Conoravirus ...

[Jamie]

http://www.youtube.com/watch?v=snAhsXyO3Ck

CGP Grey (The guy who did Humans Need Not Apply). A thoughtful video on living in lockdown.

[kimbottles]

More than you ever wanted to know about Covid-19 presented by Doctor Kent Bottles (my Brother.)
(I am told he is something of a health care expert. He does get paid to do these presentations.)

https://blog.tldgroupinc.com/helm/key-l ... sformation

Watch at your own risk.

[LarryHoward]

More than you ever wanted to know about Covid-19 presented by Doctor Kent Bottles (my Brother.)
(I am told he is something of a health care expert. He does get paid to do these presentations.)

https://blog.tldgroupinc.com/helm/key-l ... sformation

Watch at your own risk.

Kim,

404 page not found.

[kimbottles]

More than you ever wanted to know about Covid-19 presented by Doctor Kent Bottles (my Brother.)
(I am told he is something of a health care expert. He does get paid to do these presentations.)

https://blog.tldgroupinc.com/helm/key-l ... sformation

Watch at your own risk.

Kim,

404 page not found.

Let me check the link.......

https://blog.tldgroupinc.com/helm/key-l ... formations

try this one and let me know if it works.....

I just tried it from this post and it worked here....

[LarryHoward]

Good link. Watching now. Sounds like you.

[LarryHoward]

Good link. Watching now. Sounds like you.

Thought provoking and worth the time. Tell him thanks.

[kimbottles]

Good link. Watching now. Sounds like you.

Thought provoking and worth the time. Tell him thanks.

Yeah, I learned some stuff and it made me ponder a lot of things.
Long but worth it IMHO.

He and his MD wife have both been really supportive of my cancer care. They read all my tests and charts and advise me. They are both experienced with cancer patients. (Kind of handy having them in the family.)

[Olaf Hart]

More interesting and seemingly accurate information

https://youtu.be/tkW2qD6gjzI

[Olaf Hart]

That’s an impressive talk Kim, not many clinicians would be able to cross over to the social and economic topics so readily and comprehensively.

I have the feeling your brother can read my mind, he reinforces all my biases....

On the other topic I posted, the reported ten fold risk of serious complications in people with metabolic syndrome has my antennae glowing, this may explain the increased risk of some racial groups, as well as the apparent lower rates in countries like India.

I have an image of a study comparing death rates across the world against the relative frequency of MacDonalds or Starbucks outlets..

Beau, do you have any idea how we could find this data on market penetration by fast food providers?

[BeauV]

OH,

I don't have a single source which will give us a good idea of the percentage of "ultra-processed food" (UPF) in our diets. I'll start digging. I do know that it's terrible for people. I have run into this over and over in all sorts of places. When I worked at Heartflow, I read a number of clinical studies about the effects of inflammation on the cardiovascular system, it's bad. The UPF seems to stimulate a constant response from the immune system, and that causes one's own immune system to damage all sorts of things. It would make sense that when COVID-19 shows up and the immune system kicks into high gear, the previously damaged systems would collapse. I think this is called a Cytokine storm, but I'm not sure.

A friend of mine who is a military doctor has a great analogy for how the immune system works. The analogy is far from perfect, but it works on we non-medical types well enough. I'd be interested in your thoughts:

The body is a lot like a country. It needs to have a way of controlling bad actors. Normally, there aren't many bad actors around. As a result, we have a police force which is trained in how to remove the small number of bad actors without damaging the surrounding buildings and citizens. They have a set of rules to guide them as they do their job. Occasionally, the police will get overzealous or won't be zealous enough, and our Government will tune up their behavior, but typically the Police do a pretty good job. This is analogous to our first line of defenses in the human immune system. It's good at killing off a small number of bad actors, but can be overwhelmed.

