Covid-19 Pandemic Discussion

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Yeah, and while you're at it, I also need 10 billion dollars. Get it done, quickly.

The point is, it's not realistic to have 100x the steady state testing capacity in anticipation of an event which may or may not arrive, and ramping it up takes years, at which point this whole thing will play itself out one way or another. This is why NOBODY IN THE WORLD tests everyone.
USA has 340 million people in it. I am suggesting you test a fraction of it daily.

We already know what is in front of us. What you are saying is even though we see Hitler marching down on Europe let’s not get too crazy in our response. That is insane.

What is your alternative?

PS - Most Americans manage to find 3 meals a day even today. We certainly can quickly ramp up to 30 million tests a day using the federal defense act. A great depression will destroy our lives for who knows how long.
 
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Yeah, and while you're at it, I also need 10 billion dollars. Get it done, quickly.

The point is, it's not realistic to have 100x the steady state testing capacity in anticipation of an event which may or may not arrive, and ramping it up takes years, at which point this whole thing will play itself out one way or another. This is why NOBODY IN THE WORLD tests everyone.
Trump just tweeted this. You see he is passing the buck on testing to the States which is insane. We need organized mass federal production. Not 50 States doing 50 different things!

Remember when the Japanese attacked Pearl Harbor, and Hawaii was that they would have to perfect their own Navy & Air Force ?!

If this was World War 2 everyone would be speaking German by the end of the war. I am not being political here. This is just a fact of how the federal government is not handling this properly and we will all pay the consequences of that. EA793C02-E7AC-4E88-9583-006547C4AA87.jpeg
 
It's not "insane". It's how this country was designed to work from the start at the constitutional level. All the testing capacity is held by the states. How do you propose the federal government should handle this? Seize the testing equipment from the states? I'm sure that'll go over well. Or should Trump take a screwdriver and build Roche Cobas rT-PCR machines at the Oval Office? What is it that you're proposing, exactly?

Note also, that testing is not uniform by state, and the hotspots are testing more per capita than anywhere in the world. That seems pretty smart to me.

I am not being political here

Sure, bud.
 
It's not "insane". It's how this country was designed to work from the start at the constitutional level. All the testing capacity is held by the states. How do you propose the federal government should handle this? Seize the testing equipment from the states? I'm sure that'll go over well. Or should Trump take a screwdriver and build Roche Cobas machines at the Oval Office? What is it that you're proposing, exactly?



Sure, bud.
See World War 2 for my answer. Nuff said.

Commenting on a strategy that is and will be a complete total fail is not being political. I am sorry we obviously need to learn this the hard way. Some of you anyway.

PS - Imagine cliff told 50 different programmers to program 50 different needs for the AXE FX 3 with no guidance or leadership. We would be playing a Digitech rig today.
 
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We have half the death rate of Switzerland, almost 1/3rd the death rate of UK, 1/5th the death rate of Italy or Spain, 1/3rd the death rate of France, in spite of widespread political sabotage by the states. We have a surplus of hospital beds and equipment, too. That's not a "fail". That's a "win".
 
We have half the death rate of Switzerland, almost 1/3rd the death rate of UK, 1/5th the death rate of Italy or Spain, 1/3rd the death rate of France, in spite of widespread political sabotage by the states. We have a surplus of hospital beds and equipment, too. That's not a "fail". That's a "win".
We are flattening the curve which is why we are all sacrificing together. Then what? 😐

Define widespread political sabotage by States? Like Florida allowing Spring break and not closing its beaches until less than two weeks ago?

Whatever your State response is I find it interesting you are claiming some are sabotaging this recovery yet you trust them to solve this problem? You are absolutely as strong as your weakest link in this crisis. We need one strong and organized federal leader directing everyone to getting us back to work safely with the least number of deaths.
 
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We are flattening the curve

So is everyone else in the countries I mentioned. And yet, look at them piling up the body count.

Then what?

That's a trillion dollar question. At the moment, the answer is: nothing. Build up hospital capacity and supplies and let 'er burn slow by selectively opening things up, while maintaining social distancing, and working from home where possible. Fauci conceded as much the other day - some parts of the US will open up in May. NY/NJ will stay locked down for longer.

