Model S

COVID-19 discussion thread for all

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Comments

  • edited March 28
    Hey Lola, stay safe.
  • edited March 28
    Likewise Bighorn... US death rate is quickly lowering toward reality: https://www.worldometers.info/coronavirus/country/us/
  • edited November -1
    Cases rising, both infection and death.

    Remember, folks, that these two metrics aren't the only ones which measure disease burden, resource requirements, sum total of human suffering, nor can be used in a superficial way as some are doing here to justify a contrary position to the global community of experts.
  • edited November -1
    @Aerodyne

    I was expecting a 15-30 day lockdown two months ago. Here's to hope!

    @Lola Thanks for checking in!
  • edited March 28
    Cases are compounding 30% daily. Testing has been botched so now we have to rely on herd immunity. In the USA that will mean 200 million infections Now symptoms appear after up to 8 days and only 10% go to a hospital and are eventually tested and results take as long as 4 days. With instant testing that is 1.3^8=8x or without 1.3^12 or 23x. This means that with 100,000 cases confirmed the realistic number is 2.3 million. Before heard mortality kicks in we could have around 200 million exposures resulting in 2 million hospitalizations (10%). With a fully functioning healthcare system we are seeing 1% mortality that means 2 million deaths up to the time herd immunity brakes the exponentiation. Our Hospitals have 1 million beds and a woefully inadequate number of ventilators so mortality could reach 8 million deaths if 4% succumb to the virus.
    Happy talk from an alleged first responder Darthamerica is almost criminal.
  • edited November -1
    Math has no politics and sadly this is glomy. Our hope isn't from worshiping a 4th rate President elected by a 1st rate nation but in the virus itself. SARS mutated and became far less dangerous. Lets hope COVID does the same ( mutates) and millions of lives put at risk by a President that though it was a hoax or the cases 15 at the time would soon be zero will not result in funerals that no one can attend.
  • edited March 28
    @Bighorn - You find some of the best articles - although criminal that some people are fine with millions of deaths.
  • edited March 28
    Agreed... excellent article and fits what has been posted here (and sorry for the self-referential statement).

    Beyond that, it is rolling the dice to see what happens, when we know that the severe effects are not relegated to a small segment of the population.

    Taking a broader view, to show prejudice as ageism or as a comorbid "casualty of war" as some folks have espoused here is technically, ethically, morally, and functionally wrong. This point is incorrectly characterized by some here as "emotional"; it is for all purposes being practical when one looks at the all-in global cost, which is clouded by superficial treatment with a 2-dimensional spreadsheet.

    The downstream effects of relegating populations to the notion of "sacrifice for a greater good" should warn all of us of historical events that we should not recapitulate. That's a rabbit hole that should remain covered up.
  • edited March 28
    Teton County WY (Jackson) is threatening to close their borders if the gov doesn't close WY's.
  • edited March 28
    Nobody who took the Hippocratic Oath seriously would be espousing targeted sacrifices.
  • edited March 28
    Unless we have coordinated, ubiquitous use of a rapid, accurate assay VERY SOON it is extremely likely we will only delay transmission to all slightly. Reemergence will not be prevented by prolonged lockdown only. I have gone back and forth as to how effective our measures to prevent spread will be. Identification, isolation and containment for our society using rapid, broad testing and quarantine facilities should have been done initially. We (he) fubarred that. It is looking like the curve is the only thing we will be effecting and not the overall numbers of infected. Agree? No/yes? Of course we will be much more capable of managing the very ill if the curve is very flattened. Should that be our ONLY goal if eventual transmission prevention is ultimately futile? My frustration (especially after finding out about events in my own hospital after last night's ER shift) is that by the time I have the tools to somewhat contain this it will be too late. One week is too late once it steps into your community. I fear too few will stem the tide. Damage control has become our very inefficient alternative. Am I off the mark? Do the other more knowledgable here believe we can do more than just delay the infected totals with short term lockdown/isolation?
  • edited March 28
    I think the total infected will be the about same--see area under the curve remark way above. It's about handling it with our limited resources that is the crux. The only model that reduces that number is a shelter lock down that is unsustainable to the point of having an effective vaccine. Nobody knows if we'll get a vaccine. Look at other viruses such as HIV and coronavirus up until now. It's not the flu, so we just can't sequence a necessarily effective vaccine. 70% is the infection rate I've seen for both the evangelical and the thoughtful crowd, just different temporal distribution.
  • edited March 28
    Teton County WY (Jackson) is threatening to close their borders if the gov doesn't close WY's.

    May have allot some extra time for the roadblock on my way to work next month. Could take a year off.... though not my style to avoid risk, options or CV19. So guess I'll show up : ) Problem is when your very close knit neighborhood is on lockdown and your kids still can play with the others, dad coming home from ER shifts may make us pariahs. Come back from TN for good next week and will have to sort things out. No easy answers for many of us here I'd imagine. Tough choices in a potentially disastrous time.
  • edited November -1
    "just different temporal distribution"

    That is what I'm thinking and is a sobering thought.
  • edited March 28
    Say overall 10% require hospitalization and 98% survive. If the hospital isn’t there to serve, mortality goes up about 400%, just for Covid. What it is for all other comers turned away is more complicated.
  • edited November -1
    @BH

    I’d have loved to discuss in detail with you, but that obviously has to wait..

