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Started by bacardiandlime, January 30, 2020, 03:20:28 PM

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apostrophe

Quote from: writingprof on March 23, 2020, 05:13:00 PM
Quote from: Cheerful on March 23, 2020, 10:54:55 AM
Debates about human and financial costs/benefits of statewide and nationwide shutdowns are underway.  These are not all partisan debates.

What do you think happens next in individual states and for U.S. national guidelines?

Unless bodies are piling up in the streets or we're treated to news clips of U.S. hospitals looking like Mother Teresa's Calcutta, the majority will get sick of sheltering in place in about two weeks.  Because Trump's political instincts are often extraordinarily good, he is already realizing this and is clearly coming to the conclusion that "don't let the whiners keep you inside" is a winning message.

My guess is that the citizenry, businesses, and the President will want to get back to work before governors believe it's safe.  Thus, this will be settled where all American issues are settled: in court.

I look forward to the inevitable New York Times article about how the "legitimacy of the Court" is at stake if John Roberts doesn't side with the progressives and keep the economy shut down.  Needless to say, the moment Biden wins the election, you'll never hear the words "coronavirus" or "COVID" again.

Reading your posts as satire continues to be a good strategy.

Stockmann

Quote from: Cheerful on March 24, 2020, 09:48:42 AM
Quote from: Stockmann on March 24, 2020, 09:33:44 AM
The regional/cultural factor seems to outweigh everything else, as the Far Eastern countries with good numbers include both democracies and dictatorships, and the Western countries doing badly include countries with very different politics and healthcare systems.

Thanks, Stockmann.  Many lessons to be learned.

Many U.S. politicians (D and R) have shifted to focusing on mortality rates and characterizing the virus as "most people don't die" and "it's an old people's problem."  They are ignoring that the virus can be a long, miserable thing for a person to endure, regardless of age, with long-term consequences to individual health unknown.

Not only that - in Lombardy, people have died of things unrelated to coronavirus because there aren't enough respirators to go around - coronavirus patients aren't the only ones who need them. Also, doctors in parts of Lombardy are having to choose which patients to even try to save, because they can't try to save all. There are also patients in hospital corridors because there are not enough beds. I doubt the healthcare system in, say, Appalachia, Detroit, rural Alabama or Mississippi is much better than that in Lombardy. So spring breakers in Florida are not going to die of coronavirus directly, but they better hope if they have a serious accident in a drunken antic that the local hospital isn't already overwhelmed with coronavirus patients.

Treehugger

Just popping in from the rest of the Internet to report on the innumeracy of  the general populace.

A good one: "They had 5,000 new cases yesterday! Just because the new case numbers are lower doesn't mean they are flattening the curve." Actually, yes, that is exactly what that means.

Or: "No one is reporting that there are 100,000 recoveries. We need to stop cowering in our basements!" Yeah, 110,00 recoveries actually, but over 19,000 death which makes for a case fatality rate of 15%. So, 100,000 recoveries = not such great news after all.

Caracal

#243
Quote from: writingprof on March 23, 2020, 05:13:00 PM


Unless bodies are piling up in the streets or we're treated to news clips of U.S. hospitals looking like Mother Teresa's Calcutta, the majority will get sick of sheltering in place in about two weeks.  Because Trump's political instincts are often extraordinarily good, he is already realizing this and is clearly coming to the conclusion that "don't let the whiners keep you inside" is a winning message.

My guess is that the citizenry, businesses, and the President will want to get back to work before governors believe it's safe.  Thus, this will be settled where all American issues are settled: in court.

I look forward to the inevitable New York Times article about how the "legitimacy of the Court" is at stake if John Roberts doesn't side with the progressives and keep the economy shut down.  Needless to say, the moment Biden wins the election, you'll never hear the words "coronavirus" or "COVID" again.

