the Coronavirus outbreak thread

[*LexLover]

Originally Posted by *LexLover

This is the balancing act that needs to be managed. I believe we can't veer too much in either direction. Too much lockdown and the economy will implode. Not enough and the virus progresses.

Agree with you 100%. The expected unemployment for this scenario is going to have an impact that is far longer lasting than the short amount of time folks have to shelter in place. Just in my country, we are expecting two quarters worth of impact from an economic perspective. The longer the virus stays, the longer the duration of the after effects and the longer it will take to jump start the economy. We are past the point of people "just going back to work" which is a finer point you failed to call out in your simplistic response although implode may well describe it at a high level.

[Zakalwe]

Originally Posted by Fleetlord

"University of Bristol researchers say the benefit of a long-term lockdown in reducing premature deaths is outweighed by the lost life expectancy from a prolonged economic dip".

I don't agree with that in this case.

In the 2008 crisis, sure, the cause was a bunch of bad large scale financial decisions that created an economic crisis that led to a downturn in health..not a massively contagious and lethal virus to compare it against.

"There is no functioning economy unless we control the virus"

I feel like it's magical thinking to believe that letting the virus run amok and stop the restrictions will allow the economy to just go back to the way it was...there will be an abundance of people too sick to spend money and work anyway..

Then, talk about financial ruin...the people who are unfortunate to catch this and spend 3weeks in a hospital without health insurance??? Huge money. Without control we will have a lot more of that.

To be clear neither the linked article nor (as far as I’m aware) anybody on this thread has advocated letting the virus run amok.

There is though a legitimate debate to be had about the risks and benefits of any given level of intervention. I say that as someone who agrees with the effective lockdown measures being implemented here and which are likely to be in place for several months.

[Fleetlord]

Originally Posted by Zakalwe

To be clear neither the linked article nor (as far as I’m aware) anybody on this thread has advocated letting the virus run amok.

There is though a legitimate debate to be had about the risks and benefits of any given level of intervention. I say that as someone who agrees with the effective lockdown measures being implemented here and which are likely to be in place for several months.

I guess, due to the nature of the contagion, I equivalate half measures (aka balancing) as running amok..

Look at our current situation in the US. Some states have a stay at home directive, others do not, with travel allowed freely between all regions. What good is that?

[daveathall]

I have come to the conclusion that my solution of "go to bed and in the morning it will have all gone away," could very well be argued to be slightly off the mark and a slightly "laid back" approach.

[statsman]

I heard a professor say, one time, “You use models; you don’t believe them”.

100-200k dead in the US. That’s a much better number than 1-2 million (doing nothing and hospitals overwhelmed nationally). It’s much worse than a bad flu. If it comes in at 80k or 220k, will you feel like they screwed it up? I won’t.

[Brew]

Even if we are inclined to ease restrictions, it seems to me they cannot be eased any more than our hospitals' capacities to care for the population, or risk collapse. Will that amount of folks going back to work really help matters, given the risks involved in these sort of calculations?

[Fleetlord]

Originally Posted by Brew

Even if we are inclined to ease restrictions, it seems to me they cannot be eased any more than our hospitals' capacities to care for the population, or risk collapse. Will that amount of folks going back to work really help matters, given the risks involved in these sort of calculations?

Agreed. That's a whole other tangent.

There is concern over the health issues associated with a lockdown induced economic downturn....but what of the issues associated with an overwhelmed healthcare system?

People with non Covid related situations that can't get intervention because capacity is gone.

[Blansky]

I would appreciate if the death toll would be less sensationalized and more "professional" in it's depiction of the health of the people before their contracting the virus.

I realize this is difficult but it would make for a far better analysis of when and how we lift restrictions on movements.

Now it's just xx died and we have no idea the ages, general previous health and complications they have pre-existing. We do know that smoking in China and Italy is a real thing. So did a large number of deaths have compromised lung issues previously.

An actor died a couple of days ago and there was no indication he was already sick when he contracted the virus but someone on a messaged board that knew him indicated he was. Obviously anecdotal but it would be nice to have more in depth reporting on this stuff. Then we have the Tom Hanks stuff where he and his wife pretty much sailed through the virus much like getting the flu.

Bottom line is how previously compromised are the patients that are dying when they show up in hospitals.