    This is bigger than some realize, affecting our way of life.
  • edited March 28
    And maybe this is all it could ever be; damage control. In reality the only way to mute, mitigate, flatten the curve is a strong isolation approach (or some prophylactic cocktail we don't possess). But for how long? Does the curve steepen when isolation ends? Does anyone have the answers? We can't do this for 12-18 months until we have a vaccine. Already I can envision CV-19 burnout overwhelming the process in the coming weeks. We can protect everybody forever in terms of providing medical care but not from getting infected or suffering death if not medically treatable. I guess ideally we can ask for the virus to have a slower penetration with gradual transmission to all exposed (300m of us) and the capacity to treat all the critically ill. We should not be deluded or delude ourselves that we can 'beat CV19' or that we can contain it forever. The message needs to be clearly communicated to our populace that the endgame is damage control and not winning a war we have already lost. There are still millions of lives at stake if we can't care for our sick. I don't pretend to know the answers. But what I'm seeing is disturbing including but from limited to false narratives, unrealistic outlook, and ignorance. Our leadership needs to be honest with the American people about our immediate goals and the likely course of protracted challenges and strain on our health care system for many months to come. Quarantining NY, NJ, and Connecticut (had to spell check that one)? Is that the right thing? Nationwide lockdown? How much mitigation is necessary? How badly overwhelmed will our hospitals get? Can we bend and not break by transferring enough patients and spreading the load? Is that realistic? Again, NYC is quite the litmus test. Unfortunately, we may not have the answers by the time we need them.
  • edited March 28
    " Before heard mortality kicks in we could have around 200 million exposures resulting in 2 million hospitalizations (10%)."
    "Our Hospitals have 1 million beds and a woefully inadequate number of ventilators"

    @dougk71 - Can you help me understand the shortage of beds and ventilators?

    Assume 1M hospitalizations, 1M hospital beds (including navy ships and temporary army hospitals, 150k ventilators.

    Beds: Even if only 25% are available to CV patients, as long as the duration of the event (at leaset 6 months to reach 200M infections?) is 4x the length of hospitalization (or even 8x to allow for a peak at double the average), then as long as the average hospitalization is less than 3 weeks, there should be enough beds. Is my math wrong?

    Ventilators: Same calculation. Assume all 1M patients admitted to hospitals need ventilators. We have 150,000 ventilators, so each ventilator can be used to treat 7 patients through the course of the event. Assuming 50% utilization due to peaks, and a 6-month time period for the 1M hospitalizations, as long as the average ventilator usage is 12 days there would be enough. If we use a Y-splitterthe ventilator capacity would double - or quadruple with a 4-way splitter. The number of ventilators is also being increased. Is my math wrong?

    PPE equipment will be better untilized going forwar thanks to self-testing. My understanding is a lot of the PPE equipment was being used in testing, where the vast majority of testing comes back negative.

    There are also therapeutics being developed that could save at least some lives, reduce some hospital stays, and reduce some ventilator needs. The models don't seem to take that into consideration.

    I'm not a denier - just trying to understand the numbers that don't seem to add up to me.
  • edited March 28
    Sorry - I understated the hospitalizations by a factor of 2. You said 2M. Can you clarify the duration of the event resulting in 200M hospitalizations? My understanding is that is pretty much full infection and is a 12-18 month scenario.
  • edited March 28
    "Say overall 10% require hospitalization and 98% survive. If the hospital isn’t there to serve, mortality goes up about 400%, just for Covid. "
    That would be nice if true.
    Queens Doc: Kassapidis said that a "majority" of those who get moved to ventilators and continue to decompensate "don't survive."

    Ignore the source - read the quotes or watch the video of the doctor. If you watch the video the doctor is taking hydroxychloroquine prophylactically. He also believe certain blood types like his (O-) are less susceptible. Interview starts at 2:00. https://www.foxnews.com/media/nyc-doctor-coronavirus-hospital-system-has-bent

    "The system has bent, but we're surviving. The patients keep coming in in waves ... I compare it to the big, the blitzkrieg," Kassapidis said. "You get that little calm and then the other wave comes in. We have a lot of people on ventilators."

    "We've had patients from 30 to 80. No underlying conditions," Kassapidis said bluntly. "If they have underlying conditions, that's a strike against them."
    "So we get patients from every walk of life, every age," Kassapidis added. "The higher their co-morbidities are, the higher their risk of mortality."
  • edited March 28
    Sorry guys, but 10% is 20 million hospitalized, not 2 million hospitalized. Couldn't see the numbers go on like that without speaking up....2 million dead at 1% of infected. In NYC infected 1/30 end up in ICU so probably 1/40 or so at least on vents. Back of the napkin is up to 5 million vents needed eventually across country if NY is representative and trend continues with eventual 200 million infected. That is inconceivable. I guess 10% death rate in Italy was inconceivable as well.
  • edited November -1
    Mortality is FAR FAR less than 1%. We know the spread started months before people understory what was going on. Like I said, Christmas, New Year, CES, CNY, Mardis Gras etc... An unbelievably large number of people got this "bad cold" and thought it was just cold/flu season. Only the most isolated rural parts of the USA aren't infected or have been infected to some degree. What's insidious about COVID19 is that the symptoms are so similar to the cold/flu that most people do not know and never know they had it. So to all, please relax, this will pass. It ain't 1918. The key to avoiding catastrophic consequences is how we respond and live with the virus, not stopping it. That ship has sailed. But it's more Frigate than Battleship. What's truly at risk now is our way of life. It's not worth becoming a PRC Communist/Socialist Technocrocy to stop this. Just wash your hands and don't worry.
  • edited March 28
    What is the timeframe for 200M infected?
    Is 10% the true hospitalization rate and 1% the true mortality rate when "the herd" is infected?

    I'm less worried about beds (there are lots of hotels), PPE (there are lots of companies that can make it), and ventilators (4 patients on one, manufacture more).

    I think it is health professionals that are the concern - we can replicate most everything else to just about any scale we want. We need a plan to leverage this necessary and scarce resource.
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