However, every once in a while we have so many bad actors (like a major riot, invasion, or post soccer game brawl) that we have to call out the Army to rid the country of them. The Army operates under very different rules with very different tools. There can be a LOT of collateral damage. When you need them, they are great. But no one wants a group of tanks roaming around the city streets on an ongoing basis. Or troops using machine guns to stop groups of drunken party-goers. So, as soon as possible, the Government sends the Army back to the barracks and the troops are very happy to go. The Army is NOT trained or designed to gently encourage proper behavior from civilians. They are trained to kill opposing military actors and don't concern themselves with collateral damage much. This is analogous to our second line of defenses in our immune system.

My understanding is that with COVID-19, our first line of defenses (Police) are rapidly overwhelmed, probably within a day or two. The immune system calls out the second line of defense (Army) and the tanks and bombers roll in. The side effect of the battle raging in the lungs and through the circulatory system is terrible. The collateral damage showing up in all sorts of places is significant; including chilblains in the toes, heart attacks, strokes, ruptured arteries, etc.... The Army may be winning the war against the virus, but it's killing the host in the process. Thus, the use of immune suppressors during the Cytokine storm which follows the arrival of the Army.

[Tigger]

Pandemic investment advice:

Between the US and Canada there are at least a couple of million members of the Armed Forces (retired and active duty) whose hair is getting ... long. So long, in fact, that for the first time in decades they actually need conditioner.

Buy Proctor and Gamble before the word gets out!

[Ajax]

What I'm seeing, is that nationally, we are still not on the backside of a curve. We have wild oscillations across a plateau.
All we've done, is control the hospitalizations at a point that is just barely sustainable.

Now, many states are opening up.

Well I've got a message for all these protesting restaurateurs, salons, bars and fitness clubs: I'm not coming.
I don't trust them and I don't trust their employees to maintain the standards necessary to prevent transmission. In some cases, the customer environment is virtually impossible to secure against transmission unless the service provider were wearing a full isolation suit.

[Jamie]

Right with you Ajax. I suspect, if 1918 is any model, we'll have a second wave. What will the reaction be then?

Interesting - there is a Trump "yachting event" down here... clearly he has a strong following with the center console crowd. Several hundred center consoles and several thousand people have turned the ICW into a highway of boats and flags. No social distancing on display. Interesting show of force.

I think people can deal with hardship as long as they feel there is some fairness and that things are equitably applied . That's why in my mind this decentralized approach is a bad one.

[Olaf Hart]

Interesting, I bet the majority of white people with metabolic syndrome are Trump voters.

Wouldn’t be surprised if he had a mild case himself...

[Benno von Humpback]

The majority of the Trump demographic are at low risk because they live in low density areas and are relatively affluent. They will not be punished for their attitudes and will learn no lessons. The burden of any subsequent waves will be born mainly by others less visible and politically engaged. The governors know this.

[Olaf Hart]

My impression is the majority of the population will eventually catch the virus, the isolated ones will just catch it later.

If people with metabolic syndrome are 10 times as likely to die, there is nowhere to hide.

[Benno von Humpback]

My impression is the majority of the population will eventually catch the virus, the isolated ones will just catch it later.

If people with metabolic syndrome are 10 times as likely to die, there is nowhere to hide.

In the long run, if current trends hold, I think that's quite possible. However, in the long run, as Keynes said, we're all dead.

[LarryHoward]

[quote="Olaf Hart"]My impression is the majority of the population will eventually catch the virus, the isolated ones will just catch it later.

If people with metabolic syndrome are 10 times as likely to die, there is nowhere to hide.[/quote]

The published reason for the shut down was not to stop the spread but to “flatten the curve” so that responders and facilities were not overwhelmed. It didn’t work for Manhattan with nearly 1/3 of the nation’s deaths and about 1/6 of the confirmed cases. Rural areas have not been overwhelmed and case rates have been much lower. Even with the mass of humanity that is Broward, Dade and Palm Beach Counties, Florida has a population of slightly more than NY State and is currently forecast to have less than 7% of NY’s deaths. Florida’s hospitals have not reached 50% of capacity.