Stay safe everyone.

[uscmatt99]

Originally Posted by Blansky

I would appreciate if the death toll would be less sensationalized and more "professional" in it's depiction of the health of the people before their contracting the virus.

I realize this is difficult but it would make for a far better analysis of when and how we lift restrictions on movements.

Now it's just xx died and we have no idea the ages, general previous health and complications they have pre-existing. We do know that smoking in China and Italy is a real thing. So did a large number of deaths have compromised lung issues previously.

An actor died a couple of days ago and there was no indication he was already sick when he contracted the virus but someone on a messaged board that knew him indicated he was. Obviously anecdotal but it would be nice to have more in depth reporting on this stuff. Then we have the Tom Hanks stuff where he and his wife pretty much sailed through the virus much like getting the flu.

Bottom line is how previously compromised are the patients that are dying when they show up in hospitals.

Stay safe everyone.

It's very complicated. At any given time in the US the majority of ICU beds are occupied, often with vented patients. However, for other conditions, either immediate post-operative cases and medically ill people, the duration of vent time is much less than the average COVID patient once placed on a ventilator. Now all of those patients that could have been cared for through an acute event to recover will have no access to that high level of support, as the ICU beds will be full and ventilators will all be in use, some supporting 2 patients when feasible. One severe COVID case on a vent for 2-3 weeks will essentially bump a few patients who could have used that resource to recover after open heart surgery, brain surgery, sepsis, heart failure or COPD exacerbation, etc. Most of the patients that succumb to COVID will have an underlying chronic illness, but for many of those patients in normal times they would have chugged along for many years in our health care system. These numbers can be painted with many different brushes, so we need to be careful as to how they are interpreted.

One thing I know for sure. If hospitals are reaching out to retirees, students, and practitioners who haven't stepped foot in a hospital in years, we are under-resourced for this expanding crisis.

[JasoninDenver]

Originally Posted by Blansky

I would appreciate if the death toll would be less sensationalized and more "professional" in it's depiction of the health of the people before their contracting the virus.

I realize this is difficult but it would make for a far better analysis of when and how we lift restrictions on movements.

Now it's just xx died and we have no idea the ages, general previous health and complications they have pre-existing. We do know that smoking in China and Italy is a real thing. So did a large number of deaths have compromised lung issues previously.

An actor died a couple of days ago and there was no indication he was already sick when he contracted the virus but someone on a messaged board that knew him indicated he was. Obviously anecdotal but it would be nice to have more in depth reporting on this stuff. Then we have the Tom Hanks stuff where he and his wife pretty much sailed through the virus much like getting the flu.

Bottom line is how previously compromised are the patients that are dying when they show up in hospitals.

Stay safe everyone.

It will take months afterwards to correctly analyze this data. Right now, medical professionals are simply trying to keep people alive. Once the statisticians have a chance to run the numbers, then we should be able to see exactly what co-morbidities were most affected. My guess is the obvious cardio and pulmonary at risk people and then immune compromised and other diseased populations. Smoking and obesity may have a compounding effect but it will take time to figure out how much.

[Blansky]

Originally Posted by JasoninDenver

It will take months afterwards to correctly analyze this data. Right now, medical professionals are simply trying to keep people alive. Once the statisticians have a chance to run the numbers, then we should be able to see exactly what co-morbidities were most affected. My guess is the obvious cardio and pulmonary at risk people and then immune compromised and other diseased populations. Smoking and obesity may have a compounding effect but it will take time to figure out how much.

I realize it's cold blooded to take human life and make it statistical, but obviously the movement ban will have to be lifted at some point, and slotting people into, massive high risk, high risk, slightly risky etc etc, we can then sort of quarantine the most vulnerable people and try to get the planet started up again, work-wise.

But I think the longer we don't know the real numbers of previously compromised patients the longer/harder it will be to balance the death toll vs get back to work necessity that will hit in a month or two.

And I do appreciate people on the front lines of health care are overwhelmed now with bigger concerns but we need the bean counters in there as well to work the numbers statistically.

We know this thing isn't going away, and we need to soon make some hard choices.

Anecdotally my mother in law is 85, works 3 days a week, and is chomping at the bit to get back to work. Unfortunately she has compromised lung function due to asthma and there aint no way in hell she should be leaving her house. There are people that need to resign themselves that THEY can't work until there is a vaccination which is maybe at least a year to two away.

