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  #251  
Old 02-26-2020, 05:56 PM
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Originally Posted by steatopygia View Post
I also wouldn't be so quick to predict US healthcare being overwhelmed. It is very quick to adapt to things like this.

In 2009, during the H1N1 pandemic, the ER I was working at was able to set up a "flu clinic" in a separate lobby. No muss, no fuss. We were able to see an additional 50-60 people a day and somewhat isolate them from our normal population. With the low level of lethality so far demonstrated by this virus, we will be OK.
This is substantially more dangerous than the flu. So not only will you need a very large number of additional hospital beds, you will need a very large number of additional ICU beds.

Last edited by PastTense; 02-26-2020 at 05:57 PM.
  #252  
Old 02-26-2020, 05:57 PM
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Guys, you will be thrilled to learn that the HHS director, Alex Azar, is making sure that the drug companies make a profit from the Covid-19 vaccine and, therefore, can not guarantee that it will be affordable.

"We would want to ensure that we work to make it affordable, but we can't control that price, because we need the private sector to invest.. Price controls won't get us there."

https://twitter.com/mmcauliff/status...490799104?s=20
Has there ever been a usable vaccine for a coronavirus caused disease? AIUI, attempts to make one for SARS or MERS failed. Or the subset of "common cold" that is caused by coronaviruses and not rhinoviruses? Moreover, is the mutation rate of this virus established, and is the rate slow enough that a vaccine can be made that will cover a significant number of the subtypes?

It may not be achievable, no matter how much money is thrown at the problem.

OTOH, molecular biology has undergone so many revolutionary changes, it may as well be a completely different science than it was even 20 years ago.
  #253  
Old 02-26-2020, 05:58 PM
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Fake News


CBS News has a story stating that the CDC does not recommend wearing masks to prevent the spread of respiratory diseases.

That is debatable.

Here is the person they quoted, Alex Azar.

From Wiki;
"Alex Michael Azar II (/ˈeɪzər/ born June 17, 1967) is an American attorney, politician, pharmaceutical lobbyist, and former drug company executive who serves as the United States Secretary of Health and Human Services, having been Deputy Secretary from 2005 to 2007. He was nominated by President Donald Trump on November 13, 2017, and confirmed by the Senate on January 24, 2018.[2]"

I can not think of credentials that scream liar stronger than those.

Quote wearing masks "could actually sometimes be more harmful to you than not wearing a mask, because if it's not fitted right you're going to fumble with it. You're going to be touching your face, which is the No. 1 way you're going to get disease, is unclean hands touching your face."

Nonsense
  #254  
Old 02-26-2020, 06:05 PM
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We're saved! VP Pence has been placed in charge of our National Response to the virus!


Pray, pray, pray the fever away.
  #255  
Old 02-26-2020, 06:07 PM
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Originally Posted by PastTense View Post
This is substantially more dangerous than the flu. So not only will you need a very large number of additional hospital beds, you will need a very large number of additional ICU beds.
True. I still don't think it will overwhelm the system.
  #256  
Old 02-26-2020, 07:25 PM
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As has been stated above, most notably by DSeid, those are not "death rates of those exposed", or even of infected. They are death rates of those sick enough to seek medical help (or perhaps sick enough to not avoid medical help, in China). The difference between those two numbers appears to be the burning question at this point.
This.

I heard on NPR earlier today that otherwise-healthy children don't seem to get an active infection, which could be more or less dangerous, depending on your viewpoint.
  #257  
Old 02-26-2020, 07:45 PM
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Im sure the odds are very low, but what are the chances that it could mutate in such a way that the incubation period remains high (14+ days), but the virus becomes more virulent and lethal? To me, this would be a worst case scenario by which it kills off a large segment of the population before it runs out of hosts. I acknowledge this might be a dumb question, since Im somewhat ignorant about viruses, mutations, etc.
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Last edited by Jackknifed Juggernaut; 02-26-2020 at 07:46 PM.
  #258  
Old 02-26-2020, 08:13 PM
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Don't worry, Mike Pence will protect us.
  #259  
Old 02-26-2020, 08:33 PM
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I am assuming it will spread more widely, much more widely than has happened in China. Not all countries will have the inclination or the means to lock down their populations.
You are of the belief that the lock down stopped the spread of COVID-19 in Hubei and thus kept the actual infection rate much much lower than it will be everywhere else in the world.

