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  #101  
Old 03-26-2020, 05:24 PM
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40-something year-old Uber driver dies after transporting passenger with COVID-19

I'm 40-something. I don't want to die.
  #102  
Old 03-26-2020, 05:26 PM
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None of what you've quoted says what Iceland's mortality rate is going to be once the cases have resolved. In looking at resolved cases (cases in which the final outcome, recovery or death, is known), I'm not aware of any country where this rate is as low at 0.5% of cases.

An infection rate as low as one percent of the population is possible in countries that don't have a lot of links with the outside world in the first place, and that in addition have imposed social distancing and isolation early in the timeline. Both appear to be true in Iceland, but neither are true in New York or Florida, for example.
They did claim that Icelands smaller population and their ability to test a larger % of their total population means they may get a more accurate estimate of CFR and IFR, and it is showing potentially the IFR is much lower than we've been fearing.
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  #103  
Old 03-26-2020, 05:51 PM
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Its not a specific action, its more about wondering what the long term consequences will be. If the disease turns out to be highly deadly, and the global economy bounces back in 3 years that is one thing. If it turns out the disease isn't as deadly as people feared and the global economy takes over a decade to bounce back, that is another. Right now we don't know whats going to happen, which makes it harder to decide and lean towards prudence.

But as I said, if the global economy loses many trillions in wealth, that doesn't just mean that jeff bezos sees his net worth drop from 130 billion down to 80 billion. It also means less money to invent cures for cancer, to build roads, to invest in education, to transfer to renewable energy.
But you're assuming that people will have the same mindset and set of priorities after this blows over than they had before. Maybe if this shutdown continues long enough, people will realize that 90% of the consumer goods are crap anyway and what's really important are those things/experiences that make us feel connected to ourselves and others. Good food, good art, good health. Maybe instead of wasting so much on the military, people will see the importance of supporting medical research and universal healthcare. There might be a whole paradigm shift heading our way.

I think we should use this period to not only buy us more time to figure out how to deal with the virus, but to effect structural changes that will benefit both us and future generations. Capitalists want us to get back to work? OK, we'll do that when businesses are required to provide paid sick leave. And open Medicare up to everyone, ffs. Without these things in place, we shouldn't get out of our pajamas.

Is this a pipe dream? Maybe. But this is as good a time as any to renegotiate the social contract.
  #104  
Old 03-26-2020, 06:05 PM
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This is from the highly respected Imperial College team:

Coronavirus pandemic could have caused 40 million deaths if left unchecked

Actually, though, it couldn't have be left unchecked. Most people are not going to go to restaurants and plays and baseball games while hearing day after day of prominent people who got a new disease, or died from it, while emergency rooms and ICU's are overloaded.

Last edited by PhillyGuy; 03-26-2020 at 06:06 PM.
  #105  
Old 03-26-2020, 06:42 PM
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They did claim that Icelands smaller population and their ability to test a larger % of their total population means they may get a more accurate estimate of CFR and IFR, and it is showing potentially the IFR is much lower than we've been fearing.
They also note that Iceland has been able (so far) to keep it out of their elderly population, due at least in part to their quarantine measures. (I daresay it is also due to lifestyle issues; I have not heard of many elderly Icelanders going on Caribbean cruises, e.g.) We already know this disease has a death rate proportionately much higher among older people, so I'm not sure Iceland's experience will be similar to those of countries where the disease does get into nursing homes and other older populations.

Beyond that, you are still missing the point that if the number of serious cases rises too high relative to the available medical care, then IFR will rise not because the disease became more deadly but because more people received only limited or even no treatment, or palliative treatment instead of aggressive measures. That means that people who had perfectly survivable cases don't survive. That's what is happening in Italy and Spain right now, for example.
  #106  
Old 03-26-2020, 06:54 PM
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They also note that Iceland has been able (so far) to keep it out of their elderly population, due at least in part to their quarantine measures. (I daresay it is also due to lifestyle issues; I have not heard of many elderly Icelanders going on Caribbean cruises, e.g.) We already know this disease has a death rate proportionately much higher among older people, so I'm not sure Iceland's experience will be similar to those of countries where the disease does get into nursing homes and other older populations.

Beyond that, you are still missing the point that if the number of serious cases rises too high relative to the available medical care, then IFR will rise not because the disease became more deadly but because more people received only limited or even no treatment, or palliative treatment instead of aggressive measures. That means that people who had perfectly survivable cases don't survive. That's what is happening in Italy and Spain right now, for example.
I agree and I understand that. Its just that there are a lot of unanswered questions right now. We don't know the real CFR or IFR, and we don't know the long term economic impacts, nor do we know what effects those economic impacts will have. A smaller global economy with better priorities (that invests a bigger % of GDP in education, R&D, infrastructure, renewables, etc) may not harm the younger generation as badly even if the economy overall is smaller.
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  #107  
Old 03-26-2020, 07:21 PM
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So, this is clearly turned into a thread there the o.p., having “just asked the question,” proceeds to adopt an oppositional position and dogmatically defends it regardless of any evidence or logical arguments presented. Since there is no point to continuing this as an honest discussion, i’ll just leave a link to Dr. John Campbell’s latest data-based evaluation and cautionary warning to countries who aren’t taking isolation efforts seriously.

