totm april 2020 Coronavirus

[sh1pman]

5 hours ago, DDE said:

livedo reticularis are dermal symptoms, albeit rare. Their frequency is reverse-proportionate with age, so another way to spot young asymptomatics?

Really? I had an unusual rash on the back of my hands 2-3 weeks ago. No corona symptoms. Thought it was some kind of allergy, but now it’s gone.

[Hotel26]

A couple of observations:

1. pandemics kill a spectacular number of people.  it's a tidal wave event.  save lives if you can, but expect a distressing number of deaths anyway.  be reasonable in what outcome you expect, therefore in what you attempt -- and how you criticize results.
2. in general, if a plan to save one life is to ask 999 people to do a simple chore such as wash their hands properly six times a day and the plan requires full compliance, you can be sure the plan is going to fail.  (if it's one component in a much better-conceived strategy, then, sure, go ahead and educate/discuss/ask.)

Both of these are very sad to state, but I think they are key to think about.

Edited April 18, 2020 by Hotel26

[tater]

https://rt.live/

Tracks States by R_t (R effective).

 

UT Austin model:

https://covid-19.tacc.utexas.edu/projections/

 

3 minutes ago, Hotel26 said:

pandemics kill a spectacular number of people.  it's a tidal wave event.  save lives if you can, but expect a distressing number of deaths anyway.  be reasonable in what outcome you expect, what you attempt -- and how you criticize results.

This is the problem with the way this has been covered in the media, they don't talk about the tidal wave aspect, they make it sound as if X thousand deaths a day goes forever, vs the reality that this is a tidal wave that is primarily taking the lives of the elderly, and even within the elderly, a not huge subset of them. A lot of deaths, but a lot of deaths in a community where many die all the time. I expect this to infect people until herd immunity... even that is tricky, since some coronaviruses don't confer lifetime immunity. Spread it out too much, and we're back where we started. If we need 60-80% to get this, then we have to be prepared for 0.X% of that number to die.

Unrelated to the media, it's amazing that people in "assisted living" are not tracked separately in this, I know here in NM, it's a substantial % of the few dead/critical we have. They are definitionally frail, they need "assistance" to just live. My dad, and my in-laws all live regular lives, all pushing 90.

[tater]

https://ccdd.hsph.harvard.edu/research/ncov-making-sense-of-an-epidemic/

[magnemoe]

4 hours ago, Hotel26 said:

A couple of observations:

1. pandemics kill a spectacular number of people.  it's a tidal wave event.  save lives if you can, but expect a distressing number of deaths anyway.  be reasonable in what outcome you expect, therefore in what you attempt -- and how you criticize results.
2. in general, if a plan to save one life is to ask 999 people to do a simple chore such as wash their hands properly six times a day and the plan requires full compliance, you can be sure the plan is going to fail.  (if it's one component in a much better-conceived strategy, then, sure, go ahead and educate/discuss/ask.)

Both of these are very sad to state, but I think they are key to think about.

The real dying starts then your hospitals overflow, that is why flatting the curve is important. You can mitigate this moving patients like France used trains converted to hospitals to move patients out of Paris out to smaller cities who was not yet affected. Later you can hopefully move patients into Paris 

[DDE]

https://www.sciencemag.org/news/2020/04/how-does-coronavirus-kill-clinicians-trace-ferocious-rampage-through-body-brain-toes

TL;DR: This isn't pneumonia. nCOV attacks virtually every major organ and causes clotting in the blood, leading to a multitude of pathologies.

[tater]

51 minutes ago, magnemoe said:

The real dying starts then your hospitals overflow, that is why flatting the curve is important. You can mitigate this moving patients like France used trains converted to hospitals to move patients out of Paris out to smaller cities who was not yet affected. Later you can hopefully move patients into Paris 

It seems self-evidently true that if the hospitals have NO beds, then people die from all the other stuff that kills them without emergent care, but where has this happened? Northern Italy, presumably. Can't possibly be Wuhan, since they built emergency wards that doubled their hospital capacity, yet managed to come out with far, far fewer deaths than NYC which never even exceeded capacity. For reasons that escape analysis .

The COVID patients that had vents triaged? Yeah, they were almost certainly going to die anyway. We've seen the awful numbers for vent prognosis, it'd be interesting to see it by age. If it scales to COVID in general, then for 80+ vent survival is probably close to zero, with much better outcomes as people are younger.

My State has been prepping now for over a month for a surge. The hospitals are empty. People are not getting care, not because of overflow, but because the State/hospital is worried about overflow X days ahead (which is not going to happen). They need to prepare, and they don't want people to be postop and vulnerable to infection, I get it, but it's not without cost. A lot is not that the hospital can't/won't do care, they want to, but people are so freaked out they stay home.

When all is said and done, some measures we're doing could have saved lives, and the same measures might have also cost them. If someone dies in a few years because their cancer metasticized while waiting for their "elective" cancer surgery this year, no one will notice. No one will care, either, because the press doesn't breathlessly cover every awful death from cancer (or "just flu"), we don't get "dashboards" that show us how many have died from metastatic brain tumors today, or heart attacks (or "just flu"). We infrequently hear about the seemingly healthy 20 year old who went to the ER with some minor complaint, quickly crashed, and died days later in the ICU with tubes everywhere. I hear about this just because I hang with people who talk about it all the time as "work talk." Happens every day.