There's no other solution, anywhere, that does not involve sweeping bodies under the rug, Xi Jinping style. Closing down the economy for 18 months until there's a vaccine is not a realistic proposition, irrespective of what the federal government or states do.

Or at least that's the thinking with the current data. We do not know at this point how many people had this thing without symptoms or with mild symptoms earlier in the year. There are some indications there are a lot of such folks, which would explain why things did not blow up again in Korea, and why Italy is winding down even though only a small minority of its population was diagnosed.
 
So is everyone else in the countries I mentioned. And yet, look at them piling up the body count.



That's a trillion dollar question. At the moment, the answer is: nothing. Build up hospital capacity and supplies and let 'er burn slow by selectively opening things up, while maintaining social distancing, and working from home where possible. Fauci conceded as much the other day - some parts of the US will open up in May. NY/NJ will stay locked down for longer.

There's no other solution, anywhere, that does not involve sweeping bodies under the rug, Xi Jinping style. Closing down the economy for 18 months until there's a vaccine is not a realistic proposition, irrespective of what the federal government or states do.

Or at least that's the thinking with the current data. We do not know at this point how many people had this thing without symptoms or with mild symptoms earlier in the year. There are some indications there are a lot of such folks, which would explain why things did not blow up again in Korea, and why Italy is winding down even though only a small minority of its population was diagnosed.

Iceland and South Korea have shown that 20 to 50% of the infected are asymptomatic which is why your suggested solution (which is also mine) only works with mass testing and social tracing. Why is such a thing sounding so crazy hard to do relative to anything else? South Korea and Germany have this under control now because they have been testing ahead of their outbreaks. The US just dropped trillions on pork bills. It can afford to pay for the needed testing too.

If we go back to work relatively blind the virus will spike up and the econony will be crushed even more. Good luck getting people back out there the next time. We have several amazing Countries beating this thing before our eyes so let’s do it right the first time! Sweden is trying it the hard way right now and the bodies are starting to pile up. Soon they will have to abandon their ridiculous plan and they will have wasted weeks and allowed hundreds of unnecessary deaths.

Read the results about Iceland here:

https://www.google.com/amp/s/www.marketwatch.com/amp/story/guid/A3A0044C-7B45-11EA-A437-4DEB5187126D
 
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That's a trillion dollar question. At the moment, the answer is: nothing. Build up hospital capacity and supplies and let 'er burn slow by selectively opening things up, while maintaining social distancing, and working from home where possible. Fauci conceded as much the other day - some parts of the US will open up in May. NY/NJ will stay locked down for longer.
They can declare the state open... but unless they instill some confidence in people via mass testing or a vaccine, not many are going to walk out and “let ‘er burn” on themselves or their families.

You can bet that the media and everyone else is going to keep a close eye on places that open up and report on the rising hospitalizations 14 days later. Which will bring everything back to square one.
 
They can declare the state open... but unless they instill some confidence in people via mass testing or a vaccine, not many are going to walk out and “let ‘er burn” on themselves or their families.

You can bet that the media and everyone else is going to keep a close eye on places that open up and report on the rising hospitalizations 14 days later. Which will bring everything back to square one.
And that's why they're rolling out antibody testing within the next couple of weeks. Fundamentally it's an executive decision. There won't be any time when there's no danger. Not even after they roll out the vaccine - plenty of antivax nutcases in the US won't get vaccinated, and it's a free country, so you can't force them. This is why e.g. Sweden said "fuck it" and let the dice fall as they may. For the US this strategy would be disastrous 3 months ago. Now? I'm not so sure, especially in the states that aren't as hard hit. And since this is the US the decision on whether to open up will be a state decision, and not a federal one.

With all of that being said, I think we can all agree that waiting for a vaccine is not a realistic option, unless you want total economic collapse and social unrest (both of which have non-negative fatality ratios also). So that's not what's going to happen.
 
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And that's why they're rolling out antibody testing within the next couple of weeks. Fundamentally it's an executive decision. There won't be any time when there's no danger. Not even after they roll out the vaccine - plenty of antivax nutcases in the US won't get vaccinated, and it's a free country, so you can't force them. This is why e.g. Sweden said "fuck it" and let the dice fall as they may. For the US this strategy would be disastrous 3 months ago. Now? I'm not so sure, especially in the states that aren't as hard hit. And since this is the US the decision on whether to open up will be a state decision, and not a federal one.

