Questioning Conventional Wisdom - The virus

[dneal]

To start with a couple of asides:

1. The interviews Peter Robinson does at the Hoover Institution are very diverse and amazingly well done. He is a master. I recommend adding the “Uncommon Knowledge” pieces to your weekly schedule.

2. Since some of the more emotional posters should have me “ignored” now, hopefully a respectful conversation can take place. Please move on if you only have smug, smarmy comments.

Here is an intriguing discussion with Dr. Jay I’mgonnabutcherhislastname. He’s an MD and a fellow who contributes to economic policy research.

The points he makes regarding the “denominator” are crucial, but the whole thing is highly informative and great food for thought.


http://Www.youtube.com/watch?v=-UO3Wd5urg0

[mhosea]

I don't think Fauci or Birx would disagree with the assertion that we don't know the true mortality rate. There was a question at one of the press conferences, maybe 3 or 4 days ago (who can remember days anymore), where a CNN or other anti-Trump person was trying to manufacture evidence that Trump had "fiddled while Rome burned", i.e. if Trump had raised the alarm sooner and without ambiguity, could lives have been saved. Both Dr. Fauci and Birx responded that it was unknowable whether earlier mitigation would have helped precisely because we have no idea whether the virus was present and prevalent at earlier dates or not. Birx then emphasized the need for a test that determines whether someone has been exposed in the past and is now immune.

I think what's disturbing about this virus, and obviously different from non-novel influenza viruses in circulation, is the rate of hospitalization among those who develop enough symptoms to feel like they're fairly sick, as you would with the flu. If the rate were no worse than the flu, then we would not see hospitals filling up in Italy, nor shortages of ventilators, or anything of that sort. A paper I was reading the other day, which was just a run-down of statistics collected, implied (if I was reading it correctly) that for adults without serious comorbidities, the rate of hospitalization was around 10%, which is huge, i.e. get sick and have nothing else wrong with you, and you've got a 10% chance of needing to be admitted to a hospital. I don't know about you, but I don't think three weeks in a hospital is very attractive prospect to entertain at that probability rate. If there is a treatment that will knock that down to a 1% probability, it would be game changer. I know Tamiflu helps with the flu, but paradoxically, it does not reduce the rate of serious complications. Nevertheless, I keep hearing generally positive things about hydroxychloroquine (sometimes with azithromycin). I think they are focusing mainly on seriously ill patients, but I have to wonder whether it might help if prescribed after people develop symptoms and before they develop shortness of breath. There are other treatments in the works as well.

One area where I vociferously disagree with Fauci, and I do so as a scientist, is the notion that we have to prove treatments safe and effective before employing them at a time like this. This is parochial thinking. We're not talking about an anti-hypertensive or some other drug which will ostensibly be taken for life. If the treatment can reasonably be expected not to do serious, lasting harm, and it isn't expensive, if in the worst case it is no better than placebo, then not having solid proof that it is better than placebo should be no obstacle. Sure, a placebo would be cheaper, but expense is not a factor when you've shut down the economy because you do not have a cure. Anecdotal studies do not prove efficacy, but the only thing we really need to know in a time when it makes sense to act on imperfect knowledge, like now, is that it will likely do no harm. If it doesn't work, we'll stop suspecting that it does PDQ, because it won't.

[manoeuver]

dneal, are you willing to bullet point or summarize the contents of that video for those of us who aren't able to watch it?

I believe it's important to have a good faith conversation that questions what's going on and the decisions we're all subject to, but I am not able to put a half hour into watching the video at present.

I could guess at what they're talking about but I don't suppose that would be in good faith.

thanks!

[dneal]

@mhosea - Great post. The thing that gets me about Italy is that it was a relatively high average age population, which appears to be more susceptible (but that goes for the flu as well); and that they have one of the smallest numbers of per-capita critical care beds. Even if it was a "perfect storm", you make a good point in raising the question of why they were affected so seriously. Perhaps it was a matter of exceeding capacity, which is the justification for the "flatten the curve" approach.

You did make me wonder about the hospitalization rate for influenza. Here's the link to the CDC (https://www.cdc.gov/flu/about/burden/index.html). It varies year to year, but it's much higher than I thought (and that's with the availability of a vaccine). I wonder how the public would react if the media hyped it every year like they have this strain of coronavirus.

I agree with you about treatment. Hydroxychloroquine is prescribed as a preventative as well as a treatment for malaria, although the Army gave us Mefloquine for deployments. Anyway, it does seem odd that suddenly health organizations are hesitant about it. My understanding is that azithromycin is added for secondary (bacterial) infections.


@manoeuver - I suppose I could do that, but I'd need to watch it again and make notes. Give me some time.

[dneal]

dneal, are you willing to bullet point or summarize the contents of that video for those of us who aren't able to watch it?


This is a summary, not a transcript; so I've reorganized some parts of the discussion to improve brevity.

Dr. Bhattacharya is an MD that has been working on the coronavirus nonstop, but also holds a Ph D in Economics. It's useful because he understands both sides of the coin, so to speak.

He wrote an article for the Wall Street Journal (published 24 March) titled "Is the Coronavirus as Deadly as They Say?" (https://www.wsj.com/articles/is-the-coronavirus-as-deadly-as-they-say-11585088464)

Although it garnered both nods of approval and accusations of irresponsibility, he notes that although "experts" are viewed as "authorities"; they need to be as openly honest about what they do and don't know - and they don't know a lot right now (although they're learning rapidly).

Dr. Fauci from the CDC was quoted as saying (in early March) "The flu has a mortality rate of 0.1%. This [coronavirus] has a mortality rate of ten times that." Dr. B's opinion, published in his article is: "An epidemic seed on January 1st implies that by March 9th about six million people in the U.S. would have been infected. As of March 23... there were 499 Covid-19 deaths in the U.S... that's a mortality rate of 0.01%."

There is an order of magnitude difference here. Dr. B is clear that they don't know, are making educated guesses, and the discussion gets to what we're actually talking about. The term is "Measured Case Fatality Rate". That's:

Total number of new deaths due to disease
--------------------------------------------
Total number of incident patients with disease

The problem is that we don't really know the denominator, and current estimates are worst case based on a denominator of those whose illness was severe enough to warrant seeking treatment. The FDA approved a serological test a week or so ago. That will identify if a person possesses antibodies (indicating they had the virus and recovered). Until now, we were only able to identify the presence of the virus.

The media picks up on the numbers (particularly the worst case numbers) and tend to sensationalize them. Politicians respond to that. What we've seen is a very wide range, from an epidemic that will kill 2m-4m people, to one that will kill 50k-100k. That's an incredibly broad range and the policies you implement in either case are significantly different.

Holman W. Jenkins, Jr. (an journalist at the WSJ) had a quote referenced: "We are crushing our economy simply to meter out how quickly these consequences fall on our exhausted healthcare workers... I repeat: We are slowing the economy to a crawl to slot the rate of a thing happening that will happen anyway."

Dr. B points out that the virus is in fact deadly, there's value to "flattening the curve", and Italy is a case study when a healthcare system is overwhelmed. BUT, If the case fatality rate is actually much less than the worst case estimates, then this essentially "universal quarantine" we have is incredibly costly.

Although people make the argument that "it's dollars to lives", it's actually "lives to lives" and a global economic collapse will cost the lives of millions of people. The global rise in GDP has raised life expectancy everywhere. Countries are able to care for their populations. In poorer countries, cases of diseases have slowly been eliminated. That won't be the case as economies suffer or collapse. The last "great recession" alone documented lives lost to despair (opioid overdose, suicide due to depression, etc...). It will unnecessarily shorten life expectancy, particularly in poorer countries, if nothing else.

So what to do...?

A few weeks of quarantine will not eliminate the virus. We will need to evaluate healthcare capacity regionally and let people get on with their economic lives in those places where we can manage the infection. Widespread testing of the new serological test will help with this. There are several treatments being experimented with, and this raises the question mhosea alludes to with whether or not the ponderous bureaucracy is helping or hindering.

And the future...?

Dr. B thinks this is the new normal, and the cost of globalization. What we need is a 21st century approach to this happening again, and a method of "population surveillance" (not in a nefarious "big brother" sense), but routinely surveying blood samples, for example, just like we do with political opinion and other polls/surveys.

---

Here is the video description, which is informative as well.

Dr. Jay Bhattacharya is a professor of medicine at Stanford University. He is a research associate at the National Bureau of Economic Research and a senior fellow at both the Stanford Institute for Economic Policy Research and the Stanford Freeman Spogli Institute. His March 24, 2020, article in the Wall Street Journal questions the premise that “coronavirus would kill millions without shelter-in-place orders and quarantines.” In the article he suggests that “there’s little evidence to confirm that premise—and projections of the death toll could plausibly be orders of magnitude too high.” In this edition of Uncommon Knowledge with Peter Robinson we asked Dr. Bhattacharya to defend that statement and describe to us how he arrived at this conclusion. We get into the details of his research, which used data collected from hotspots around the world and his background as a doctor, a medical researcher, and an economist. It’s not popular right now to question conventional wisdom on sheltering in place, but Dr. Bhattacharya makes a strong case for challenging it, based in economics and science.