Wasn't meant as a rant, it's just odd to see the global level of concern for this, when over some multi-year average, this is going to be noise.

Edited April 18, 2020 by tater

[tater]

https://www.bostonglobe.com/2020/04/17/business/nearly-third-200-blood-samples-taken-chelsea-show-exposure-coronavirus/?event=event25

Wow.

[Hotel26]

7 hours ago, magnemoe said:

that is why flatting the curve is important

I understand the theory, which is based on the theory that dying people can be saved in ICUs.

Perhaps if less thought had been spent on drones 'herding' people, out for a walk, and more on what to do about the concentration of the old and vulnerable in nursing homes?

Edited April 19, 2020 by Hotel26

[tater]

28 minutes ago, Hotel26 said:

I understand the theory, which is based on the theory that dying people can be saved in ICUs.

We had a Zoom party tonight with mostly doctors, they're all horrified by the vent stats, and it's not being done as much, here in the US they've largely decided that they might be doing more harm than good. The hospitalist on the chat pointed out that the long term survival for the geriatrics who managed to live after being on a vent was probably not gonna be great. She said that that many are losing kidney function (so dialysis going forward).

Course the pediatric oncologist said they had a cancer kid with COVID that ended up on a vent, and is now fine. FWIW, she said that was rare, and that from all her friends back in NYC (they moved here from there), even kids actively treated for cancer seem to do as well as other kids.

28 minutes ago, Hotel26 said:

Perhaps if less thought had been spent on drones 'herding' people, out for a walk, and more on what to do about the concentration of the old and vulnerable in nursing homes?

Yeah, the nursing homes are bad mojo right now. The slight majority of deaths here in NM are actually coming from the some of the Pueblos and the Navajo Nation, but of those that are not are dominated by deaths from a single assisted living place.

You are exactly right, first order of defense was not closing schools, it should have been nursing homes. There is even a good business case for this, as the patients have to be alive for them to get paid, so it would be worth it to keep them alive as long as possible (dunno what the cost is to put someone there, but it can't be cheap).

[magnemoe]

5 hours ago, Hotel26 said:

I understand the theory, which is based on the theory that dying people can be saved in ICUs.

Perhaps if less thought had been spent on drones 'herding' people, out for a walk, and more on what to do about the concentration of the old and vulnerable in nursing homes?

True, but if hospitals are full this affect other sick or wounded too. Horror stories about ambulances having to wait in queues or try out multiple hospitals come from multiple countries. 

At least here in Norway they was well aware of the danger at nursing homes before this became an pandemic and it was among the first things closed off. 
One problem is that you can have employee getting sick without symptoms bringing the disease in, you also have the bad practice of some employee working at multiple institutions. 

[Hotel26]

1 hour ago, magnemoe said:

At least here in Norway they was well aware of the danger at nursing homes before this became an pandemic and it was among the first things closed off. 
One problem is that you can have employee getting sick without symptoms bringing the disease in, you also have the bad practice of some employee working at multiple institutions.

Q.E.D.

In a fight against Mother Nature, you cannot expect to win.

So don't burn down the house, in addition.

                                                            

Personally, I would rather see the human race put effort into finding out how this happened and taking steps to prevent it happening again.

 

Edited April 19, 2020 by Hotel26

[tater]

 

[mikegarrison]

Obviously the more actual instances of the virus you are exposed to, the greater the risk. Can he quantify what a "significant risk" is?

[tater]

25 minutes ago, mikegarrison said:

Obviously the more actual instances of the virus you are exposed to, the greater the risk. Can he quantify what a "significant risk" is?

When they do contact tracing, they only even bother to count contacts that you spent at least 30 minutes with.

 

[mikegarrison]

1 minute ago, tater said:

When they do contact tracing, they only even bother to count contacts that you spent at least 30 minutes with.

Is that because it takes that long to spread the disease? Or just because I have no Fing clue who the people I spent 30 seconds near while I was shopping yesterday actually are?

[tater]

5 minutes ago, mikegarrison said:

Is that because it takes that long to spread the disease? Or just because I have no Fing clue who the people I spent 30 seconds near while I was shopping yesterday actually are?

It's a little bit of both, I think. Transmission far more likely with increased exposure, and just the logistics of calling all the possible contacts.

Realistically for contact tracing they need actual names, so they mean face to face contact for ~30min+ (could also be sitting next to someone on a train or something, I suppose). I want to say there's a paper up thread linked where the average patient they traced had 32 contacts. Tracing needs to go both directions, too. Ie: back X days to figure out of they know who you got it from, and then forward to that point to contact the people at risk from you who need to quarantine. If this was Measles, they'd have to use much shorter exposure duration, though, as it's very transmissible. So I think it has some basis in what they think R₀ is.

