Coronavirus Outbreak...

[Mountain Man]

Okay. Did DeWine make a reasonable call?

Just what is the threshold at which it should be treated as a dangerous disease? Is 37 too low or not?

Tens of thousands of people get the common flu every year in Ohio, and several thousand require hospitalisation.

So you tell me.

[Mountain Man]

MM doesn't understand exponential spread...

Mountain Man understands that you're talking about a very worst case scenario based on unproven assumptions and incomplete data, and that what we're seeing in the real world does not appear to support such dire prognostication.

But have fun with your Chicken Little routine.

[JimboJSR]

I'm a medical hospital doctor in the UK. I've seen the stats, the patterns, and most of all the individual reports of what is going on in the hospitals of Italy and elsewhere in Europe.

This is not the flu. This is not being blown out of proportion by the media. This is something that, no matter what we do, will kill thousands as the numbers of cases rise exponentially, and overwhelm pretty much any health service.

And when I say "overwhelm", I mean you (or an elderly relative) will get sick, you will go to a hospital, you will need to be intubated and ventilated in ITU and that won't happen because there are no beds, staff or ventilators left. This means dying in a room somewhere, or dying in a corridor along with lots of other scared, panicking, dying people before you get a chance to be moved somewhere. One alternative is you arrive at hospital and are told that they DO have bds, but they won't take your 70-yr old relative because they have a higher chance of dying, and the bed will almost certainly be needed tomorrow for a 30-yr old who has a better chance.

There are things we can do to minimise and slow this effect, but these won't make it anything remotely like "normal" , and won't stop a high death toll. (Although the panic bulk-buying in supermarkets is dumb and unhelpful).

As someone looking at you guys from Britain, I say to the christians here: do NOT make this political. Do NOT say that this is all a ruse by Democrats trying to bring down Trump. Do NOT say the mainstream media is fearmongering and actually Brietbart is totally cool. Do NOT pretend that this is a minor issue. It reflects REALLY badly on you as individuals, and on us a fellowship of believers - and, subsequently, on the Gospel that we suposedly preach. Absolutely we should be channels of God's peace, and absolutely we should commit to God what we can and can't handle, in humility and reverence. But if I were an unbeliever coming on these boards and seeing some of the stuff that supposedly rational christians were putting up, I'd be SERIOUSLY turned off. It's a bad advert for the faith, and turns folks away from God.

[firstfloor]

Mountain Man understands that you're talking about a very worst case scenario based on unproven assumptions and incomplete data, and that what we're seeing in the real world does not appear to support such dire prognostication.

But have fun with your Chicken Little routine.

Stats so far:
Incubation, 7 - 14 days but up to 30 days,
Critical - 2% of infected
Of those critical, 10 days from first symptoms to ARDS.
Acute Respiratory Distress Syndrome.
Death rate in this group is quite high. If you survive, lungs are permanently damaged.

[MaxVel]

This is the best article I've come across so far on the epidemiology of coronavirus. Lots of references, graphs and charts.


Some 'highlights'....

Due to the lag between getting the virus and developing symptoms (and thus getting tested after going to the hospital etc) the number of known cases is about an order of magnitude less than the actual number of cases. So if there are, say, 37 known cases, there are probably upwards of 2,500. All those people are probably infectious and thus spreading the virus (to about another 7,000 new people). What changed this was going on lockdown, which slowed the spread.

See the detailed Chart 7 on the Wuhan epidemic for this.



Actually, this is an optimistic outlook. See Chart 11 and the discussion above it. The conclusion is that the number of actual cases (i.e. people infected) is about 27 times the current number of deaths.



Mortality rates:

The two ways you can calculate the fatality rate is Deaths/Total Cases and Death/Closed Cases. The first one is likely to be an underestimate, because lots of open cases can still end up in death. The second is an overestimate, because it’s likely that deaths are closed quicker than recoveries.
What I did was look at how both evolve over time. Both of these numbers will converge to the same result once all cases are closed, so if you project past trends to the future, you can make a guess on what the final fatality rate will be.
This is what you see in the data. China’s fatality rate is now between 3.6% and 6.1%. If you project that in the future, it looks like it converges towards ~3.8%-4%. This is double the current estimate, and 30 times worse than the flu.

and (after more analysis)

This is what you can conclude:

Excluding these, countries that are prepared will see a fatality rate of ~0.5% (South Korea) to 0.9% (rest of China).

Countries that are overwhelmed will have a fatality rate between ~3%-5%

Put in another way: Countries that act fast can reduce the number of deaths by a factor of ten. And that’s just counting the fatality rate. Acting fast also drastically reduces the cases, making this even more of a no-brainer.

Chart 18, from an AHA webinar:

5% of cases require hospitalisation 4.8 million admissions
1-2% require ICU support 1.9 Million in ICU
1% require ventilatory support

Estimated US deaths: 480,000

[MaxVel]

Mountain Man understands that you're talking about a very worst case scenario based on unproven assumptions and incomplete data, and that what we're seeing in the real world does not appear to support such dire prognostication.