As well as being absurd, this doesn't make any sense. The president hasn't ordered anything to shut down./ He probably could, using certain emergency powers, but he can't use those powers to end restrictions that governors have enacted. That's how Federalism works. So this whole weird scenario you've imagined bears no relationship to reality. The danger is Trump issuing new guidance at Easter that says everybody should reopen everything. I think its unlikely to actually happen, mostly because the pace of actual events is unfortunately likely to totally wash over all of this nonsense. By the way, that isn't a prospect that fills me with lots of glee.

I'm struck by your limited (and rather racist) imagination of how bad things could get. No, it isn't the Zombie apocalypse, but Spain and Italy have high quality health care systems and things there are very bad. Are most people ok? Sure, but a ton of people are getting sick and a lot of people are dying. Do you think Spanish and Italian people aren't complaining about restrictions because they enjoy sitting around in their houses all the time?

By the way, I know a lot of people who really detest Trump. I have heard nobody say that this is great because they think it will cost him the election. If someone did say that I'd be pretty furious. I'm worried about my parents and other older family members, as well as a few friends who have conditions that could put them more at risk. I have a toddler and the idea of me or my wife getting sick makes me pretty anxious. Chances are, we'd be fine, but it isn't a pleasant thought to imagine trying to isolate in our very compact house. Also, I can't say I'm loving the sudden end of daycare, and losing all the aspects of my job that I actually enjoy, interacting with students in person, but having to deal with more of the parts I hate. If in a couple weeks, the local situation was clear enough and there was limited and containable local spread, do you know how happy I'd be to send the kid back to hang out with his friends at school? To go hang out with some friends and have a beer?

Caracal

Quote from: Treehugger on March 25, 2020, 03:47:28 AM
Just popping in from the rest of the Internet to report on the innumeracy of  the general populace.

A good one: "They had 5,000 new cases yesterday! Just because the new case numbers are lower doesn't mean they are flattening the curve." Actually, yes, that is exactly what that means.

Or: "No one is reporting that there are 100,000 recoveries. We need to stop cowering in our basements!" Yeah, 110,00 recoveries actually, but over 19,000 death which makes for a case fatality rate of 15%. So, 100,000 recoveries = not such great news after all.

This is innumeracy too. If you divide fatality rates by total number of cases, you could be underestimating fatality rate early on if there are lots of people who have recently gotten sick, those people skew young and if testing has been extensive. However, if you only count resolved cases when numbers have been rapidly increasing, especially if lots of sick people aren't being tested, you are going to get some really distorted numbers. You start getting deaths before you get recoveries.

None of this back of the envelope math is actually how epidemiologists figure out what a real fatality rate is though. To do that you have to find ways of estimating the actual number of people infected. I'm not going to pretend to have any sort of expertise, but I saw various people who do on Twitter saying that they think a study that did this through various methods and estimated a death rate of a bit over one percent in Hubei is probably the most accurate measurement of the death rate there. It doesn't do any good to pretend this isn't a big deal, but it also isn't helpful to overestimate the bad effects either.

zyzzx

Quote from: Caracal on March 25, 2020, 04:48:55 AM
Quote from: Treehugger on March 25, 2020, 03:47:28 AM
Just popping in from the rest of the Internet to report on the innumeracy of  the general populace.

A good one: "They had 5,000 new cases yesterday! Just because the new case numbers are lower doesn't mean they are flattening the curve." Actually, yes, that is exactly what that means.

Or: "No one is reporting that there are 100,000 recoveries. We need to stop cowering in our basements!" Yeah, 110,00 recoveries actually, but over 19,000 death which makes for a case fatality rate of 15%. So, 100,000 recoveries = not such great news after all.

This is innumeracy too. If you divide fatality rates by total number of cases, you could be underestimating fatality rate early on if there are lots of people who have recently gotten sick, those people skew young and if testing has been extensive. However, if you only count resolved cases when numbers have been rapidly increasing, especially if lots of sick people aren't being tested, you are going to get some really distorted numbers. You start getting deaths before you get recoveries.

