Finally a voice of reason

Doc Holliday said:
You can over treat a cancer patient with chemo. It will probably get rid of the cancer, but at the risk of killing the patient. Is it worth it only to wind up with a dead patient? o_O
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Fauci is a physician, so of course he is going to look at the problem from a public health standpoint, not an economic one. But as I wrote somewhere else, if your reaction is not adequate, and you return to business as usual too soon, then the virus resurges and may well take down a significant fraction of the work force. So that option, too, has a strong possibility of dire social and economic consequences, not just public health ones.
 
azure said:
Fauci is a physician, so of course he is going to look at the problem from a public health standpoint, not an economic one. But as I wrote somewhere else, if your reaction is not adequate, and you return to business as usual too soon, then the virus resurges and may well take down a significant fraction of the work force. So that option has a strong possibility of dire social and economic consequences, not just public health ones.
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Poverty has a direct correlation with public health. Inducing more and more poverty only increases health concerns. So yes, Fauci is affecting the economic side as well as the public health side by not considering the consequences.
 
My point is, it works both ways: by not adequately addressing the public health side, you risk doing serious damage to the economy as well.
 
Rcmutz said:
Let’s hope everyone remembers this when the Monday morning quarterbacking begins in a couple of months.
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In a couple of months? It's already begun. And stridently. (And this is not in any way, on my part, political.)
 
Doc Holliday said:
Poverty has a direct correlation with public health. Inducing more and more poverty only increases health concerns. So yes, Fauci is affecting the economic side as well as the public health side by not considering the consequences.
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It's not just Fauci. State public officials have been more involved in the shutdown decisions than he has.

The issue as I understand it is whether more people will die with the shutdowns than would have died without them. Advocating shutdowns does not prove that deaths due to economic reasons haven't been considered. How do we know that the decision-makers didn't consider potential economic impacts and conclude that the number of deaths would be higher without the shutdowns?
 
azure said:
My point is, it works both ways: by not adequately addressing the public health side, you risk doing serious damage to the economy as well.
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It's also been pointed out that the dramatic reduction in vehicle use is likely to dramatically reduce vehicle deaths.
 
Palmpilot said:
it shows that anyone can have unconscious habits that might have unfortunate consequences
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That was kind of my point, people aren't nearly as clean or conscientious as they think when it comes to not spreading this
 
Palmpilot said:
It's also been pointed out that the dramatic reduction in vehicle use is likely to dramatically reduce vehicle deaths.
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Interestingly, humans seismic footprint has diminished dramatically in the last few weeks.
 
azure said:
My point is, it works both ways:
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Only in theory and discussion. In reality only one way will be decided. As we discussed the 80/20 percentile points, the "risk management" numbers continue to be run. And as history has proven "the needs of the many outweigh the needs of the few." This is as real as it gets. Someone will make that decision to restart the economy well before the last person falls ill from SARS. Just as other countries are doing today.
 
Tantalum said:
That was kind of my point, people aren't nearly as clean or conscientious as they think when it comes to not spreading this
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The question is whether we work on educating people on how to safely do what needs to be done or whether we suddenly run around and scream 'it has gone airbooorne' and lock everyone in their room with a N95 on their face.
 
weilke said:
The question is whether we work on educating people on how to safely do what needs to be done or whether we suddenly run around and scream 'it has gone airbooorne' and lock everyone in their room with a N95 on their face.
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I'll take the N95...for $1,000 please. ;)
 
weilke said:
The question is whether we work on educating people on how to safely do what needs to be done or whether we suddenly run around and scream 'it has gone airbooorne' and lock everyone in their room with a N95 on their face.
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Unfortunately we tried the educating approach and life here went on as usual so they shut places down. The whole thing sucks :(
 
