don't think it'll be worst case scenario. But it'll get worse before getting better. If you look at that China data I posted, as soon as they did lockdown , their case incidence dropped. USA can do the same.

i think some thread was there saying if social distancing had any proof it works? Plenty of proof it worked in Spanish flu some 100 yrs ago: https://www.google.com/amp/s/qz.com/...ing-works/amp/

[PedsCCM]

https://www.forbes.com/sites/niallmc.../#6625b0437f86

I think this has been covered by Bruce Aylward in the last month.
Basically he thinks there is a false narrative that :
a) assumes higher rate of asymptomatic cases - if you look at China - few
b) assumes China mortality rate is higher than the west - if you listen to people who visited China - very possible that west may do worse and so false sense of security from extrapolation of China mortality - that it will be lower in the west.

My base case is that figures are accurate, but that a bomb will still explode. US may be about 3 weeks behind Italy. US has younger population than Italy. Feom
what I can find (but maybe inaccurate) similar number of ventilators per 1000 population (? 2) which is low from a world standard.

A problem is US healthcare. In China one of the first things they did was tell the population that they would be covered by getting treatment and testing for Covid-19 and that no one would go broke from coming forward to get tested and treated. Then population education and getting the population behind the surveillance and case finding. Then ramping up facilities in a very short period of time to reduce mortality:

https://youtu.be/PfR2pECJoeY

from 2 weeks ago

We have ~20 vents and 35 ICU beds per 100,000 population. I can't easily find the number of vents per population of other countries, but VERY few have 20 ICU beds per 100,000 population so I would guess we are in the upper couple percentiles.

https://sccm.org/getattachment/Blog/...pdf?lang=en-US

[nephron]

The news articles that I've read on predicting the number of cases already out there are interesting. They are also frustrating. Instead of using mathematical formulas and different models to predict how many people are already infected, it would seem to me to be beneficial to just test a lot of people and know for sure. That's part of the problem with lack of testing, you end up quarantining a large number of staff when all you had to really do was test them and then move on. I listened to meet the press and they had guys from MGH and some California hospital saying that they just started testing people in house because they just got approval to do so from the FDA last week. It is just shocking that no one thought back in January it would useful to have some capacity to test a large number of people at different large medical centers. You waste a lot of resources on infection control if you don't even know who is infected.

[billy]

The news articles that I've read on predicting the number of cases already out there are interesting. They are also frustrating. Instead of using mathematical formulas and different models to predict how many people are already infected, it would seem to me to be beneficial to just test a lot of people and know for sure. That's part of the problem with lack of testing, you end up quarantining a large number of staff when all you had to really do was test them and then move on. I listened to meet the press and they had guys from MGH and some California hospital saying that they just started testing people in house because they just got approval to do so from the FDA last week. It is just shocking that no one thought back in January it would useful to have some capacity to test a large number of people at different large medical centers. You waste a lot of resources on infection control if you don't even know who is infected.

MSKCC in NYC already has staff that tested positive. Scary how exposed many of us are by each other/fellow staff members, and how many more pts we potentially spread this to. An ER doctor was on buzzfeed saying how he came back from an Emergency med conference in NYC (total asymptomatic the whole time) and now has it. I wish we had the capacity to broadly test the asymptomatic so that we know who to isolate before they spread the disease. Start with hospital staff who have the ability to spread to large numbers of people then to the general public. I dont see it happening though

[formerly_cn]

Well yea I want increased testing but for whatever reason its not happening. Mathematical models atleast gives you an idea whats going on and why take extreme measures. Every day counts re: social distancing etc. Testing en masse would be perfect. HARD to implement though if you really think about it.

[Kamban]

It is just shocking that no one thought back in January it would useful to have some capacity to test a large number of people at different large medical centers. You waste a lot of resources on infection control if you don't even know who is infected.

It's simply not the case that no one thought of it.

It's the case that there was leadership failure at the highest levels.