With all of that being said, I think we can all agree that waiting for a vaccine is not a realistic option, unless you want total economic collapse and social unrest (both of which have non-negative fatality ratios also). So that's not what's going to happen.

You seem to be missing what I am saying. We can get the same result as the Sweden strategy without all the deaths if we go with mass testing and contact tracing. The production can happen quickly if the federal defense act is heavily enforced. South Korea and Germany are doing this now!!
 
And I can get great "results" if I just get a few billion dollars to my name. Doesn't mean it's feasible. You have to always run the numbers to see how realistic your propositions are, and how long they will take to ramp up. Some drugs that are being tested are just baffling. Some monoclonal antibody stuff in particular. At $1500 per vial, and hard as fuck to make even in small quantities (requires transgenic animals!), it's just not going to fly unless it cures world hunger as well.

I'd like to know what they're doing in Germany in greater detail though. About the same infections per million as the US (so whatever "testing" and "tracing" they're doing is about as (in-)effective as our own), but half as many deaths per million. Could be that they have more effecive treatment. Could be simply that when someone dies of, say, a stab wound and has C19 they mark it down as a stab wound fatality and not C19 fatality. In the US currently any fatality that also had C19 is chalked up to C19, even if the patient did not die of complications of C19. This is as per Dr. Birx. Cancer patient with C19? Congratulations, you've beat cancer by dying of C19.
 
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Could be simply that when someone dies of, say, a stab wound and has C19 they mark it down as a stab wound fatality and not C19 fatality. In the US currently any fatality that also had C19 is chalked up to C19, even if the patient did not die of complications of C19. This is as per Dr. Birx. Cancer patient with C19? Congratulations, you've beat cancer by dying of C19.

If you have an underlying condition and C19 throws you into the hospital towards an early death, yeah it is a C19 death. If someone gets stabbed, they sure as hell aren’t getting a C19 test. Tests are in high demand and there aren’t enough to go around testing without a reason.
If anything, NYC has under counted deaths. There were 1100 deaths at home/streets of NYC that were not counted in the C19 total in the first week or so in April. That is 8x the number of deaths from the same period last year. Not a coincidence.
 
There were 1100 deaths at home/streets of NYC that were not counted in the C19 total in the first week or so in April. That is 8x the number of deaths from the same period last year.

I've seen only a few numbers/analyses on "excess deaths" compared to normal. But those that I've seen have been striking.

That would potentially be a better metric (or at least a different one on the high end) than identified covid deaths (low end).
 
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yeah it's a C19 death
Is it a C19 death if you would have died 2 weeks from now anyway? Or to reduce this ad absurdum: if someone dies of food poisoning (5K deaths in the US each year according to CDC) and they also test C19 positive, is it a C19 death or not? Because right now in the US you can guess which counter you'll end up incrementing.

People tend to forget that in a normal year 160K people in the US die of lower respiratory disease without C19. If the majority of those deaths are now chalked up to C19, no wonder the numbers are high. But this does not change the fact that those people would have died anyway. I agree with @yyz67 that excess deaths would be a more meaningful metric. Problem is, the "normal" metrics from which excess would be computed (such as deaths from pneumonia) often lag by weeks or months, hence the misleading graph floating around the internet where pneumonia deaths have "fallen off a cliff". Nope, they did not. It's just a laggy metric - give it 4-6 weeks and it'll catch up.
 
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@Donnie B.:
You say, about a certain graph,
This speaks for itself. :mad:

4S8ispj.jpg
Respectfully...you sure about that?

I mean, are you confident that that graph "speaks for itself" in the sense that what it seems to mean, at first glance, actually is what it means? And, that what it means to convey is even knowable-in-principle, given currently-available information?

I guess it depends on what one's first-glance conclusion is. But if the first thing I thought, on seeing that graph, was "What the U.S. was doing sucked, in comparison to what Spain and Germany were doing, from March 22 to April 11."