Bell206 said:
Only in theory and discussion. In reality only one way will be decided. As we discussed the 80/20 percentile points, the "risk management" numbers continue to be run. And as history has proven "the needs of the many outweigh the needs of the few." This is as real as it gets. Someone will make that decision to restart the economy well before the last person falls ill from SARS. Just as other countries are doing today.
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As far as I know, countries that are restarting their economies are doing so because they believe they have contained the epidemic within their borders (China), or because they have the capability to identify and isolate people who have contracted the virus (South Korea). I don't know of any country that has gone back to anything approaching business as usual without first getting a handle on the problem. Maybe they exist and I just haven't heard about them, but I would be very nervous if I was a citizen of a country like that. If you abandon the cure because it hurts too much, you're condemning yourself to worse pain down the road.
 
azure said:
As far as I know, countries that are restarting their economies are doing so because they believe they have contained the epidemic within their borders (China), or because they have the capability to identify and isolate people who have contracted the virus (South Korea). I don't know of any country that has gone back to anything approaching business as usual without first getting a handle on the problem. Maybe they exist and I just haven't heard about them, but I would be very nervous if I was a citizen of a country like that. If you abandon the cure because it hurts too much, you're condemning yourself to worse pain down the road.
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Maybe, maybe not. So far we are seeing that this virus is no worse than the flu.
 
Doc Holliday said:
Maybe, maybe not. So far we are seeing that this virus is no worse than the flu.
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If with 'no worse' you mean 'only about 10 times as deadly', then yes, its 'no worse'.

I just talked to our crew of hospitalist physicians. Can't talk hospital internal numbers, but this thing is pretty awful.

NYC dept of health is storing the bodies in refrigerated trailers until they can get around to them. The last time they did that was after 9/11. I guess in the grand scheme of things, 9/11 wasnt all that bad either because it didn't really move the needle on all-cause mortality for 2001, so that makes it ok right ?

This is the loading dock at Brooklyn hospital center earlier this week. I am sure they just had to practice how to use the forklift or something:

6_news_Albany.jpg
 
Cap'n Jack said:
The only problem with denatured alcohol is that you usually don't know what you are buying, if it came form a DIY store, or a hardware store. They often denature the ethanol with methanol. The problem is, there is sometimes little ethanol, and the can is mostly ethanol. While that doesn't matter for most tasks, for this purpose, methanol doesn't do much as a disinfectant.

[1] https://www.cdc.gov/infectioncontrol/guidelines/disinfection/disinfection-methods/chemical.html , one sentence mentions it in the link
[2] https://medcraveonline.com/JBMOA/JBMOA-07-00247.pdf
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91 and 99% isopropyl alcohol from the pharmacy. great stuff.
 
weilke said:
The question is whether we work on educating people on how to safely do what needs to be done or whether we suddenly run around and scream 'it has gone airbooorne' and lock everyone in their room with a N95 on their face.
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Wouldn't a third alternative have been to follow the South Korean example? My understanding is that they managed to have enough testing capability to get their epidemic under control faster than most other countries.
 
weilke said:
If with 'no worse' you mean 'only about 10 times as deadly', then yes, its 'no worse'.

I just talked to our crew of hospitalist physicians. Can't talk hospital internal numbers, but this thing is pretty awful.

NYC dept of health is storing the bodies in refrigerated trailers until they can get around to them. The last time they did that was after 9/11. I guess in the grand scheme of things, 9/11 wasnt all that bad either because it didn't really move the needle on all-cause mortality for 2001, so that makes it ok right ?

This is the loading dock at Brooklyn hospital center earlier this week. I am sure they just had to practice how to use the forklift or something:

View attachment 84274
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So are we equating New York to the rest of the country? Yes, NYC seems to have it bad right now. But in many parts of the US, not so. I've been reading today about many hospitals laying off staff in significant numbers. Seems everyone believes hospitals are only to be used for Covid19.

In 2019 NY had 18,000 flu hospitalizations. Just this February in one week NYC had 8,602 flu cases. We didn't see South Dakota shutting down because of it.

And your "10 times as deadly" doesn't fly, the numbers have been proving that is false.
 
It's far worse than the flu.. that kills about 60,000 people a year in the US (on a very bad year, some years much much fewer).. that works out to 165 people a day. The Coronavirus so far has killed an average of 1K people in the US the last several days..