[Chrissy]

According to what I've seen online some of those stats have changed. As of today there are 339,028 known cases of coronavirus in the US and out of those 9,687 have sadly died. That number has risen 2355 cases and 71 deaths from yesterday.
No cases were noted before February 15th, so IMHO we shouldn't be taking January 1st as the start point.

[Ray-VIgo]

We have two large unknowns: the first is how many people actually have gotten the coronavirus, and the second is what will happen to the law and economy. Where I am, in order to get tested, you need a doctor's order and to be pretty sick already. Otherwise, you are told to just presume you have coronavirus and quarantine yourself at home for two weeks. We have no clue how many people have actually gotten the coronavirus. At best, we're using the test data as a sort of crude "tip of the iceberg" multiplier. Then there is the question of whether people, as is happening now in China, become infected a second time in an asymptomatic way - how contagious is that?

Second, business has stopped or severely slowed for most entities and employees (not all, but most people). Meanwhile debts and overhead continue to accrue on a time basis, regardless of the coronavirus or people being out of work. Does the government continue to offer assistance like unemployment or SBA loans? If so, what if the processing time is so large as to render them useless - if someone goes on unemployment but does not see any money for 2 months, what does that mean? Does the government try to "freeze" debts (e.g., call for a moratorium on mortgage payments? Rents? etc?). What are the legal implications of such action (e.g., a "taking" of property without due compensation?). Some jurisdictions have put a moratorium on evictions - but what happens to the ball of rent or mortgage payments once the crisis has passed? What are the limits of governance by executive orders? Where I am located the governor has suspended whole swaths of state law by fiat - 200 years of statutes swept away by a signature. Which of these actions are constitutional? What is the remedy if there is an unconstitutional act, and how will it be handled (our state courts here are shut down to everything except emergency orders). Will all of the statutes go back into effect when this is over, or will some of them continue to be suspended? What role does the government have in combating hoarding or ensuring supply chain (e.g., N95 masks perhaps, but what about toilet paper and other secondary sanitary items that seem unrelated, but which cause panic)?

The United States will rise to the occasion and gain the upper-hand in due course. What concerns me is the initial phase of haphazard response, in looking at federal and state governments. Only in the week or so has the full machinery come to bear in expanding hospital capacity and allotting resources. I think we're finding our feet more and more as time goes on. But there needs to be hard lessons taken from the early response and lack of coordination and comprehension. In retrospect, the country needed to jump right onto testing prep, coordination production of vital machines, and allocating hospital resources as soon as we learned about the outbreak getting out of control in China (and certainly China willfully covered up the extent of the problem until it proved to be too much). The notion of denial that, "it can't or won't get as far as here" should go into the dustbin.

[dneal]

According to what I've seen online some of those stats have changed. As of today there are 339,028 known cases of coronavirus in the US and out of those 9,687 have sadly died. That number has risen 2355 cases and 71 deaths from yesterday.
No cases were noted before February 15th, so IMHO we shouldn't be taking January 1st as the start point.

Good point, and I have no idea when we would start counting a thing we weren't really looking for - let alone capable of testing for. I wonder how many people just thought they had the flu (or even died from it), when it could have been coronavirus. Of course we will never really know.

I'm reminded of the time I got Lyme disease from a tick bite at Fort Chaffee, AR. Symptoms showed some time later, and when I called my doctor with my suspicions, particularly the tell-tale "ring" around the site of the bite. He was on vacation, but his quack partner responded: "There's no way you could have Lyme, because no cases have been reported in this area". Well, with that logic there never would be; never mind that I wasn't in "this area" when I was bitten...

[mhosea]

I had been looking at https://covid19.healthdata.org/projections, which Massachusetts had been tracking pretty closely, actually just above the projection line. The latest update made it virtually useless, extending the confidence bands so high and so low that it almost can't be wrong, and worse, I can't even correlate their actual figure for the number of deaths in MA on April 4 with any official report. Previously I had been able to. At any rate, if anything about this model is useful, within 2 weeks it should be apparent what will happen in Massachusetts. Either they will be talking about hospitals being full and no respirators available, or they won't. My wife is a medical coder who works remotely for a hospital system that extends from NM to FL and up to TN. Because elective procedures have been put off, the coders don't have enough work. The hospitals must be at very low utilization. You have to wonder whether putting off elective procedures in states that have not been hard hit was the correct decision in hindsight. If it is about to get bad somewhere, then maybe start putting them off at that point, not weeks beforehand.

[manoeuver]

Everything about this epidemic is a lesson in how to act when you don't have information.

I understand that people are skeptical of the measures we're taking to contain the virus in the US.
These measures hurt-- I'm feeling it. My businesses are currently mostly demolished.

It's a double whammy, cause if the measures work as we hope they do, the numbers of infected and the numbers of deaths will stay low.
If we're able to keep casualties low, we'll never hear the end of it from the armchair critics.

Another criticism I hear is coming almost exclusively from Academia: the data we have don't support the measures we're taking.
As if that data exists somewhere. It's deadly nonsense. You don't wait for a DNA analysis to find out if it's a grizzly or black bear in your tent before you do something.
You don't put your seat belt on after you've determined that yes, your car has been t-boned.

Looking forward, I can't imagine Americans supporting measures that would make border lockdowns and contact tracing easy for fed and local governments to enact.
And I'm not sure they should anyway. We've lost faith in our institutions, and for damn good reasons.

I dunno. stay safe folks.

[welch]

We don't know the number of deaths from the Coronavirus. A cause of death has to be assigned by a medical examiner, at least in the US. Different ME's can have different standards. It not certain that medical people should be taking time from treating CV to assign an accurate cause of death.

The entire video seems to be yet another silly example of right-wing college boys who have an over-powering desire to defend Trump's inaction, before mid-March, and to defend Trump's wacky-toon daily meandering attacks on doctors, hospitals, experts, and states with Democratic governors.

Pointless.

[Dave]

Sentinel surveillance already exists for influenza (it is a reportable disease), so setting one up for SARS-CoV-2 should be fairly straightforward.

Incidentally, in the video the speaker mentions EVD* in the same breath as the current pandemic. EVD never achieved pandemic status. However, lessons learned from attempts to contain and treat this much more dangerous infection are valuable. Typically those measures included PPE for health workers, isolation, quarantine and contact tracing. All methods that have been tried and/or are in place for dealing with SARS-CoV-2 in countries other than the US, with good results in many places.

There is now a vaccine for EVD - which took nearly 5 years to develop.

So what is to be done now? Hard to say.

H1N1, swine flu or US flu if we use Trump's logic behind naming these things, was reported by the WHO as a pandemic two months after the first cases were reported in the US. About the same length of time it took to achieve significant infection levels in all 50 States. H1N1 resulted in approximately 61 million infected Americans and 12,469 confirmed disease-related deaths (fatality rate 0.02%). Current SARS-CoV-2 confirmed deaths in the US has just passed 10,000.* These are scary numbers.

There is now a vaccine for H1N1 - which took about 7 months to develop.

If people continue working, if non-symptomatic people may be carriers, and if the infection rate and mechanisms are correct and the death rate fits to current modelling, then it can be expected that the sheer number of deaths in the US will escalate geometrically. This will have a knock effect in general industry, to say nothing of the potentially catastrophic burden to the health services - which will further exacerbate the situation.

There will be a vaccine for SARS-CoV-2 in due course.

One point to consider is that the Great Depression (1929-37) is not a good indicator of what an economic downturn would look like today. Mortality rates as a total remained more or less steady, although there were shifts in rates across mechanisms of death - for example, vehicle related deaths dropped sharply while suicide rates rose (the former by a much greater number). Also, that period of history (globally) is marked by a number of innovations and improvements in healthcare, which will affect the statistics. In addition, during the Great Depression there wasn't anywhere near the level of federal reserve that there is today, so a bailout was much less, and was more or less was addressed afterwards by the New Deal. At present the US has this massive bailout going, but nothing has been yet said about what happens later - at least not that I've read.



Edited to add two points of clarification:

EVD = Ebola viral disease.

In the death rate comparison between H1N1 and SARS-CoV-2, as the video shows, the incidence of the SARS-CoV-2 is unknown, but it is perhaps reasonable at this stage to predict it is less than the 61mil seen in H1N1, meaning the measured case fatality rate (MCFR) will be higher for now. However, this doesn't say anything about the MCFR in the future. Incidence may decline and overall death rate may be adjusted to a much lower figure.

[dneal]

We don't know the number of deaths from the Coronavirus. A cause of death has to be assigned by a medical examiner, at least in the US. Different ME's can have different standards. It not certain that medical people should be taking time from treating CV to assign an accurate cause of death.

The entire video seems to be yet another silly example of right-wing college boys who have an over-powering desire to defend Trump's inaction, before mid-March, and to defend Trump's wacky-toon daily meandering attacks on doctors, hospitals, experts, and states with Democratic governors.

Pointless.

Thanks for contributing absolutely nothing worthwhile to this thread. Here’s (https://fpgeeks.com/forum/showthread.php/30840-Combatting-the-virus-and-economic-risk) the other one, feel free to go be an ass in there. I’ll even play.