But have fun with your Chicken Little routine.

We understand that you're responding to facts and analysis (by experts) of the actual data we have with hand-waving. It's not a good look.


Here's the thing: governments and leaders that take strong, early action may have over-reacted, but we'll never know. If the situation in their country or area remains relatively mild and under control, we probably will think they took it too seriously. However, if they don't act strongly, and early, then the risk is a Wuhan situation occurring, or even one on a larger scale than that.

It's pretty clear that the difference between the two is a death rate of around 1% and one of around 4%. When you're talking of tens of thousands, or even millions of people being infected, that is a lot of lives. The AHA estimates 96 MILLION cases in the US. (See article cited in my post above). That's a difference between 960,000 deaths (1% of 96 million) and 3.8 million deaths (4% of 96 million).

Lots of people are going to get infected - probably at least 30% up, maybe up to 60%. IF that happens slowly, due to social distancing, lockdowns in hot spots, other mitigating measures, then we're set for 1% or less death rate. If that happens in an exponential surge, then we're set for the upper figure - 3.8 million dying, plus all the pain and suffering of not being able to help people who could be saved, having to abandon other patients to treat the coronavirus victims, triage and not treating people at all - i.e. what's happening right now in Lombardy, Italy.


You're waving your hands and saying 'It's not that bad' when you don't know, you're not presenting any data or expert analysis, and when the data and the experts are saying otherwise.

[Mountain Man]

We understand that you're responding to facts and analysis (by experts) of the actual data we have with hand-waving.

Depends on which experts you listen to, I suppose. I've heard anything from wide scale death and destruction to the coronavirus has been in the US a lot longer than we realize and is the cause of the slightly elevated rates of flu cases we've been seeing this season. My parents got really sick a couple of weeks ago and recovered, and we all assumed it was just a bad case of the seasonal flu, but for all we know, it was the Wuhan virus.

[carpedm9587]

I accept your clarification of your post, but it doesn't change the gist of mine. With 84% of our people concentrated in urban areas, and 51 state/federal leadership elements, establishing widespread testing should not take the two months it has taken (and it is STILL not happening). There were significant missteps. Our ability to deploy solutions rapidly has been demonstrated in the past numerous times. This should be no exception. Can we test, 100%? absolutely not - and not even close. But a few thousand tests two months after the initial infection was detected is an abysmally bad outcome, IMO.

2. You should have bothered to learn why. Many test kits were giving false negatives with what? A 30% failure rate? How does it do any good in testing people when one in three, gives a false reading?

This claim is close to the same MM made, but I have seen/found no substantiation for this claim. If you have some, I'd like to see it. MM provided one Brietbart article that quoted one person. That's not exactly up to normal journalistic standards. If you have other resources, please share them.

3. Length and border security has to do with containment of outbreaks. How easy is it, for us to completely lock our border down? How easy is it for South Korea?

The discussion was about testing distribution. Since I have taken the position that there is little/nothing that will "contain" this outbreak beyond voluntary social isolation and proper hygiene/sanitation (unless we want to revert to a police state), I have no further response.

I have no response to this since I am aware of no strawman. I'll let the data I provided speak for itself.

See my previous post and the linked article that quotes Trump.

[carpedm9587]

It's odd that you thought to "fact check" an obvious joke.

I'm not sure what joke you are referring to here. AFAIK, the only posts I fact checked were the ones where you were making an argument. Can you clarify?

[carpedm9587]

Okay. Did DeWine make a reasonable call?

Just what is the threshold at which it should be treated as a dangerous disease? Is 37 too low or not?

Given the level of contagiousness of this disease, the only way it will be significantly slowed, IMO, is through social isolation and proper hygiene/sanitation. If you have 37 people in a single state where testing has been only sparsely executed, it stands to reason that the 37 are only the tip of the iceberg and the level of spread is already significantly more. Personally, I do not think we can afford to take the chance. I conclude that he made a good call.

[oxmixmudd]

We understand that you're responding to facts and analysis (by experts) of the actual data we have with hand-waving. It's not a good look.


Here's the thing: governments and leaders that take strong, early action may have over-reacted, but we'll never know. If the situation in their country or area remains relatively mild and under control, we probably will think they took it too seriously. However, if they don't act strongly, and early, then the risk is a Wuhan situation occurring, or even one on a larger scale than that.

It's pretty clear that the difference between the two is a death rate of around 1% and one of around 4%. When you're talking of tens of thousands, or even millions of people being infected, that is a lot of lives. The AHA estimates 96 MILLION cases in the US. (See article cited in my post above). That's a difference between 960,000 deaths (1% of 96 million) and 3.8 million deaths (4% of 96 million).