Oh, and by the way, PBS News Hour: “The US now has the most confirmed COVID-19 cases in the world.”

America, fuck yeah!

Stranger

Last edited by Stranger On A Train; 03-26-2020 at 07:25 PM.
  #108  
Old 03-26-2020, 07:39 PM
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I've posted this vox article elsewhere:
https://www.vox.com/2020/3/23/211900...-deaths-by-age

It's not complete but it does discuss available stats on the % who require hospitalization and ICU by age.
Thanks, it is useful, and interesting. It broadly agrees with my back of the envelope thoughts. In fact it is a bit grimmer for some age groups. In a saturated health system the ultimate death rate for younger age groups probably rises between ten and twenty times from a situation where the system has capability to care for them. (I'm essentially assuming that if you need ICU care and don't get it, you will die.)

If the pandemic is unchecked we can expect up to 1 in 50 of people between 30 to 49 to die. Something of a worst case, but quite reasonable. Hard to imagine what would happen in the few months when this was happening. Family members arriving at hospitals with guns demanding that their relative be put on a ventilator is probably just the start. You can be pretty sure that it anarchy resulting would rip the country apart.
  #109  
Old 03-26-2020, 08:10 PM
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I don't want to die.
I got bad news for you...
  #110  
Old 03-26-2020, 11:20 PM
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....
But isn't newer research showing the death rate is closer to 0.5%, possibly even lower?
It's looking like 10% in Italy right now. I think that's mostly because their medical system was completely swamped. Unfortunately, I fear the same here.
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...The major strain of smallpox had a 30% mortality rate, and I don't believe they shut society down when they were vaccinating against that disease. a case fatality rate of 0.5% is about on par with malaria, and societies with that don't shut down....
Smallpox outbreaks routinely DID shut down the economy of the place with the outbreak, back in the day. And that's despite some people being immune (due to having recovered in the past) and
And malaria kind of shuts down the economy on its own. I read a paper that plotted economic production per capita against incidence of malaria in some region of Africa, once, and the correlation was huge -- huge enough that it was enough to explain the underperformance of a lot of African nations on a global scale. Lots of adults who don't have the energy to work makes a difference in productivity.

Here's an article with a nice graph comparing how contagious and how deadly various diseases are:

https://www.theguardian.com/news/dat...tious-diseases
  #111  
Old 03-27-2020, 01:42 AM
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This is NOT a politician's dream... Why do you think Trump and Congress were so eager to pass this huge stimulus bill? Why do you think Trump keeps bucking scientists, including his top advisors, by saying we should ease up on the restrictions?
It's a disaster relief bill, not an economic stimulus, and it looks like attempted bribery, not a way to funnel cash to those most needful. And why does Putin's puppy behave so erratically? Only his insightful intestines know for sure.

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Its more like debating if trying to conquer the entire nation of Afghanistan is worth it to stop a few hundred Al Qaeda fighters. Its a valid question.
The A-Q 9/11 crew also trained in Germany, Florida, and Arizona, which weren't invaded. Let's instead debate the worth of mandatory tamper-proof seals after only a *few* pill bottles were poisoned. What! Massive FDA over-reaction over almost nothing!
  #112  
Old 03-27-2020, 04:44 AM
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Same, but a lot of these you will never know (often for good reason, due to medical privacy) how much coronavirus caused the death versus how much it was the complications on top of other health conditions. Even most of the deaths in the 50s-60s I'm seeing a lot of vague language alluding to "in addition to other factors."
  #113  
Old 03-27-2020, 06:03 AM
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Same, but a lot of these you will never know (often for good reason, due to medical privacy) how much coronavirus caused the death versus how much it was the complications on top of other health conditions. Even most of the deaths in the 50s-60s I'm seeing a lot of vague language alluding to "in addition to other factors."
People say this like this is supposed to be comforting. It isn't. A lot of us have "other factors". A lot of us have these factors without knowing we do, because we haven't been to the doctor in ages.

On Reddit, you will always find people hand-waving away a story about a young-ish person dying from COVID-19 when it turns out the person was overweight. 60% of American adults are overweight. 40% are obese. But I guess those of us who aren't overweight can be glad we're safe, right? Not unless we have asthma, diabetes, or are heavy smokers.

Hell, Redditors have even diagnosed this super fit cycling fanatic who is battling COVID-19 with some underlying medical condition, despite the article clearly stating he has none. "He's a cycling fanatic! Everyone knows those people are prone to heart attacks!" says the skinny-fat, vitamin D-deficient neckbeard who hasn't touched a vegetable other than marijuana in the past year.
  #114  
Old 03-27-2020, 07:18 AM
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If this lockdown saves 25 million lives, but it costs 100 trillion dollars, that is 4 million per life saved. Since many of those saved are going to be people past their productive years.
If you let the disease run its course, it will crush the health system - ffs, look at what's happening to hospitals in NYC and that's *with* extraordinary restrictions on commerce and movement. You're just looking at survival rates; you're not looking at many, many young people who go to the hospital who can't breathe, some of whom end up in the ICU.

Trust me, in sufficient numbers, friends watching their friends gasp for air and stagger into a hospital where they lie on the floor and feel like they're going to suffocate - and in some cases, do - that is going to scare people out of work, out of hanging out, out of shopping. It's a fucking pandemic. There's no getting around the public health impact, and there's no getting around the economic impact either.