[uscmatt99]

Originally Posted by Blansky

I realize it's cold blooded to take human life and make it statistical, but obviously the movement ban will have to be lifted at some point, and slotting people into, massive high risk, high risk, slightly risky etc etc, we can then sort of quarantine the most vulnerable people and try to get the planet started up again, work-wise.

But I think the longer we don't know the real numbers of previously compromised patients the longer/harder it will be to balance the death toll vs get back to work necessity that will hit in a month or two.

And I do appreciate people on the front lines of health care are overwhelmed now with bigger concerns but we need the bean counters in there as well to work the numbers statistically.

We know this thing isn't going away, and we need to soon make some hard choices.

I think that's part of the equation Blansky. We need to risk stratify people. We need to have adequate testing to know the true-ish number of infected people in a geographical area, via PCR testing. We need to know how many people have been infected and are (presumably) immune via antibody testing, as they will be the safest bunch to interact with the high risk groups until there is a vaccine. Armed with this info, ASAP, we can get people back to work on site to get the economy on track.

One important thing we can all do is talk with our at-risk family members about their wishes should they become ill. Making these decisions under duress is stressful for everyone involved. Having a plan is always helpful, and particularly now.

[JasoninDenver]

And thoughts on the constitutional issues at play...

We can limit the freedoms granted under the constitution and have done so frequently to prevent a clear and present danger to the publics health or welfare. The historical example is that restrictions preventing you from yelling fire in a movie theater is a reasonable restriction on free speech. Yet, preventing a KKK march is not a reasonable restriction.

Historians have debated the Japanese Internment Act. At the time, people were convinced that it was reasonable and necessary. However, it was not enacted with a factual basis for the restrictions (no actual evidence of plots by these American citizens) just perceptions based on bias.

The justifications for governmental action on Coronavirus are clearly allowable to prevent a clear and present danger to public health and welfare. At some point, we can start to balance that equation but not now, no matter how severe the short term impact to the economy.

Once we have the medical resources available to meet the demands on the system then lets think about re-opening. We have China as guide here. I just hope that we do not ignore their experience and think we will be different as we did in the early weeks of this.

[Moggo]

Originally Posted by JasoninDenver

And thoughts on the constitutional issues at play...

We can limit the freedoms granted under the constitution and have done so frequently to prevent a clear and present danger to the publics health or welfare. The historical example is that restrictions preventing you from yelling fire in a movie theater is a reasonable restriction on free speech. Yet, preventing a KKK march is not a reasonable restriction.

Historians have debated the Japanese Internment Act. At the time, people were convinced that it was reasonable and necessary. However, it was not enacted with a factual basis for the restrictions (no actual evidence of plots by these American citizens) just perceptions based on bias.

The justifications for governmental action on Coronavirus are clearly allowable to prevent a clear and present danger to public health and welfare. At some point, we can start to balance that equation but not now, no matter how severe the short term impact to the economy.

Once we have the medical resources available to meet the demands on the system then lets think about re-opening. We have China as guide here. I just hope that we do not ignore their experience and think we will be different as we did in the early weeks of this.

With respect I think using anything China have done or do is flawed, they have manipulated and lied, it’s completely untrustworthy.

Not to mention that for 20+ years they have been warned about the potential cost of their dinning habits.


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[andyxxx]

Originally Posted by JasoninDenver

We have China as guide here. I just hope that we do not ignore their experience and think we will be different as we did in the early weeks of this.

I think that any nation taking China as a guide would be foolish as I do not believe any of their numbers/statistics.

If we do in fact take Chinas figures as fact, it looks like there’s little further to worry about (Just re-open after a few weeks shutdown)

Somehow they have re-opened and the virus has virtually stopped spreading to the rest of the population with miraculously few new cases or deaths.

[Fleetlord]

Originally Posted by Blansky

I would appreciate if the death toll would be less sensationalized and more "professional" in it's depiction of the health of the people before their contracting the virus.

I realize this is difficult but it would make for a far better analysis of when and how we lift restrictions on movements.

Now it's just xx died and we have no idea the ages, general previous health and complications they have pre-existing. We do know that smoking in China and Italy is a real thing. So did a large number of deaths have compromised lung issues previously.