See Dave’s post for an example of how to present the other side of the argument. Thanks Dave.

[mhosea]

The entire video seems to be yet another silly example of right-wing college boys who have an over-powering desire to defend Trump's inaction, before mid-March, and to defend Trump's wacky-toon daily meandering attacks on doctors, hospitals, experts, and states with Democratic governors.


You might want to watch the video before trying to characterize it.

[dneal]

Sentinel surveillance already exists for influenza (it is a reportable disease), so setting one up for SARS-CoV-2 should be fairly straightforward.

I think that was the point he was making, but I wasn't clear if he meant that we randomly sample things like lipid draws just to check. I don't even know how that would work if it's another novel virus. Perhaps its just limiting to symptoms present, and sending a blood sample off to a research lab. The DOD was supposed to stand up three (I think, maybe four), but that's been a bureaucratic hole money has been dumped into with no worthwhile results so far.


If people continue working, if non-symptomatic people may be carriers, and if the infection rate and mechanisms are correct and the death rate fits to current modelling, then it can be expected that the sheer number of deaths in the US will escalate geometrically. This will have a knock effect in general industry, to say nothing of the potentially catastrophic burden to the health services - which will further exacerbate the situation.

I agree to a great extent. It seems that resources need to be invested in identifying 3 general groups:

1. Those with antibodies present, who are assumed to have had the disease. They go back to their normal lives.
2. Those with the active virus. They quarantine and are treated appropriately.
3. Those with neither. I'm not sure what to do about them. Some are easier sub-categories, like those more vulnerable. But shouldn't we assume the inevitability of catching the virus? The Spanish Flu ran for about 3 years.


One point to consider is that the Great Depression (1929-37) is not a good indicator of what an economic downturn would look like today. Mortality rates as a total remained more or less steady, although there were shifts in rates across mechanisms of death - for example, vehicle related deaths dropped sharply while suicide rates rose (the former by a much greater number). Also, that period of history (globally) is marked by a number of innovations and improvements in healthcare, which will affect the statistics. In addition, during the Great Depression there wasn't anywhere near the level of federal reserve that there is today, so a bailout was much less, and was more or less was addressed afterwards by the New Deal. At present the US has this massive bailout going, but nothing has been yet said about what happens later - at least not that I've read.

Great points, but I think it misses a couple of things. The society during the Depression was largely self sufficient with food production. That's not the case anymore. Hungry people are dangerous people. The other thing is how the Depression affected the world outside of the U.S. There are lots of reasons for WWII, ranging from the shoddiness of the Treaty of Versailles to the adjustment from an Imperial Europe to a Democratic one; but the hyperinflation exhibited during the Weimar Republic weighed heavily. It will be interesting to see how relations between countries pan out when this is over, particularly the EU.

[TSherbs]

This video presents the conventional wisdom; it doesn't question it. The math was basic, and both presenters admitted that no one knows accurate morbidity rates. This is what everyone says, if you pay attention past the headlines and sound bites. Everyone already knows that we are instituting measures now to prevent worst-case scenarios, even while we don't know accurate infection rates. The interviewee did not question the merits of flattening the curve, either. Flattening the curve has never meant that fewer people are exposed in total. I didn't see any unconventional wisdom here at all. Everyone already knows that IF we find out that certain people are immune or that the medical systems can handle the serious case load, then we will ease restrictions. Second and third waves of disease spread are not uncommon, which we also already know. Our restriction lifting will likely be in stages and with purposeful planning. We already know this, too. Many industries will alter how they manage worker and customer space. We already know this too. Some people haven't thought about it all much, but that is just some people.

Sent from my Moto E (4) using Tapatalk

[Dave]

Just some thoughts.


1. Those with antibodies present, who are assumed to have had the disease. They go back to their normal lives.
2. Those with the active virus. They quarantine and are treated appropriately.
3. Those with neither. I'm not sure what to do about them. Some are easier sub-categories, like those more vulnerable. But shouldn't we assume the inevitability of catching the virus? The Spanish Flu ran for about 3 years.

1. At present it is not known if those with antibodies are expressing immunity or just exposure to the virus.1
2. Are the terms correct? If someone is actively infected they should be in isolation rather than quarantine. Sorry to be nitpicky, but for those who may not know isolation and quarantine are not the same thing.2
3. Very difficult to assess. Those with no antibodies are generally those who have not been exposed3 to the virus. These are all potentials for infection. At present, considering that it is unknown what is causing deaths in healthy persons who get infected, it is hard to make a recommendation other than quarantine.4 For those with co-morbidities quarantine is likely the most effective action for now.


Regarding the Great Depression, those are good global points, and certainly something to ponder on as we come out of this pandemic. In my other post I was focussing on the US response at the time, without looking at the bigger picture. A little artificial I suppose, but sometimes it helps to separate out parts for a closer look. A change in response to the economic shift now, compared to then, may have a different global impact in the future compared to post-1937. I may have misread the situation, so do take this point with caution.



Some clarifying notes for the above comments. Apologies if these are obvious to some of you.


It is possible to be infected with a disease and survive without becoming immune. Antibodies to the disease that are detected by test indicate only a person's immune response, and not whether that response was adequate to recovery.
In isolation an infected person is kept separate from the population of uninfected persons. In quarantine, persons who may have been exposed to a disease vector are separated and their movements restricted while waiting to see if the disease presents in them.
For clarity, in epidemiology, exposure specifically relates to close contact or proximity to a vector affecting health, such as a pathogen.
Only suggesting this because other plausible courses of action are not clear.

[VertOlive]

Thanks to all. This thread has been a breath of fresh air.

[dneal]

This video presents the conventional wisdom; it doesn't question it. The math was basic, and both presenters admitted that no one knows accurate morbidity rates. This is what everyone says, if you pay attention past the headlines and sound bites. Everyone already knows that we are instituting measures now to prevent worst-case scenarios, even while we don't know accurate infection rates. The interviewee did not question the merits of flattening the curve, either. Flattening the curve has never meant that fewer people are exposed in total. I didn't see any unconventional wisdom here at all. Everyone already knows that IF we find out that certain people are immune or that the medical systems can handle the serious case load, then we will ease restrictions. Second and third waves of disease spread are not uncommon, which we also already know. Our restriction lifting will likely be in stages and with purposeful planning. We already know this, too. Many industries will alter how they manage worker and customer space. We already know this too. Some people haven't thought about it all much, but that is just some people.

Sent from my Moto E (4) using Tapatalk

In fairness, it's a fast moving train and the article they're discussing was published two weeks ago. The interview was a week ago. Doesn't seem like much, but those are light years of learning about this thing. The conventional wisdom at that time was anywhere from 3-8% fatality rate (or more, depending on who was asked).

[ethernautrix]

Thanks to all. This thread has been a breath of fresh air.

Ditto.

This is how we can have nice things.

[TSherbs]

This video presents the conventional wisdom; it doesn't question it. The math was basic, and both presenters admitted that no one knows accurate morbidity rates. This is what everyone says, if you pay attention past the headlines and sound bites. Everyone already knows that we are instituting measures now to prevent worst-case scenarios, even while we don't know accurate infection rates. The interviewee did not question the merits of flattening the curve, either. Flattening the curve has never meant that fewer people are exposed in total. I didn't see any unconventional wisdom here at all. Everyone already knows that IF we find out that certain people are immune or that the medical systems can handle the serious case load, then we will ease restrictions. Second and third waves of disease spread are not uncommon, which we also already know. Our restriction lifting will likely be in stages and with purposeful planning. We already know this, too. Many industries will alter how they manage worker and customer space. We already know this too. Some people haven't thought about it all much, but that is just some people.

Sent from my Moto E (4) using Tapatalk

In fairness, it's a fast moving train and the article they're discussing was published two weeks ago. The interview was a week ago. Doesn't seem like much, but those are light years of learning about this thing. The conventional wisdom at that time was anywhere from 3-8% fatality rate (or more, depending on who was asked).You posted it two days ago, right? I'm simply pointing out that there is actually much agreement after you cut through journalistic and political polarity, which revolts me on the television and on these threads. That gentleman doing the interview kept trying to amp up the guy he was interviewing. I was pleased with how the interviewee resisted hyperbole and cheap zingers.

Sent from my Moto E (4) using Tapatalk

[dneal]

This video presents the conventional wisdom; it doesn't question it. The math was basic, and both presenters admitted that no one knows accurate morbidity rates. This is what everyone says, if you pay attention past the headlines and sound bites. Everyone already knows that we are instituting measures now to prevent worst-case scenarios, even while we don't know accurate infection rates. The interviewee did not question the merits of flattening the curve, either. Flattening the curve has never meant that fewer people are exposed in total. I didn't see any unconventional wisdom here at all. Everyone already knows that IF we find out that certain people are immune or that the medical systems can handle the serious case load, then we will ease restrictions. Second and third waves of disease spread are not uncommon, which we also already know. Our restriction lifting will likely be in stages and with purposeful planning. We already know this, too. Many industries will alter how they manage worker and customer space. We already know this too. Some people haven't thought about it all much, but that is just some people.