It is dramatically worse

And yes, I have a sister who is an MD and work in an ICU in Rhode Island.. it's the real deal. People on ventilators, shortage of PPE, etc.
 
Palmpilot said:
Wouldn't a third alternative have been to follow the South Korean example? My understanding is that they managed to have enough testing capability to get their epidemic under control faster than most other countries.
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Iceland has an impressive program as well

Our solution is basically "burn the house down to kill the cockroaches" .. which, if your only option is to have a house infested with cockroaches or to burn the place down, you are probably better off burning it down

BUT.. other options like actually testing people, isolating them, doing the detective work to figure out who likely has it, etc., just isn't being done.

And yes.. there is a MAJOR shortage of test kits.. at least the doctors I have talked to
 
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Doc Holliday said:
NYC seems to have it bad right now. But in many parts of the US, not so
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But three weeks ago no one in the country "had it that bad" - the way this spreads and how contagious it is that's the nature of the beast.. you have to catch it *before* it goes nuts

All the Florida people who shrugged it off or thought they couldn't get it, or that it was a NYC / China problem are now sitting there with this thing running amok

Looking at the chart below, from covidly.com, Florida is sky rocketing with their infection rate..

California has a comparatively low infection rate per million and is not increasing exponentially, just growing slowly, and slower than the rate of testing.. means the extreme measures worked.New York has finally started to slow too

Take a look below.. 3 weeks ago Florida was basically free of this.. and did nothing.. and now they're going to be screwed

This is like continuing flying into a wet cloud when it's -5*C because you don't have any ice yet.. 20 minutes later you have a quarter inch, but the plane is still flying, so you keep going, 15 minutes later 1 inch, and you think "gee, the plane is not flying so well, maybe I should look for options" and 5 minutes later you crash.. and the best part is.. all these other planes are doing the same and not learning from the data

It totally sucks.. but the economy is going to recover much easier in 1-3 months with only 100K-200K dead as opposed to 18 months from now 2 million have died and the hospitals have basically turned into corona clinics

upload_2020-4-4_20-2-10.png
 
Tantalum said:
It's far worse than the flu.. that kills about 60,000 people a year in the US (on a very bad year, some years much much fewer).. that works out to 165 people a day. The Coronavirus so far has killed an average of 1K people in the US the last several days..
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Do you have the bell chart that shows the 2018/2019 flu season and broken down into months and days showing hospitalizations and deaths? If so, I'd like to see it. Because I'm sure in the peak of the flu season it killed more than just 165 a day.

Tantalum said:
And yes, I have a sister who is an MD and work in an ICU in Rhode Island.. it's the real deal. People on ventilators, shortage of PPE, etc.
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The local hospital where my brother lives just laid off almost 400 workers, and several hospitals in surrounding counties are laying off people. And their emergency rooms are seeing below average due to lack of regular activity.
 
Doc Holliday said:
Do you have the bell chart that shows the 2018/2019 flu season and broken down into months and days showing hospitalizations and deaths? If so, I'd like to see it. Because I'm sure in the peak of the flu season it killed more than just 165 a day.



The local hospital where my brother lives just laid off almost 400 workers, and several hospitals in surrounding counties are laying off people. And their emergency rooms are seeing below average due to lack of regular activity.
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I'm not sure what part of the country you are in.. NYC/MA/RI hospitals are getting shafted. Not to say the whole country is, I'm sure the majority of hospitals are well below capacity nationally, but the idea is to keep it that way, not let it spread like wild fire

But these aren't our only two options, do nothing or go bonkers. But it seems we don't have the organizational capability to do smarter approaches to this. Iceland has their restaurants and businesses open, and very low instance of this.. as does South Korea. People who caughed in the last 2 weeks have extensive testing done, and a full detective panel is taken of the people they met and hung out with, to trace back the spread of it. Hell, Taiwan even has an app people can use

So I agree, there are other options, and this option we're taking sucks.. but I do think in the 30,000 ft view of things this approach is better than the do nothing approach
 
Doc Holliday said:
Maybe, maybe not. So far we are seeing that this virus is no worse than the flu.
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It depends on what you think is worse, but in my opinion that's not a fair assessment of the facts. People are very focused on the death rate of COVID-19 as the measure of its severity. According to the CDC, around 1-2% of people that get the seasonal flu require hospitalization, and only about 1-2% of those people die from it (referencing the pyramid chart on the website I linked). The overall case numbers for the flu are also controlled by the common adoption of a vaccine that is usually pretty effective.

