SSOTT

[Captain Blood]

Originally Posted by GrussGott

How everyone holding up? What's happening out there?

So how are y'all doin?

[minn19]

Originally Posted by GrussGott

How everyone holding up? What's happening out there?

Originally Posted by Captain Blood

So how are y'all doin?

Going to work and can't wait to get home to spend some serious quality time with the fam at the end of the day/weekends. Unfortunately we've had a few suspected cases at work so waiting for that to decimate our staff. Then I get to do some jobs I haven't done for a decade since moving into the front office and wait for my turn to get it (16-20 hour days most likely).

I've had RSV, Pertussis and Pneumonia in the last ten ish years. So even though I'm only 46 (my bday was the day the WHO (unfortunately not the band) declared Covid-19 a pandemic ). So yah, wondering what these lungs can still take on...........and hoping the family stays safe not only from the pandemic, but the loonies that are thinking it is the end of the world and what them crazy mother fuckers are gonna do.

How 'bout fellers and little lady?

[Joekerr]

Things are good over here for now - wife is in healthcare so she's on the frontline every time she goes in, so we are taking a little more precautions from that standpoint where she doesn't touch the kids when she comes home until she's taken a shower. But other than that, so far so good.

I'm sort of torn on this COVID-19 bit though to be honest. I'm not sure what the American health care system is like in terms of capacity, but the Canadian one is basically operating at or close to 100% as it is and COVID hasn't blown up yet here. And yes, part of that is likely due to a government response and people agreeing to distance a little, but it isn't to say we aren't going to get a reasonable increase even with the restrictions that breaks the system and we are in Italy mode with the ventilators. I anticipate an increase because my unbeloved prime minister is basically doing half measures (as is my provincial government). Apparently at the airports its still just "recommended" you isolate yourself, but there are no requirements or penalties or follow up at all to see if you did. And on a provincial level, they declared a state of emergency, indicated they'd release a list of essential businesses today that can remain open, but all non-essential businesses would need to close by midnight tonight.

Ok, so I peruse the list that gets released today and guess what...basically almost all businesses I can think of are on the essential list. Unless you are a hairdresser. Or maybe work at Old Navy. Or have a restaurant. Other than that, good to go. So that's pretty stupid. This thing is either serious, and treat it as such, or it isn't and stop the fear mongering.

And that's why I'm on the fence. I don't know - this thing might be orders of magnitude more deadly than the current estimates at 3% fatality (especially if you do some simple but somewhat flawed math and take known fatalities divided by the sum of recovered patients + known fatalities - that math indicates a fatality rate closer to 14%).

Or it might be a lot less than 3% because the denominator might be much bigger than the reported cases because either A: the countries aren't testing everyone, or B: people with it might not report themselves and they just get better.

Honestly, I don't know.

But I'm relatively certain that restaurants / bars are going to struggle to survive if this goes to May/June, which I think is a minimum at this point. And any businesses that shut due to pressure are also potentially going to have a hard time coming back - margins are very thin in some businesses.

So which causes the greater harm - businesses go under and unemployment goes up and related ripples in the economy, but we hopefully avoid overwhelming the health care system and have less deaths, OR, we all go back to work, some of us die, primarily the older generation if death stats are accurate, but everyone still has a job and things return to some semblance of what it was? Ie. we basically treat this thing as WW3, knowing there will be fatalities.

[Joekerr]

On a slightly related note to the above, but in a morbid way:

Let's say everyone goes back to work and we accept that there will be a higher proportion of deaths, and that the most affected will be seniors.

What happens to the economy? That generation would be primarily savers, they would have invested in the market (though likely no longer in equities, but fixed income), but would have been responsible for at least some of the upward march in the index over the past 30 years I think.

Hypothetically, some die, early inheritance for the next generation. This generation doesn't save as much, not necessarily on the level of the generation after it which seems much more instant gratification, but they err closer to that I think than they do towards "saving".

So presumably, a lot of it is spent on things, which means companies make more profit hypothetically, which might suggest shares are worth more, but there is less money in the market too because it is being consumed rather than invested, so there would be less trading volume which makes stocks less liquid.