An actor died a couple of days ago and there was no indication he was already sick when he contracted the virus but someone on a messaged board that knew him indicated he was. Obviously anecdotal but it would be nice to have more in depth reporting on this stuff. Then we have the Tom Hanks stuff where he and his wife pretty much sailed through the virus much like getting the flu.

Bottom line is how previously compromised are the patients that are dying when they show up in hospitals.

Stay safe everyone.

Tom Hanks has Type 2 Diabetes

https://www.today.com/health/tom-han...s-i-was-t93111

Seems to have fared ok.

But, there have been numerous cases of young, healthy individuals passing away from it. No known diabetes, no heart issues, no renal issues, no cancer...etc

It might come down to the amount of virus they were exposed to?? That needs to be considered in the balancing proposals, along with quarantining the vulnerable, as with enough virus exposure, the "healthy" are vulnerable too...they are still humans after all...

That is one thing the proponents of masks will say is that even if the masks aren't perfect, they will limit the inoculum that enters the respiratory tract. Less inoculm = less illness

[Blansky]

Originally Posted by Fleetlord

It might come down to the amount of virus they were exposed to?? That needs to be considered in the balancing proposals, along with quarantining the vulnerable, as with enough virus exposure, the "healthy" are vulnerable too...they are still humans after all...

That is one thing the proponents of masks will say is that even if the masks aren't perfect, they will limit the inoculum that enters the respiratory tract. Less inoculm = less illness

That's a good point. One doesn't really think of "how much" one gets when one gets a virus. We seem to think more of, like when we get the flu "bug" that we get it or we don't. We sometimes think more along the lines my immune system may have been a bit down and I caught it.

The how much is definitely a variable that isn't on most peoples radar.

[Fleetlord]

Originally Posted by Blansky

That's a good point. One doesn't really think of "how much" one gets when one gets a virus. We seem to think more of, like when we get the flu "bug" that we get it or we don't. We sometimes think more along the lines my immune system may have been a bit down and I caught it.

The how much is definitely a variable that isn't on most peoples radar.

I agree. The perception is you either have it or you don't...but there does seem to be a case for viral load exposed to and level of illness.

I am not sure what the data is on that, but you do see doctors and nurses being exposed to a very high concentration and duration of exposure to virus and they can get very very ill..

So, again, my mask crusade does allow mitigation of viral load taken in as there is a barrier to block more virus from getting up you nose...

I don't see a path to balancing without masks for the general public...either commercially produced or homemade. Get something in front of your face holes.

[Phooi]

Originally Posted by Fleetlord

I agree. The perception is you either have it or you don't...but there does seem to be a case for viral load exposed to and level of illness.

I am not sure what the data is on that, but you do see doctors and nurses being exposed to a very high concentration and duration of exposure to virus and they can get very very ill..

So, again, my mask crusade does allow mitigation of viral load taken in as there is a barrier to block more virus from getting up you nose...

I don't see a path to balancing without masks for the general public...either commercially produced or homemade. Get something in front of your face holes.

There are current discussions by the CDC on the efficacy of using face masks for the general public. You can search for articles online.

I have a friend in Taiwan, a country that has CV19 under control, explained to me what their country implemented when CV19 occurred. One of their first acts were to put on face masks. In fact, the government provides face masks to its population.

In Taiwan, masks have become a socially acceptable practice after the SARS epidemic. It is so commonplace that people wear them even if you have any signs of being ill (ie., allergies, colds, etc.). People will get upset if you’re coughing and not wearing your mask.

All of this was an anecdote for the use of face masks. The problem in the US currently is the lack of supply of surgical masks. At this stage, all supply should go towards the frontline people (ie., healthcare workers, essential services) who needs them the most. For the rest of the populace, I think some sort of face mask wouldn’t hurt. I think the challenge would be messaging it in a way that minimizes panic and hoarding.

[Andad]

Originally Posted by Blansky

That's a good point. One doesn't really think of "how much" one gets when one gets a virus. We seem to think more of, like when we get the flu "bug" that we get it or we don't. We sometimes think more along the lines my immune system may have been a bit down and I caught it.

The how much is definitely a variable that isn't on most peoples radar.