Even if you ignore the COVID-19 death rate, estimates are that around 7% of healthy people with COVID-19 require hospitalization, and around 28% of people with underlying conditions (last paragraph of the "Summary" on this CDC website). I've read in news reports that 15% require oxygen and 5% require a ventilator, but can't currently find a source for that. Now I definitely believe the overall COVID-19 percentages in the US especially are somewhat overstated as a result of a lack of testing in the US. But if we just look at it anecdotally, the seasonal flu doesn't result in hospitals being overrun with patients. And that's in locales that have already placed pretty heavy measures in place to limit the spread.

Speaking as someone who's in one of the more heavily affected counties/states outside of New York, and the one that briefly was the biggest in the country, I was scoffing about all of this as recently as four weeks ago. I have since totally changed my tune. Exponential growth is a more fun concept in math class.
 
Doc Holliday said:
it killed more than just 165 a day.
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No, I wish I did have a bell curve.. even if scrunch that 60K death into 6 months (the winter) that still works out to just 330 deaths per day. Or, if we assume only 3 months, that is till under 700 people per day
 
Tantalum said:
No, I wish I did have a bell curve.. even if scrunch that 60K death into 6 months (the winter) that still works out to just 330 deaths per day. Or, if we assume only 3 months, that is till under 700 people per day
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Yea, but as we've seen, these operate within a bell curve, so on either side of the peak we have declining numbers, correct? So couldn't we reasonably deduce that at some point the flu was killing a thousand a day?
 
azure said:
they believe they have contained the epidemic
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Exactly. They believe. Key word. But as for China the official CCP figures don't jive with the "un-official" figures being posted.
azure said:
I don't know of any country that has gone back to anything approaching business as usual....
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azure said:
but I would be very nervous if I was a citizen of a country like that.
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Never said business as usual. But there are dozens of countries that still operate business as usual or have implemented all the requirements to jump start their respective economies prior to their last SARS case: US, UK, Switzerland, Norway, etc.
azure said:
If you abandon the cure because it hurts too much, you're condemning yourself to worse pain down the road.
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Out of curiosity, can you provide one situation in human history where the "cure" was entirely implemented to save all concerned?
 
Palmpilot said:
Wouldn't a third alternative have been to follow the South Korean example? My understanding is that they managed to have enough testing capability to get their epidemic under control faster than most other countries.
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South Korea had a couple of other advantages beyond some wise choices regarding the testing:
- as 60+% of the cases were members of a small religious group and the government was able to obtain the member lists, they were able to proactively isolate those members and their close contacts.
- based on the age distribution in that religious sect (apparently popular with college aged kids), the overall age distribution of their epidemic was favorable.

Note that this isn't over in SK, while they are past the 'hump', they are still dealing with a long 'rats tail' of cases through re-infection and the imperfect nature of traditional epidemic control methods.

Korea_new_cases_4_4_20.jpg

Another place where we have good data to look at is Austria. Remember, there is lots of exchange with the neighboring regions in Italy that got clobbered. Still, after they closed down travel and started social distancing, it looks like they got a grip on the growth of cases. The first graph are 'active infected cases' (I de-selected the 'total', 'recuperated' and 'deaths' curves).

Austria_4_4_20_total_active_cases.jpg

The second graph is 'percentage increase in cases':

Austria_4_4_20_daily_percentage_increase.jpg

The last one is for 'daily tests' (dont know whether that includes commercial labs or is stricly health ministry data):

Austria_4_4_20_daily_tests.jpg

Ignoring what is likely a data fluke on 4/1/20, it doesn't look like they 'tested the virus into submission'. They are testing, but it isn't the testing that allows this to burn out. It's the social distancing and the public health interventions like quarantines and contact tracing.
 
