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09 March 2020

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turcopolier

b

I am ready to go but hope to piss on your grave. "Overwhelmed ICUs?" You hope for overwhelmed ICUs is for the US, not in the countries of your little friends.

turcopolier

Eric Newhill
There is "a chance of panic?' Are you blind?

turcopolier

stephanie

You are as full of BS as "b"

Harlan Easley

This is much more serious than the flu. The flu is overhyped significantly. 0.1% CFR(Case Fatality Rate) in a bad year. Average CFR is 0.04% according to serology studies.

For this new virus Sars-Cov2 the CFR is estimated to be anywhere from 0.7% to 3.4%. Depends on the data and country. At the low end it suggest the new coronavirus Sars-Cov2 is 7 times as deadly as the worst flu year. But the 0.7% is data from South Korea where many cases have not resolved. Many deaths take 3 to 6 weeks. So it's a naive CFR. Most likely to rise above 1%. So at a minimum 10 times as deadly as the worst flu year. In a high functioning intellect society. Not the US.

Just look at Lifecare Nursing Home in the State of Washington. 123 patients and 25% dead from the virus. And most likely to go up. Also 70 of 180 workers showing symptoms.

The virus is estimated to cause 20% severe cases. Meaning hospitalization. And 5 to 10% ICU. 50 to 60% do not survive ICU. Also the attack measurement RO(ease of transmission) appears to be much higher than the flu. RO of flu is 1. Estimated RO of this virus is all over the place but I've read as high as 3+ in reputable studies.

Others have pointed out the major concern is overloading the healthcare capacity of ICU beds. Italy is already beginning triage of patients.

On a low end scale if 20% of Americans(flu infects estimated avg. 45 million per season) get infected that is 66,000,000 Americans. 20% need hospitalization = 13,200,000 = disaster. Avg CFR of 1% = 660,000 americans dead. Same number who perished in the 1918 Spanish Flu. It must be blunted by public education/actions or we are in a hell of a mess.

The virus doesn't care if you test for it or not. It will continue to spread. Especially as the President communicates it is "just the flu".

I still believe warmer weather will blunt some of the worst for this year. Doesn't mean we are out of the woods. This virus is endemic to the world now and will come back for me/you next flu season. Maybe in a more deadly form after mutanting. Much more smarter people who read this blog can comment on this. The guys who commented the other day with expertise in this subject.

I personally believe this will cost President Trump reelection. Though how does a candidate like Dementia Joe win is beyond me. President Trump is out of touch and delusional when it comes to the danger and lethality of this virus for individuals 40 and over. Especially 60 and over. Many in his base will turn on him when mom and dad contract this virus and die. Like I said we may get lucky with spring and summer blunting this season's lethality of the virus. And Trump will gloat. I hope for a warm weather savior. I have many elderly relatives and I cannot tell you how much I resent Trump for downplaying the danger to them.

The evidence is clear from Italy and China this ain't no damn flu. Also WHO stated they found very little evidence for asymptomatic transmission in China. They tested 30,000 samples in storage to come to this data point. This means the hoped for huge iceberg that is invisible below the surface of infected but asymptomatic probably doesn't exist. So CFR may go up rather than the pollyanna predictions of down.

blue peacock

Col. Lang

There is no hysteria yet, at least where I live. This past weekend I noticed the restaurants and bars were packed. The store shelves are not bare of toilet paper or bottled water. The symphony, ballet and opera have cancelled all their shows for the next 2 weeks in an abundance of caution as they say. I have taken 3 flights around the country in the past two weeks. Most flights are full but traffic is noticeably less. Many companies have sent out no travel notices including mine sent out on Friday. The email from my company CEO noted his concern on the lack of information on availability of testing and a containment plan of the government.

There is a lot of concern among pretty much everyone that I have interacted with in the last 4 weeks that the government and the authorities don't have a plan and don't really know what they're doing. Clearly the US health authorities reaction has been slow at least from a communications perspective. They knew first week of January and as of yet have not presented a coherent containment strategy that people believe in. There seems to be no trust that the government will act in the best interests of the people. Trump's tweets dismissing the virus threat are not helping as many people are concerned. It can't just be wished away. By not addressing those concerns it only exacerbates the distrust of government competence.