This has been insanely well documented, it is uncomfortable but no less true for being that.

We are all such wonderful Monday morning quarterbacks that we will make Tom Brady proud. I did not see any posts on this forum about anything like that back then, and we are supposed to be physicians

The reality is that in January we were gripped in a different type of pandemic - the impeachment one. If the leadership had tried to do more COVID testing, restricting import of more cases from China etc we would be calling that diversionary tactics..

As for leadership crisis it is one that has afflicted the whole Western world. The conditions in Italy, Spain, France and Germany are much worse and only now is the idiot Macron instituting a lock down. Even the wonderful Nordic Country Norway that many here idolize is having a crisis and is now going into a lock down. And our neighbor in the North is finally sealing its borders and for all all its precautions its PM's wife has contracted the virus.

I am not saying we have done a wonderful job. We certainly have not and the leadership has certainly had its faults. But to blame everything on leadership is stupid since it is not restricted to one country. And it is easy to state that we should test everyone and quarantine every positive case. The test kits just don't magically come from somewhere. It has to be produced, shipped and used for testing the right way. The economy has to somehow run in all these mayhem. There are thousands of food and hotel industry workers without jobs and without money for the toilet roils that are nowhere to be found. We as physicians have a reserve of funds and a steady paycheck and can afford a shutdown that they cannot.

Maybe you people in ivory towers don't have this issue but my practice cannot run more than 2 weeks from tomorrow because I am unable to get any masks or gloves from my supplier and neither WalMart, Sams or Costco has any toilet rolls or wipes or hand towels. I am not sure how I can continue to pay my staff through the next few weeks. That is my major worry than what the leadership did or did not do in Jan 2020.

Getting off my soapbox.

[formerly_cn]

Kamban well said. As I mentioned, we all want more testing, checking etc but it is difficult to implement. Many reasons I'm not gonna get into.

However you can't deny that response - when whitebeard rang the alarm bells on these forums - or appalling data/news of Italy and people here are lax. Conspiracy theory. Just like flu. Telling me (and others) i am disingenuous. Really ? That is what gets me going.

January 2020, can't blame them fully: no one saw this coming in USA with any objectivity.

[Zaphod]

I think this has been covered by Bruce Aylward in the last month.
Basically he thinks there is a false narrative that :
a) assumes higher rate of asymptomatic cases - if you look at China - few
b) assumes China mortality rate is higher than the west - if you listen to people who visited China - very possible that west may do worse and so false sense of security from extrapolation of China mortality - that it will be lower in the west.

My base case is that figures are accurate, but that a bomb will still explode. US may be about 3 weeks behind Italy. US has younger population than Italy. Feom
what I can find (but maybe inaccurate) similar number of ventilators per 1000 population (? 2) which is low from a world standard.

A problem is US healthcare. In China one of the first things they did was tell the population that they would be covered by getting treatment and testing for Covid-19 and that no one would go broke from coming forward to get tested and treated. Then population education and getting the population behind the surveillance and case finding. Then ramping up facilities in a very short period of time to reduce mortality:

https://youtu.be/PfR2pECJoeY

from 2 weeks ago

Chinas number are frankly not believable. This is most likely to be so far behind the curve when starting, and that the initial test had horrific sensitivity.

Do you really think Italy in week 3 was having 2x the deaths of all of china at the peak of the epidemic with 1/4 of the infections? Me neither.

Bruce Aylward and the CDC do not have any reasonable credibility and screwed this whole thing up.

These are the same people saying "mild" disease which includes hospitalization with pneumonia, and no one is asymptomatic and all cases counted. None of that is even a reasonable postulation, let alone being proven wrong in every other country it gets to.

[Kamban]

Kamban well said. As I mentioned, we all want more testing, checking etc but it is difficult to implement. Many reasons I'm not gonna get into.