So rebound...or not?

On a different note, I'm actually thinking of buying some gold and silver bars just to diversify a little.

[GrussGott]

Originally Posted by Joekerr

Let's say everyone goes back to work and we accept that there will be a higher proportion of deaths, and that the most affected will be seniors.

What happens to the economy?

Good posts! We're just hanging here in silicon valley all sheltered-in-place and, based on data of 'unspecified pneumonia' cases as well as known covid cases, we've flattened the curve here SO FAR, but I have the same thoughts/concerns as you ... here are a few additional thoughts:

* Of course, covid isn't instead of car accidents or the flu, it's in addition to them - so that means if someone needs healthcare for a bacterial infection they might not be able to get it.

* This brings up the difference between the "case fatality rate", CFR (deaths just related to covid), and the death rate; the death rate includes all deaths which becomes important at and after peak hospital capacity because, in a sense, someone who needs a ventilator due to car accident, can't get it due to covid use, and dies, is also a victim of covid

* The CFRs between China, S Korea, Italy, France, and Germany are odd - SK appears to have had a high youth infection rate, especially compared to Italy which is the opposite, thus the CFR in Italy is much higher than SK. China, if #s are accurate, is similar. France is odd as their infections are fairly distributed and their CFR was low but now is getting close to 4%. Germany is also age-distributed with the current CFR much lower than 1%.

* I also wonder if the economy CAN get back to normal without, at a minimum, SK-style wide-scale testing and contact-tracing. That's clearly the gold standard for getting back to normal; however without that, sure, some people may return to restaurants but what if the death rate skyrockets and horror stories start coming out of our healthcare system with workers quitting? And then I'd bet a lot of people will stop travel and eating out until we get to some minimal management. I would.

* So if the lowest bar to return to normal is wide-spread testing and contact tracing, then I guess that seem like the thing we should be working the fastest to get to - however we're not doing that in the US, at least at the federal level, and NYC is turning into a crisis and a harbinger of every major north american city.

* Add this all up with no shelter-in-place and it does seem like opening up the economy will drive the death rate quite high - easily into the millions for the US.

So it seems like that's the chain:

(1.) Broadly, 2 in 10 infected with covid need hospitalization, or 20% - this becomes the most important number because ...
(2.) So 20% of our entire population lump on top of existing healthcare needs if we do nothing to stop the spread
(3.) The new 20% blows up our healthcare system capacity driving up ALL death rates from ALL conditions
(4.) That treatment crisis causes healthcare staff to quit or get sidelined, making the problem worse.
(5.) With the healthcare system failing, the economy melts down.

So how do we avoid 20% of the population flooding our healthcare system?

a.) shelter-in-place to slow the progression of the 20%
b.) Use the slowed progression to get wide-spread testing and contact tracing in place.
c.) Use the testing and tracing to get those infected out of the general population so the economy can resume.

if this all doesn't come together it's because it's a stream-of-consciousness post and I have mixed up thoughts about all of this ... but what I've talked myself into is there is no option to just re-open things without creating the 20% problem (unless as countries we simply say no covid hospital treatment - you're on your own)

[Joekerr]

Originally Posted by GrussGott

Good posts! We're just hanging here in silicon valley all sheltered-in-place and, based on data of 'unspecified pneumonia' cases as well as known covid cases, we've flattened the curve here SO FAR, but I have the same thoughts/concerns as you ... here are a few additional thoughts:

* Of course, covid isn't instead of car accidents or the flu, it's in addition to them - so that means if someone needs healthcare for a bacterial infection they might not be able to get it.

* This brings up the difference between the "case fatality rate", CFR (deaths just related to covid), and the death rate; the death rate includes all deaths which becomes important at and after peak hospital capacity because, in a sense, someone who needs a ventilator due to car accident, can't get it due to covid use, and dies, is also a victim of covid

* The CFRs between China, S Korea, Italy, France, and Germany are odd - SK appears to have had a high youth infection rate, especially compared to Italy which is the opposite, thus the CFR in Italy is much higher than SK. China, if #s are accurate, is similar. France is odd as their infections are fairly distributed and their CFR was low but now is getting close to 4%. Germany is also age-distributed with the current CFR much lower than 1%.