Contrast with South Korea. As I noted on Walrus's thread, they have tested 160,000 people, identified and isolated 7,300 people and have seen 50 fatalities. They have mass drive-thru testing facilities. Takes 5 minutes to provide a sample and 24 hours to get the results. If one is infected, then the authorities determine who all you've been in contact with and follow up to have as many of them that they can reach tested. If one is infected and have debilitating symptoms then they are immediately hospitalized, if not then they have to be self-quarantined until they test negative. This strategy was communicated early on when there was limited information. People bought into the strategy and there is no panic nor any mass cordons. This strategy is working as the infection growth rate is reducing.

IMO, this shows that a clear strategy of containment that includes mass testing and isolation of those infected is the antidote to hysteria & panic. It may be just another flu, but if many people don't perceive it that way, then by dismissing their concerns one is creating the environment for panic.

I've been sympathetic to Trump during his term, particularly with respect to the soft coup by law enforcement and intelligence agencies. As Scott Adams has noted during the 2016 election campaign Trump is a master persuader. However in this case to quote Mike Cernovich, a conservative blogger with a large following:

These tweets FEEL off key.

Trump is a master usually, this time he isn’t reading the room.

Coronavirus is and should be the utmost priority, as is oil war with Saudi.

I agree with Mike. Trump is misreading the sentiment. He should not be dismissing concerns of coronavirus or the Saudi's crashing the oil market. He should be showing he is in command of the situation. At best folks are going to see a savings of $100/month at the pump. But the impact on the shale patch in Texas, Pennsylvania and North Dakota could be much bigger.

Kyle Bass, a Texan hedge-fund manager and strong advocate for Trump tweeted this:

The Saudis and the Russians have flown a metaphorical jet into the heart of the US energy business. This is the equivalent of an economic 9/11 with the Saudis as the pilots AGAIN. US energy independence is under attack...and it’s not for lower prices at the pump.
steve

"But will you worship ME if you are wrong? Why are our hospitals not overwhelmed with influenza patients each year?"

It is a different disease. Not as high a percentage of flu patients end up in the ICU. Covid-19 is different in a number of ways. The flu kills the very young and the old. Covid doesn't seem to have much if any increased mortality for the young, for which I am eternally grateful. On the other hand, Covid seems to have a bimodal pattern where you are either fairly mildly sick or you end up in the ICU. Also, in bad years we do run it pretty close in our major hospitals. Our sickest patients often end up on ECMO (machine that oxygenates the blood) and we have run out of those several times in bad years.

Finally, I forgot not everyone is a doctor, you do realize we need testing just to establish a diagnosis right? We use that to help determine treatment, including isolation, need for admission and precautions staff need to take. Wearing the PPE gear and the N-95 mask (or even the PAPR) is exhausting and dehydrating. If we have testing available we can rule out some people and not have to wear that gear. Given that we already have shortages in some of that gear that helps tons.

different clue

Colonel Lang,

I do not know the South Korean plan for treating those who test positive. I would suspect that for the basically-healthy young and middle aged the plan would be self-quarantine at home or be quarantined somewhere for the called-for time period ( considered to be 14 days for now). And if such people under quarantine were to develop lung-involvement symptoms ( mild shortness of breath, etc.), come into hospital for pre-emptive intensive care to maintain the body alive long enough for the body to mount its own immune response against the virus. That would be my best thinking for how to treat the non-old who test positive.

For the old or immunocompromised or the non-old with lung or kidney disease, I would admit into hospital upon testing positive for observation and for being right there if symptoms begin which call for placement on intensive-care body-life-maintenance. If people in those categories develop any lung or kidney symptoms, or develop the general cluster of symptoms short of lung or kidney symptoms, they should report right to a hospital to be tested and kept for observation and intensive-care-if-necessary
till their test came back definitely negative.

But I am just a layman here. If anyone sees problems with that approach, they should be pointed out. Since I have had bad pneumonia in the past as well as ongoing chronic kidney disease,
the virus may well consider my lungs and kidneys to be old if it finds its way to them. So I think about best treatment and for whom firstest of allest.