If we do expect the virus to spread throughout the population, have we moved the goalposts from “flatten the curve” to an unachievable “stop the disease” with the “Hammer” of shutdowns that will ultimately fail? Certainly, I’m staying in and wearing a mask when I do go out since I’m in the high risk demographic. Unless we expect a vaccine before the second wave, how long should the shutdown last? Some are suggesting a case rate of 1 per million is the metric that the states should use. That would be 330 cases in the US. Really? Supply chains are already stressed. The economy is a shambles and folks are lining up for hours for food bank had outs because the support system can’t handle a 100 fold increase in applicants.

Perhaps one lesson in this is clustering in high density urban centers isn’t the best way to fight a pandemic but a great way to put the burden on low paid service workers and the institutionalized elderly in nursing homes.

Just some thoughts. If we take off our red/blue filters, maybe one response isn’t the best for every county, state or region.

[Jamie]

Might it be the case that rural areas have not been overwhelmed just because it hasn’t gotten to them? It’s a long standing issue that rural communities are under served with healthcare. Right now it’s a NYC the “den of iniquity” issue but coming to a town near you?

Id argue that the whole purpose of a Federal government is to coordinate and align resources where it is not effective for lone states to do so. It’d be pretty hard to fight a foreign war on a state-by-state basis, but that’s what in effect we’ve been doing.

Simple question with probably a complicated answer: Why are we not able to get the testing and tracing in place needed to open without creating a lot of excess deaths?

[BeauV]

I agree with Larry, we set out to flatten the curve. We have done so. Now, it's time to make a rational decision to try and cure this thing with isolation or hold the infection rate at what the medical system can deal with. If we chose the latter, we have a damned strong moral obligation to educate folks on how to avoid catching it. It kills far too high a percentage to just say: "Ya, whatever, it's up to you. Party on."

We are definitely moving the goalposts. But that could be the right answer or wrong answer. Two months ago the VAST majority of citizens knew F-all about this disease and were listening to politicians for medical advice. Now, those same politicians have been either proven correct or discredited. I don't hear folks quoting a retired speaker of the house as an authority on a medical issue anymore, I used to get that all the time.

I also agree with Jamie, the disease just hasn't reached the far corners of the country (or the world). As we've flattened the curve, we've helped delay the infection of those who aren't in larger metro areas. But imagine what's going to happen when Las Vegas re-opens. The 1918 flu faded, then came back. This one will too as the virus expands into new areas without any immunity (assuming immunity actually works for this particular coronavirus).

I think re-opening with a firm hand on the throttle to cut back when it spikes again is a great strategy. However, we STILL don't have enough tests to even test everyone who is symptomatic, let alone anyone who is at risk. Could we PLEASE get off our asses as a country and fix this. It is absurd! The level of screw up this represents is massive.

[kimbottles]

If we take off our red/blue filters, maybe one response isn’t the best for every county, state or region.

Yes, this.

[Benno von Humpback]

If we take off our red/blue filters, maybe one response isn’t the best for every county, state or region.

Yes, this.

True and the politicization of this issue is particularly harmful and sad.

[LarryHoward]

Might it be the case that rural areas have not been overwhelmed just because it hasn’t gotten to them? It’s a long standing issue that rural communities are under served with healthcare. Right now it’s a NYC the “den of iniquity” issue but coming to a town near you?

Id argue that the whole purpose of a Federal government is to coordinate and align resources where it is not effective for lone states to do so. It’d be pretty hard to fight a foreign war on a state-by-state basis, but that’s what in effect we’ve been doing.

Simple question with probably a complicated answer: Why are we not able to get the testing and tracing in place needed to open without creating a lot of excess deaths?

Jamie,

Locally, data shows that with 50% or more of the local workforce "essential", that we are at a plateau or going down. Out of 113K residents, we are seeing 1-3 infections per day (we were at 10% daily increase 3 weeks ago) and have a total of 7 deaths. 35 total residents have been hospitalized and we have empty tents around the local hospital that have not held a single patient. Our case fatality rate is about 3.7% or positive tests.
for the country as a whole, the curve has flattened and way below exponential.