Sent from my Moto E (4) using Tapatalk

In fairness, it's a fast moving train and the article they're discussing was published two weeks ago. The interview was a week ago. Doesn't seem like much, but those are light years of learning about this thing. The conventional wisdom at that time was anywhere from 3-8% fatality rate (or more, depending on who was asked).You posted it two days ago, right? I'm simply pointing out that there is actually much agreement after you cut through journalistic and political polarity, which revolts me on the television and on these threads. That gentleman doing the interview kept trying to amp up the guy he was interviewing. I was pleased with how the interviewee resisted hyperbole and cheap zingers.

Sent from my Moto E (4) using Tapatalk

Peter Robinson using hyperbole and cheap zingers? Clearly you're unfamiliar with him or the series. He's playing devil's advocate.

Here's a link to the series (https://www.youtube.com/playlist?list=PLq8BgDugd2oyqmYx6RdVlJfQeAdhJkhc3).

At any rate, there are plenty of "the sky is falling" people out there, particularly in the media. You seem to be offering that we've all agreed that it's not nearly as bad as we've been led to believe initially, or that the scientists have come to some consensus. They haven't, "measures" have been extended, we're still talking about overwhelming the system and trumpeting the death count. Like mhosea has said, they've just drawn a range of severity from all to none, with some dotted line plotted in between. That's not conventional wisdom anymore. It's hedging bets.

[mhosea]

"Doctor Qanta Ahmed, Pulmonologist and Intensive Care Specialist from New York, reveals what it's really like in hospitals right now #Coronavirus. Dr. Ahmed also comments on the promise shown by Hydroxychloroquine."


https://www.youtube.com/watch?v=CNd7ml9VUAc

[Jon Szanto]

Why New York has 12 times as many coronavirus deaths as California
California is not in the clear yet, but its experience so far has some potential takeaways. (https://www.vox.com/2020/4/7/21205890/coronavirus-covid-19-pandemic-new-york-california)

[VertOlive]

Why New York has 12 times as many coronavirus deaths as California
California is not in the clear yet, but its experience so far has some potential takeaways. (https://www.vox.com/2020/4/7/21205890/coronavirus-covid-19-pandemic-new-york-california)

I have been musing a lot about California. There were thousands of people traveling to and from China from California for the Chinese New Year celebrations. This was the time frame during which the virus was afoot.

I can’t help but wonder if the illness has already run through the population there before we really knew what was going on. That said, it’s just an armchair theory. Besides the subway travel, what else is different about California vs New York?

[Jon Szanto]

I can’t help but wonder if the illness has already run through the population there before we really knew what was going on. That said, it’s just an armchair theory. Besides the subway travel, what else is different about California vs New York?

They did take pains to point out, lacking adequate testing resources and reporting speed (thanks to the poor Federal leadership), that it is difficult to know the exact breadth and depth of the infections here. That said, and with (always) the possibility of secondary peaks, the biggest differences appear to the the relatively quick, pro-active measures put in place statewide and locally. I give a lot of credit to Gov. Gavin Newsome so far, and quite of a bit of what he did was politically risky, but with the needs and concerns of the population paramount. I also think that there has been far better compliance by the citizens here - not perfect, since we are dealing with humans - something that has surprised me a bit. NYC is the densest city in the US, but SF is 2nd, so it was really wise that the mayor there closed things down.

These are all snapshots of the moment; we will all learn much more in the weeks, months and years ahead. I am grateful for the leadership locally and statewide; the news conferences here have been multiple light-years beyond the clown show from the White House, with good, clear directives to the citizens and a lot of information available. Only time will tell, and no matter how small the number of deaths, they are all painful. I wish more states would have gone this route and I am quite concerned about the many that are still playing cavalierly with the lives of their residents. We have become a very ignorant, arrogant nation, and the days of people looking out for the betterment of the population as a whole seem to be shrinking in the rear-view mirror.

[dneal]

The last two Hoover Institution videos have been with economists. One With Kevin Warsh (https://www.youtube.com/watch?v=Da8ZspnvR2s&list=PLq8BgDugd2oyqmYx6RdVlJfQeAdhJkhc3&index=3&t=0s) (who is an economist that served on the Federal Reserve board of governors), is pretty good.

I like this one a little better, and think it's slightly more relevant to the thread. It's shorter too... ;)


https://www.youtube.com/watch?v=TAYWWzD9c9E&list=PLq8BgDugd2oyqmYx6RdVlJfQeAdhJkhc3&index=3

[TSherbs]

Peter Robinson using hyperbole and cheap zingers? Clearly you're unfamiliar with him or the series. He's playing devil's advocate. No, I watched this interview, beginning to end. I thought Robinson smarmy. You may like him. The guy he interviewed was measured and not smarmy, despite Robinson's invitations to join in.



At any rate, there are plenty of "the sky is falling" people out there, particularly in the media. You seem to be offering that we've all agreed that it's not nearly as bad as we've been led to believe initially, or that the scientists have come to some consensus. I did not say the former. I did say the latter, and then elaborated. But not how you have depicted it. There is no empirical consensus about actual population infection rates. The consensus is that they don't know. Most epidemiologists say exactly that, just how the guy interviewed said it too. That's the consensus. The rest is hype-journalism or political spin-doctoring, or FPG clickbait.



Sent from my Moto E (4) using Tapatalk

[Jon Szanto]

From the Annals of Internal Medicine:
Use of Hydroxychloroquine and Chloroquine During the COVID-19 Pandemic: What Every Clinician Should Know (https://annals.org/aim/fullarticle/2764199/use-hydroxychloroquine-chloroquine-during-covid-19-pandemic-what-every-clinician?campaign_id=134&emc=edit_db_20200407&instance_id=17455&nl=debatable&regi_id=78967600&segment_id=24225&te=1&user_id=d951d2b237983dfdf744c821ffdcba11)

[dneal]

No, I watched this interview, beginning to end. I thought Robinson smarmy. You may like him. The guy he interviewed was measured and not smarmy, despite Robinson's invitations to join in.



At any rate, there are plenty of "the sky is falling" people out there, particularly in the media. You seem to be offering that we've all agreed that it's not nearly as bad as we've been led to believe initially, or that the scientists have come to some consensus. I did not say the former. I did say the latter, and then elaborated. But not how you have depicted it. There is no empirical consensus about actual population infection rates. The consensus is that they don't know. Most epidemiologists say exactly that, just how the guy interviewed said it too. That's the consensus. The rest is hype-journalism or political spin-doctoring, or FPG clickbait.



Sent from my Moto E (4) using Tapatalk

So you don’t like it then. Cool with me. Here’s the even cooler thing - there are a whole bunch of other threads on all sorts of topics scattered across the forum. You might like one of those.

[Chrissy]

From the Annals of Internal Medicine:
Use of Hydroxychloroquine and Chloroquine During the COVID-19 Pandemic: What Every Clinician Should Know (https://annals.org/aim/fullarticle/2764199/use-hydroxychloroquine-chloroquine-during-covid-19-pandemic-what-every-clinician?campaign_id=134&emc=edit_db_20200407&instance_id=17455&nl=debatable®i_id=78967600&segment_id=24225&te=1&user_id=d951d2b237983dfdf744c821ffdcba11)
That was an interesting article. Thanks. :)
I'm sure that a suitable vaccine will be developed following information gleaned from many sources.

[mhosea]

From the Annals of Internal Medicine:
Use of Hydroxychloroquine and Chloroquine During the COVID-19 Pandemic: What Every Clinician Should Know (https://annals.org/aim/fullarticle/2764199/use-hydroxychloroquine-chloroquine-during-covid-19-pandemic-what-every-clinician?campaign_id=134&emc=edit_db_20200407&instance_id=17455&nl=debatable®i_id=78967600&segment_id=24225&te=1&user_id=d951d2b237983dfdf744c821ffdcba11)
That was an interesting article. Thanks. :)
I'm sure that a suitable vaccine will be developed following information gleaned from many sources.

Be sure to read the comments attached to the article.

[dneal]

This link (https://www.worldometers.info/coronavirus/) was posted in another virus thread. I can't vouch for the accuracy, but they seem to have been thorough in their citing of sources.

Currently, they show 1,448,534 total cases and 83,416 deaths. Using the "measured case fatality rate", we arrive at:

83,416
------- = .05 or 5%
1,448,543

[Jon Szanto]

Be sure to read the comments attached to the article.

I.E. other people have differing opinions on the matter. Not a surprise.

[dneal]

Be sure to read the comments attached to the article.

I.E. other people have differing opinions on the matter. Not a surprise.

Did you read them? For me, they appeared to be behind a subscription wall.

[mhosea]

Be sure to read the comments attached to the article.

I.E. other people have differing opinions on the matter. Not a surprise.

Did you read them? For me, they appeared to be behind a subscription wall.

It auto-scrolls you back to the top to talk about a subscription. Just scroll back down.

[Jon Szanto]

Did you read them?

Yes. I wouldn't have commented if I hadn't. They were in plain sight when I clicked on "Comments" near the top. I don't have a subscription.