Deap

Do not overlook the fact Italy has been wanting to close its borders for a long time, led by the Northern League of conservatives, in the area that first went into lock down.

EU membership has forced immigration policies on Italy which has made them one of the most vulnerable targets to North African and Middle Eastern "boat people".

There willingness to go into total lock-down may have already been in the stars.

Deap

I believe the 1918 flu was so deadly because it moved into pneumonia and we were pre-antibiotics in those days. The vast majority of those "flu deaths" were in fact from other causes than the flu.

Read elsewhere applying intense cortisone therapy to those with respiratory complications for those who also exhibit this co-incidental "flu" marker (the Wuhan corona flu) has been beneficial.

Consequently, comparisons to the 1918 flu under these more modern therapeutic options and understandings could be irresponsible.

J

7 year old in NYC has COVID 19

Eric Newhill

Sir,
My perception of panic is more pervasive, frenetic and lunatic than what we're seeing now. The stock market appears to be in full panic mode, but it's a good time to take some fat profits too. Who knows the real reason(s) for things happening? Most people aren't that self-aware and people acting as mobs or markets even less so. It's a stampede. Try stopping a cow and asking her why she's running. Worse, humans will stop running for a minute to say anything to explain why. They assign rational explanations to their subconscious emotion driven behaviors; so as to appear smart or something.

In my circles people seem less concerned about catching the virus than they were about being killed by terrorists circa 9/11/01. Are you seeing personal contacts being truly panicked?

J

Colonel,

Jeffery K. Taubenberger is an American virologist

https://www.ibtimes.sg/tipping-point-death-that-coronavirus-victims-suffer-never-return-40718

J

FYI

Disinfectants for Use Against SARS-CoV-2 list have qualified under EPA’s emerging viral pathogen program for use against SARS-CoV-2, a coronavirus that causes COVID-19.


https://www.epa.gov/sites/production/files/2020-03/documents/sars-cov-2-list_03-03-2020.pdf

ked

The panic is more about panicing - how that effects finance and the wider economy - more so than about public mortality. Panic management among the general public is accomplished similarly to combat preparation. Expertise, procedures, practice, and leadership. Those are top-down functions. If the pres would shut up and get outta the way, we’d merely have a manageable public health crisis, instead of laughable reality TV.

Walrus

Col. Lang is right, hysteria is the main threat. The @#$@ing media are doing all they can to stoke it. Our media are now wildly talking about prepping in a way that will provoke panic buying and thereby create artificial shortages. That creates huge problems for the poor and elderly who are not in a position to buy much more than their daily needs.

Testing is now an academic argument because the current test reports many false negatives - FACT. Add to that the FACT that many people can be virtually asymptomatic and still be infected and shedding virus.

So all testing does is give everyone a warm feeling unless it is done very early and followed with vigorous contact tracing when it MIGHT buy you some time. As I stated in my previous note, there are at least ten times the number of infections as is being reported according to what I was told last Friday first hand by local researchers, virologists and epidemiologists, who have been working with the virus, the Chinese and the WHO since January 2.

What appears to work to blunt the peak of the pandemic is Chinese style mass quarantine, however I am not sure other countries have the Government authority or the guts to do it.

I hope America can again surprise the doomsayers and beat this thing. Americans are good at problem solving. There must be a way to build ventilators and bare bones ICU’S staffed by volunteers the same way they built liberty ships.

smoke

Someone posted a video graphic, which helps visualize the theory of containment with respect to a fast spreading disease outbreak.

As others here have observed, containment may or may not reduce total number of cases. But by stretching out the rate of spread, the medical resources of a community have a better chance to treat severe cases. And we do know, with this disease, that treatment makes a difference in the severe stages. Thus, overall mortality and morbidity will be reduced.

https://twitter.com/alxrdk/status/1237021885239635969

The situation in Italy is a concern. One report said that, in Bergamo, no one over 70 is being given access to ICU.

I like the advice of a nearby Texas town on handwashing. "Wash your hands like you just chopped jalapenos and you are about to put contact lenses in."

