totm april 2020 Coronavirus

[Superfluous J]

2 hours ago, DDE said:

Do you see the guy in a suit with a nametag to the right of the ATMs?

I just assumed he came out to see why someone was taking pictures of the ATMs.

[tater]

2 hours ago, Arugela said:

So, what is happening?! How has india not dropped in population by at least 50% yet?! It's one of if not the most bizarre thing so far out of the entire, "pandemic."

The Infection Fatality Rate is likely under 0.5 (0.37 according to German serological testing so far). Given the SEIR model of epidemics (Susceptible Exposed Infectious Removed (last is often "Recovered" but the dead are removed as well) there is an upper limit for how many get infected, because you run out of people you can randomly infect who are still susceptible. That herd immunity upper limit is about (1-1/R₀)*population. If this is like R₀ = 2.2, then that's ~54% of the pop. Call it 60%?

So at worst you could expect 0.4% of 60% of the population to die.

But there is also age demographics. That IFR is an average. The reality is that this overwhelmingly kills medically fragile people of all ages, and the very elderly. The younger patients that die tend to be sick enough they are medically more like 80 year olds, basically. If your pop has a lot of really old people more will die, and the IFR will be higher, if they have mostly young people, it's probably much lower.

 

This is interesting... those tests also need to be "in office" tests that produce results while you wait.

 

[Guest]

42 minutes ago, tater said:

So at worst you could expect 0.4% of 60% of the population to die.

The math mostly checks out, with two caveats:
1. This seems based on German studies, in absence of other data I'm assuming these numbers to be true with a functioning healthcare system. I'm not sure if it factors in people who would have died had they not been put on respirators or anti-cytokine drugs. A true worst case IFR should assume no treatment is available. Some other (admittedly older) data I've seen put the number of "critical" cases at 4.7%, and you can count those people as dead without treatment. If we assume every case requiring hospitalization would not recover without it, we could end up at 19% fatality rate (again, old data), which is probably too much, but it does give you an idea of how crucial proper healthcare is.
2. R0 depends on population dynamics. I'm not sure on what assumptions the R0=2.2 is based, but for a densely packed population like India, you can expect it to be a lot higher. Indeed, the point of quarantine is to bring R0 down (though "herd immunity" acquired with an artificially lowered R0 will be somewhat tenuous).

Lastly, with 0.4% out of 60% of all population of India is still three million people. Not quite an apocalyptic scenario, but still pretty devastating. If you assume their hospital system breaks down (and it will, if flooded with 3M people), you can assume at least 5%, which, at about 40M dead, would be close to the estimated civilian death toll of WWII on the Allied side. At 10%, it would be on order of the combined death toll of WWI and WWII, crammed into a single country. That's still using your R0, which is probably low for India (mostly because I have no idea how to estimate it). TBH, I don't think it'll be quite that bad, but if you want a worst-case scenario, that's more like it.

Edited April 10, 2020 by Guest

[DDE]

I have a new social distancing plan now.

 

[tater]

2 hours ago, Dragon01 said:

The math mostly checks out, with two caveats:

I think most of the people who are dying would die anyway, frankly. The vent statistics are terrible (the % they have to vent that live is small, and the ones that live are in pretty rough shape afterwards—given most are also very elderly...). My guess is that in retrospect we will find that this overwhelmingly killed people who were going to die of something in 2020 anyway. Overwhelmingly is not all, there will sadly be people who will die who would not have, for sure.

The people at risk for lack of treatment will be those who need supplemental O2 short of a vent/cpap, etc. That could definitely be a thing in some countries.

[Arugela]

That brings up something I've been curious about.

1. Are cpaps counted as ventilators in the count for ventilators/lack thereof we keep hearing about?

2. Do cpaps work in place of other ventilators in case of sickness etc.

3. If 1 is no and 2 is yes are there more cpaps about in warehouses that could be added to the list to keep people alive who get sick?

If there is a large stock of various cpap machines why can't they be bought or handed out to people who need them to increase the ventilator stock? I bet they are cheaper than many hospital varieties also. Assuming they don't use them as such. And there could be large amount of them. Not to mention a separate production que potentially. If they are not from the same companies, or even if they are, it could be an additional production que to get more faster.

Edited April 10, 2020 by Arugela

[magnemoe]

2 minutes ago, Arugela said:

That brings up something I've been curious about.

1.Are cpaps counted as ventilators in the count for ventilators we keep hearing?

2. Do cpaps work in place of other ventilators in case of sickness etc.

3. If 1 is no and 2 is yes are there more cpaps about in warehouses that could be added to the list to keep people alive who get sick?

No an ventilator is an pipe down into your lungs who blow in and remove air / oxygen directly into them. You are placed into coma during this because you have an pipe down you mouth into your lungs. 
This require that you need doctors and nurses monitoring you at all time making it very labor intensive in addition to the complex equipment. 
cpaps as I understand are external devices like an pilot oxygen mask however it will give oxygen enchanted air and over pressure then under pressure on breathing out. 
You are conscious using them its just an mask so you can call an nurse if needed and the equipment is much simpler. 
For corona virus the cpaps is uses on less affected patients who don't need ventilators but they are less efficient. 