Timing does not fit. See the timeline here remember incubation period and thus lag time between exposure and symptom onset.

The lock down of Wuhan and other cities occurred right about the same time as there was a peak of new symptoms onset in the confirmed cases which then in that timeline drops a week or more before any significant impact of the lock down would be seen.

The bug had been out there in the community with some of those who became confirmed cases having been symptomatic back in early December. By mid January there were hundreds of those who later sought care and were confirmed out and about across the region symptomatic.

This germ is quite contagious. In a densely populated community for well over a month. It had already spread.

If you do believe that the lock down was effective, what happens when it is eventually eased? Still a bunch of previously uninfected in that case with the germ still in circulation. Should they stay on lock down forever?
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Originally Posted by PastTense View Post
This is substantially more dangerous than the flu. ...
Given that the mortality rate per infected case is still an unknown that is not something that can be stated as fact. Unless one believes that the lock down was a very effective tactic, so effective that it stopped the exposure to uninfected people even before it was put in place, then the excess mortality rate from infections in Hubei is much less than seasonal influenza usually is.

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Originally Posted by Gray Ghost View Post
Has there ever been a usable vaccine for a coronavirus caused disease? ...
No.
  #260  
Old 02-26-2020, 09:30 PM
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Oops Forgot link. Timeline here.
  #261  
Old 02-27-2020, 12:48 AM
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I also heard earlier today that a number of people are currently housed in the Biocontainment Unit at the University of Nebraska, the same one where 3 Ebola patients were treated in 2014 (and they sent two of them home ). Two are being treated in isolation and the others are in quarantine, and they've used it for other quarantines in the meantime.

Here's a 25-minute video they made when it opened. It's worth a view, and there's an underlying theme that they were hoping they would never need to use it.

https://www.youtube.com/watch?v=a68NdXDk9Tk&t=284s

More than once, administration wanted this unit to open up because the ICU was full, and they refused because they said that's all they wanted to use it for, and even transferred patients rather than house them there. That's dedication.
Replying to myself: I told this story and posted this link on my Facebook page, and one of my FBFs, who is an ICU nurse in Winnipeg, said that her own hospital has such a unit, also designated only for things like this, and she is one of the nurses who has trained to work there, although she's not at the top of the list to do it. It was originally a burn unit but didn't meet current standards for that, so they remodeled it into this.
  #262  
Old 02-27-2020, 03:28 AM
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We're saved! VP Pence has been placed in charge of our National Response to the virus!
::: looks at Pence's record on public health as governor of Indiana :::

We're doomed.
  #263  
Old 02-27-2020, 03:29 AM
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True. I still don't think it will overwhelm the system.
Wuhan might have something to say about that...

I hope it doesn't overwhelm our system, but I recognize the possibility that it could.
  #264  
Old 02-27-2020, 06:28 AM
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This may be of interest: Japanese woman confirmed as coronavirus case for second time, weeks after initial recovery

FTA:
Quote:
The woman, a resident of Osaka, in western Japan, tested positive on Wednesday after developing a sore throat and chest pains, the prefectural government said in a statement, describing her as being in her forties. She first tested positive in late January and was discharged from hospital after recovering on Feb. 1, according to the statement.

Health Minister Katsunobu Kato said in parliament the central government would need to review patient lists and keep tabs on the condition of those previously discharged, as health experts analyzed the implications of testing positive for the virus after an initial recovery.

Once you have the infection, it could remain dormant and with minimal symptoms, and then you can get an exacerbation if it finds its way into the lungs, said Philip Tierno Jr., Professor of Microbiology and Pathology at NYU School of Medicine.

Tierno said much remains unknown about the virus. Im not certain that this is not bi-phasic, like anthrax, he said, meaning the disease appears to go away before recurring.
There is a lot we don't know about this virus and the disease it causes.
  #265  
Old 02-27-2020, 07:53 AM
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Japan just closed schools for a month.

https://nypost.com/2020/02/27/japan-...read-of-virus/
  #266  
Old 02-27-2020, 09:24 AM
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Another little bit to illustrate how using a hospitalized population to extrapolate broadly could give a very skewed perception of case fatality rate.