LondonBob

The PM will be going along with what the Chief Scientific Adviser and Chief Medical Officer, Chris Whitty, are recommending.

https://youtu.be/IfJcwDaZrsA

Whitty's testimony to MPs is worth watching. Manageable, but has to be managed, and will have passed in a few months. He also believes it will be less than one percent and many will never know they even had it.

turcopolier

smoke
"One report said that, in Bergamo, no one over 70 is being given access to ICU." Well, pilgrims, it will be interesting to see who else does something like that.

turcopolier

Eric Newhill
No. We gave bottles of Purell to neighbors. They seemed receptive but no panic. Tried to order in some Chinese last night. They were closed early. Got some sandwiches from Subway instead. The driver was an immigrant from Istanbul. Had a nice talk.

A.I.S.

Testing reducing mortality is to be expected.

If one does test broadly, one will detect many somewhat ill individuals who do not feel sufficiently ill to actually visit a doctor, or an ER. People who do not feel sufficiently ill to do this, and who do have corona, are probably a lot less likely to die then people who feel the need to visit and ER. Still important to do this testing because knowing what proportion of people is low sympthoamtic and asymptomatic is important.

My company in Germany essentially made a "do homeoffice unless they are really strong reasons not to", and "if you do feel somewhat ill, stay at home, you can stay for up to 3 days without needing to visit a doctor for a "this person is sick and does not have to work notice" " policies.

Reasoning being that people can easily catch the thing in a waiting room, and everyone is essentially better off if somewhat ill persons just self quarantine.

This being Germany, paid sick leave is a thing paid by the insurance rather then the employer for periods less of less then 4 consecutive weeks.

There are several cross use trials (you use another medicine which you expect to be capable of doing something, and where sideeffects are known to test, first in vitro then in vivo, if it affects CovId19) are already on its way. Preliminary results imply that reducing ACE and TRRF (these are 2 otherwise useful proteins that sadly jointly facialiate virus entry in this case) functions can work.

Jack

“It may be just another flu, but if many people don't perceive it that way, then by dismissing their concerns one is creating the environment for panic.”

blue peacock,

Yes. Many don’t want their neighborhoods to become like Wuhan or Italy where the ICUs are slammed and they’re now contemplating triage. By not presenting and hammering home a believable containment strategy the government is creating the environment for panic. Folks just want reassurance that the federal, state and local government along with the healthcare care system are on top of it and have a credible strategy to contain the spread and treat those with adverse symptoms.

If there’s a better game plan than South Korea they should present it and convince the people. Many are not going to buy the strategy that it’s just the flu and it will burn itself out.

Diana Croissant

At my age it is interesting to observe the coarse of this current infection causing so much worry.

My poor mother had four elementary school children at the same time. She almost never had a week without at least one child home from school with a bad cold, a strep infection, one of the two forms of measles, or mumps.

I remember lining up in our school gymnasium to receive our polio shot.

For some reason, I catch everything going around. This time I am at an age when I can isolate myself most of the day. I could not do that when I was teaching in public schools. The infection that I contracted most often was strep throat. I did early in my career take every opportunity to wash my hands with disinfectant soap or carry with me packages of disinfectant wipes.

Somehow I survived spending my days with 1,500 germy teenagers every week day for over nine months a year; so I am not panicking in regard to this new flu. (But it was nice that my son in CT was worried enough to call me to make sure I was taking precautions.}

What I am waiting to hear is whether this flu is indeed a "snake" flu. The flu that killed so many after WWI was an avian flu, and then later the Swine flu was actually also determined to be an avian flu. It seems the pigs contracted it from birds.

I do admire the people who figure these things out. We no longer worry much about the Great Plague. But then, maybe remembering having studied that is what makes us all a bit jumpy.

This too will pass.

Eric Newhill

Sir, the driver from Constantinople is a nice touch

Eric Newhill

oh, BTW I don't recognize the Islamic entity occupying Armenia

Travis

Larger data set. The bigger the data set, the better idea you can get about the actual death rate, what protocols work and what doesn't, vectors where the spread is happening etc. Is it 2% for everyone or 50% for people over 60 with chronic illness? Hard to know if you only test people who show up at the hospital. The more testing done is more data for epidemiologists to study the disease and develop protocols for future outbreaks of new viruses.

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