* I also wonder if the economy CAN get back to normal without, at a minimum, SK-style wide-scale testing and contact-tracing. That's clearly the gold standard for getting back to normal; however without that, sure, some people may return to restaurants but what if the death rate skyrockets and horror stories start coming out of our healthcare system with workers quitting? And then I'd bet a lot of people will stop travel and eating out until we get to some minimal management. I would.

* So if the lowest bar to return to normal is wide-spread testing and contact tracing, then I guess that seem like the thing we should be working the fastest to get to - however we're not doing that in the US, at least at the federal level, and NYC is turning into a crisis and a harbinger of every major north american city.

* Add this all up with no shelter-in-place and it does seem like opening up the economy will drive the death rate quite high - easily into the millions for the US.

So it seems like that's the chain:

(1.) Broadly, 2 in 10 infected with covid need hospitalization, or 20% - this becomes the most important number because ...
(2.) So 20% of our entire population lump on top of existing healthcare needs if we do nothing to stop the spread
(3.) The new 20% blows up our healthcare system capacity driving up ALL death rates from ALL conditions
(4.) That treatment crisis causes healthcare staff to quit or get sidelined, making the problem worse.
(5.) With the healthcare system failing, the economy melts down.

So how do we avoid 20% of the population flooding our healthcare system?

a.) shelter-in-place to slow the progression of the 20%
b.) Use the slowed progression to get wide-spread testing and contact tracing in place.
c.) Use the testing and tracing to get those infected out of the general population so the economy can resume.

if this all doesn't come together it's because it's a stream-of-consciousness post and I have mixed up thoughts about all of this ... but what I've talked myself into is there is no option to just re-open things without creating the 20% problem (unless as countries we simply say no covid hospital treatment - you're on your own)

I hear what you are saying and I agree generally, two points:

1. The 20% estimate requiring hospitalization is still based on very preliminary figures and I don't know how accurate it is. For the reason that we really don't know our denominator. We know the numerator...that's fine, but do we know the denominator? I would say we don't, because a number of countries were not (and still are not) doing adequate enough testing. Instead, you are told to self isolate and you aren't actually tested. Such cases aren't tallied in the total number of COVID cases as they weren't tested. So the denominator could be much bigger, leading to a reduction in the % requiring hospitalization (and also the fatality rate).

2. Your point on this causing healthcare professionals to either quit or get sidelined is bang on. I can tell you as I'm married to a surgeon that already the hospital she is at has cancelled basically all cases that aren't cancer. So far, cancer cases can still proceed.

But, lets say you are high risk for colon cancer based on history and you are coming in for your once every 5 year colonoscopy. Not anymore you aren't. Hope you don't have cancer. Only those who are critical are getting in and endoscopy is only being done once a week instead of four/five times a week. And a number of her patients with unusual breast lumps that were slated to be either biopsied or removed (but have not yet been tested to PROVE cancer) are now cancelled. And she is PISSED about that, because now she can only hope it isn't cancer and that it doesn't progress in her patients because this is something that could have a relatively good outcome if addressed now, but might not in six plus months from now depending on whether its aggressive or not. And I'm sure other specialties are seeing the same sort of thing. So she is really worried about the backlog...and all this is happening without any current COVID patients in the hospital right now.

[GrussGott]

Originally Posted by Joekerr

1. The 20% estimate requiring hospitalization is still based on very preliminary figures and I don't know how accurate it is.

Maybe for our needs, directionally accurate is good enough?

* We know that China (according to them) brought in a huge number of medical staff from around the country to Wuhan, presumably due to blown healthcare capacity

* We know Italy is blowing their health system capacity

* We know Spain is blowing their health system capacity

* We know the UK is blowing their health system capacity

* We know NYC is blowing their health system capacity

* We know WA is somewhat over capacity (stay-at-home order)

* We know MI is now at capacity

* We know in Taiwan where there was widespread social distancing, testing, and contract tracing they've been able to manage healthcare capacity

* We know in South Korea where there was widespread social distancing, testing, and contract tracing they've been able to manage healthcare capacity


So, in short, we know that just about anywhere there's been widespread transmission - without stay-at-home and widespread test / tracing, the healthcare capacity is quickly overrun. Does that seem right?