That's why they want to flatten the curve. People have already studied the public health impact of this. We don't need to reinvent the wheel; we need to be disciplined, keep our heads straight, and get through this.
  #115  
Old 03-27-2020, 07:21 AM
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Same, but a lot of these you will never know (often for good reason, due to medical privacy) how much coronavirus caused the death versus how much it was the complications on top of other health conditions. Even most of the deaths in the 50s-60s I'm seeing a lot of vague language alluding to "in addition to other factors."
It's not 50 and 60 in addition to other factors; it's the other factors. These other factors accumulate with age. But there are plenty of younger Americans with other factors as well - like diabetes, cardiovascular disease, high blood pressure, obesity, etc.

Even if it doesn't necessarily kill you, the scarring of your lung tissue will deprive you of pulmonary function, possibly for the rest of your life. You might be disabled. You might have to call it quits for your career. And oh yeah, you might end up having to file for medical-related bankruptcy. All things that young people can look forward to.
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Old 03-27-2020, 08:30 AM
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Even if it doesn't necessarily kill you, the scarring of your lung tissue will deprive you of pulmonary function, possibly for the rest of your life. You might be disabled. You might have to call it quits for your career. And oh yeah, you might end up having to file for medical-related bankruptcy. All things that young people can look forward to.
That's a very strongly worded claim. One small study found about a quarter of recovered patients had some residual lung issues. Obviously this was done soon after recovery, so long term prognosis is unknown. Presumably this is more likely to be a problem in severe case, not your average 20 year old.

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  #117  
Old 03-27-2020, 08:40 AM
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That's a very strongly worded claim. One small study found about a quarter of recovered patients had some residual lung issues. Obviously this was done soon after recovery, so long term prognosis is unknown. Presumably this is more likely to be a problem in severe case, not your average 20 year old.
It's intended to be strongly worded, and it's based on fact. I'm not referring to all cases that self-resolve, but if COVID-19 is bad enough to send you to the hospital, you're sustaining lung damage - I said *possibly* for the rest of your life.

I think we should err on the side of caution. I haven't written anything that's alarmist. People are taking a lot of false comfort in statistics that do not nearly tell the whole story. Almost from the beginning, people have been taking false comfort in the fact that *only* 1 percent die from the illness (in some countries, the death toll is considerably higher than that). We've been taking false comfort in the supposition that this afflicts older people or people who have extremely poor health. The reality is far more complex than that, and we're seeing this time and time again, in country after country and city after city.

People want to believe that this is being overblown by the media - it's not.
  #118  
Old 03-27-2020, 08:44 AM
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It's looking like 10% in Italy right now. I think that's mostly because their medical system was completely swamped. Unfortunately, I fear the same here.
It's mostly because they are under counting milder cases, especially in younger patients. This can easily be seen in the available data:

https://jamanetwork.com/journals/jam...rticle/2763667

"The distribution of cases is very different in the 2 countries: individuals aged 70 years or older represent 37.6% of cases in Italy and only 11.9% in China."

While Italy has an old population, those 70 and older represent far less than 37.6% of their population, suggesting a true denominator much higher than the number of positive tests they are reporting.

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  #119  
Old 03-27-2020, 10:06 AM
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It's mostly because they are under counting milder cases, especially in younger patients. This can easily be seen in the available data:

https://jamanetwork.com/journals/jam...rticle/2763667

"The distribution of cases is very different in the 2 countries: individuals aged 70 years or older represent 37.6% of cases in Italy and only 11.9% in China."

While Italy has an old population, those 70 and older represent far less than 37.6% of their population, suggesting a true denominator much higher than the number of positive tests they are reporting.
What point are you trying to make exactly? Are you saying it's not that serious or that we're blowing it out of proportion?
  #120  
Old 03-27-2020, 10:23 AM
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It's mostly because they are under counting milder cases, especially in younger patients. This can easily be seen in the available data:

https://jamanetwork.com/journals/jam...rticle/2763667

"The distribution of cases is very different in the 2 countries: individuals aged 70 years or older represent 37.6% of cases in Italy and only 11.9% in China."

While Italy has an old population, those 70 and older represent far less than 37.6% of their population, suggesting a true denominator much higher than the number of positive tests they are reporting.
On the one hand, yeah, I certainly hope that 10% is overstated, and it seems likely that it is. On the other hand, I think they are seeing a lot more than the 0.5% mortality cited by the OP.
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Old 03-27-2020, 10:35 AM
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I agree and I understand that. Its just that there are a lot of unanswered questions right now. We don't know the real CFR or IFR, and we don't know the long term economic impacts, nor do we know what effects those economic impacts will have. A smaller global economy with better priorities (that invests a bigger % of GDP in education, R&D, infrastructure, renewables, etc) may not harm the younger generation as badly even if the economy overall is smaller.
And what is your conclusion with these unknowns and the other unknowns about the exact stats about the spread/fatality rates for the virus? People have to make decisions about how to act without all the information, and I'm wondering where you come down. Do you still believe it an "over-reaction" or is it possible it is better, at this point, to err on the side of saving human lives and continuing with social distancing and quarantines? Are there certain stat levels that will make your opinion change? If it's 2% is that enough to warrant this level of alarm? If it ends up only being .5% will that make this all look silly?
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Old 03-27-2020, 10:44 AM
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On the one hand, yeah, I certainly hope that 10% is overstated, and it seems likely that it is. On the other hand, I think they are seeing a lot more than the 0.5% mortality cited by the OP.
It's probably not *that* overstated.