Time to open South Beach completely? Of course not. Even Florida's gov has exempted your area from relaxation of the restrictions. Can we lock down hard for another 3 months and include the at risk supply chain and utility workers? Going to be hard to have a Gucci supermarket deliver decontaminated food when the trucks are empty. We are going to have to manage the waves of this pandemic which means throttling the response. Hiding in place for another 18 months is simply not sustainable.

Again, not arguing that shelter in place isn't good public health. We need to manage the return to a somewhat normal society and that means extensive and rapid testing and a coherent national plan. That doesn't have to be the same plan in Manhattan as in Wyoming.

[BeauV]

Just some thoughts. If we take off our red/blue filters, maybe one response isn’t the best for every county, state or region.

Larry,

A lot of us would be perfectly willing to accept that if the nation as a whole wasn't busy underwriting the stupid decisions being made by some places. So long as we are obligated to help states and regions by insuring them against disaster, then we as a nation have a say in the risks they take. It's like auto insurance. It's higher in Boston than Chattanooga.

[Jamie]

Might it be the case that rural areas have not been overwhelmed just because it hasn’t gotten to them? It’s a long standing issue that rural communities are under served with healthcare. Right now it’s a NYC the “den of iniquity” issue but coming to a town near you?

Id argue that the whole purpose of a Federal government is to coordinate and align resources where it is not effective for lone states to do so. It’d be pretty hard to fight a foreign war on a state-by-state basis, but that’s what in effect we’ve been doing.

Simple question with probably a complicated answer: Why are we not able to get the testing and tracing in place needed to open without creating a lot of excess deaths?

Jamie,

Locally, data shows that with 50% or more of the local workforce "essential", that we are at a plateau or going down. Out of 113K residents, we are seeing 1-3 infections per day (we were at 10% daily increase 3 weeks ago) and have a total of 7 deaths. 35 total residents have been hospitalized and we have empty tents around the local hospital that have not held a single patient. Our case fatality rate is about 3.7% or positive tests.
for the country as a whole, the curve has flattened and way below exponential.

Time to open South Beach completely? Of course not. Even Florida's gov has exempted your area from relaxation of the restrictions. Can we lock down hard for another 3 months and include the at risk supply chain and utility workers? Going to be hard to have a Gucci supermarket deliver decontaminated food when the trucks are empty. We are going to have to manage the waves of this pandemic which means throttling the response. Hiding in place for another 18 months is simply not sustainable.

Again, not arguing that shelter in place isn't good public health. We need to manage the return to a somewhat normal society and that means extensive and rapid testing and a coherent national plan. That doesn't have to be the same plan in Manhattan as in Wyoming.

Look I don't have great answers. But I don't see much coordination or progress on testing. I also don't disagree with your point about the workforce. It's easy for white collar workers to say continue the lockdown since they can work at home. Not that I have a great love for the aparatchiks at OSHA, but how about ensuring proper protections for workers and not shielding employers from lawsuits for failure to comply, especially if we are going to mandate that some must work? Most employers make a good faith effort, but there are always a number that flout the rules. That sounds more "fair" to me.

When I see a couple hundred center consoles with a Trump 2020 flags with max capacity people on them, I just think about who might have to clean up the mess later. (Oh noes! The creeping nanny state!?) They aren't the Orangemen are they?

[LarryHoward]

Might it be the case that rural areas have not been overwhelmed just because it hasn’t gotten to them? It’s a long standing issue that rural communities are under served with healthcare. Right now it’s a NYC the “den of iniquity” issue but coming to a town near you?

Id argue that the whole purpose of a Federal government is to coordinate and align resources where it is not effective for lone states to do so. It’d be pretty hard to fight a foreign war on a state-by-state basis, but that’s what in effect we’ve been doing.

Simple question with probably a complicated answer: Why are we not able to get the testing and tracing in place needed to open without creating a lot of excess deaths?