[mhosea]

Be sure to read the comments attached to the article.

I.E. other people have differing opinions on the matter. Not a surprise.

Rather than come at it as a question of opinions, I was more interested in the technical points. For example, one of them discussed the dosage problem, i.e. it is possible that higher dosages are required to elicit desired effects, and while accepted dosages for other "on label" purposes may be safe, it is uncertain whether dosages required to for the effect we are seeking here would be safe, at least for some patients. It's an even-handed comment, not simply disagreeing but rather adding substance to the discussion of what inconclusive prior studies actually imply.

To some extent the discussion of the inconclusive support for hydroxychloroquine use is a digression, as are the potential side-effects of hydroxychloroquine. The authors make these arguments (and end up overstating them, I suspect) because they are primarily concerned that hydroxychloroquine is effectively being taken from many patients who certainly benefit from it. They're trying to influence their colleagues' behavior in the hope (probably the vain hope) that it will help solve the supply problem for on-label users. At any rate, I fully agree with them that we should not allow this deprivation to continue. If hydroxychloroquine is not effective for COVID-19 treatment, then the deprivation is obviously not justified. If it is, then it still would not be justified. I'm not informed on the hydroxychloroquine supply chain, but what is needed for these on-label uses should come off the top, and what is left over is what we have to play with. If we're not happy with that, then we need to work on the supply problem just like we're working every other supply problem we have.

[Jon Szanto]

The number of scientific papers on the novel coronavirus is doubling every 14 days (https://qz.com/1834521/scientific-papers-on-novel-coronavirus-doubling-every-14-days/)

[Jon Szanto]

Rather than come at it as a question of opinions, I was more interested in the technical points.

Whatever the nomenclature you choose, it is an article followed by a number of comments offering varying viewpoints on, as you say, the technical matters of the discussion.

I am not a scientist or medical professional. I am not going to fake trying to be on top of the science aspect of all of these developments (note my next article submission on the amount and profundity of papers), that would be folly. I'm trying to listen to the voices that seem to be most viable and considered in their course of action. I also am hyper-aware, in the discouraging state of our society, of how this has all been diminished and politicized as partisan proponents push conspiracy theories and other absurdities.

I do quick reads of some of the alternate viewpoints and try to have a somewhat broader take on things. I don't ever fool myself into thinking I completely understand the science and pathology, at the deepest levels necessary, to make overt pronouncements on any of this.

[dneal]

Did you read them?

Yes. I wouldn't have commented if I hadn't. They were in plain sight when I clicked on "Comments" near the top. I don't have a subscription.

You seem to have taken something from my post that I didn’t intend.

I got a blank screen essentially, although maybe the page wouldn’t completely load; with “ This feature is available only to Registered Users” and nothing after.

Anyway, I thought the comments were just a bit more academic than the routine internet bickering of the general interwebz. The point about dismissing malaria medications because they aren’t proven, but we use “unproven” ventilators (and I’m not sure that’s a fair analogy) was relevant. We are very familiar with the benefits and side effects of malarial meds. If doctors are not violating the “do no harm” rule, why not use them; particularly when there is a life at stake?

[Jon Szanto]

You see, dneal, you are comfortable using the term "we". I'm not. You make it appear or sound as if these things are universally accepted, that "we" are all in agreement. If that were the case, there wouldn't be any debate at all. That means to me that "we" is actually "a number of people" or something.

I've read enough on the general topic to know that I won't be able to, on my own, judge the efficacy or veracity of the use of these alternative interventional avenues. I see a lot of people in the media and elsewhere speaking as if they are certain of much of this. I find that troubling at best.

Everything I have said here I've tried to be measured and contained.

[dneal]

Everything I have said here I've tried to be measured and contained.

I suspect that you have, and I have given you the benefit of the doubt when I read unnecessary remarks like White House Clown Show. Perhaps you could do the same for my lack of the requisite precision of language.

To paraphrase an earlier poster, we can have nice things... or not.

[Jon Szanto]

Everything I have said here I've tried to be measured and contained.

I suspect that you have, and I have given you the benefit of the doubt when I read unnecessary remarks like White House Clown Show. Perhaps you could do the same for my lack of the requisite precision of language.

Fair enough - I said I was trying. ;) Also, you misquoted me, which was not intentional, I'm certain, but not accurate, either.

What would be fascinating is if any single one person around here actually had expertise in the area. This is all just... occupying our time, I suppose.

[TSherbs]

Wait.

I want to be clear about my point of view: a clown does presently masquerade as the POTUS. His mishandling of improving our readiness for this virus once he was warned is another reason I look forward to voting him out in November of this year.

Jon is being magnanimous in retracting any part of his screed against Trump. I applaud it.

/Opinion

Sent from my Moto E (4) using Tapatalk

[Jon Szanto]

Jon is being magnanimous in retracting any part of his screed against Trump. I applaud it.

Ha! Well, look, I still believe it to my core, it's just that it didn't have a direct relevance to the topic at hand, so I agree that it would have been better left out. I could easily screed on for pages!

Honestly, I think - though I probably said it before - that I've contributed enough at this point. I wish everyone well.

[dneal]

Everything I have said here I've tried to be measured and contained.

I suspect that you have, and I have given you the benefit of the doubt when I read unnecessary remarks like White House Clown Show. Perhaps you could do the same for my lack of the requisite precision of language.

Fair enough - I said I was trying. ;) Also, you misquoted me, which was not intentional, I'm certain, but not accurate, either.

What would be fascinating is if any single one person around here actually had expertise in the area. This is all just... occupying our time, I suppose.

Well if we’re going to be pedantic, I didn’t quote you since I didn’t use quotation marks... ;)

I’ve found that there are a lot of people with expertise you wouldn’t expect to find on forums. I’m on a guitar forum where people argue about strings (among a great many other things). Composition, harmonic frequencies, sympathetic resonances, whether or not they should be stretched or if they even do stretch, etc... Turns out there are friggin’ Ph.D. physicists and lifelong metallurgists that play guitar. Even the professional luthiers learn something on occasion.

I don’t know the background of most folks here, but this isn’t just you’re either a doctor or you’re not issue; and they don’t even agree. Dr. Fauci isn’t an economist. John Taylor isn’t a medical doctor. Either’s opinion is enhanced in light of the other’s, and that’s why discussion is key. I’m neither a doctor or economist, but I am a professional logistician and strategic planner. I’m well versed in emergency management and interagency operations. Of course I’m not thinking we’re going to solve the world’s problems on a pen forum, but as Seneca the Younger said: “No man became wise by chance”.

If anything, I enjoy the mental exercise. Some don’t. I don’t understand why they don’t have the self-control to just move on without feeling like they have to take a shit in every thread they come across.

[Jon Szanto]

I don’t understand why they don’t have the self-control to just move on without feeling like they have to take a shit in every thread they come across.

Is that directed at me? If not, why put it in a response to me?

I mean, fuck, dneal. I deserve a bit better than that.

[dneal]

I don’t understand why they don’t have the self-control to just move on without feeling like they have to take a shit in every thread they come across.

Is that directed at me? If not, why put it in a response to me?

I mean, fuck, dneal. I deserve a bit better than that.

You know, I almost added “of course I’m not talking about you”. If I did, do you really think I’d be so subtle? Of course it isn’t directed at you. It’s in the post because I would have said it if we were sitting in person, because it’s a comment germane to the preceding paragraph and my thoughts on the the current state of the forum. There’s a lot of thread-shitting going on lately.

[dneal]

Back on topic, and particularly for mhosea...

Have you seen the reporting on the correlation that the Tuberculosis vaccine (Bacillus Calmette-Guerin vaccinations) and lower rates of coronavirus (specifically in S. Korea and Japan)? The studies themselves are showing as pre-printed and not yet peer reviewed.

[rocl]

I'm not sure what place an economist has in working out how to respond to a pandemic and neither is the PM down here in NZ. What she said on the topic sounds really simple so it probably can't be right. She said -
Ultimately, though the best protection for the economy is containing the virus, a widespread outbreak will hurt our economy far more in the long run than short-term measures to present prevent a mess outbreak occurring.

[dneal]

I'm not sure what place an economist has in working out how to respond to a pandemic and neither is the PM down here in NZ. What she said on the topic sounds really simple so it probably can't be right. She said -
Ultimately, though the best protection for the economy is containing the virus, a widespread outbreak will hurt our economy far more in the long run than short-term measures to present prevent a mess outbreak occurring.

I think there is some truth to her statement, but I’m not convinced the current strategy (here in the U.S. anyway) is the most effective way to minimize risk to both the economy and the public health. I don’t think it’s economic suicide, as some pundits argue; but I think the repercussions are going to be very serious. Most western nations carry enormous debt, and printing money to monetize it is dangerous. The EU concerns me, particularly those countries that are essentially bankrupt but tied to the Euro. The world’s economies are so closely linked that one drags down all.

[Dave]

Back on topic, and particularly for mhosea...

Have you seen the reporting on the correlation that the Tuberculosis vaccine (Bacillus Calmette-Guerin vaccinations) and lower rates of coronavirus (specifically in S. Korea and Japan)? The studies themselves are showing as pre-printed and not yet peer reviewed.