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This study included patients with respiratory symptoms who were seen in the emergency department or hospitalized. HCoV was found in 133 patients (1.6%) of the 8,071 tested for respiratory viruses using multiplex PCR. The 30-day mortality rate of patients with HCoV infection was 22.7% for HCoV 229E and 11.6% for HCoV OC43.
Dang. Based on this sort of look, similar to the look we have with COVID-19, case fatality rates of 22.7 and 11.6% for these HCoVs!!! Those two HCoVs are very contagious bugs too!

Yet there were no alarm bells and lock downs to these two HCoVs ... which are two of the germs that are frequent causes of the common cold and other minor viral illnesses. But if the only view of illness caused by these two HCoVs was the view of looking at those in the ED or hospitalized with respiratory symptoms, the view we essentially have of the HCoV-SARS-2, the germ of COVID-19, it would have been almost as rational of a decision.
  #267  
Old 02-27-2020, 09:33 AM
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I for one, am longer concerned about this coronavirus.

The President's words, like some unguent, soothing, were a balm that banished fear from my panicked brain.
Quote:
Originally Posted by The President of the United States of America

"We have 15 people infected but not too bad, but there are only 9 that are serious but they are from Japan we felt we had to bring over, we didn't really have to, but they are citizens and Congress....Congress gave us too much money, but we will take it, not as much for the Wall...and the 15 patients are doing great...China, China is doing a great job just like India, but everything is ok, many people say we couldn't get it done, but the Coronavirus is in good shape, I mean, the 15 people are in good shape, because we are great"
God bless you, Mr. President.
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  #268  
Old 02-27-2020, 10:38 AM
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Just got off a flight from Boston Logan to Gatwick, is guess 2/3rd full. See what happens when we fly into Bologna next week.
  #269  
Old 02-27-2020, 11:26 AM
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Let's just rebrand this thing. Coronavirus is too silly... makes it seem like "beer flu". COVID-19 is kinda scary, but boring. Me? I propose a simple modification:


Captain Trumps


... you're welcome.
  #270  
Old 02-27-2020, 11:37 AM
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I miss the halcyon days of last month where people were legitimately afraid Iran was going to nuke the United States and that would cause Trump to act "disproportionately"
  #271  
Old 02-27-2020, 11:57 AM
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Let's just rebrand this thing. Coronavirus is too silly... makes it seem like "beer flu". COVID-19 is kinda scary, but boring. Me? I propose a simple modification:


Captain Trumps


... you're welcome.
PERFECT!

Man, this whole thing has been playing out like Stephen Kings envisioned apocalypse. Its freaking me out. Its been forever since I read The Stand. How long start to finish did it take to kill off 90 something percent of the worlds population? A few months?

But dont worry! Captain Trumps to the rescue!
  #272  
Old 02-27-2020, 12:19 PM
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Not exactly sure how to ask this question or if it is even relevant. Each tie someone is infected a new colony starts. How many generations of colonies does it take for a virus to mutate itself into a weaker version of itself. It would seem that it could go a million different directions with each new colony being isolated from the others??
  #273  
Old 02-27-2020, 01:59 PM
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Surreal and Grey Ghost - you are both confusing "confirmed case fatality rate" with "infection mortality rate". The two are very very very very different things.

"Confirmed case fatality" is a subset of those who are notably sick - those who are sick enough to have gotten tested with the very limited resource of testing kits. Those who are notably sick are a subset of those who infected.
Good point, I'll account for that.

I think it's reasonable to assume that around 60% of the population will contract the virus based on Marc Lipsitch's estimates based on previous pandemics. Using the data from the Chinese CDC (https://jamanetwork.com/journals/jam...rticle/2762130) we can assume around 19% of those cases will be severe enough to require hospitalization, and among those cases that are severe enough to require hospitalization around 2.3% will die.

This works out to around 850,000 deaths in the US and 20 million deaths worldwide.
  #274  
Old 02-27-2020, 02:12 PM
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PERFECT!

Man, this whole thing has been playing out like Stephen Kings envisioned apocalypse. Its freaking me out. Its been forever since I read The Stand. How long start to finish did it take to kill off 90 something percent of the worlds population? A few months?