However you can't deny that response - when whitebeard rang the alarm bells on these forums - or appalling data/news of Italy and people here are lax. Conspiracy theory. Just like flu. Telling me (and others) i am disingenuous. Really ? That is what gets me going.

January 2020, can't blame them fully: no one saw this coming in USA with any objectivity.

Anyone who saw what was happening in China could see it was much more infectious and had higher morbidity and mortality than flu. But it was not Ebola either. I too was upset when people stated the usual crap that 46000 die of flu each year in USA yet this has killed less than 1000 worldwide, ignoring the fact that this has no vaccine or effective therapy.

Unfortunately China is an opaque country and they had lockdowns and restriction of info. There was no clear cut info on how many were infested in nearby cities and provinces. Their leadership has cracked down on people who dissented on his version of the virus. How are we supposed to prepare with all this half truths and outright lies in a country half a world away.

Right now the hoarding and lack of availability of supplies is forcing many of us to consider closing till the situation improves. Once summer comes there will a glut of fresh supplies that no one will want anymore.

[Zaphod]

We are all such wonderful Monday morning quarterbacks that we will make Tom Brady proud. I did not see any posts on this forum about anything like that back then, and we are supposed to be physicians

The reality is that in January we were gripped in a different type of pandemic - the impeachment one. If the leadership had tried to do more COVID testing, restricting import of more cases from China etc we would be calling that diversionary tactics..

As for leadership crisis it is one that has afflicted the whole Western world. The conditions in Italy, Spain, France and Germany are much worse and only now is the idiot Macron instituting a lock down. Even the wonderful Nordic Country Norway that many here idolize is having a crisis and is now going into a lock down. And our neighbor in the North is finally sealing its borders and for all all its precautions its PM's wife has contracted the virus.

I am not saying we have done a wonderful job. We certainly have not and the leadership has certainly had its faults. But to blame everything on leadership is stupid since it is not restricted to one country. And it is easy to state that we should test everyone and quarantine every positive case. The test kits just don't magically come from somewhere. It has to be produced, shipped and used for testing the right way. The economy has to somehow run in all these mayhem. There are thousands of food and hotel industry workers without jobs and without money for the toilet roils that are nowhere to be found. We as physicians have a reserve of funds and a steady paycheck and can afford a shutdown that they cannot.

Maybe you people in ivory towers don't have this issue but my practice cannot run more than 2 weeks from tomorrow because I am unable to get any masks or gloves from my supplier and neither WalMart, Sams or Costco has any toilet rolls or wipes or hand towels. I am not sure how I can continue to pay my staff through the next few weeks. That is my major worry than what the leadership did or did not do in Jan 2020.

Getting off my soapbox.

Lots of people saw this coming. It was no shock except the lack of response. Go back to the beginning of the original thread, I was surprised it took that long to get mentioned. Several people indeed saw the potential, most were flippant. I think these processes and scales are just hard for most people to process, its unnatural.

The people in charge have no excuse, this has to be top 5 obvious simulation/prep situations in any government. One of the most predictable issues in all of humanity to have to face on large scale.

[Kamban]

Lots of people saw this coming. It was no shock except the lack of response. Go back to the beginning of the original thread, I was surprised it took that long to get mentioned. Several people indeed saw the potential, most were flippant. I think these processes and scales are just hard for most people to process, its unnatural.

The people in charge have no excuse, this has to be top 5 obvious simulation/prep situations in any government. One of the most predictable issues in all of humanity to have to face on large scale.

If you were in charge of USA, what would you have done from Jan onward. Remember, you had not adequate test kits, you would not just ban people from coming in from certain countries, you cannot quarantine large number of people except self quarantine which could have been ignored, you had the various sectors of the economy like travel, hotels, sports, restaurants etc that were against any restriction and you have an opposing party that stated that everything you did was wrong. And you are already being compared to Hitler and a dictator even without imposing any restrictions on the locals that would have been necessary for control of this disease.

I certainly would have failed and don't envy a leader from either party for attempting to tackle this difficult situation.