None of this back of the envelope math is actually how epidemiologists figure out what a real fatality rate is though. To do that you have to find ways of estimating the actual number of people infected. I'm not going to pretend to have any sort of expertise, but I saw various people who do on Twitter saying that they think a study that did this through various methods and estimated a death rate of a bit over one percent in Hubei is probably the most accurate measurement of the death rate there. It doesn't do any good to pretend this isn't a big deal, but it also isn't helpful to overestimate the bad effects either.

With South Korea testing like crazy, seems like they should have the best handle on numbers of infected. They did aggressive testing of contacts, etc. and if they had missed a lot of asymptomatic cases, it seems unlikely that the new cases would be so low now. They are also well past their peak, so a large proportion of their cases have been resolved. Their death/recovery is 3.3% and death/cases is 1.4%. The first number will continue to go down, and the second number will continue to go up (assuming they don't get a second wave of cases), putting the final rate somewhere in between.
Similarly, the cruise ship where everyone was tested now has a death/case rate of 1.4%, which also still has the potential to increase.

So yeah, while we don't know the real death rate yet, we're not totally clueless. Best case scenarios where everyone can still receive top-quality care, and it seems like 1-2%. As health care systems get overwhelmed, this will go up. 

polly_mer

#246
People might also want to use the fact that once things get bad enough, like NYC and Italy, no one is bothering to test; all the hospitals do is treat the people in front of them as best they can.

In terms of fatalities, the numbers that seem most convincing to me are from the weekly CDC Morbidity and Mortality Weekly Reports.  A very readable overview from last week is https://www.statnews.com/2020/03/18/coronavirus-new-age-analysis-of-risk-confirms-young-adults-not-invincible/ with breakdowns by age group.  1-3% overall fatality rate with good medical care while in quarantine is not nearly as informative as 10% over age 80 and within rounding of 0% below age 29. 

Fatality rate is also not nearly as informative as how many people need medical care to survive as well as what type (the goal of not overwhelming the medical system in each local place that flattening the curve is an abstraction to describe) and what after effects survivors might feel for weeks/months/years.  The on-the-ground rate is affected by quality of medical care; no/limited medical care is going to be very different outcomes than immediate quarantine with good medical care.

What scares me are the reports that rural hospitals may close before they even get to treat any COVID-19 because they were already in dire financial straits.

Stay home.  Call/Skype/Portal/FaceTime your family and friends instead of visiting.  We can rebuild businesses a lot more easily with adults ready to resume their activities when the time comes than we can if we have random lottery choosing which people are still able to work with no regard to experience, skill sets, or ability.
Quote from: hmaria1609 on June 27, 2019, 07:07:43 PM
Do whatever you want--I'm just the background dancer in your show!

Caracal

Quote from: zyzzx on March 25, 2020, 05:34:24 AM
Quote from: Caracal on March 25, 2020, 04:48:55 AM
Quote from: Treehugger on March 25, 2020, 03:47:28 AM
Just popping in from the rest of the Internet to report on the innumeracy of  the general populace.

A good one: "They had 5,000 new cases yesterday! Just because the new case numbers are lower doesn't mean they are flattening the curve." Actually, yes, that is exactly what that means.

Or: "No one is reporting that there are 100,000 recoveries. We need to stop cowering in our basements!" Yeah, 110,00 recoveries actually, but over 19,000 death which makes for a case fatality rate of 15%. So, 100,000 recoveries = not such great news after all.

This is innumeracy too. If you divide fatality rates by total number of cases, you could be underestimating fatality rate early on if there are lots of people who have recently gotten sick, those people skew young and if testing has been extensive. However, if you only count resolved cases when numbers have been rapidly increasing, especially if lots of sick people aren't being tested, you are going to get some really distorted numbers. You start getting deaths before you get recoveries.