Although the data changes from day to day, Italy appears to be in the top ten countries of the world in terms of testing per capita, so it's not as though they're not testing.

https://www.statista.com/statistics/...ies-worldwide/

They've actually tested more than Germany, yet they have a much higher fatality rate. The difference isn't just in the number of tests; it's also likely a matter of *when* the two countries decide to test. This might be inaccurate, but from what I gather, Italy's surveillance efforts seemed to get ramped up as a result of an outbreak in northern Italy. Germany may have started testing ahead of the crisis, similar to what South Korea did.

The fatality rates for Italy may indeed go down, but they are not likely to go down immediately or dramatically. They will go down once the virus has wiped the most vulnerable people out of existence. That's the problem that Italy has right now: the most vulnerable have been infected at around the same time that those who are more likely to survive have been infected. But those who are likely to survive are still showing up at hospitals in desperate need of healthcare.
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Old 03-27-2020, 10:54 AM
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It's probably not *that* overstated.



Although the data changes from day to day, Italy appears to be in the top ten countries of the world in terms of testing per capita, so it's not as though they're not testing.

So young Italians are simply much less likely to become infected than their elders?

Last edited by Shmendrik; 03-27-2020 at 10:54 AM.
  #124  
Old 03-27-2020, 11:11 AM
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It's a disaster relief bill, not an economic stimulus, and it looks like attempted bribery, not a way to funnel cash to those most needful. And why does Putin's puppy behave so erratically? Only his insightful intestines know for sure.!
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  #125  
Old 03-27-2020, 11:39 AM
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I agree and I understand that. Its just that there are a lot of unanswered questions right now. We don't know the real CFR or IFR, and we don't know the long term economic impacts, nor do we know what effects those economic impacts will have. A smaller global economy with better priorities (that invests a bigger % of GDP in education, R&D, infrastructure, renewables, etc) may not harm the younger generation as badly even if the economy overall is smaller.
We don't know for sure what the infection rate is or how many people have it.

We do know how many people have died from it. That number has doubled every 3 days. Get a calculator out and pick any day's death count. Multiply it by 2 and repeat it 9 more times. That's how many more per month would die without intervention. yes it will curve down naturally as we kill off all the people with added health problems but the numbers go up very quickly. So far it's actually closer to doubling every 3 days plus 25%.

As an example, we had 115 dead on 3/17. 9 days later it was at 1,177. that's a little over a week.

Last edited by Magiver; 03-27-2020 at 11:40 AM.
  #126  
Old 03-27-2020, 11:47 AM
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So young Italians are simply much less likely to become infected than their elders?
Italians under the age of 18 are a very small percentage of the cases, but the numbers start going up for adults between 19 and 50 years old, who have so far accounted for almost 25% of the total cases.

Another 38% are between the ages of 51 and 70 - aging, but hardly old. If they were in America, people at this age would be more likely to be in positions of senior management and earning the highest salaries of their lives. And if they were retired, they'd be just recently so and in otherwise good health and with some money to spend, well before their predictive end-of-life care expenditures begin to kick in. In other words, these are not the sort of people a smart economist would want to consider expendable and flush down the toilet.
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Old 03-27-2020, 12:16 PM
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Italians under the age of 18 are a very small percentage of the cases, but the numbers start going up for adults between 19 and 50 years old, who have so far accounted for almost 25% of the total cases.



Another 38% are between the ages of 51 and 70 - aging, but hardly old. If they were in America, people at this age would be more likely to be in positions of senior management and earning the highest salaries of their lives. And if they were retired, they'd be just recently so and in otherwise good health and with some money to spend, well before their predictive end-of-life care expenditures begin to kick in. In other words, these are not the sort of people a smart economist would want to consider expendable and flush down the toilet.
That wasn't my point at all. You said that 10% was likely to be a good approximation of the actual fatality rate in Italy. I was simply saying that the case fatality rate is very different from the infection fatality rate, and this is easily seen from the fact that there are far fewer infections reported in younger people, including the middle aged. The most likely explanation for that, especially in an overloaded health care system, is that the true number of infections in young and middle aged people is considerably higher than the number of positive tests.

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  #128  
Old 03-27-2020, 12:28 PM
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That wasn't my point at all. You said that 10% was likely to be a good approximation of the actual fatality rate in Italy. I was simply saying that the case fatality rate is very different from the infection fatality rate, and this is easily seen from the fact that there are far fewer infections reported in younger people, including the middle aged. The most likely explanation for that, especially in an overloaded health care system, is that the true number of infections in young and middle aged people is considerably higher than the number of positive tests.
Well to be accurate, I think I said that it wasn't that much of an exaggeration and I believe I also agreed that it would go down over time.

But here's a more important question: does that matter? If we find out later that there was an extremely high number of people in Italy who got infected but went undetected...so fucking what? What matters is what the health system was able to handle, and clearly, Italy's health system, which by all accounts has more beds and was in some regards better equipped to handle a pandemic than our system, has been wrecked by COVID-19.

I think that's what needs to be pointed out: who gives a shit if only 1% of the people who get infected die? If the timing and the incidence combine to shut down a health system - even if it's for a matter of weeks - then you've got a serious problem.