But dont worry! Captain Trumps to the rescue!
Except that Captain trips had a 99% kill rate. Captain Trumps has about a 99% survival rate.
  #275  
Old 02-27-2020, 04:02 PM
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Captain Trumps is loose in California because of poor coordination with the Trump administration and the CDC, according to a whistleblower complaint:

https://www.nytimes.com/2020/02/27/u....co/Rl0xvqjN22
  #276  
Old 02-27-2020, 04:07 PM
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Chris Hayes summarizes:

Quote:
So here's what appears to be chain of events:

The Trump administration repatriated infected Americans over the objections of the CDC.

HHS then sent federal workers to interact with the infected population without adequate training or protection

Then those workers went out into the public with no monitoring or testing regime in place.

And now the first US-contracted case has appeared right near one of the airforce bases where this all happened.

When someone at HHS raised alarms about all this s/he was criticized for hurting morale and then ordered to another position or be fired.

This is real real real bad.
THE WHISTLEBLOWER WAS PUNISHED, GUYS! SOMEONE SAYING 'THIS ISN'T THE CORRECT BIOHAZARD PROCEDURE' WAS PUNISHED.

... is this in the Pit, yet?
  #277  
Old 02-27-2020, 04:24 PM
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Why are you shocked?

I mean, yes, I'm appalled and horrified and mad.... but not surprised. Or shocked.

Trump punishes the messanger and never actually considers the problem. Then he hires someone who will tell him what he wants to hear regardless of whether or not that reflects actual reality. We've seen this over and over.
  #278  
Old 02-27-2020, 04:40 PM
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Just FYI, San Antonio got a number of the Captain Trumps patients as well, using the same procedures. I texted the Mayor about the new reporting... hope I didn't ruin his day.
  #279  
Old 02-27-2020, 04:43 PM
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My company just put a moratorium on all plane travel, international and domestic. I don't expect we'll be alone on this.
  #280  
Old 02-27-2020, 04:53 PM
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My shares of Alpha Pro Tech have been skyrocketing. If they keep going up, I'm looking at potentially a pretty nice chunk of change. I bought last week when the shares were 6 to 7 dollars. Now it's trading at $29.80.
  #281  
Old 02-27-2020, 04:53 PM
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... double post....

Last edited by JohnT; 02-27-2020 at 04:54 PM.
  #282  
Old 02-27-2020, 04:59 PM
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I plan to fly from Chicago to (whatever airport serves Conneticut) in October. Trump, genius, says this will blow over in the spring. I'm good then, right?
  #283  
Old 02-27-2020, 05:46 PM
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Trump, genius, says this will blow over in the spring. I'm good then, right?
If it doesn't blow over, he'll bring out his Sharpie.

Last edited by KarlGauss; 02-27-2020 at 05:47 PM.
  #284  
Old 02-27-2020, 07:12 PM
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Good point, I'll account for that.

I think it's reasonable to assume that around 60% of the population will contract the virus based on Marc Lipsitch's estimates based on previous pandemics. Using the data from the Chinese CDC (https://jamanetwork.com/journals/jam...rticle/2762130) we can assume around 19% of those cases will be severe enough to require hospitalization, and among those cases that are severe enough to require hospitalization around 2.3% will die.

This works out to around 850,000 deaths in the US and 20 million deaths worldwide.
There are only somewhat over 900,000 hospital beds in the U.S. and about 2/3 are normally occupied. Assuming hospitalization lasts one to two weeks how do you expect there will be enough hospital beds available--and notice a significant number will need to be ICU beds?
  #285  
Old 02-27-2020, 07:37 PM
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There are only somewhat over 900,000 hospital beds in the U.S. and about 2/3 are normally occupied. Assuming hospitalization lasts one to two weeks how do you expect there will be enough hospital beds available--and notice a significant number will need to be ICU beds?
2/3 occupied? In Toronto (and I suspect in much of the country), occupancy rates are seldom below 95 percent (and often over 100 percent, i.e. hallway medicine). I suppose we'll use school gymnasiums (they'll be closed anyway) and local hockey rinks.

I also expect that many healthcare workers will get infected making for a greater workload for those remaining well (at least to that point). And if SARS experience is anything to go by, some will overstate their 'symptoms' in order to fail screening and be turned away from work.
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  #286  
Old 02-27-2020, 09:14 PM
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More fun news--you can be reinfected after having it once.