None of this back of the envelope math is actually how epidemiologists figure out what a real fatality rate is though. To do that you have to find ways of estimating the actual number of people infected. I'm not going to pretend to have any sort of expertise, but I saw various people who do on Twitter saying that they think a study that did this through various methods and estimated a death rate of a bit over one percent in Hubei is probably the most accurate measurement of the death rate there. It doesn't do any good to pretend this isn't a big deal, but it also isn't helpful to overestimate the bad effects either.

With South Korea testing like crazy, seems like they should have the best handle on numbers of infected. They did aggressive testing of contacts, etc. and if they had missed a lot of asymptomatic cases, it seems unlikely that the new cases would be so low now. They are also well past their peak, so a large proportion of their cases have been resolved. Their death/recovery is 3.3% and death/cases is 1.4%. The first number will continue to go down, and the second number will continue to go up (assuming they don't get a second wave of cases), putting the final rate somewhere in between.
Similarly, the cruise ship where everyone was tested now has a death/case rate of 1.4%, which also still has the potential to increase.

So yeah, while we don't know the real death rate yet, we're not totally clueless. Best case scenarios where everyone can still receive top-quality care, and it seems like 1-2%. As health care systems get overwhelmed, this will go up.

Not to be difficult here, but I think that range doesn't really describe what experts seem to think is likely. The problem is that no matter how good the testing is, you still aren't getting all the symptomatic cases , and then you also have to consider the population effected. The people on the Diamond Princess skewed really old which makes them more vulnerable, but also were probably in pretty good health because they were on a cruise in the first place. So even when it seems like you have a natural experiment, you can't just divide deaths by cases and have a good number. Again, I can't claim any actual expertise, I just follow some people who seem well respected on Twitter and they all seemed to think the study that showed about 1.4 percent in Hubei was pretty good and that the methods they used to estimate unrecorded cases were solid.  At least early on, they were pretty overwhelmed there so that is probably more of an upper bound than a lower bound although I wouldn't want to assume things couldn't get worse here.

In a larger sense, I agree with Poly, it is really more about the health care system. However, I actually do think there's a danger to what I've been seeing with attempts to scare younger, healthy people with numbers that are misleading or overinflated. It is pretty clear that if hospitals are going to keep their heads above water and be able to treat very sick people, people who are just pretty sick need to be at home or somewhere else. I've seen suggestions coming from Italy and Spain that they need systems where people who would normally be admitted into the hospital but don't need ICU care could either stay at home and receive daily visits from people who check their vitals and supply oxygen if needed, or that you need to create centralized places where non-critically ill people can get these services. You aren't going to get people to accept this stuff if you've persuaded them that they are at really high risk when they aren't.

To be clear, Poly's point is valid

pigou

There's a really urgent need to get better data. California is doing some of it by randomly selecting people to test from some communities, including people with no symptoms and no connection to people who tested positive. That's a much better way to get a real sense of infection rates and share requiring hospitalization. That is, right now we have P(hospitalization|testing) and P(mortality|testing), and P(testing|symptoms). That's going to upward bias the actual estimate. The problem is that this still doesn't let us detect people who already had the virus and are now immune to it (so the estimate is still going to be too high). For that, we'll need a different test (that I'm sure is being developed).

Incidentally, if you look on reddit's nursing forum, you'll see universal reporting that ER visits are down massively. People avoid going to the hospital for minor injuries, most likely because they don't want to get in contact with potential COVID patients. That's also going to drive demand for testing: if you have a mild fever, are you really going to risk exposure just to confirm one way or another? No: you'll just stay home unless your symptoms get more severe. That's the best outcome for the healthcare system, too -- we don't need everyone with mild symptoms taking up scarce hospital beds.

If it turns out that for 10,000 known positive cases there were 90,000 unknown positive cases, the mortality rate drops from 2% to 0.02%. The former is "shut down the economy!" bad, the latter is basically business as usual.