No offense, but trying to minimize the scale and dimension of the pandemic by pointing out percentages is, frankly, not a very educated way to analyze this crisis. Look at the actual impact of the pandemic right now. That's all you need to know.

Last edited by asahi; 03-27-2020 at 12:29 PM.
  #129  
Old 03-27-2020, 01:02 PM
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I think a lot of people are taking false comfort in the high number of unconfirmed cases for some reason. Let's say that all of us have the virus and 80% are asymptomatic in this sliver of time. Is this really all that comforting?

Are the 40 Italian doctors who have died after treating COVID-19 patients breathing a sigh of relief up in heaven now that they know the true number of cases?

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  #130  
Old 03-27-2020, 01:13 PM
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I think a lot of people are taking false comfort in the high number of unconfirmed cases for some reason. Let's say that all of us have the virus and 80% are asymptomatic in this sliver of time. Is this really all that comforting?
Its comforting because it could mean the IFR is much lower if most people who get the disease have no symptoms or only mild symptoms.
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  #131  
Old 03-27-2020, 01:15 PM
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I think a lot of people are taking false comfort in the high number of unconfirmed cases for some reason. Let's say that all of us have the virus and 80% are asymptomatic in this sliver of time. Is this really all that comforting?

Are the 40 Italian doctors who have died after treating COVID-19 patients breathing a sigh of relief up in heaven now that they know the true number of cases?

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No, but maybe the tens of million of Americans who won't die in the next few months if the virus turns out to not have a ten percent mortality rate would be relieved to hear it. It makes every difference in terms of predicting the extent of this epidemic and how long it will last.

Frankly, the thousands of new cases being reported every day in northern Italy make me very skeptical that we're going to be able to do much to slow down the spread of this virus, given that they've been as "locked down" as anywhere in the USA or Western Europe for 3 weeks now. The draconian lockdown of Wuhan wasn't only made possible because China is a totalitarian state, they needed the resources of the rest of their vast relatively unaffected country to do it. Because of how the virus is spreading, that won't be possible anywhere else, regardless of their political system.

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Old 03-27-2020, 01:22 PM
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Its comforting because it could mean the IFR is much lower if most people who get the disease have no symptoms or only mild symptoms.
I get that in relative terms, a death rate of 1% is a relief compared to a fatality rate of 4%. It's entirely possible that the fatality rate may vary from one country to the next, and that its outcomes are very dependent on how well a country's health system is prepared to test, triage, and treat.

It might be a folly for an American to look at Germany or South Korea's data and say "See, the real fatality rate is 1 in 1000" if America's health system isn't similarly prepared to deal with it. Perhaps over time we can improve these outcomes - then again, maybe the US keeps bungling the response, never fully enforces social distancing, encourages people to return to work, and successive waves of infection perpetually wear down the health system. Maybe the virus mutates. Maybe our COVID outcomes are never as good as Germany's or South Korea's.
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Old 03-27-2020, 01:28 PM
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No, but maybe the tens of million of Americans who won't die in the next few months if the virus turns out to not have a ten percent mortality rate would be relieved to hear it. It makes every difference in terms of predicting the extent of this epidemic and how long it will last.
Oy!

The last thing we want is for millions of people to be relieved; we want them to practice social distancing so that they stop accelerating the spread of the outbreak. It's the acceleration of the outbreak that is likely inflating the mortality rate beyond where it should be. Do you not get that?!
  #134  
Old 03-27-2020, 01:39 PM
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Oy!



The last thing we want is for millions of people to be relieved; we want them to practice social distancing so that they stop accelerating the spread of the outbreak. It's the acceleration of the outbreak that is likely inflating the mortality rate beyond where it should be. Do you not get that?!
Is there any evidence that even relatively strong "social distancing" measures will be sufficient to prevent the collapse of the healthcare system, given the necessity of people circulating for food production, distribution, and essential industry? Have we actually seen this work anywhere? Like I said, for logistical reasons we can't achieve a Wuhan level of distancing anywhere else.

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Old 03-27-2020, 01:40 PM
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This is the straight dope. This should be one place we can freely discuss the IFR, death rate etc, putting to one side whether the true data might make the man on the street complacent.

It's not as though millions of people are going to suddenly base their decisions on this message board (And good luck with the SD server with that increased traffic. The hamster wheel already needs oiling).

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  #136  
Old 03-27-2020, 02:02 PM
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Originally Posted by monstro View Post
I think a lot of people are taking false comfort in the high number of unconfirmed cases for some reason. Let's say that all of us have the virus and 80% are asymptomatic in this sliver of time. Is this really all that comforting?

Are the 40 Italian doctors who have died after treating COVID-19 patients breathing a sigh of relief up in heaven now that they know the true number of cases?

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Well, IF a lot of us have mild cases and IF that confers useful immunity, then the total death toll will be a whole lot lower than if that's not happening.
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Old 03-27-2020, 02:13 PM
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I don't know if this had been mentioned yet, but covid 19 is particularly fearsome because of how communicable it is. You can get it just by getting coughed or breathed upon.

HIV/AIDS has also been described as a pandemic, but since its routes of transmission are so much more limited, it's far easier for people to stay out of its way without extraordinary countermeasures like social distancing and sheltering in place.