Jamie,

Locally, data shows that with 50% or more of the local workforce "essential", that we are at a plateau or going down. Out of 113K residents, we are seeing 1-3 infections per day (we were at 10% daily increase 3 weeks ago) and have a total of 7 deaths. 35 total residents have been hospitalized and we have empty tents around the local hospital that have not held a single patient. Our case fatality rate is about 3.7% or positive tests.
for the country as a whole, the curve has flattened and way below exponential.

Time to open South Beach completely? Of course not. Even Florida's gov has exempted your area from relaxation of the restrictions. Can we lock down hard for another 3 months and include the at risk supply chain and utility workers? Going to be hard to have a Gucci supermarket deliver decontaminated food when the trucks are empty. We are going to have to manage the waves of this pandemic which means throttling the response. Hiding in place for another 18 months is simply not sustainable.

Again, not arguing that shelter in place isn't good public health. We need to manage the return to a somewhat normal society and that means extensive and rapid testing and a coherent national plan. That doesn't have to be the same plan in Manhattan as in Wyoming.

Look I don't have great answers. But I don't see much coordination or progress on testing. I also don't disagree with your point about the workforce. It's easy for white collar workers to say continue the lockdown since they can work at home. Not that I have a great love for the aparatchiks at OSHA, but how about ensuring proper protections for workers and not shielding employers from lawsuits for failure to comply, especially if we are going to mandate that some must work? Most employers make a good faith effort, but there are always a number that flout the rules. That sounds more "fair" to me.

When I see a couple hundred center consoles with a Trump 2020 flags with max capacity people on them, I just think about who might have to clean up the mess later. (Oh noes! The creeping nanny state!?) They aren't the Orangemen are they?

Jaime,

Agree with all. I'll match your Trumptsters with crowds in Central Park and surfers in California. Covidiots come in colors to include orange. As to employer lawsuits, there is a balance. No matter what precautions they take, it can't be perfect. If you are going to invoke DPA and force someone to open, you need to do more than tell them "be careful out there."

[SemiSalt]

2020-05-04_1459.png

Well, how are things going in Fairfield County, Connecticut? Today I figured out how to download all the back data from a state website. Annoyingly, it's the original day-by-day numbers, not numbers as corrected later. But it's something.

Do you perceive a max followed by a decline? Nothing striking, but 8 of the last ten values are near or below the 200 line, while going back before the annoying, data collection-caused, spikes, 9 of 10 are above the 200 line. So I guess you can say there is a decline. I don't know how to reconcile this with the 35% drop in the number of people hospitalized.

Also annoying to all the data geeks up here, they are not reporting any data today because "Connecticut’s Department of Public Health (DPH) is transitioning to a new process to make the daily collection of data more sustainable."

[kdh]

Two words for you, Semi. Small sample.

I'm more probabilist than statistician, but I know that much.

The graphic in this article is a good one. Deaths by state on a log scale with the slopes for different doubling times indicated. A statistic built by someone smart.

https://www.npr.org/sections/health-shots/2020/04/10/829167659/are-we-flattening-the-curve-states-keep-watch-on-coronavirus-doubling-times

[Benno von Humpback]

This from the CEO of our hospital today:

It has become clear over the last several days that there are a small number of COVID-19 patients who have repeatedly negative tests using nasopharyngeal swabs but who have serious lower respiratory tract and lung disease that can be spread by coughing. We encountered one of these patients last week. In spite of 2 negative tests, the patient had coronavirus diagnosed readily by bronchoalveolar lavage.

[Olaf Hart]

This from the CEO of our hospital today:

It has become clear over the last several days that there are a small number of COVID-19 patients who have repeatedly negative tests using nasopharyngeal swabs but who have serious lower respiratory tract and lung disease that can be spread by coughing. We encountered one of these patients last week. In spite of 2 negative tests, the patient had coronavirus diagnosed readily by bronchoalveolar lavage.

Same story as legionella...