[Captain Blood]

It seems like the testing is the key.

Anyone else growing a beard?

[Joekerr]

Originally Posted by GrussGott

Maybe for our needs, directionally accurate is good enough?

* We know that China (according to them) brought in a huge number of medical staff from around the country to Wuhan, presumably due to blown healthcare capacity

* We know Italy is blowing their health system capacity

* We know Spain is blowing their health system capacity

* We know the UK is blowing their health system capacity

* We know NYC is blowing their health system capacity

* We know WA is somewhat over capacity (stay-at-home order)

* We know MI is now at capacity

* We know in Taiwan where there was widespread social distancing, testing, and contract tracing they've been able to manage healthcare capacity

* We know in South Korea where there was widespread social distancing, testing, and contract tracing they've been able to manage healthcare capacity


So, in short, we know that just about anywhere there's been widespread transmission - without stay-at-home and widespread test / tracing, the healthcare capacity is quickly overrun. Does that seem right?

Definitely no argument - it will overrun the healthcare system and quickly too. Possibly will either way unless we REALLY flatten the curve, but that's going to take additional measures more than what we've got going on here in Canada anyways. Have to go full bore in my view if you want to treat this seriously.

But yes, I agree!

[GrussGott]

Originally Posted by Captain Blood

It seems like the testing is the key.

Anyone else growing a beard?

I started, then got sick of it and shaved

On the testing, a few other thoughts amiright?

(a.) The goal is to stop the doubling. So if we do nothing, every 5 days or so cases double, so if your area is at 2,500 (whether you know or not), then in 5 days it doubles to 5,000, and in 10 days it's 10,000 - at that point your healthcare system is overwhelmed, but cases are still doubling!

(b.) BUT - 10k cases over 100 days is workable. This is where the stay-at-home and testing/tracing comes in: the first, SAH, is the shotgun approach to slowing cases and the latter, T&T, is the sniper version. We still get the 10k cases eventually, but in a manageable way, and the doubling stops! That's why it's key to do a stay-at-home before you get to 10,000 - that's the first step to managing it.

(c.) As healthcare goes, so goes national psyche. This is my guess, but if we opt for an unmanaged approach, healthcare will crumble, psyches will collapse, and so will the economy.

So, if economic health is the only question, which is worse hole to dig out of? A managed rollout or an unmanaged rollout?

I'd vote for managed rollout.

[Joekerr]

Originally Posted by Captain Blood

It seems like the testing is the key.

Anyone else growing a beard?

I already had one. I have been contemplating letting it grow out to ensure social isolation...err, distancing. But I think my current facial features are sufficient enough as they are to effect that goal, so I'll probably keep it trimmed.

[UncleWede]

Mercy arrived in LA Harbor to treat all the people who don't have corona. 2000 beds. A little further than I would travel unless by copter

Still working, haven't shaved face or head in 10 days. I'm not on call so going to indulge in some sort of quarantini

[GrussGott]

I also shaved because I wear a mask nowadays - it's not one I could've donated as it was previously used - actually we both wear one when we go anywhere likely to have crowds or we have to stand in line like the grocery store.

On a related note, contrary to stuff in the media, any type of mask is better than nothing for covid and plain ole 100% cotton is actually one of the better things you can use. I'd recommend everyone wear a mask of some sort until your area is under controlled management. For example you could use a hiking dust neckerchief and then wash it out each time.

Some people have pointed out that, even for N95 masks, the micron size of the virus particle is smaller than the smallest opening - that's true, however it doesn't mean masks of even large size aren't effective due to how airflow works (or water flows or traffic moves). When you breathe in, you create a large inflow through those few holes; this takes all of the particles in the air and jams them together, trying to stuff them through and since there's not enough space, they get blocked but air doesn't.

This is also why even cotton works: if you're in a space with a lot of particles they all jam up in front of the openings, but if there's only one or two virus particles that could get through you're highly unlikely to encounter them.