I suspect some may be asking, "well AIDS was a pandemic but we didn't shut everything down for that, so why do we have to do it now?". If HIV was as communicable as Coronavirus, we certainly woukd have, especially in the early days when there were no deu3gs for it.



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  #138  
Old 03-27-2020, 02:21 PM
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I don't know if this had been mentioned yet, but covid 19 is particularly fearsome because of how communicable it is. You can get it just by getting coughed or breathed upon.

HIV/AIDS has also been described as a pandemic, but since its routes of transmission are so much more limited, it's far easier for people to stay out of its way without extraordinary countermeasures like social distancing and sheltering in place.

I suspect some may be asking, "well AIDS was a pandemic but we didn't shut everything down for that, so why do we have to do it now?".



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Also with HIV we have medications to slow the virus from spreading inside your body. Right now we only have experimental antivirals for coronavirus.

I don't know if we really even know 'how' coronavirus is spread yet. I got the impression that it was spread via respiration, but lots of other people seem to feel that it is spread through touching infected doorknobs and surfaces. Also even with respiration, there seems to be debate on what kinds of masks are effective or how effective they are.
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  #139  
Old 03-27-2020, 03:00 PM
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I don't know if this had been mentioned yet, but covid 19 is particularly fearsome because of how communicable it is. You can get it just by getting coughed or breathed upon.

HIV/AIDS has also been described as a pandemic, but since its routes of transmission are so much more limited, it's far easier for people to stay out of its way without extraordinary countermeasures like social distancing and sheltering in place.

I suspect some may be asking, "well AIDS was a pandemic but we didn't shut everything down for that, so why do we have to do it now?". If HIV was as communicable as Coronavirus, we certainly woukd have, especially in the early days when there were no deu3gs for it.



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In the early years of the AIDS epidemic, we had no idea that a virus was responsible, or how the disease was spread. We didn't know how to "stay out of its way", and many places, like gay establishments, were shut down because of this ignorance. There were even suggestions to isolate all gay men on an island somewhere. Or worse.
  #140  
Old 03-27-2020, 03:07 PM
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I don't know if we really even know 'how' coronavirus is spread yet. I got the impression that it was spread via respiration, but lots of other people seem to feel that it is spread through touching infected doorknobs and surfaces. Also even with respiration, there seems to be debate on what kinds of masks are effective or how effective they are.
First of all, it is pretty much confirmed via community transmission with no traceability that the SARS-CoV-2 virus is spread at least in part via aerosol vectors. This isn't the same as "airborne", where the pathogen can actually spread in dry air without droplets, but it is still bad; it means that while cleaning door knobs and washing hands is still good practice, it isn't sufficient to assure no transmission. Nor is just following the 6 foot/2 meter guidelines for spacing; if you are outside in a part with a light breeze dispersing any aerosols your likelihood of getting enough of a viral load for transmission, but in a confined area where an aerosol will not be dispersed, it means it could hang in the air for minutes.

There is no real "debate on what kinds of masks are effective or how effective they are". Ordinary surgical masks that do not seal around the face are only good for stopping droplets from being openly emitted by the wearer, and do nothing to protect the wearer from inhaling aerosolized pathogen. N95 respirator masks are much better insofar as they prevent aerosols from directly entering the respiratory system but pathogen can become embedded in the mask and eventually make its way through, especially as the mask becomes saturated with moisture from the breath of the wearer and the ability for the mask to capture droplets and hold it until the moisture evaporates and the virion (virus-containing particle) desiccates degrades. This is why staff in emergency wards and ICUs--who are being required to wear the same respirator mask for days--are covering it with a surgical mask (which mostly just serves to keep it from looking soiled) and face shields (which actually protect against direct impaction from aerosols but make it very difficult to communicate with patients or perform a thorough examination).

Seven to ten days from now, when the virus is everywhere and emergency rooms and ICU wards are packed to capacity, and physicians and nurses (and receptionists, and nurses aids, and EMTs, and everyone else who is on the front lines of the response) start suffering en masse, the question isn't going to be "Are we overreacting?"; it is going to be, "Given everything we saw from China, and Italy, and Spain, why didn't we react quickly enough?" At this point there is no excuse other than blithe ignorance of what is happening right now in nations that didn't respond to the warnings of the epidemiological community to argue that the current measures to just stay at home and stop mingling with people as if this is a mild outbreak of cold or some disease that only affects old people who are going to die soon anyway. There is no "debate"; there are no "both sides make reasonable arguments"; and there is no fact-based analysis that doesn't involve the difference between a few hundred thousand deaths and millions of avoidable deaths because of a lack of hospital capacity.

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  #141  
Old 03-27-2020, 03:12 PM
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Well, IF a lot of us have mild cases and IF that confers useful immunity, then the total death toll will be a whole lot lower than if that's not happening.
But we can see the death toll with our own eyes and it's crazy bad.

Just because we aren't all going to die doesn't take away from that.
  #142  
Old 03-27-2020, 03:23 PM
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Is there any evidence that even relatively strong "social distancing" measures will be sufficient to prevent the collapse of the healthcare system, given the necessity of people circulating for food production, distribution, and essential industry? Have we actually seen this work anywhere? Like I said, for logistical reasons we can't achieve a Wuhan level of distancing anywhere else.