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See what happens when we fly into Bologna next week.
It will probably be quite messy.
  #287  
Old 02-27-2020, 10:33 PM
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Good point, I'll account for that. ...
It is very entertaining, cute even, to see you say that and then in the very next breath not do so!



Meanwhile some interesting data to throw into the mix as the real infection mortality rate is figured out.

Currently outside of Hubei the confirmed case mortality rate (still far overweighted to testing the very sickest and not identifying the unknown number that are asymptomatic to moderately symptomatic with infections) is 176 deaths worldwide out of 17428 identified cases: 1%.

And a more interesting factoid out of a NYT article
Quote:
In February, Germany flew 126 people home from the Wuhan area. Ten passengers were segregated from the others, because they didnt feel well or thought they had been exposed to the coronavirus. But everyone was offered testing.

The 10 isolated patients tested negative, but two people who felt fine surprised scientists by testing positive. They were hospitalized, monitored and tested repeatedly.

While one developed a mild rash and slightly sore throat, neither became ill.
Now small n but still that would be consistent with roughly 2% of the population being asymptomatically or minimally symptomatically infected in the Wuhan area (i.e. Hubei) ... 1.2 million cases if the number is in fact that low. If THAT is all there is in that community (and is seems very low to me), and the reported death rate is reasonably accurate, then the true infection mortality rate is 0.2%. Not far off from the mortality rate in the 2018-19 influenza season in the United States (0.1%) and the 2017-18 season (0.14%). About 14% of the United States population was infected with influenza in the 2017-18 season.

Interpret how you will.


Surge capacity for pandemic illness is a real problem to be sure. It is actually true that the United States ranks best prepared in the world for pandemic preparedness it is only because everyone else does so poorly.
Quote:
no country is fully
prepared for epidemics or pandemics and all
countries have gaps to address. Collectively,
international preparedness is quite weak. The average overall GHS Index score among all 195 countries
assessed is 40.2 of a possible score of 100. Among
the 60 high-income countries, the average GHS Index
score is 51.9. Additionally, 116 high- and middle-income
countries do not score above 50. ...

... Most countries (67%) score in the bottom tier for health
system indicators, including indicators related to healthcare
workforce, access to healthcare, availability of equipment for healthcare workers, and capability to treat the
sick. The average GHS Index score for the health systems
category is 26.4.
When we DO get a pandemic that significantly exceeds a bad influenza season much of the world will be not able to handle it unless they change current systems.

As to the Osaka woman - one, it is unclear yet if she was reinfected or if the disease was biphasic; two her symptoms have apparently been mild (sore throat and chest pain).
  #288  
Old 02-28-2020, 11:11 AM
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I wonder how the extreme cost of testing in the US will help this spread - the man in Florida who was worried about exposure and got tested ended up being charged over $3000 for testing, of which $1400 was not covered by insurance. I really don't think food service workers are going to drop $1400-$3200 plus time off from work if they're worried they have an infection, so will continue to go go in and make/serve food to people until they are physically unable to work.

https://www.businessinsider.com/coro...e-broke-2020-2
  #289  
Old 02-28-2020, 11:12 AM
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I don't think it's yet established whether this is an aspect of COVID, an artifact of testing, or a hitch in the individual patients' immune reactions. This Reuters article covers the possibilities through several patient case studies.
  #290  
Old 02-28-2020, 02:35 PM
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I subscribe to HARO (Help a Reporter Out) which is a place where people writing a story ask for sources. It is interesting in tracking what people are writing about.

This afternoon half the queries in the health section were virus related, including this one:

Quote:
Originally Posted by HARO
CORONAVIRUS - How can a boutique fitness studio best deal with potential coronavirus outbreak. (Anonymous)
Which says nothing about medical issues, but maybe something about the psychology of the public. Which is going to impact the economy.

Last edited by Voyager; 02-28-2020 at 02:36 PM.
  #291  
Old 02-28-2020, 02:55 PM
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Calling for a tax cut to stop a virus may be Peak GOP.
  #292  
Old 02-28-2020, 03:44 PM
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Quote:
Originally Posted by me
... it requires no great leap of faith to imagine that the death rate for those over age 60 will be several percent.
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Originally Posted by DSeid View Post
In my opinion a huge leap of imagination is required to think that.
FWIW, two articles released by the NEJM today (both free access) cite an overall mortality rate of "around one percent" and "1.4 percent", respectively.