None of which is to say that the optimal policy response is business as usual. In a crisis, you make decisions with the information you have, not the information you wish you had. But at the same time, we could have been ahead of the game if it hadn't taken us months to approve commercial labs to do COVID testing. A municipal health department running 20 tests per day by hand vs. a single Cobas machine running 3,000 per day fully automated (and there are over 100 of them scattered throughout the country). Only one of those is useful. Incidentally, FDA only just now relaxed ventilator regulation, allowing manufacturers minor changes like using a different type of plastic or an engine sourced from a different supplier without going through re-certification. So we should expect production of those to speed up, too. Maybe we can end the trade war with China so these supplies don't get stuck at the border.

Morris Zapp

I was really scared about all the reports of people in their 20s, etc.  getting a serious case of the virus, since I have adult children.  However, I wondered if anyone has looked at whether those who are getting serious cases have perhaps vaped in the past?  Given the stories last year about how vaping damages your lungs, I wondered if it might be something that made coronavirus worse.  Haven't seen anything about that, however.  Has anyone looked at this?

nebo113

From polly_mer:  What scares me are the reports that rural hospitals may close before they even get to treat any COVID-19 because they were already in dire financial straits.

My rural area definitely falls into that category but I just learned that one small area hospital (within a larger combined, multi-state health system) is being converted to Covid 19.  And now one confirmed case at area nursing home.

Cheerful

Illness rates reported today are apparently due to people being infected up to 14 days ago.  There is a lag time for state and local shut downs to yield results in terms of fewer reported cases.



apostrophe

Quote from: Stockmann on March 24, 2020, 01:02:41 PM
Quote from: Cheerful on March 24, 2020, 09:48:42 AM
Quote from: Stockmann on March 24, 2020, 09:33:44 AM
The regional/cultural factor seems to outweigh everything else, as the Far Eastern countries with good numbers include both democracies and dictatorships, and the Western countries doing badly include countries with very different politics and healthcare systems.

Thanks, Stockmann.  Many lessons to be learned.

Many U.S. politicians (D and R) have shifted to focusing on mortality rates and characterizing the virus as "most people don't die" and "it's an old people's problem."  They are ignoring that the virus can be a long, miserable thing for a person to endure, regardless of age, with long-term consequences to individual health unknown.

Not only that - in Lombardy, people have died of things unrelated to coronavirus because there aren't enough respirators to go around - coronavirus patients aren't the only ones who need them. Also, doctors in parts of Lombardy are having to choose which patients to even try to save, because they can't try to save all. There are also patients in hospital corridors because there are not enough beds. I doubt the healthcare system in, say, Appalachia, Detroit, rural Alabama or Mississippi is much better than that in Lombardy. So spring breakers in Florida are not going to die of coronavirus directly, but they better hope if they have a serious accident in a drunken antic that the local hospital isn't already overwhelmed with coronavirus patients.

I realize this wasn't your main point, but the opposite is likely the case—the hospitals in Lombardy (certainly in Milan) are likely to be much better than those in the US.

Parasaurolophus

A friend asked, and I have no idea, but imagine someone here does: is there any reason why we can't use the oxygen masks on airplanes to supplement the ventilator shortage? (I mean, I know they're not ventilators, but I imagine they might be helpful for less severe cases?)
I know it's a genus.

Puget

Quote from: Parasaurolophus on March 25, 2020, 08:44:50 AM
A friend asked, and I have no idea, but imagine someone here does: is there any reason why we can't use the oxygen masks on airplanes to supplement the ventilator shortage? (I mean, I know they're not ventilators, but I imagine they might be helpful for less severe cases?)

Unfortunately they are not remotely the same thing. Those just supply the oxygen levels of a normally pressurized cabin (the equivalent of 5000-8000 ft elevation) in the case of cabin depressurization. A ventilator breathes *for* the patient when they are unable to breath on their own. Supplemental oxygen may help some patients but that is already given in hospitals. Ventilators are what there is a critical shortage of.
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