Lots of people are going to get infected - probably at least 30% up, maybe up to 60%. IF that happens slowly, due to social distancing, lockdowns in hot spots, other mitigating measures, then we're set for 1% or less death rate. If that happens in an exponential surge, then we're set for the upper figure - 3.8 million dying, plus all the pain and suffering of not being able to help people who could be saved, having to abandon other patients to treat the coronavirus victims, triage and not treating people at all - i.e. what's happening right now in Lombardy, Italy.


You're waving your hands and saying 'It's not that bad' when you don't know, you're not presenting any data or expert analysis, and when the data and the experts are saying otherwise.

NYT article here: https://www.nytimes.com/2020/03/13/u...gtype=Homepage

Source: above

925,000 staffed hospital beds. Fewer than a tenth of those are for people who are critically ill.

© Copyright Original Source

So, IOW, If we could make full use of all available beds for critically ill patients, we can accommodate less than 92,000 critically ill patients. With a criticality percentage of around 2%, assuming we have some way of getting the patients to the beds (or the beds to the patients) the maximum outbreak we can handle before people are left to die is 4.6 million infected at a given time. disease duration for critically ill patients that survive can be as much as 6 to 8 weeks, I do not know how much of that time requires critical care.

The critical percentages that we actually see are a good bit higher than 2%, 2% is a hopeful number based on the assumption there are many more mild cases out there that we don't know about because we can't test the general population.

S.Korea shows the lowest mortality rate (.8%), which is similar to the real china rate outside Wuhan (.9%), and they have had a massive testing campaign. So again, they are probably a good window into the reality of what the impact is when there are enough medical facilities available to handle the critical cases.

Italy is much worse. And a good window into what it looks like where there are not enough medical facilities available to handle the critical cases.

[carpedm9587]

MM doesn't understand exponential spread - so he doesn't understand that at 37, the actions to stop the spread of the disease must take place ASAP or there will be too many sick for less drastic actions (like closing schoools and restruants) to be effective. At more than 3700 in two weeks, there are too many to stop the spread (because 3700 known cases likely means somewhere north of 10,000 are actually sick). So the window to take action is days to a week.

OK...I'm sorry - but I just can't resist. The numbers seem to be showing that it is largely Democrats and Independents who are taking this seriously and most Republicans (especially Trump's base) are swallowing the party line coming from Trump (i.e., we have it under control). Therefore, I wouldn't be surprised to see a significant differential in deaths along party lines. Unlike the climate issue, which takes everyone down equally if the claims of the scientific community are correct, this pandemic will disproportionately kill the weakest and the most foolish, if the projections prove to be correct.

Wouldn't that help with the election in November?

ETA: BTW, thanks for your analysis. I found it enlightening.

[carpedm9587]

This is the best article I've come across so far on the epidemiology of coronavirus. Lots of references, graphs and charts.


Some 'highlights'....

Due to the lag between getting the virus and developing symptoms (and thus getting tested after going to the hospital etc) the number of known cases is about an order of magnitude less than the actual number of cases. So if there are, say, 37 known cases, there are probably upwards of 2,500. All those people are probably infectious and thus spreading the virus (to about another 7,000 new people). What changed this was going on lockdown, which slowed the spread.

See the detailed Chart 7 on the Wuhan epidemic for this.



Actually, this is an optimistic outlook. See Chart 11 and the discussion above it. The conclusion is that the number of actual cases (i.e. people infected) is about 27 times the current number of deaths.



Mortality rates:




and (after more analysis)







Chart 18, from an AHA webinar:

5% of cases require hospitalisation 4.8 million admissions
1-2% require ICU support 1.9 Million in ICU
1% require ventilatory support

Estimated US deaths: 480,000

Also - thanks. I had not seen these resources, but they align with what I have seen.

[oxmixmudd]

OK...I'm sorry - but I just can't resist. The numbers seem to be showing that it is largely Democrats and Independents who are taking this seriously and most Republicans (especially Trump's base) are swallowing the party line coming from Trump (i.e., we have it under control). Therefore, I wouldn't be surprised to see a significant differential in deaths along party lines. Unlike the climate issue, which takes everyone down equally if the claims of the scientific community are correct, this pandemic will disproportionately kill the weakest and the most foolish, if the projections prove to be correct.

Wouldn't that help with the election in November?

ETA: BTW, thanks for your analysis. I found it enlightening.

thanks.

as for the election, I've been avoiding speculation along those lines. Mainly because there are a lot of people that will die from this. It's just too real for that sort of thing for me.

However, it is very, very sad that allegiance to the ignorance we see in conservative direction may well be a factor in the probability of one's own death ( or the death of friends of family members) from this pandemic.

The recklessness we've observed in presidential briefings, in comments from prominent Republicans (Nunes etc) are nothing less than gross negligence. The extent to which feet are being dragged in deference to various industry lobbyists, even now, and the focus still on playing to the desire for greater profits (e.g. not fully mandating sick leave to relieve the pressure to work while sick) are simply beyond comprehension.

[Darfius]

Interjecting politics into this is in very poor taste from either side. This is literally a matter of life and death and we don't need to clog up people's information sources with partisan crap.