Interesting potential correlation between BCG vaccination and incidence of SARS-CoV-2. That's not to say that BCG vaccine is effective as a vaccine for SARS-CoV-2, but may offer some insights into possible components. Will add this to the candidate watch list.

[dneal]

Back on topic, and particularly for mhosea...

Have you seen the reporting on the correlation that the Tuberculosis vaccine (Bacillus Calmette-Guerin vaccinations) and lower rates of coronavirus (specifically in S. Korea and Japan)? The studies themselves are showing as pre-printed and not yet peer reviewed.

Interesting potential correlation between BCG vaccination and incidence of SARS-CoV-2. That's not to say that BCG vaccine is effective as a vaccine for SARS-CoV-2, but may offer some insights into possible components. Will add this to the candidate watch list.


Not potentially, but of course how strongly and whether it’s causal are a different story. I was looking through medical articles, and apparently they’ve studied using it for prevention of acute respiratory illness in seniors.

[Dave]

Do you have a link to the articles on this correlation? Haven't been able to read them yet, so was making a general statement.

[mhosea]

Have you seen the reporting on the correlation that the Tuberculosis vaccine (Bacillus Calmette-Guerin vaccinations) and lower rates of coronavirus (specifically in S. Korea and Japan)? The studies themselves are showing as pre-printed and not yet peer reviewed.

I had not. It certainly would be a welcome development if there turns out to be some causality there. The more plausible potential treatments the better. Avigan/Favipiravir made the news recently. Then we have possible artificial antibody drugs which could enter trials by early fall. We don't need to keep people from getting sick to get out of this pickle. We just need to figure out how to keep people from developing ARDS when they do get sick.

[dneal]

Do you have a link to the articles on this correlation? Haven't been able to read them yet, so was making a general statement.

I was being a little pedantic about “possible”, because correlations are just that - possibilities - based on a perceived association between two things.

Anyway, here are the links (there are news articles as well, but I didn’t post them). It’s early, and the articles haven’t been published. Not sure where they’re at for peer review. It seems we’re all over the place with the mechanics of the virus and treatment. I was just reading that it’s not necessarily pneumonia, but the ability of the blood to transport oxygen that’s the issue.

https://www.medrxiv.org/content/10.1101/2020.03.24.20042937v1

https://www.researchgate.net/publication/340263333_Correlation_between_universal_BCG_vaccin ation_policy_and_reduced_morbidity_and_mortality_f or_COVID-19_an_epidemiological_study

[Dave]

Thanks for the link - both to the same article, for some reason I had the impression there were two articles. My mistake.

Idle musings ahead!

As this is not peer reviewed as yet it would be premature (of me) to read too much into it. One thing that did jump out on a first pass was that the UK doesn't seem to get a mention (I may have overlooked it). This would be a bit strange as the UK has had BCG vaccination since 1953, which should make that country a useful comparator. I would want to look at the differences between the Japan and the UK, as the UK has 104.54 deaths per million (https://ourworldindata.org/grapher/total-covid-deaths-per-million) and Japan has 0.64 deaths per million (same source). Both have implanted national BCG vaccination policies just 6 years apart on incept. Of course this likely overlooks many factors of difference between the two countries/cultures, such as volume of movement of people in and out of the country, modes of living/working, among many others, that may affect the incidence of the disease in the respective populations. Hard to know what to control for I would think.


As before, I haven't really read it in detail so I may have missed something, like an exclusion criterion.

[Dave]

Just going back to the video on denominators. There are two numbers that are kind of known. One is the fatality rate among known cases, and one is the best case scenario if the entire US population is infected and nobody else dies. These are, as of this post being written, 14797/435160 or 3.4%, and 14797/327200000 (figure from 2018) or 0.005% respectively.

3.4% and 0.005%. That's a big range. It doesn't mean a great deal, other than to say the MCFR cannot get any better than 0.005% in the US, which is pretty low anyway; and it will definitely be worse than this because there will be more deaths. However, there is also the possibility that it could get worse than 3.4%.

For those who are not inclined to crunch numbers, 3.4% of the total population is a shade over 11 million. Now that is a truly scary number for a single country, so let's hope it doesn't go there.


Anyway, a simple way of getting one's head around the figures. Nothing really sciencey about it.

[dneal]

If this site (https://www.worldometers.info/coronavirus/) is accurate, globally we're at around a 5% case fatality rate and about 3.5% for the U.S.

The denominator still has issues, and will as long as we don't expand testing. The CDC plays a role in this (https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/testing.html), still saying "Not everyone needs to be tested for COVID-19". Context is important, and I think they mean that if you aren't experiencing symptoms then you don't need to be tested. From a treatment standpoint, not to mention one of resources; that makes perfect sense. From the standpoint of an organization that is supposed to be controlling disease, you would think they would want more testing - representative samples of the population at a minimum; to better understand what we're facing.

[Ray-VIgo]

Speaking of the United States, the errors of the early response were not the product of one person, whether it be the President or any other one leader. I saw an article in The Atlantic recently saying that the coronavirus debacle is "Trump's Fault", an assertion ridiculous on its face. The debacle is the product of a country in denial as a whole - that these periodic epidemics break out elsewhere, but they'll never really harm the United States. SARS and Ebola both made it to our proverbial "front door". But then they subsided. We'd been repeatedly spared the worst, so why would coronavirus be any different? After all, this was yet another outbreak of an exotic, alien pathogen on the far side of the world.

But this time was different, and having been spared repeatedly in the past, there was a denial that permeated virtually everything. This was exacerbated by inaccuracies and fabrications of a periodically hostile foreign government ruling the country where the virus originated. We had a state of denial that permeated the U.S. - that global trade and ease of travel did not have severe drawbacks. We ignored the lessons of things like the Emerald Ash Borer and other invasive plants and animals that were brought here as a byproduct of global trade. Our country, as a whole, asked for cheap goods, electronics and other items that come from trade, but never considered the darkside of it - the rapid transmission of pathogens and invasive things from other places. If we are as connected as we are to foreign countries, we must be prepared for the darkside of globalization as well. Nothing comes free.

As far as the U.S. is concerned, this is not about Trump. Clinton, Biden, and the whole lot of the present political leadership would have fallen into the exact same traps. This is about our country living in denial of how dangerous the world can actually be, and in a state where this sort of thing happened in other countries, but "never here". We fell into the old trap that our prosperity and vast distances would protect us again. But like past times, we are finding our feet more and more as time goes on as a country - most people are trying to slow or stop the spread of the virus, and various levels of government are beginning to churn their machinery to protect people. But the country should also learn the lesson that if we're going to have travel and trade as we do - on a global basis, we need to be prepared for the downsides and to have a plan in place to address it.

[TSherbs]

Trump vocalized this denial even once the experts were saying publicly otherwise. You're not wrong, but only one person is president right now; only he is responsible for his actions and words. Even though he also said publicly that he did not take responsibility "for anything", I plan to hold him responsible through my vote.

Sent from my Moto E (4) using Tapatalk

[dneal]

I think the comments on U.S. society’s perception of being insulated from those things that affect predominately the 3rd world are insightful, I would ask that we leave the political aspect and personalities for the political forum; lest this thing spiral out of control.

[TSherbs]

I think the comments on U.S. society’s perception of being insulated from those things that affect predominately the 3rd world are insightful, I would ask that we leave the political aspect and personalities for the political forum; lest this thing spiral out of control.I promise not use invective against another FPG member here. I certainly don't promise not to criticize (or support) leaders, scientific or political. Politicians and scientists make comments every day on this topic, and are part of establishing what is considered "conventional" in outlook or response. Easter, for example, became a target of hope for many people and a much discussed topic, because the POTUS said it. He also said, to hundreds of millions, that this disease would disappear in the summer. I heard this idea repeated by many others because he said that. It became a commonly traded notion. I consider it irresponsible that he made those pronouncements in those words, and it was no wonder to me that so many others in the medical/science fields who backpedaled and qualified and retracted those comments. Their efforts were to avoid the president's words becoming "conventional" understanding. There is nothing rude or inflammatory about my saying this.

If we all not degrade into personal invective against each other, we should be fine. What is so hard about that?



Sent from my Moto E (4) using Tapatalk

[dneal]

If we all not degrade into personal invective against each other, we should be fine. What is so hard about that?

It’s what I’ve posted time and time again, and I don’t understand it either... but it happens, usually with passive aggressive or snide condescension. I’m a crusty old soldier, and I’m happy to talk trash and use salty language if that’s what people want to do (although they usually don’t like the two way street). I don’t take it personally.

Problem is that once it starts down that road, people get butthurt and hold grudges.

p.s.: I thought you had me on “ignore”? ;)

[TSherbs]

[QUOTE]

Problem is that once it starts down that road, people get butthurt and hold grudges.

Is "butthurt" a crude anal sex reference, or maybe anal rape reference toward people whom you disagree with or spar with?