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weilke said:
South Korea had a couple of other advantages beyond some wise choices regarding the testing:
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FYI: Not a realistic comparison. South Korean actually had a number of significant advantages. Due to history with their brethren to the north, the South's national strategic supply of all things survival was light years beyond most other countries. And it came a financial cost. However, with the current SARS it finally paid dividends. Fast for ward to 2009, the US had a similar stockpile but not on the scale of South Korea. Yet once our stockpile was 60%+ depleted due to the Swine Flu it was never replenished due to financial concerns and a "rolling inventory" mentality. Same as the G7 nations.
 
Tantalum said:
I wish I did have a bell curve.
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Not a bell curve, but as of the week ending 03/28/2020, the SARS mortality rate was .26% of all deaths in the US per the National Vital Statistics System.
 
Tantalum said:
No, I wish I did have a bell curve.. even if scrunch that 60K death into 6 months (the winter) that still works out to just 330 deaths per day. Or, if we assume only 3 months, that is till under 700 people per day
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Methodology explained here:
https://blogs.sas.com/content/graphicallyspeaking/2019/03/18/how-deadly-was-the-flu-in-2019/

Note that I'm not a statistician or in the medical field, so I can't comment on the method used. Just curious. If we say the worst week since 2010 saw about 1600 deaths per week, that's 228/day. Pretty sure we are exceeding that.


us_flu_deaths-1.png
 
Doc Holliday said:
So are we equating New York to the rest of the country?
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Don't know who 'we' is.

As in so many things, NYC is where things tend to be most concentrated. Be it crack cocaine or covid. From folks I trained with who are in King County and Chicago, it isn't a picnic there either.

But in many parts of the US, not so.
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Not yet. As I noted further up in the thread, our hospital and our county have been testing aggressively in the last couple of weeks and until last saturday, we hadn't seen a single case. In the days since, this has changed and the beds in the dedicated covid floor are starting to fill. As the US didn't do the chinese thing and just put soldiers on checkpoints around King County and NYC, this will move in waves moving out from NYC, Seattle etc. The waves are not concentric as they follow things like interstates and family connections rather than the physics of a seismic wave. This will get to every state and most counties eventually, heck it even got to West Virginia.

I've been reading today about many hospitals laying off staff in significant numbers. Seems everyone believes hospitals are only to be used for Covid19.
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Right now they are. Our hospital stopped doing all but the most urgent surgical cases and shut down most outpatient imaging over the course of the past two weeks. Doing so, allowed them to free up capacity for the arrival of the 'wave' and hopefully allow us to get through this without ever capping out on vent beds and personal protective equipment. I dont know whether we have any staff on furlough yet, I believe so far those who are idled are asked to take PTO. The experience from other hospitals shows that as this hits, you go from 'too much staff' to 'too little staff' in about 3 days as you end up with key employees in quarantine or sick.

In 2019 NY had 18,000 flu hospitalizations. Just this February in one week NYC had 8,602 flu cases. We didn't see South Dakota shutting down because of it.
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You are making my point. 8602 weekly flu cases in a regular season cause a bump in hospitalizations and a few hundred ICU admissions. They dont outstrip the ability of the NYC health system to treat them.
In the past week, Covid created 21877 cases which caused 4632 hospitalizations.
18,000 flu hospitalizations are throughout a season that runs from November through March, not in a week or two.

And your "10 times as deadly" doesn't fly, the numbers have been proving that is false.
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Babbling on about the 'denominator' doesn't make it go away. I know I know the data from 'Vo' and 'Iceland' are different, but they aren't comparable to the flu data either. We dont go around and test everyone in a jurisdiction with a Influenza array. We test those who present to their doctor with 'flu like illness' and whom the provider considers sufficiently high risk to get seriously ill. Those who have good immunity against this years Influenza strain (e.g. because they had their flu shot), just get a upper respiratory infection and tough it out. We never know whether they had influenza A or B or one of the other 100 respiratory viruses.
 
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