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We're probably too late to stop the initial wave of COVID-19 infections, which are now putting a strain on the health system. The question is what do we do now? I personally don't believe that Wuhan is COVID free, but they clearly slowed the spread of the infection, and that has given them time to play catch up. It has given them time to *perhaps* implement better testing and a more robust in the event of additional outbreaks.

Ideally, we would have had in place a better surveillance system and had a more systematic approach to catching COVID cases extremely early - and the data (though it's still early) seem to suggest that early detection and treatment is *the* key. We're way, way behind in that regard. It should be pointed out that the reason we're having to shutter stores and offices is due to the lack of rapid identification and early treatment. Extreme social distancing is arguably not ideal, but in the absence of surveillance and treatment, it's the best option for allowing the medical system to get on top of COVID.

And I disagree: we actually *could* impose an authoritarian style lock-down if the president in coordination with governors wanted it done. But nobody has the grapefruits to pull the trigger for political reasons.
  #143  
Old 03-27-2020, 03:41 PM
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In the early years of the AIDS epidemic, we had no idea that a virus was responsible, or how the disease was spread. We didn't know how to "stay out of its way", and many places, like gay establishments, were shut down because of this ignorance. There were even suggestions to isolate all gay men on an island somewhere. Or worse.
Actually, even after researchers knew how HIV was being transmitted and that AIDS (then often referred to as "Gay-Related ImmunoDeficiency Syndrome" by those on the Religious Right) there was opposition within the Reagan Administration to releasing information. It was then-Surgeon General C. Everett Koop--who was an evangelical Christian and die-hard conservative--who essentially defied he administration and sent out the infamous "Understanding AIDS" pamphlet to every household, which pissed off a lot of people on both the left and right but kicked off the national conversation on how we should be viewing and treating patients with AIDS. (William F. Buckley wanted to tattoo all gay men and intravenous drug users, and his was far from the most extreme proposal.)

We need this kind of devotion to truth and duty right now. Instead, what we're getting is inadequate at best and dangerously misinformed at worst.

Stranger

Last edited by Stranger On A Train; 03-27-2020 at 03:45 PM.
  #144  
Old 03-27-2020, 03:41 PM
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First of all, it is pretty much confirmed via community transmission with no traceability that the SARS-CoV-2 virus is spread at least in part via aerosol vectors. This isn't the same as "airborne", where the pathogen can actually spread in dry air without droplets, but it is still bad; it means that while cleaning door knobs and washing hands is still good practice, it isn't sufficient to assure no transmission. Nor is just following the 6 foot/2 meter guidelines for spacing; if you are outside in a part with a light breeze dispersing any aerosols your likelihood of getting enough of a viral load for transmission, but in a confined area where an aerosol will not be dispersed, it means it could hang in the air for minutes.

There is no real "debate on what kinds of masks are effective or how effective they are". Ordinary surgical masks that do not seal around the face are only good for stopping droplets from being openly emitted by the wearer, and do nothing to protect the wearer from inhaling aerosolized pathogen. N95 respirator masks are much better insofar as they prevent aerosols from directly entering the respiratory system but pathogen can become embedded in the mask and eventually make its way through, especially as the mask becomes saturated with moisture from the breath of the wearer and the ability for the mask to capture droplets and hold it until the moisture evaporates and the virion (virus-containing particle) desiccates degrades. This is why staff in emergency wards and ICUs--who are being required to wear the same respirator mask for days--are covering it with a surgical mask (which mostly just serves to keep it from looking soiled) and face shields (which actually protect against direct impaction from aerosols but make it very difficult to communicate with patients or perform a thorough examination).

Seven to ten days from now, when the virus is everywhere and emergency rooms and ICU wards are packed to capacity, and physicians and nurses (and receptionists, and nurses aids, and EMTs, and everyone else who is on the front lines of the response) start suffering en masse, the question isn't going to be "Are we overreacting?"; it is going to be, "Given everything we saw from China, and Italy, and Spain, why didn't we react quickly enough?" At this point there is no excuse other than blithe ignorance of what is happening right now in nations that didn't respond to the warnings of the epidemiological community to argue that the current measures to just stay at home and stop mingling with people as if this is a mild outbreak of cold or some disease that only affects old people who are going to die soon anyway. There is no "debate"; there are no "both sides make reasonable arguments"; and there is no fact-based analysis that doesn't involve the difference between a few hundred thousand deaths and millions of avoidable deaths because of a lack of hospital capacity.

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Most Pit threads leave a shred of dignity. This is just brutal.
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  #145  
Old 03-27-2020, 03:42 PM
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And I disagree: we actually *could* impose an authoritarian style lock-down if the president in coordination with governors wanted it done. But nobody has the grapefruits to pull the trigger for political reasons.
No, it's literally impossible, regardless of political will. It only works when you have a large functional uninfected area which can send supplies, healthcare workers, food, etc. When the whole country is infected, that's impossible. You'd literally have people starving to death in their homes.



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Old 03-27-2020, 03:44 PM
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I suggest that everyone who thinks we might be overreacting read this ProPublica article.

https://www.propublica.org/article/a...young-patients

Quote:
A Medical Worker Describes Terrifying Lung Failure From COVID-19 Even in His Young Patients

It first struck me how different it was when I saw my first coronavirus patient go bad. I was like, Holy shit, this is not the flu. Watching this relatively young guy, gasping for air, pink frothy secretions coming out of his tube.