That was my first thought. Then I reconsidered.

That conclusion may be true. But you couldn't possibly, even in principle, draw such a conclusion from the data that graph is displaying. That graph is profoundly bad. If it should happen to prompt a true conclusion in someone's mind, it only does so the same way a stopped clock tells the "correct" time twice a day.

Think about it: It's "total cases" (reported to Johns Hopkins); i.e., confirmed by testing. But we know confirmed cases are some fraction of actual cases, and we know that doubling-rate-slowing happens for the following reasons:
  • implementing social distancing
  • diminishing percent-of-population infectable (by death, or recovery, or vaccination)
Well, the timing and degree of social distancing obviously varies from country-to-country. That's fair; presumably that's something the graph is trying to bring out. But, the percentage of population still infectable also varies (though we can't know by how much). That's a major variable that's not normalized.

And, we know that artificial increases in "total cases" happens when you have more testing now vs, previously. (It reflects increasing awareness of reality, but it looks like a failure of social distancing.)

And, we know that the countries listed had outbreaks that began at different times (why were those dates chosen?), with different numbers of initial vectors. That's setting aside other countries available for comparison. (Why these in particular? Where are Taiwan and South Korea? France? Israel? Canada? Australia? Why Spain if not also Greece and Portugal?) And of course test-availability has followed different timelines in each country as well.

And, we know that the percent-of-population still infectable is probably very different in Italy than, say, here. New York and Italy probably are closer to one another than anyplace in Kansas is to New York.

So here we have a graph with an orange line that probably ought to have been separate bars depicting five countries that, had they all responded to COVID-19 identically on a per-capita basis, and been equally successful, could still have shown wildly different outcomes on this graph (for the reasons stated above).

What would be required for that graph to become validly informative, rather than probably misleading is it is now? (Or, if it isn't misleading, it's only by accident?)

Well, first change it to all bars. (What're the slopes of the orange line between countries supposed to convey, anyway? It's not like the U.S. gradually morphs into Spain on one side!)

Secondly, ensure that your cases are measured only through random testing of the general population using statistically-valid sample sets. You need to know the actual infection numbers, not something warped out-of-recognition by targeted testing.

Thirdly, don't arbitrarily use March 22 as your start date. Find out when, in each country, 5% of the population was infected. Use that date as the starting point for that country, and then run your measurements forward.

Fourth, only make comparisons between comparable population-size regions with comparable mixes of urban and rural living. Don't compare France to the whole U.S.A.; compare it to the state of Georgia, perhaps.

Finally, maybe make the vertical axis a percentage of population axis, not an absolute numbers axis. Maybe. None of my other four requirements should be controversial, but this one could be. On the one hand, we want to save lives, not "percentages of populations." On the other hand, the entire population of Lichtenstein could be infected and they'd still have such a low caseload they'd look like heroes.

Anyway, without those kinds of changes, that graph is, I think, non-informative. The U.S. response from March 22 to April 11 may have sucked; but that graph is no good reason to think so.

What reasons there are must be found elsewhere.
 
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You're presuming that @Donnie B. was trying to make a valid point. If that were the case, he'd also take into account where in their respective timelines these countries were, and normalized by population. Had he done that, the post would not be worth making. :)

Number of infections is a meaningless metric anyway - a valid comparison there would be between France+Germany+Italy+UK+Spain (which combined have about 324M people) vs the US. I don't need to tell you who would come out ahead on that one. What's meaningful are severe cases per million and deaths per million, and we're doing well on both.
 
Trump just tweeted this. You see he is passing the buck on testing to the States which is insane. We need organized mass federal production. Not 50 States doing 50 different things!
Sorry, but I have to dissent. At least I think I have to; I might be responding to something you didn't mean to imply.