Quote:
Originally Posted by Zakalwe View Post
The answer to this is undoubtedly complex and probably not completely understood for what is a new pathogen. I’m certainly no expert in immunology or virology but it’s likely that the variation in severity (which is also seen with seasonal influenza) relates more to the host response than to the virus itself.

When you get an infection you generally feel ill because of the response mounted by your immune system. Some people’s immune systems over-react to the presence of a pathogen and it causes collateral damage and it’s these people that can become seriously unwell. Why do a minority react this way whilst most don’t? Genetics almost certainly plays a part. Certain environmental factors may be at play e.g. smoking. Advanced age degrades every system in your body, including response to infections.

The observation about more young people being affected is related to the increasing number of cases over time. It was never the case that young people could not become seriously unwell (the first notable death of the entire pandemic was a young, healthy Chinese doctor) but simply that their odds are much, much better than older people. Again to analogise with ‘flu - it’s known as a disease that seriously afflicts older people but it certainly does also kill young people - 674 annually in the U.K. in the 15-44 age group according to this:

https://www.sciencedirect.com/scienc...63445313003733

It’s just that you never hear about them.


I agree and mentioned this in a previous reply.

Could it just be that some were exposed to a higher viral load due to either multiple exposures or someone in a higher infectious condition?

[Moggo]

In the U.K. now they are starting to include those that died at home which I believe they weren’t previously doing, the cases have risen a fair bit today.

Why people are dying at home with no care is something I can’t work out?


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[Zakalwe]

Originally Posted by Moggo

In the U.K. now they are starting to include those that died at home which I believe they weren’t previously doing, the cases have risen a fair bit today.

Why people are dying at home with no care is something I can’t work out?


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If you have people who are so frail and demented that that cannot walk or talk, or people who have advanced, incurable cancer and they get seriously ill with a respiratory infection, sending them in to die in hospital is not always the right thing to do.

These people don’t get no care in the community, though palliative care services are being tested, not so much by the numbers but the difficulties imposed by social distancing and isolation protocols.

[Moggo]

Originally Posted by Zakalwe

If you have people who are so frail and demented that that cannot walk or talk, or people who have advanced, incurable cancer and they get seriously ill with a respiratory infection, sending them in to die in hospital is not always the right thing to do.

These people don’t get no care in the community, though palliative care services are being tested, not so much by the numbers but the difficulties imposed by social distancing and isolation protocols.

This is a huge part of the whole problem that gets missed, all concentrate on the virus and everything else slides. It’s lose/lose.


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[Zakalwe]

Originally Posted by Moggo

This is a huge part of the whole problem that gets missed, all concentrate on the virus and everything else slides. It’s lose/lose.


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The kinds of people we’re talking about here would not be going in to hospital with most serious ailments they might contract, regardless of what’s happening with COVID-19. It’s a fact of life that, if you live long enough, the human body degrades to the point that trying to keep whatever is left vaguely animated becomes impossible and sometimes even cruel.

Also consider that a lot of people in care and nursing homes either have advanced directives which stipulate they don’t want to go into hospital in the event of severe illness or their NOK have had discussions with their doctors and concluded that their ceiling of care should not escalate to going into hospital.

This is all standard stuff in community medicine and not related to COVID-19.

[Moggo]

Originally Posted by Zakalwe

The kinds of people we’re talking about here would not be going in to hospital with most serious ailments they might contract, regardless of what’s happening with COVID-19. It’s a fact of life that, if you live long enough, the human body degrades to the point that trying to keep whatever is left vaguely animated becomes impossible and sometimes even cruel.

Also consider that a lot of people in care and nursing homes either have advanced directives which stipulate they don’t want to go into hospital in the event of severe illness or their NOK have had discussions with their doctors and concluded that their ceiling of care should not escalate to going into hospital.

This is all standard stuff in community medicine and not related to COVID-19.

The brutal truth is sobering.


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[Rolexatlast]

JPMorgan have released their predictions for corona virus impact on GDP.

They seem to saying that only a handful of economies will be affected by >5%. Obviously any drop is bad, particularly if you lose your livelihood.

However, 5% does not seem to equal ‘destroyed economy’, and should be made up within a couple of years, and seems a price worth paying for saving 100 000s of lives

https://www.telegraph.co.uk/business...ndation-widget

[Blansky]

Originally Posted by Rolexatlast

JPMorgan have released their predictions for corona virus impact on GDP.