Quote:
Before the virus came to New Orleans, his days were pretty relaxed, nebulizing patients with asthma, adjusting oxygen tubes that run through the nose or, in the most severe cases, setting up and managing ventilators. His patients were usually older, with chronic health conditions and bad lungs.

Since last week, hes been running ventilators for the sickest COVID-19 patients. Many are relatively young, in their 40s and 50s, and have minimal, if any, preexisting conditions in their charts. He is overwhelmed, stunned by the manifestation of the infection, both its speed and intensity. The ICU where he works has essentially become a coronavirus unit. He estimates that his hospital has admitted dozens of confirmed or presumptive coronavirus patients. About a third have ended up on ventilators.
And here's the money line:

Quote:
His hospital had not prepared for this volume before the virus first appeared. One physician had tried to raise alarms, asking about negative pressure rooms and ventilators. Most staff concluded that he was overreacting. They thought the media was overhyping it, the respiratory therapist told me. In retrospect, he was right to be concerned.
Like many hospitals across the country, across the globe: not anywhere near prepared.

Quote:
Patients will be on minimal support, on a little bit of oxygen, and then all of a sudden, they go into complete respiratory arrest, shut down and cant breathe at all.
As others have pointed out: seemingly fine one moment, fighting for their lives the next.

Quote:
That seems to be what happens to a lot of these patients: They suddenly become unresponsive or go into respiratory failure.
Here's another money quote: once you suffer from acute respiratory distress...you're in a world of shit.

Quote:
Its called acute respiratory distress syndrome, ARDS. That means the lungs are filled with fluid. And its notable for the way the X-ray looks: The entire lung is basically whited out from fluid. Patients with ARDS are extremely difficult to oxygenate. It has a really high mortality rate, about 40%. The way to manage it is to put a patient on a ventilator. The additional pressure helps the oxygen go into the bloodstream.
What's not mentioned in the article, but what public health experts have said in terms of the importance of slowing the spread and flattening the curve is this: the aim is to make it so that ICU teams are dealing with a handful of these patients. Instead, they're dealing with a flood.

Quote:
In my experience, this severity of ARDS is usually more typical of someone who has a near drowning experience they have a bunch of dirty water in their lungs or people who inhale caustic gas.
Gasping for air, trying to rip out their ventilator tube because they feel the sensation of being choked.

Quote:
I was like, Holy shit, this is not the flu. Watching this relatively young guy, gasping for air, pink frothy secretions coming out of his tube and out of his mouth.
Drowning in their own blood.

Quote:
When someone has an infection, Im used to seeing the normal colors youd associate with it: greens and yellows. The coronavirus patients with ARDS have been having a lot of secretions that are actually pink because theyre filled with blood cells that are leaking into their airways. They are essentially drowning in their own blood and fluids because their lungs are so full.
Like I said, even if you survive, I'm guessing this is not the kind of experience the average person would want to go through.
  #147  
Old 03-27-2020, 04:01 PM
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By the way, I don't know how many people have ever seen someone on a ventilator, but you basically have a big tube stuck down your trachea that is pushing air through with enough force to partially inflate your lungs. It is horrifying experience (I am told; I've never been on one myself) and patients generally have to be sedated, which given the condition that you have to be in to have to be respirated is actually a relief. "Drowning in their own blood," is something out of a horror movie, and it is no occurring on a routine basis in every hospital in New York City and soon to come to your town.

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  #148  
Old 03-27-2020, 04:11 PM
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I've been on a ventilator: a lung collapsed during surgery when I was 15.

I remember trying to pull the tube out because I felt I could breathe on my own, but the nurses/docs kept reinserting it. Intubation wasn't painful IME but I was on some pain meds and still recovering from general anesthesia. WHat it was, was weird. It goes against your natural instincts to leave a tube inside your body.
  #149  
Old 03-27-2020, 04:12 PM
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By the way, I don't know how many people have ever seen someone on a ventilator, but you basically have a big tube stuck down your trachea that is pushing air through with enough force to partially inflate your lungs. It is horrifying experience (I am told; I've never been on one myself) and patients generally have to be sedated, which given the condition that you have to be in to have to be respirated is actually a relief. "Drowning in their own blood," is something out of a horror movie, and it is no occurring on a routine basis in every hospital in New York City and soon to come to your town.



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OFFS. Patients are always sedated on a ventilator, unless they are comfortable being awake for it. They are invariably sedated for the process of inserting the big tube down their trachea. And "drowning in their own blood" is a crappy description of ARDS. This is a horrible enough disease without vaguely accurate lurid descriptions. ARDS could probably better be described as having your lungs turn to leather, if you want a horror movie phrase.

Expertise in one field doesn't really make people experts in all fields, however much they may think they are.

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  #150  
Old 03-27-2020, 04:21 PM
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OFFS. Patients are always sedated on a ventilator, unless they are comfortable being awake for it. They are invariably sedated for the process of inserting the big tube down their trachea. And "drowning in their own blood" is a crappy description of ARDS. This is a horrible enough disease without vaguely accurate lurid descriptions. ARDS could probably better be described as having your lungs turn to leather, if you want a horror movie phrase.

Expertise in one field doesn't really make people experts in all fields, however much they may think they are.

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Um...ok.
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