Let me try to break it down a bit, for my own clarity:
1. Neither Federal nor State governments have facilities, labor, or expertise for mass-producing tests, masks, PPE, etc.
2. Only businesses have, or can rapidly acquire, those things; and only businesses can ramp up production to meet the needs. It isn't just that it's the kind of thing they do; it's that they're already stocked with the kind of people who do it, and governments aren't.
3. Federal government can serve as a clearinghouse, a coordinator, and a stockpiler, but not a producer. I think it'd be hilarious to shackle Mitch McConnell and Nancy Pelosi at the ankle and set them to work stitching masks, but entertaining as that notion is, it wouldn't produce many masks. (Anyway, I hear McConnell is too busy sitting on his throne of skulls, one of which Pelosi apparently stole and used for a face.)
4. States differ wildly. Do I trust the president, or anyone working for him, to become an expert on the best way to rezone for field hospitals in Illinois? About as far as a I can spit a rat.
5. More broadly, this problem is a problem requiring massive, coordinated-but-independent, distributed parallel processing. If the president were directing the emergency in New York, he'd be at a loss to do anything for anyplace else. Fortunately, New York has a governor, which reduces the processing load. The governor has mayors, which reduces his load; and so on. Team Trump has a mix of talents and deficiencies to be sure, and features no angels or Vulcans, only imperfect human beings with armpits that stink; but what of it? If you put the 100 smartest people on the face of the Earth, superstars whose personal faeces are non-odorific, into a room in Washington D.C. and asked them to direct every decision (from resource allocation to production techniques) of this effort, they couldn't do it. No way they could! They're too far away from the information; they have no local familiarity; there's no way to get them all the information they'd need to make good decisions in a timely way; and even if there was, the 100 smartest people on Earth couldn't process that information and calculate correct conclusions. (In fact, I wouldn't trust that lot to pick the correct price for a packet of peanuts sold at a convenience store in Iowa. For that job, give me a convenience-store owner whose family depends on whether he makes the correct decisions. Amazing what you can figure out when your livelihood comes from it.)

So I don't think we need 50 states each doing a different thing. I think we need 1,400 businesses each doing its different thing within localities that are each doing their different things enabled by mayors and councils in communication with 50 governors each doing his/her different thing, all coordinating and sharing information facilitated by the team in the White House, who is (one hopes) kind enough to organize help when needed, and rude enough to poke and provoke when things don't look right.

The trick is how to make the incentives naturally motivate all those entities to be following our common goal of churning out a lot of tests and PPE that aren't defective, and eliminate roadblocks arising at any level. The DPA cleared the last roadblock that could be cleared at the Federal level; namely, shareholder resistance to risky shifts-of-resources ordered by the executives whom they'd originally hired to do a completely different job! Now that that's settled, the roadblocks will be things like water and transportation: That's municipal-level administration. Want Drs. Fauci and Birx to try their hands at that? 'Cos I don't! (Bet they don't, either!)

It could very well be that we're speaking the same notions with different emphases, and sensitivities to different risks. I'd wager you weren't really proposing some kind of Soviet-style commisariat for production, at the Federal level. But I'm not really proposing one at the State level, either; there are vastly more entities and lines of communication than that! (As I'm sure you already know.)

But we (We The People, we the public) don't see the communication from governor to municipality, or mayor to local union, or council to factory manager. Our visibility is limited to what Trump says to the states, because he's Trump, and like it or not (I generally don't) his Twitter feed sucks all the oxygen out of the room, media-wise, producing outright neglect of every other story on the planet.

So we get a skewed picture. What we see looks like mere buck-passing until we realize it couldn't possibly look any other way, so long as we remain in-the-dark about what everyone else in the system is saying.

Still, what I hear him saying, over and over, is: "We'll get you what you need if we can; let us know what it is; don't complain if we haven't yet come forward with something you haven't asked for; keep us informed and we'll share what we know; buckle down and make some progress; and if you learn important lessons share them with everyone else." Sounds about right. I hope those governors are saying the same things to the mayors, the factory owners, etc.
 
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Is it a C19 death if you would have died 2 weeks from now anyway? Or to reduce this ad absurdum: if someone dies of food poisoning (5K deaths in the US each year according to CDC) and they also test C19 positive, is it a C19 death or not? Because right now in the US you can guess which counter you'll end up incrementing.

I don’t know where you’re getting your information from, but someone going to the ER due to food poisoning or anything non respiratory is not tested for C19, forget being added to any count.
Heck, even people showing C19 symptoms are not tested unless they need to be admitted. Deaths are definitely underreported in places like Italy/Spain/NYC.
 
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