I have read some stuff off medical twitter over the weeks suggesting that the chance of getting infected out in the world was really, really small compared to at home from a family member. I want to say I linked one up thread from Taiwan (?) that said the attack rate within a household was 10%, and at large in the world (shopping, etc) it was 0.4%. I don't recall the time interval being specified, though.

 

[mikegarrison]

9 minutes ago, tater said:

It's a little bit of both, I think. Transmission far more likely with increased exposure, and just the logistics of calling all the possible contacts.

Realistically for contact tracing they need actual names, so they mean face to face contact for ~30min+ (could also be sitting next to someone on a train or something, I suppose). I want to say there's a paper up thread linked where the average patient they traced had 32 contacts. Tracing needs to go both directions, too. Ie: back X days to figure out of they know who you got it from, and then forward to that point to contact the people at risk from you who need to quarantine. If this was Measles, they'd have to use much shorter exposure duration, though, as it's very transmissible. So I think it has some basis in what they think R₀ is.

I have read some stuff off medical twitter over the weeks suggesting that the chance of getting infected out in the world was really, really small compared to at home from a family member. I want to say I linked one up thread from Taiwan (?) that said the attack rate within a household was 10%, and at large in the world (shopping, etc) it was 0.4%. I don't recall the time interval being specified, though.

If I only French kiss someone for a minute or two, then that's not an issue, right?

[tater]

Just now, mikegarrison said:

If I only French kiss someone for a minute or two, then that's not an issue, right?

Hair smelling is totally safe, too.

 

[tater]

 

Another model, obviously.

[tater]

Long story, short: We will need to transition back to a more normal life, or everything crashes. No economy, no tax money to pay for services, etc. People under 50-60 are not at substantial risk, let them work (with caveats for people with serious health risks, etc, obviously). Stuff we've been saying here for what seems like years, but is only weeks.

[mikegarrison]

5 hours ago, tater said:

Long story, short: We will need to transition back to a more normal life, or everything crashes. No economy, no tax money to pay for services, etc. People under 50-60 are not at substantial risk, let them work (with caveats for people with serious health risks, etc, obviously). Stuff we've been saying here for what seems like years, but is only weeks.

Yes, but IT'S ALL BEEN NEARLY USELESS IF WE DO IT TOO SOON. All the models seem to agree that we need to try to hold things together until mid- or late- May. Is that really too much to ask?

Sure, it seems like younger people aren't at a lot of risk, but all that means is that they are doing this to save the lives of others rather than their own. Younger people going out, catching the virus, and continuing to spread it and keep it burning in the population may not kill them, but it just keeps the damn thing active and churning and trying to get at the more vulnerable people. Whereas just a few weeks more of pretty good quarantine and it will be much easier to keep it from getting to the vulnerable people at all.

[Shpaget]

7 hours ago, tater said:

Long story, short: We will need to transition back to a more normal life, or everything crashes. No economy, no tax money to pay for services, etc. People under 50-60 are not at substantial risk, let them work (with caveats for people with serious health risks, etc, obviously). Stuff we've been saying here for what seems like years, but is only weeks.

Yeah, but who has the balls to publicly state that it's ok to sacrifice 3,5% of the world population (~about 250 million) in order to save the economy? Perhaps 15% of 70+ age group sounds better for younger folks, and they wouldn't mind, but it's still one hell of a press conference. After all those people are mostly not beneficial to the economy. We can call it the Great Culling of 2020.

A cold hearted, rational calculation may indicate that the bigger picture and in the long it's better to just get it over with, sacrifice whoever needs to be sacrificed and for the life to get back to normal, but there are those that will claim that one life is a price too high, and that it's worth the effort to try to now save as many as possible no matter the long term cost.

[mikegarrison]

20 minutes ago, Shpaget said:

Yeah, but who has the balls to publicly state that it's ok to sacrifice 3,5% of the world population (~about 250 million) in order to save the economy? Perhaps 15% of 70+ age group sounds better for younger folks, and they wouldn't mind, but it's still one hell of a press conference. After all those people are mostly not beneficial to the economy. We can call it the Great Culling of 2020.

A cold hearted, rational calculation may indicate that the bigger picture and in the long it's better to just get it over with, sacrifice whoever needs to be sacrificed and for the life to get back to normal, but there are those that will claim that one life is a price too high, and that it's worth the effort to try to now save as many as possible no matter the long term cost.

It's not about "we'll never be the same again". It's about waiting just a few more weeks in order to head off a nasty "second wave".

When you are busy adding up the dollars or rubles or yen or whatever for waiting out a couple more weeks, why not start factoring the cost of what happens if there is a second wave that sends us all back into this same position again in about four months?

[DDE]

2 hours ago, Shpaget said:

Yeah, but who has the balls to publicly state that it's ok to sacrifice 3,5% of the world population (~about 250 million) in order to save the economy? Perhaps 15% of 70+ age group sounds better for younger folks, and they wouldn't mind, but it's still one hell of a press conference. After all those people are mostly not beneficial to the economy. We can call it the Great Culling of 2020.

And that's where we run headlong into Rule 2, even though I have worthy candidates.