They seem to saying that only a handful of economies will be affected by >5%. Obviously any drop is bad, particularly if you lose your livelihood.

However, 5% does not seem to equal ‘destroyed economy’, and should be made up within a couple of years, and seems a price worth paying for saving 100 000s of lives

https://www.telegraph.co.uk/business...ndation-widget

So much of this depends on WHEN we go back to work. If we went back in 2 weeks, probably no economic affect, but if we go back in September or later, predicted number are probably out the window.

Obviously if there are limited deaths and people go back in a few months, the economy should pretty much rebound to where it is today within not too long.

We also have the law of unintended consequences, where companies see that, you know what, some of these jobs can be part time and from home, or we can teleconference more and travel less, or small businesses just can't bounce back and disappear. etc.

It will be interesting to see if there are corporate workforce reductions that don't go back to previous numbers after this.

[Rolexatlast]

Originally Posted by Blansky

So much of this depends on WHEN we go back to work. If we went back in 2 weeks, probably no economic affect, but if we go back in September or later, predicted number are probably out the window.

Obviously if there are limited deaths and people go back in a few months, the economy should pretty much rebound to where it is today within not too long.

We also have the law of unintended consequences, where companies see that, you know what, some of these jobs can be part time and from home, or we can teleconference more and travel less, or small businesses just can't bounce back and disappear. etc.

It will be interesting to see if there are corporate workforce reductions that don't go back to previous numbers after this.

Back in the early 2000s in the UK we had a couple of very bad winters (for the UK) with extensive flooding followed by major railway works, and people not able to commute into London, which gave a step-change in people working from home. Then later in the decade and the 2010s, big business decided that if workers still do their jobs can from their UK home, then they could employ lower wage peopled overseas.

Be interesting the consequences of this outbreak : will it also lead to a further step change in working from home, but this time with reduced international supply chains? And after the warnings from SARS and Bird Flu, will the international business community scale back work in China? And what could be China’s response to try to boost confidence? Could this lead to wholesale regulatory change?

[Blansky]

Originally Posted by Rolexatlast

Back in the early 2000s in the UK we had a couple of very bad winters (for the UK) with extensive flooding followed by major railway works, and people not able to commute into London, which gave a step-change in people working from home. Then later in the decade and the 2010s, big business decided that if workers still do their jobs can from their UK home, then they could employ lower wage peopled overseas.

Be interesting the consequences of this outbreak : will it also lead to a further step change in working from home, but this time with reduced international supply chains? And after the warnings from SARS and Bird Flu, will the international business community scale back work in China? And what could be China’s response to try to boost confidence? Could this lead to wholesale regulatory change?

I remember back maybe 10-15 years ago (maybe longer) when the whole teleconferencing thing was taking off and you'd see people around boardrooms with the big screen talking to customers on a similar screen miles away.

Then American Airlines ran a commercial of how some sales exec was traveling around doing face to face meetings and getting all the contracts. I do think that humans still need the face to face thing more than sterile big screen communications to feel they want to do business with you.

My wife and I were discussing this walking on the beach in Maui 10 days ago ( seems much much longer) because she is in medical education for a medical device company and she travels a lot as well as is on conference calls 5 hours a day. We wonder how this will change.

Time will tell. But I doubt that things will go back to the exactly the same as before.

[mountainjogger]

Originally Posted by Blansky

So much of this depends on WHEN we go back to work. If we went back in 2 weeks, probably no economic affect, but if we go back in September or later, predicted number are probably out the window.

Obviously if there are limited deaths and people go back in a few months, the economy should pretty much rebound to where it is today within not too long.

We also have the law of unintended consequences, where companies see that, you know what, some of these jobs can be part time and from home, or we can teleconference more and travel less, or small businesses just can't bounce back and disappear. etc.

It will be interesting to see if there are corporate workforce reductions that don't go back to previous numbers after this.

Agree depends on when we go back. Also depends on how good of a job we do beefing up medical system in interim and changing peoples behavior and being to test and track to try and keep form having to have this happen to this extent a few months later.

As to a couple of weeks, US has extended current guidance till end of April I am unaware of any plan under consideration in the nation that will have us back with a couple of weeds.

Stay safe.