Anyway, point is, you may feel goofy, but masks work; and all of our best defense is to not get the virus in the first place. Asians figured this out 10 years ago with SARS which is why masks are so common there, this pic is from a convenience store in Tokyo 5 months ago, masks are just part of the culture there

[GrussGott]

Here's Andy's daily update thread - if you want the latest and you're not following him daily, you should:

highlights:

[GrussGott]

Just in case any of you get tired of having to always type out "trumpublican death cult" all of the time ... well, it turns out, there's a word for killing off the elderly: senicide!

So much shorter.

[Arcades]

Originally Posted by UncleWede

Mercy arrived in LA Harbor to treat all the people who don't have corona. 2000 beds. A little further than I would travel unless by copter

Still working, haven't shaved face or head in 10 days. I'm not on call so going to indulge in some sort of quarantini

I overheard this conversation yesterday as my father and his company is working from home.

The health care workers that are there at LA Harbor, are using our hotel in San Pedro to stay in. I also know that they are probably setting up tents too. There is another ship all the way in New York as they are also hit pretty hard. This stay for the hotel is a very welcome thing too since, no travel and all of that has hit their income pretty hard already.

They are the owners/management team behind that Hilton hotel.

[GrussGott]

US is on track to have a worse infection rate than any other country:

[Arcades]

Originally Posted by GrussGott

US is on track to have a worse infection rate than any other country:

That's because half of the US are brain dead and won't do anything about it until the entire country is infected. Even if COVID-19 doesn't effect them (the person) physically nearly as much as other people.

P.S. Oh also, my father clarified that the people staying at our hotel is actually the US Marines that are guarding the USNS Mercy. Not too sure if any of the healthcare workers will be there.

[UncleWede]

My oldest who is a nurse was offered a "contract" option. He works an extra shift a week minimum, mixed days and nights, and if he makes it thru to July he gets 8k bonus. He was telling me this last night with the tight blue wrap on his elbow, he's giving everything he can.

Proud and somewhat scared papa. My dad has shunned me because of my son. Dad felt bad but I told him I totally understand. Dad is 80 and 15 years out from triple bypass and apparently been afib that whole time. He was just getting checked for a pace maker when the world changed

[GrussGott]

Originally Posted by UncleWede

My oldest who is a nurse was offered a "contract" option. He works an extra shift a week minimum, mixed days and nights, and if he makes it thru to July he gets 8k bonus. He was telling me this last night with the tight blue wrap on his elbow, he's giving everything he can.

Special thanks to your son and you for your service!

I'm super hopeful we can get to widespread testing soon - was on the CA gov's conf call today and while testing is improving (68k tests so far), it's still just a drop in the bucket as we need 40x that amount to get folks back to work. Based on what he said, a lot of people are working on it, but no real estimates on when we'll see a faster ramp ...

Here in norcal we received the shelter order on the 17th and it takes about 2 weeks to see the results of that - we're still doubling, but that data is unreliable so, if we're lucky, we're just linearly increasing.

Hopefully the same is true of you guys and we can get our arms around this thing!

[UncleWede]

The little town I work for got their first confirmed case today, but it's a transfer. Loser son got sick/confirmed. Mom picked him up from county hospital and brought him home to her house

Was funny listening to the officer that had an interaction : NO lady, I don't want to read the confirmation letter!!

[GrussGott]

Originally Posted by UncleWede

The little town I work for got their first confirmed case today, but it's a transfer. Loser son got sick/confirmed. Mom picked him up from county hospital and brought him home to her house

Was funny listening to the officer that had an interaction : NO lady, I don't want to read the confirmation letter!!

Here's what 'presumed community transmission' looks like in our county (it's updated daily from stanford, which is why it has university stuff on it):



The shelter-in-place orders (and other stuff) typically takes 2 weeks to show up in the data due to the time between infection, symptoms, and then testing. We're about 10 days since the CA order and you can see community transmissions spiking so, if we're lucky, the shelter-in-place happened just in time and in about 4-8 days we should see those numbers start to come down.

For places with fewer infections, hopefully you'll see numbers stay low and then drop off like those first few dots on the graph.