[mikegarrison]

28 minutes ago, magnemoe said:

cpaps as I understand are external devices like an pilot oxygen mask however it will give oxygen enchanted air and over pressure then under pressure on breathing out.

This is not correct, at least for common CPAP machines at home. They do not enrich the air with oxygen, nor do they lower the pressure for exhale. All they do is supply "continuous positive air pressure". They are not really intended to help a person breathe due to issues with their lungs, but rather the extra pressure holds open the airway for people with obstructive sleep apnea.

There is a machine called a BiPAP that does lower the pressure during exhale.

 

[Arugela]

But a lot of machines have both bipap and cpap. They can be set to either with a setting. Cpap is kind of a catch all term.

They do put a good amount of stuff in your lungs though. Maybe not if it's filled with flem and pus, but it's still something.

Edited April 10, 2020 by Arugela

[tater]

5 hours ago, mikegarrison said:

This is not correct, at least for common CPAP machines at home. They do not enrich the air with oxygen, nor do they lower the pressure for exhale. All they do is supply "continuous positive air pressure". They are not really intended to help a person breathe due to issues with their lungs, but rather the extra pressure holds open the airway for people with obstructive sleep apnea.

There is a machine called a BiPAP that does lower the pressure during exhale.

 

Asked my wife, and she said most people have O₂ delivered with both types of machines (at least in the hospital).

She just added that she talked to an ER doc today who said they are actually trying to avoid venting people if possible, they think the prognosis is worse if they do that, and they are actually doing CPAP/BiPAP with Oxygen unless they absolutely have to vent them. Only 19 dead here in NM, and the few under 70 have all had bad health problems. Most are 80 and 90 YOs here who are dying.

My wife joked that your age is probably your % chance of dying if put on a vent with this. (dinner conversation around here can be pretty dark, it's always funny when the kids have friends over. It is much the same at my in-laws' house. My father in law was a neurosurgeon, and his "day at the office" talk when we were there before he retired was filled with horrible outcomes—if they helo you in to the ER and you need an immediate neurosurgical consult, things are not looking good for you).

[farmerben]

I'm curious what people think about the wisdom of homemade breathing apparatus?  In particular O2 welding gas tanks.  To make a low pressure nose hose is pretty simple.  Mannually operated bellows are simple to make out of household items.  In college I was taught about something called a gravity bong... etc.  

[tater]

1 hour ago, farmerben said:

I'm curious what people think about the wisdom of homemade breathing apparatus?  In particular O2 welding gas tanks.  To make a low pressure nose hose is pretty simple.  Mannually operated bellows are simple to make out of household items.  In college I was taught about something called a gravity bong... etc.  

Unless you live someplace without medical care available, if you are seriously short of breath (ever) seek medical attention.

That said, I'm sure it's possible to use alternate O₂ delivery systems, most that are hospitalized get nasal cannula (O₂ tubes under the nose) to increase their O₂ sat. As for pressure (bellows) and O₂... yeah, no, I'd not do that without actual skill I think. Put it this way, my wife said she'd not be comfortable doing that, because it's not something she does (and she's a surgeon). In the zombie apocalypse, Omega Man style? Sure. In a country with actual healthcare? No.

[Shpaget]

4 hours ago, farmerben said:

I'm curious what people think about the wisdom of homemade breathing apparatus?  In particular O2 welding gas tanks.  To make a low pressure nose hose is pretty simple.  Mannually operated bellows are simple to make out of household items. 

I'd say that's a good way to do some serious damage to the lungs. Pulmonary barotrauma is of concern and possible complication even with dedicated medical devices that have precision pressure regulation system.

Lungs don't feel pain, so if you overpressure them, by the time the patient notices something wrong, the damage has already been done.

https://www.ncbi.nlm.nih.gov/books/NBK545226/

[mikegarrison]

6 hours ago, tater said:

Asked my wife, and she said most people have O₂ delivered with both types of machines (at least in the hospital).

I believe this. Makes sense. That's why I qualified my answer with "for the common CPAP machines at home".

[Selective Genius]

@Arugela [snip] how about giving an authentic 100% Indian from the village a chance to clarify your doubts? 

[snip]

1. India is poor, hence deaths should be high

- True, a percentage of Indians are poor, but that does not mean that India is poor. It has sufficient resources to stave off the epidemic, including a strong health infrastructure. Maybe you should also take into account that COVID tests are free for the populace, no matter how rich or poor. It has always been free in government hospitals, and following a Supreme Court order, private labs are providing it free too (their costs will be borne by the government). We have not had a case of community transmission yet in most states, so a 'track and test' approach is in use in most states.

Rest assured, it is very difficult to cover anything up in a painfully transparent democratic country like India unlike [others]

2. Most of their population don't have means of communication

[snip] Internet charges in India is  extremely affordable and there's not a single village which dont have any means of mass media.

This is not the 18th century!