Sent from my Moto E (4) using Tapatalk

[rocl]

This guy has been questioning the conventional wisdom for a few weeks now.
https://www.youtube.com/watch?v=JnXzGB170GI&t=5s

[Dave]

In my opinion, any discussion about where this virus originated, and whether to blame that place, is irrelevant in the face of what needs to be done to combat it. The exception is if the place of origin holds information that could be used in the search for effective treatment/prevention. It is understood that this blame game is purely political - after all, as I note in another post (and paraphrasing myself), the US could be considered a net exporter of H1N1. So it works both ways, and neither accusation is at all helpful.

Despite this, the US is in the unfortunate position where one man spends far too much airtime promulgating inaccurate, misleading or plain false information about the pandemic. While he may be part of the national feeling of "these things happen in other countries, not here", he also has sufficient expert advisors to avoid worsening the situation. That he doesn't speaks of some difficult issues ahead of the American people.


As for questioning conventional wisdom on the virus, I will say this: something obviously had to be done. While what is being done could be considered conventional with respect to how other outbreaks are dealt with, it is still a good place to start. It would not surprise me if the approach gets modified as we go along. In fact I would be surprised if it didn't. So, I don't question the conventional wisdom per se, because at the start of a novel viral outbreak you can only you use the tools you have. How long it may take to figure out other plausible approaches to dealing with this situation is beyond my ability to sensibly predict.

Apologies to a bit of Capt. Obvious there. Just thought a couple of things needed re-saying, and wanted to clarify my position re conventional wisdom vs new ideas.

[dneal]

Problem is that once it starts down that road, people get butthurt and hold grudges.


Is "butthurt" a crude anal sex reference, or maybe anal rape reference toward people whom you disagree with or spar with?

*sigh*

Butthurt (https://www.urbandictionary.com/define.php?term=ButtHurt)

I like this definition in particular:

"Being butthurt means being aggravated, pissed off, or bugged over something completely trivial. Usually when people are butthurt they are really dramatic about it. Most people like to laugh at or even mock the annoyance of butthurt people because their reasoning for being so butthurt is ridiculously stupid."

[dneal]

This guy has been questioning the conventional wisdom for a few weeks now.
https://www.youtube.com/watch?v=JnXzGB170GI&t=5s

I suffered through the 29+ minutes of that. The number one rule of using slides it to not just read the slides! (sorry, pet peeve) I would like to see them in just a power point file and read them for myself.

Now that I'm done with that silly rant, he makes very salient points. Thanks for sharing it. For everybody else, the theme is: You’re going to die. That’s just life. It’s just exceedingly unlikely that Coronavirus is the thing that’s going to kill you. He presents a lot of data to demonstrate.

--edit--

He did post a .pdf version of the slides HERE (https://peerlessreads.s3.us-east-2.amazonaws.com/CV19FNF_Original_Full.pdf).

[TSherbs]

We know what it means, dneal. I was asking what it "referenced." Nevermind. I'm clearly done here.

Sent from my Moto E (4) using Tapatalk

[dneal]

We know what it means, dneal. I was asking what it "referenced." Nevermind. I'm clearly done here.

To paraphrase Shakespeare, you were too cunning to be understood.

I assumed you were trolling. I ignored it. I think it's probably best that you move on too. You seem really angry about something. Life's too short to be angry at people on the interwebz.

[mhosea]

Life's too short to be angry at people on the interwebz.

True dat. I myself can be a little obsessive, in case you hadn't noticed. I always try to remember this one.

https://imgs.xkcd.com/comics/duty_calls.png

Doesn't always work. But you haven't seen me engage politically in this thread, so it works a little bit.

[dneal]

Life's too short to be angry at people on the interwebz.

True dat. I myself can be a little obsessive, in case you hadn't noticed. I always try to remember this one.

https://imgs.xkcd.com/comics/duty_calls.png

Doesn't always work. But you haven't seen me engage politically in this thread, so it works a little bit.

One of my favorites, and an inside joke between me an the wife (referencing her uncle, who the meme clearly depicts).

[welch]

On the argument that (1) the Coronavirus deaths are not as many as from car accidents or gun violence or the seasonal flu; or, (2) the Coronavirus death numbers are exaggerated, see Philp Bump in the Post:


"To advocate for a quick or immediate return to America as normal, one must figure out how to rationalize the fact that this week alone, tens of thousands of people have died of covid-19, the disease caused by the coronavirus that emerged in China last year. You can’t simply say, “open up the economy and let the bodies fall where they may.” Instead, we get two different arguments: “open up the economy because the number of deaths is comparable to other causes,” or “open up the economy because the number of deaths isn’t a high as suggested.”

Both of those arguments, though, have significant flaws.

https://www.washingtonpost.com/politics/2020/04/10/not-that-bad-or-not-that-high-how-advocates-return-normal-misrepresent-coronavirus-deaths/

[Dreck]

This has undoubtedly been a time of considerable fear, disruption, and uncertainty for everyone. When stressors run high, so do tempers and reactions. I would ask that we all please take a step back, unplug for a while, and try to focus on something else for a bit.

FPG is clearly an important place to many of us, but the direction it has taken during this crisis highlights the uglier, baser side that prevails on so many social networks. This is heartbreaking. We have already seen some members distance themselves from this beloved nook in the worldwide web because of heated exchanges and the uncomfortable atmosphere that has permeated the forum. There are currently no less than three separate threads in The Lounge on COVID-19 in some way, shape, or form. Regardless of why any of them may have been started, every one of them has degenerated into something toxic, malicious, and nasty. I believe this has occurred, to a large degree, because of the overall lack of moderation here at FPG. While this freedom has made FPG a great place, it also provides the opportunity for FPG to become an ugly, hostile, and extremely unpleasant place.

I’m certain that none of us intentionally or overtly want this to happen, but every one of us must also be careful to prevent it from degrading in this way.
We have a dedicated area for topics concerning inflammatory subjects. If you must discuss the pandemic—including theories, models, projections, or perceptions of political failings—or anything else that may become objectionable, provocative, or incendiary, I would ask that you take—and contain—the discussion to the “Politics, Religion and Society” area. Let the current, out-of-place threads die. Enough damage has been done. Enough finger-pointing and accusations have occurred. Enough words have been said.

I would also ask that each one of us act to self-moderate by not engaging in or responding to these threads or discussions outside of the forum dedicated to “Topics pertaining to politics, religion, philosophy, and social issues.” Without Eric swooping in to take broad actions and correct our current path, we have only ourselves to make FPG the great, friendly, fountain-pen place we all want it to be.

[ilikenails]

Speaking of the United States, the errors of the early response were not the product of one person, whether it be the President or any other one leader. I saw an article in The Atlantic recently saying that the coronavirus debacle is "Trump's Fault", an assertion ridiculous on its face.


It's very hard to interpret that sentence in any other way than "I know things just by looking at them". Which is never a good start...



The debacle is the product of a country in denial as a whole - that these periodic epidemics break out elsewhere, but they'll never really harm the United States. SARS and Ebola both made it to our proverbial "front door".

This is silly. It isn't the job of "the country as a whole" to order more medical supplies or to make the decision for a lockdown. The country as a whole doesn't receive expert briefings strongly advising these things. It's Trumps job, he got the briefings, and he ignored them.

It's also ignorant. In fact, experts and competent politicians realised that SARs would be repeated - that's why the Whitehouse had a dedicated pandemic unit until Trump shut it down...

[ilikenails]

[QUOTE=rocl;288721]This guy has been questioning the conventional wisdom for a few weeks now.
Now that I'm done with that silly rant, he makes very salient points. Thanks for sharing it. For everybody else, the theme is: You’re going to die. That’s just life. It’s just exceedingly unlikely that Coronavirus is the thing that’s going to kill you. He presents a lot of data to demonstrate.
.

I'm bemused at the thought that anyone needs telling this. It also has nothing to do with anything that any intelligent person would care about: if C19 kills 500,000 people in the USA - which it probably would without extraordinary measures - then yes, you're very unlikely to be one of them. But that's still 500,000 dead people. Unless your worldview is based on utter selfishness, this is something you should want to avoid...

[ilikenails]

FPG is clearly an important place to many of us, but the direction it has taken during this crisis highlights the uglier, baser side that prevails on so many social networks.

It has nothing to do with social networks. It's because most people here are American. I really doubt that any major "social network" approaches the level of bitterness and division normal in the US now.

[ilikenails]

I don't think Fauci or Birx would disagree with the assertion that we don't know the true mortality rate. There was a question at one of the press conferences, maybe 3 or 4 days ago (who can remember days anymore), where a CNN or other anti-Trump person was trying to manufacture evidence that Trump had "fiddled while Rome burned", i.e. if Trump had raised the alarm sooner and without ambiguity, could lives have been saved. Both Dr. Fauci and Birx responded that it was unknowable whether earlier mitigation would have helped precisely because we have no idea whether the virus was present and prevalent at earlier dates or not. Birx then emphasized the need for a test that determines whether someone has been exposed in the past and is now immune.


No, they really didn't. Because earlier mitigation always helps. If you restrict the spread at the point where the virus has infected 1% that's better than 2%. If you mitigate at 20% that's better than at 30%. Etc.




One area where I vociferously disagree with Fauci, and I do so as a scientist, is the notion that we have to prove treatments safe and effective before employing them at a time like this. This is parochial thinking.


I have to ask

1. Why being "a scientist" is relevant?

and

2. What sort of scientist doesn't know what "parochial" means?

Seriously - what sort of "scientist" are you??? I have a degree in theoretical physics but I'm not about to walk into the local hospital and tell them to change how they're treating people based on the first opinion I wake up with tomorrow morning...



if in the worst case it is no better than placebo


No one who knows anything about medical treatment would make that assumption. A *lot* of medical treatments have very high risks if even applied to healthy people who don't need them. If you give them to people already badly sick, the risks get much higher. To give one very simple example that you should have known about:

https://www.bmj.com/content/368/bmj.m1086
Scientists and senior doctors have backed claims by France’s health minister that people showing symptoms of covid-19 should use paracetamol (acetaminophen) rather than ibuprofen, a drug they said might exacerbate the condition.

In the case of chloroquinine, side effects side effects can vomiting, cramps, and diarrhea

https://www.buzzfeednews.com/article/danvergano/chloroquine-dangers-coronavirus

...If you give a drug with zero effectiveness to very sick people - many of who are old and have other medical problems - and it creates symptoms like this in some of them, then the mortality rate will go UP not down. This isn't quantum mechanics - it's basic stuff.

Again - I really am curious what sort of "scientist" you are, because most of the ones I know stuff like this as basic general knowledge and would NEVER assume that a active drug can only be as bad as a placebo. Come to think of it - if you'd ever watched a couple of episodes of House you'd know better than that.

[mhosea]

In the case of chloroquinine, side effects side effects can vomiting, cramps, and diarrhea



My impression was that experience with chloroquine has been negative for COVID-19. I did not mention this drug.

I think you have misapprehended my intention of saying "as a scientist". It was not intended as an appeal to authority. My intention was to indicate that the opinion to follow was, in some sense, against my nature. I also felt that, as a member of the club, I was entitled to my opinion. But it was stated only as an opinion, and if you disagree, you are entitled to say so. I have no objection whatsoever, though I would be happier to receive it if it were offered in a less caustic manner. I have been known to change my opinions when presented with sound arguments.

The premise I articulated was that the clinician determines that the proposed treatment will likely do no harm. I certainly never suggested that such medications be made available without a prescription. At the time I made that remark, Fauci had been advocating for a normal scientific approach of proving that the drug was effective in randomized double-blinded trials before utilizing hydroxychloroquine for COVID-19 treatment except for "compassionate use" circumstances. A little back-of-the-envelope math suggested that if hydroxychloroquine actually does help, it would be weeks at a minimum before any preliminary data was available, and even that would require a bit of magic in order to conjure up the administrative details to put a study in motion. I do not know whether he changed his mind or his preferences became irrelevant, because my understanding is that it is now being used more generally. Whether it is effective remains an open question, I suppose.

Generally, for a prescription medicine to be approved for something, it should be proven both safe and effective (relatively). We cannot rush the deployment of a vaccine, for example, because it would be a completely new vaccine, and we would have no way to know it was safe. It might or might not even be effective, but having no safety data makes the risk of doing harm very high. In the case of hydroxychloroquine, we do know the drug's side effects, so a clinician prescribing it for COVID-19 knows what to watch out for. While we don't know what dosage would be effective for COVID-19, if any, we do at least know some dosage information for on-label uses. Naturally in a given case it could be contraindicated. I'm not saying it should be used. Rather, that it should be up to the clinician, not the scientist, to determine whether to give it a try.

The word "parochial" is a segue into another way of looking at it. I used the word "parochial" to mean "having a limited or narrow outlook or scope." The "parish" I had in mind was that of the medical researcher operating in normal circumstances, the concept of the church and its dogma being replaced with the unbending requirements of the scientific method, which in this case mandates the use of double-blinded randomized controlled studies to determine safety and efficacy before approving of the use of a drug. Within this "parish", the scientist is concerned with proof, and he isn't wrong about what is required to establish that proof. While he may feel pressure to proceed as quickly as possible, he does not question his core assumption that proving efficacy is a prerequisite to using the drug. We do have the aforementioned "compassionate use" exception for exigent circumstances, but how can we apply that here, given the way COVID-19 kills when it kills? We don't know who will develop ARDS and who will not, and compassionate use only applies once a great deal of lung damage is done. We're not talking about a cure, rather a substance that is believed to reduce the viral load. You could restate my opinion as asserting that, for this drug, clinicians needed a broader exception than "compassionate use".

[dneal]

RE: chloroquine. The reason it is being considered a potential treatment is a Chinese study that showed it was effective in the lab. No, that doesn't mean it will work on people infected; but it doesn't mean it won't. One would assume a medical doctor is familiar with a drug that's been around a long time and prescribed for non life threatening problems like arthritis, risk to specific patients given their medical history, and side effects of the drug.

Seems like someone who wants to prevent up to 500,000 deaths would also be amenable to a case of the trots if it could save a life... but I'm bemused by silly things.

https://www.nature.com/articles/s41422-020-0282-0

[ilikenails]

RE: chloroquine. The reason it is being considered a potential treatment is a Chinese study that showed it was effective in the lab.

That isn't something a scientist would say: it's VERY inexact and misleading. Most people would read that and believe medical efficacy was demonstrated in the lab, possibly on humans. Nope: this wasn't the case. Firstly, the study only tested with the drug could stop the spread of c19 from on cell to another in mice cells. It didn't test for eg a delivery mechanism, so it may well be worthless even if it's not a false positive. Secondly, most small sample results like that ARE false positives! There is no way that a real scientist would claim "a Chinese study that showed it was effective in the lab" - it simply didn't. Which is why - and I shouldn't have to explain this - that overwhelming medical opinion is extremely sceptical.

Again: what sort of scientist do you claim to be??? (You are that guy, yes?) Spreading false news is bad enough. Claiming fake expertise and spreading it is much, much worse.

[ilikenails]

Also, for whichever person claimed - with no source - that Fauci said that Trump wasn't advised to lockdown earlier:

https://www.theguardian.com/world/2020/apr/12/fauci-trump-rebuffed-social-distancing-advice-coronavirus

CNN host Jake Tapper asked if Fauci thought “lives could have been saved if social distancing, physical distancing, stay-at-home measures had started [in the] third week of February, instead of mid-March”.

“It’s very difficult to go back and say that,” Fauci said. “I mean, obviously, you could logically say, that if you had a process that was ongoing, and you started mitigation earlier, you could have saved lives. Obviously, no one is going to deny that.

“But what goes into those kinds of decisions is complicated. But you’re right. I mean, obviously, if we had, right from the very beginning, shut everything down, it may have been a little bit different. But there was a lot of pushback about shutting things down back then.”

..So the complete opposite. And really -NEVER make claims on contentious subjects without evidence.

[dneal]

RE: chloroquine. The reason it is being considered a potential treatment is a Chinese study that showed it was effective in the lab.

That isn't something a scientist would say: it's VERY inexact and misleading. Most people would read that and believe medical efficacy was demonstrated in the lab, possibly on humans. Nope: this wasn't the case. Firstly, the study only tested with the drug could stop the spread of c19 from on cell to another in mice cells. It didn't test for eg a delivery mechanism, so it may well be worthless even if it's not a false positive. Secondly, most small sample results like that ARE false positives! There is no way that a real scientist would claim "a Chinese study that showed it was effective in the lab" - it simply didn't. Which is why - and I shouldn't have to explain this - that overwhelming medical opinion is extremely sceptical.

Again: what sort of scientist do you claim to be??? (You are that guy, yes?) Spreading false news is bad enough. Claiming fake expertise and spreading it is much, much worse.

I didn’t say I was a scientist. Please give it a rest.

[Dreck]

I didn’t say I was a scientist. Please give it a rest.

It should be obvious by now this person has no interest in a rational discussion. You'd be better off arguing with that Osage Orange growing in the back 40...

53367

[ilikenails]

Just going back to the video on denominators. There are two numbers that are kind of known. One is the fatality rate among known cases, and one is the best case scenario if the entire US population is infected and nobody else dies. These are, as of this post being written, 14797/435160 or 3.4%, and 14797/327200000 (figure from 2018) or 0.005% respectively.

3.4% and 0.005%. That's a big range. It doesn't mean a great deal, other than to say the MCFR cannot get any better than 0.005% in the US, which is pretty low anyway; and it will definitely be worse than this because there will be more deaths. However, there is also the possibility that it could get worse than 3.4%.

For those who are not inclined to crunch numbers, 3.4% of the total population is a shade over 11 million.

Actually you can make a case for a worse scenario: the early fatality rate in Wuhan was 17% among known cases - which probably means 8% overall, with about an equal number of cases asymptomatic. That was before extra medical resources were brought in from other areas, etc. If you had a scenario where US medical resources were overstretched for the country as a whole and the virus spread at high rate, then an 8% death rate wouldn't be impossible in the US. This is the happy scenario you might have achieved if Trump hadn't been scared into going against his instincts. (These being the instincts of a man who couldn't even make money in the casino business...)