And since no one is claiming that people over age 60 do better than average, I'd say it's looking pretty good that "the death rate for those over age 60 will be several percent."
  #293  
Old 02-28-2020, 04:33 PM
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OTOH Dr. Drew is saying this is being overhyped by the press LINK

Then again later he still says its being overhyped while other medical concerns are not getting attention. LINK
  #294  
Old 02-28-2020, 04:36 PM
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Quote:
Originally Posted by KarlGauss View Post
FWIW, two articles released by the NEJM today (both free access) cite an overall mortality rate of "around one percent" and "1.4 percent", respectively.



And since no one is claiming that people over age 60 do better than average, I'd say it's looking pretty good that "the death rate for those over age 60 will be several percent."
And another which says that "...If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%"

https://www.nejm.org/doi/full/10.1056/NEJMe2002387

Last edited by Shmendrik; 02-28-2020 at 04:37 PM.
  #295  
Old 02-28-2020, 04:44 PM
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Originally Posted by Urbanredneck View Post
OTOH Dr. Drew is saying this is being overhyped by the press LINK

Then again later he still says its being overhyped while other medical concerns are not getting attention. LINK
Dr Drew is an idiot. However, I am glad an addiction specialist is finally working with Limbaugh.

Last edited by JohnT; 02-28-2020 at 04:44 PM.
  #296  
Old 02-28-2020, 05:09 PM
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Quote:
Originally Posted by Shmendrik View Post
And another which says that "...If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%"

https://www.nejm.org/doi/full/10.1056/NEJMe2002387
I had not seen that, thanks.

About the rates, we will see . . .
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  #297  
Old 02-28-2020, 05:16 PM
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Now YOU (and the Gates Foundation writer of that opinion piece) definitely know better than to confuse current confirmed case fatality rate with infection mortality rate. Now the purpose of the opinion piece is to sell the importance of wealthier countries donating to low- and middle-income countries out of self-interest, so spinning the worse number as something "we should assume it will be until we know otherwise" is maybe excusable.

The second link, an actual article, recognizes that since they are looking only at the "7736 patients with Covid-19 who had been hospitalized at 552 sites" and "patients who were mildly ill and who did not seek medical attention were not included in our study", they may (ya think?) be only looking at "the more severe end of Covid-19". (Bolding mine.)

Remember that looking only at those who show up to ED and get hospitalized with respiratory symptoms one finds two of established HCoVs that are mainly thought of as causing common colds and sore throats to have case fatality rates of about 23 and 12%! Recognize that in the swine flu case the initial numbers underestimated the true infections numbers (and thus the fatality rate) by two to three orders of magnitude.

Stop holding up the tail of an elephant and concluding you have a very long rope.

We have very few samples of testing complete populations and seeing how many are infected what fraction of those are ill or die.

The prison population numbers that I posted about and linked to your "professional mor(t)ality" thread is one such ... captive ... population. Prisoners tend in general to have co-morbid health conditions more than the general population and of course do not include kids (influenza rates do).

In Shandong prisons 2,077 inmates and prison workers tested and about 10% (200 prisoners and 7 guards) infected. No report of how many completely asymptomatic. No deaths. Of all Chinese prisons 555 confirmed infections. No deaths. So far mortality rate in that captive population zero. 4 critically ill. One who was seriously ill recovered and eleven others who were ill recovered already Will one or two of the four critically ill die? Maybe. Let's imagine two. If so then infection mortality rate in that small population is 0.3%. One and it is 0.15%. Not far off from the 0.2% infection mortality that a mere 2% subclinical or asymptomatic infection rate in Hubei leads us to.
  #298  
Old 02-28-2020, 05:18 PM
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BTW the discussion section of your second cite also points out that they are missing the mild or asymptomatic cases which didn't come in. Also of interest, current or former smokers make up 33% of the ventilator/icu/death endpoint group, but only 13% of the non endpoint group.

Last edited by Shmendrik; 02-28-2020 at 05:18 PM.
  #299  
Old 02-28-2020, 05:24 PM
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I hope you are both correct.

Last edited by KarlGauss; 02-28-2020 at 05:25 PM.
  #300  
Old 02-28-2020, 09:27 PM
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Captain Trumps in Oregon:

https://twitter.com/kylegriffin1/sta...267455489?s=19
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