3. How do the poor (or anyone for that matter) get supplies.

- Through the Public Distribution System. The poor get their fixed amount of rations per member of the family, at negligible cost ( Rs 1 /kg of rice in my state during normal times. Translates to Rs. 7 for a decent meal). Our neighborhood which is a bit affluent gets doorstep delivery. (We have stocked up on quite a lot, so we are okay for the next 2 weeks)

4. Government is not capable of keeping a lockdown

-Oh heck no!!! It seriously is. It does not matter who the guy is. If caught roaming outside , at any time of the day (or night) he/she gets dragged away to the quarantine centers to be held for the next 14 days. A more hot tempered police force (in the northern regions) resorts to the good-old 'Lathicharge' beating the krap out of anyone who's breaking the lockdown.

We have been living in lockdown since 25th March, and it has been extended till 30th April, because of the Tablighi Jamaat mess.

People obey the government out of their own free will. You are making it sound like we are a bunch of poopy zombies or something.

Thus, in conclusion: There's a considerable chance that the virus will hit us hard but we have considerable counter measures deployed against those. The rest of the World has provided us with enough time and experience to lean on, and I am pretty confident we can win this

Edited April 11, 2020 by Vanamonde

[DDE]

12 hours ago, Selective Genius said:

2. Most of their population don't have means of communication

[snip]  Internet charges in India is  extremely affordable and there's not a single village which dont have any means of mass media.

This is not the 18th century!

As a rule, mobile telecom is adopted almost obscenely quickly in the developing world.

12 hours ago, Selective Genius said:

3. How do the poor (or anyone for that matter) get supplies.

- Through the Public Distribution System. The poor get their fixed amount of rations per member of the family, at negligible cost ( Rs 1 /kg of rice in my state during normal times. Translates to Rs. 7 for a decent meal).

Granted, the corruption in this system is a sight to behold. Remember the Uttar Pradesh embezzlements of the 2000s?

My moderate conclusion is that, while India is not defenseless per se, it is going to have a hard time maintaining lockdowns, although, because it initiated restrictive measures relatively early it should be able to avoid mass graves.

Edited April 11, 2020 by Vanamonde

[Selective Genius]

12 minutes ago, DDE said:

Granted, the corruption in this system is a sight to behold. Remember the Uttar Pradesh embezzlements of the 2000s?

There are tons of corruption cases in my country and all over the world, UP embezzlements were relatively meek Have you heard of the Fodder scam? or the Telecom scam? They were several 100 times more damning.

The Re 1/ kg rice scheme has been going perfectly in my state. Of course there's BOUND to be corruption at every level, but it is not big enough to impact people hugely. Governments understand that if a person is in a comfy enough position, he will most likely steal. So it turns a blind eye to them until his stealing becomes truly obstructive.

[kerbiloid]

5 hours ago, Selective Genius said:

The poor get their fixed amount of rations per member of the family, at negligible cost ( Rs 1 /kg of rice in my state during normal times.

Some daily limit in kilograms?

[tater]

This doc is in NY, the same applies to any area with a lot of cases. Places less slammed have more mildly sick tests.

 

[Selective Genius]

1 hour ago, kerbiloid said:

Some daily limit in kilograms?

A monthly limit of 30 kg per family. If you got 3 members in your family it's BANZAI for you, you can sell the extra rice at market price (30-40 Rs/kg). If you have like 8 family members, you are in a tough spot.  Unless you register as 2 families instead of one. Then it's BANZAI again!

Like I said, corruption is at every level. You just need to make sure you dont get caught.

[DDE]

Moscow is going into Papers, please mode. No driving around without one-time permits. Finally, this is weeks overdue.

https://rg.ru/2020/04/11/moscow-ukaz43-reg-dok.html

[Vanamonde]

A number of comments in this thread have been edited. Please do not attack entire nationalities as if everyone who lives in them is the same. Also, if you encounter something which you believe violates our forum rules, please report it to the moderators rather than reply to it yourself. Nobody benefits from having to read through personal arguments. 

[tater]

 

[tater]

Friend said they are not venting people unless they absolutely have to, they're proning them, and giving some O₂. Lots of 4 letter words regarding venting people and how violent and bad it is in general. They are taking some the few they have vented off, too (he's a pulmonary critical care doc treating covid patients).

The trouble with proning is that for really fat people it's difficult vs normal people (just because of geometry, keeping airway open, etc). He said many of the bad ones he has seen are obese. He said he saw a fat guy at Whole Foods in an N95 and thought, "Yeah, that;s probably a good idea." Like the French said, don't be fat.

He said that he was called to intubate a guy, he put his full gear on (taped seams, no air in except through filter), and asked the patient if he could roll over onto his stomach. the guy did, and his O₂ sat almost instantly shot up where he didn't need to be vented. That was a couple days ago, guy is still breathing on his own. The critical care people are learning fast.

I told him about that paper (might have posted it here) about the nursing home with patients that they thought had SARS in 2003, where 8/95 died, then they found out it was a coronoavirus cold, not SARS. He was utterly unsurprised. He said that elderly people can die of almost anything (which is why when elderly people at large like neighbors ask him if they should get the flu shot he says "%$#@ yes!"

 

[tater]

This is cool: