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Tuesday, March 24, 2020

This Is Not The Flu--Anecdotal Stuff

Michael Snyder has a blog at Zerohedge that provides ... anecdotal stuff, to try to drive home the concept that so many still fail to grasp: THIS IS NOT THE FLU. Yes, I'm aware that Snyder thrives on alarmism. Nevertheless ...

The blog is titled It's Not "Just The Flu": Here's Why You Definitely Don't Want To Catch COVID-19. He begins with a general description that contains an important reminder: people don't "recover" quickly. Even with chloroquine treatment from Doc Didier, the patients too 5-6 days to recover. Without it, it takes much longer. That alone should tell you that this is different from any flu most of us have had experience with. I've edited out hyperbolic terms that don't come from the patients:

Can you imagine being in “blinding pain” for weeks, constantly gasping for air as you feel like you are being suffocated, ...?  As you will see below, coronavirus survivors are telling us about their ... ordeals, and they are warning us to do everything that we can to avoid this virus.  Of course they are the lucky ones.  ...  So those that survive should consider themselves to be very fortunate, but many of those same individuals will be left with permanent lung damage.  
This virus attacks the respiratory system with a ferocity that is shocking doctors, and those that are still attempting to claim that COVID-19 is “just like the flu” need to stop, because they are just making things worse.

He then presents first person accounts from five survivors, ranging in age from 12 to 55. Well, no first person account from the 12 year old--she's on a ventilator, currently in stable condition. The accounts describe people fighting for their lives. I remember the worst flu I ever had, when I was in my mid 30s. I was so weak that I literally crawled down the hall to the bathroom and back. But I didn't feel the way these people describe it. And I was over it in a few days. I didn't even miss a full week of work.


Snyder concludes with this:

At this point, even doctors and nurses are “scared to go to work”… 
Doctors and nurses on the front lines of the fight against the coronavirus in the United States say it’s “the first time” they’ve been scared to go to work. With a shortage of personal protective equipment, some have resorted to using bandanas to cover their faces. 
“It’s the first time we’ve ever been truly scared to come to work, but despite being scared we are trained to save lives and we’re committed to doing that,” Dr. Cornelia Griggs, a surgeon in New York City, told “CBS This Morning.” “I’m embarrassed to say, but prior to this, my husband and I had never gotten around to writing a will, but this weekend that became one of our to-do list items.”

Here's a story about another doctor, in Detroit--Facing Shortage, Neurosurgeon Sews Masks From Vacuum Cleaner Bags:

Last Wednesday night, my younger sister asked me to overnight her three dozen vacuum cleaner bags. A neurosurgeon, Rachel was worried about the dwindling supply of surgical face masks at her hospital. She’d been told to do her rounds without a mask, to save precious supplies for health-care workers in the emergency department and Intensive Care Unit providing direct care to COVID-19 patients.

Of course, she realized that she could be an asymptomatic carrier, doing her rounds and infecting her patients. Thus the vacuum cleaner bags.

38 comments:

  1. The addition of Azithromycin to the malaria drug is interesting. I have been given a Z-Pak a few times when bronchitis hung on and on. Wiped it out quickly. Here are the numerous conditions for which Azithromycin is used:

    https://www.webmd.com/drugs/2/drug-1527-3223/azithromycin-oral/azithromycin-250-500-mg-oral/details/list-conditions

    For example, used in conjunction with antivirals to treat HIV, it prevents the opportunistic diseases that cause serious illness and death. Bacterial pneumonia, for one.

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  2. I am prone to bronchitis. This started when I was around 18. So, I have experience with not being able to catch my breath. It's not pleasant.

    This sounds like bronchitis on steroids.

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  3. I don't think anyone said the young don't get sick or can't get Coronavirus. It's just they are much less susceptible to serious illness and death with things like the seasonal flu and Coronavirus. Some say that's why Germany has such a low Case Fatality Rate (0.4%) as compared to Italy (9.5%) and elsewhere. Please see the Bloomberg article below.

    https://www.bloomberg.com/news/articles/2020-03-24/coronavirus-less-deadly-in-germany-because-of-youthful-patients

    With a Case Fatality Rate of 0.4%, Coronavirus would be about 4 times as deadly as the seasonal flu. That probably tracks more with what we're seeing as opposed to the hysteria in the media and elsewhere.

    As more real data becomes available, I find it interesting we're hearing more and more "anecdotal" accounts, all in absence of actual news stories about overloaded hospitals and mass death. Still waiting for that.

    Of course, if the sky doesn't fall, it will be because we "flattened the curve" when we shut down the country.

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    1. 'I find it interesting we're hearing more and more "anecdotal" accounts'

      You realize that most of your post is either anecdotal or speculation on very incomplete data?

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    2. "You realize that most of your post is either anecdotal or speculation on very incomplete data?"

      Unverified and out-of-context anecdotal accounts about having Coronavirus are quite different than data based on testing, which is what I posted.

      Don't you find it interesting Germany has such a low Case Fatality Rate, or is that just anecdotal speculation?

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    3. I think the difference in fatality rates between Italy and Germany might be explained by the fact that the Italians are listing as deaths from coronavirus many deaths that may not be, and the Germans go the other way, mot listing them.

      Can't vouch for the accuracy of this statement, though. I read it somewhere (sorry!). But it makes sense. For instance, Europe has lower infant mortality rates than the U.S. because they have a different way of counting live births than we do.

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    4. That's what the Italians are claiming, but it's a clumsy explanation--really more of a 'pushback' because the Italians feel their health professionals are being disparaged. The German economist Bayer--in the Bloomberg article--provides a very coherent explanation which I go into below.

      Here's the German response to the Italian claim--and also a dissenting Italian response--from the article:

      But Germany’s Koch Institute says it’s following a similar procedure. “The real risk is the geriatric age and also concurring illnesses such as high blood pressure and diabetes,” said Roberto Bernabei, geriatrics professor at Catholic University in Rome. “These lead to a greater aggressiveness from the virus.”

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  4. "data based on testing, which is what I posted."

    Really? I somehow missed any form of the word 'test' or 'testing' in your comment.

    The ONLY data you present is that Germany--as of right now--has a fatality rate of .4%, which you recognize to be 4x that of the seasonal flu. And from that you invalidly extrapolate that "that PROBABLY tracks more with what we're seeing." IOW, you think that .4% is somehow a "normal" rate. You know this ... how? What testing gave you that?

    So let's ask: Why does Germany have a much lower fatality rate than Italy?

    Your reply is "Some say ..." Oh, thanks. You never actually complete the thought, perhaps because it's incoherent.

    However, the Bloomberg article you link actually contains a lot of information--and it directly disproves any point that you're trying to make.

    First of all, Germany is an obvious outlier, data wise, to the rest of the world. Whereas SARS-2 cases throughout the world skew heavily toward the elderly, in Germany 80% of the cases occur--so far--below age 60. The result is that since in Germany fewer of the most vulnerable are getting infected, fewer deaths are occurring. The question that you don't ask is--WHY? Why are the elderly not getting infected in Germany, but they are elsewhere?

    The authors, to their credit and unlike you, dig deeper to find out what's going on. They come up with an answer that tracks one that I pointed to the other day--networking--but which you apparently didn't bother to read.

    The authors consulted an economist who provided the explanation:

    “Why are so many elderly in some countries getting infected whereas in other countries they don’t?” Bayer said. “The social network is a natural explanation.”

    As we'll see, what that boils down to is this: Social Distancing! In Germany there is significant social distancing between young and old, whereas in Italy "To a degree uncommon in most other parts of Europe, ... adults are in frequent contact with their parents."

    As a result, once the virus got to Italy "it easily infiltrated the high-risk older generation." But in Germany the government took aggressive steps to test very widely and to specifically warn younger people to stay away from older people--as the article documents.

    If Bayer's analysis is correct--and he's careful to note that "other factors are certainly influencing fatality rates"--the real question for the US is, to what degree does the average Social Network in the US mix the young and the old? The answer is pretty obvious, or should be even to you: Since the elderly in the US are getting infected AT LEAST as often as the young, we have no particular reason to expect the death rate here to be as low as in Germany.

    So there's some real date for you, which you dishonestly failed to mention.

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  5. I didn't read the Bloomberg article, but Willis Eschenbach has an interesting post on the high number of Italian deaths at WUWT.

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    1. I just read that. Yes, there's some interesting thought there. Right up front he mentions what Bayer is talking about--social networking. In the Italian case, close extended families with intense inter-generational contact. I have no doubt that that's a major factor. On another thread I mention what I heard this afternoon from our local major urban health official--their investigation shows that tyically you need 10 minutes of contact within 6 ft. A school aid transmitted, but not to the kids--to her family. (More on this in a bit.)

      Re the hospital transmission, I know I've mentioned that. The Italians initially failed to sequester adequately and the result was lots of medical personnel getting infected, as Eschenbach notes.

      I found his account of what's happening in Korea very interesting. If you compare that to the account I just gave of what's going on in my area, it doesn't compute. In Korea it seems to be hyper-virulent, whereas in my area it's obviously pretty infectious, but not to the Korean degree. What's up with that?

      Another example I've mentioned is Singapore. In Singapore it has apparently been confirmed that the virus mutated to a less virulent strain, and that helps explain the success in combatting it there. There's no reason to suppose that hasn't happened elsewhere--even within a large country like the US. These viruses are known to mutate frequently. As a result some of the variation may be explained in that way, too.

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  6. Related ...

    What is an essential job/industry?

    Grocery stores? Yes. We need food. Inherently that means clerks, stockers, etc are essential jobs.

    This means that farmers, ranchers, and processesors are essential.

    This means the companies and employees that make that packaging from cardboard to styrofoam, to plastics are essential.

    This means, obviously, truckers and their service places/personnel, etc are essential.

    In turn, the companies that supply parts for trucks and their employees are essential.

    On and on it goes, industry to industry, sector to sector.

    Who supplies the clothes and equipment? Who makes the plastic pellets to form essential medical gear? Who drills/pump/process the oils/gas?

    We cannot realistically shut most things down. This means human interaction with many times being fairly close or actually close contact.

    It is what is. We mitigate, we reduce as much as we can, but there is no real way to make "shelter in home" actually feasible.

    Even worse, as we are seeing, we release criminals for what I call "normal" crime, but imprison those that defy such shelter orders, making it even more illogical. Hello, New Jersey.

    The plague still kills. The hauntavirus still kills.

    I am in no way saying that we should not attempt to stop or lesson this.

    What I am saying is that there is no way possible without shutting everyone in their homes by force of local, state, and federal level no matter who is essential or not to truly, effectively stop it.

    Short term, very short termz what is going on now if fine. Put this in multi-month time frames is unrealistic.

    After typing this in a cell phone, I suppose that I could have just stated that essential jobs means a heck of a lot more than what it appears most people consider are essential.

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    1. "What is an essential job/industry?"

      Gun stores. At least they are where I live, and who am I to argue?

      Even after listening to Olsterholm yesterday, I'm still not that pessimistic. I think for the time being we have to continue with social distancing--which is relatively easy to do in the US, compared to many other places. But we can reevaluate strategy. That's a complex topic, given the size of the US. The disease is obviously not evenly distributed. Could we isolate the disease ridden areas (NY, Seattle, etc.) from the rest of the country if other areas seem able to contain it? Possibly. I could consider that.

      However, two things to keep in mind. Even those who postulate a lower rate of fatality than 1%+ have to recognize that in a nation of 330M that computes to many times the seasonal flu rate--one helluva lot of dead people.

      The other factor is that if this thing becomes endemic life the flu and continues to mutate, vaccines become very problematic. In that case, you could have a far more deadly disease added to the yearly toll from flu.

      We appear to accept flu deaths because we basically can't prevent them. But this would be a lot more added to that toll. I wouldn't not want to readily accept that if there's a chance of preventing that outcome.

      Which is to say: China has a lot to answer for.

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    2. I like what we are doing now, I just don't see it feasible very much longer.

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  7. @Mark

    You wrote: "Even those who postulate a lower rate of fatality than 1%+ have to recognize that in a nation of 330M that computes to many times the seasonal flu rate--one helluva lot of dead people."

    FWIW, here are the CDC statistics this year for seasonal flu (through 3/14/2020)

    38,000,000 reported cases of the flu.

    390,000 hospitalizations due to the flu.

    23,000 deaths due to the flu, including 149 children.

    Source: https://www.cdc.gov/flu/weekly/index.htm?fbclid=IwAR0uHjmdWmBhO46ijmCJtAiDqEOCV2GUYJ5aoD0JE4MgGo-SwW4zhZCF7nY

    Current U.S. COVID-19 stats as per WHO as of March 24:

    42,164 confirmed cases
    471 deaths

    Source: https://www.who.int/.../20200324-sitrep-64-covid-19.pdf...

    (FWIW, this is not a political post. Just statistics.)

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    1. More or less. I take my numbers from Worldometer, and I come up with a mortality rate of 0.013--which is equivalent to the seasonal flu, year in, year out. In terms of absolute numbers, however, flu deaths sometimes go as high as 60K.

      However, we're still in early days, and deaths are a lagging statistic. That's why Trump and the SG keep talking about waiting for at least a couple more weeks, with the SG stating that these next two weeks will be hard. Dr. Lin at Stanford, otoh, argues that the peak won't come until June. And Osterholm and Lin both remind us that there will likely be a return in Fall, possibly worse, just as will likely happen in China and elsewhere.

      I have no quarrels with such numbers, nor do I offer a prediction in that regard. I do say, however, that based on the usual factors that are discussed that we have no reason to expect a lower fatality rate than in Germany--which is low by world standards, even in comparison, for example, to S. Korea which is praised for its response.

      I'll repeat what my position has always been, and that I've openly stated:

      1. In the circumstances--knowing that this virus is SARS-like, knowing what SARS was like, and knowing that this is a true pandemic that has spread rapidly--Trump had no real choice but to go with social distancing as the only strategy that is known to work with SARS-like viruses. He did the right thing and should be given full credit. SARS-like viruses are simply too dangerous for complacency to be a strategy.

      2. OTOH, I have repeatedly stated that I believe that we're still in early days here in the US, and that the human geography of the US makes it possible that the outbreaks--I use the plural, because I believe there have been several independent outbreaks--can be limited in their spread by the social distancing strategy. That strategy, as I have also said, can be modified based on developments in the individual states and regions of the country.

      I think that's a reasonable and defensible position. If I'm wrong, I'll have been wrong on the low side.

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    2. @Cassander

      I just took another look at your comment, and I think you're misunderstanding what I've been saying. If I understand your comment, you seem to believe that I'm suggesting that Covid-19 deaths in the US will exceed seasonal flu deaths. That's not it.

      What I'm saying is that the death rate in the US will exceed that of the flu by several times--which appears to be the case in every country we know of so far. But the total deaths will depend on the number of infections--and that is a number we don't know. Refer to #2 in my most recent comment above. I have said repeatedly that I suspect that factors peculiar to the US will keep the spread of infections lower than in other countries--at least on a per capita basis. That logically means fewer actual deaths.

      In addition, I've argued that the penetration of the disease into the US probably didn't occur until close to the end of January, and that in isolated instances (Washington and NY). As a result, NY is the only true breakout locale in the US and social distancing is probably suppressing spread elsewhere before breakouts occurred.

      We may learn of new breakout locales in the coming weeks, but that won't necessarily work against my argument that breakouts in the US will be mainly localized and containable.

      As I say, I may be wrong about that, but if so I'll have been wrong on the low side.

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    3. Cassander, your CDC stat is incorrectly stated. There are not 38 million reported cases of the flu. There are 240,000 confirmed cases. The 38,000,000 figure is an estimate.

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    4. Anon, thanks for the important reminder.

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    5. Thanks, Anonymous. Facts matter. I'm guilty of having cut and pasted that info from a friend's email without having gone back to the underlying data. Here it is in the CDC's own words:

      "CDC estimates that so far this season there have been at least 38 million flu illnesses, 390,000 hospitalizations and 23,000 deaths from flu."

      However, the fact that CDC can itself only estimate the number of total flu cases (a disease CDC is extraordinarily familiar with), to me, underscores the same problem with Covid-19. We just don't know the total number of cases and, accordingly, cannot (yet) precisely estimate the mortality rate per infection.

      Perhaps another useful way to compare the risk of death of the two diseases is to look at deaths/hospitalization. The seasonal flu data divides out to 5%, I think. I found a CDC report from a few days ago which seems to indicate that 508 hospitalizations resulted in 44 deaths, a ratio of 8.7%. Higher than seasonal flu...but not 10 times higher...

      In any event, the mortality rate, whatever it turns out to be, does matter. As the Stanford profs say, you probably don't invoke the same economic consequences for an epidemic which kills 20 or 40 thousand as you do for one which kills millions. Better understanding is definitely warranted!

      Having said all that, Mark, you and I are generally on the same page...I think.

      I agree with Trump's actions to date, whatever the mortality rate turns out to be. I especially agree that there is and has been a risk that an 'exponential' increase in cases could overwhelm treatment resources, with cascading negative consequences. I also agree that social distancing has probably been the only way to date to stem the increase in numbers of cases.

      Now we'll see what Trump and his team come up with to limit the downside consequences of trillions of dollars of market losses -- to date.

      Postscript: You guys -- Mark and Anonymous -- remind me - appropriately - of the dangers of laymen stepping into this quagmire. Riddled with minefields. Since I'm retired and self-isolated, and have a laptop, its too tempting not to join the discussion. I like to semi-sanctimoniously advise others to be careful with anecdotes, facts and stating opinions. I will try to take my own advice.

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    6. I wrote "I found a CDC report from a few days ago which seems to indicate that 508 hospitalizations resulted in 44 deaths, a ratio of 8.7%."

      Here's my authority: https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm

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  8. Mark --

    I do understand that what you're saying saying is that the death rate in the US will likely exceed that of the flu by several times. Here I might disagree.

    We really don't know how many infections have occurred, either here or in China, Italy or South Korea. We only know how many cases have been reported. And we know testing has been problematic.

    I think it may well be the case that the numbers of infected persons (as opposed to reported cases), both globally and in the US, is grossly underestimated. Rates of infection may in fact be much higher than reported cases and, if so, mortality rates may be much lower than estimates of, say, 10x seasonal flu.

    Helpfully, Stanford professors of medicine, Eran Bendavid and Jay Bhattacharya, seem to agree with me. In an Op Ed in today's WSJ they write:

    "An epidemic seed [in the United States] on Jan. 1 implies that by March 9 about six million people in the U.S. would have been infected. As of March 23, according to the Centers for Disease Control and Prevention, there were 499 Covid-19 deaths in the U.S. If our surmise of six million cases is accurate, that’s a mortality rate of 0.01%, assuming a two week lag between infection and death. This is one-tenth of the flu mortality rate of 0.1%. Such a low death rate would be cause for optimism."

    Wow!

    They go on to write:

    "This does not make Covid-19 a nonissue. The daily reports from Italy and across the U.S. show real struggles and overwhelmed health systems. But a 20,000- or 40,000-death epidemic is a far less severe problem than one that kills two million. Given the enormous consequences of decisions around Covid-19 response, getting clear data to guide decisions now is critical...If we’re right about the limited scale of the epidemic, then measures focused on older populations and hospitals are sensible."

    They conclude by saying

    "A universal quarantine may not be worth the costs it imposes on the economy, community and individual mental and physical health. We should undertake immediate steps to evaluate the empirical basis of the current lockdowns."

    Its hard for me to disagree.

    Here's a link: https://www.wsj.com/articles/is-the-coronavirus-as-deadly-as-they-say-11585088464?cx_testId=3&cx_testVariant=cx_2&cx_artPos=1#cxrecs_s

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    1. I'll be reading that this morning. Some comments:

      As Anonymous reminds us, the flu infection rate is an estimate.

      I'm not plugged into high death or infection rates in the US, so I don't feel compelled to disagree with the Stanford docs. However, up till now, I've been persuaded that the virus was--for reasons unknown--not "seeded" in the US until near the end of January. That is what I've read that genomic sequencing tells us. Note that in Seattle the breakout occurred around Ash Wednesday per yesterday's WSJ--putting that outbreak near the end of February. Allowing a lag of up to a month does get us back to late January or maybe not until early Feb. Same goes for NY.

      The point is, if this is correct then the US is still in early days. My argument for an optimistic forecast--and I claim no expertise--is that if we're still in early days, then Trump has acted expeditiously before we get true community spreading. That also was the point that I quoted from my local health official--that spread here still appears to be more intra familial from a very limited "seeding".

      Again, my point is that SARS-like viruses are far too dangerous for Trump to have acted in any other way than he did. Therefore I support his approach which is based on sound science and past experience: if you have an outbreak of an infectious disease but no vaccine and no specific treatment (thus far), then social distancing is responsible. In the case of a pandemic, all the more so.

      Perhaps the Stanford docs will be proven correct. However, they speak of their "surmise".

      I have stated repeatedly that my concern is not for estimated rates of infection/death but with preventing hospitals from being overwhelmed. That's the point of social distancing. Trump's actions may have already achieved that, if the US is still in early days and the spread of the virus was limited.

      I don't doubt that Trump is getting thoroughly briefed and considering all options. Fauci has said that Trump is a careful listener. Based on his performance so far I trust Trump and am willing to wait for his decision rather than act on "surmises" or libertarian ideology.

      On to the WSJ.

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    2. Trump is saying Easter. Pelosi is saying never. Four Mortgage REITs collapsed yesterday. Dominoes are falling. When the cotton was high, REITs were practically free money. And now?

      Here we go again.

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    3. I read the article and was underwhelmed. The authors make a number of unwarranted assumptions, the first of which I already noted--the timing of infection spread in the US. I readily grant that what the authors think is probable would seem probable to most, but we do in fact have some actual evidence for a later onset. Further, their "probability" is based on the seat of the pants observation that lots of people travel between the US and China and basically nothing more.

      They also use the WHO death rate, which few accept anymore--so their use of it is tantamount to using a straw man argument to bolster their conclusion.

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    4. FWIW, Mark, Profs. Bendavid and Bhattacharya seem to be highly credentialed doctors with most impressive curricula vitae in the areas of infectious disease, health policy, and health economics. Their conclusions may be based to some extent on 'surmise' but they would certainly appear to have the experience and background to make some assumptions.

      https://cap.stanford.edu/profiles/viewCV?facultyId=9404&name=Eran_Bendavid

      https://fsi-live.s3.us-west-1.amazonaws.com/s3fs-public/cv-jay-march2016.pdf

      I assume that when they publish an opinion piece in the WSJ they are well aware of the potentional reputational consequences if they are way off base.

      So...we probably shouldn't rule out the possibility that the rate of infection has been underestimated and the mortality rate overestimated...

      Just sayin...

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    5. Most people who write op-eds are highly credentialed. I'm not sure dueling creds is helpful. Richard Friedman, highly credentialed in his own way, predicted US deaths wouldn't pass 500. Oh well. Michael Osterholm, highly credentialed in epidemiology and public health is more alarmist--and has hands on experience with epidemics. Michael Lin, also from Stanford, differs from his fellow Stanford docs. But where they differ is that the WSJ piece, to me, offers no real justification for the presumptions beyond pretty much man in the street type stuff--people travel from China to US and vice versa.

      If you want a study to support the Stanford docs, here's one by a highly credentialed guy:

      Oxford Epidemiologist: Here’s Why That Doomsday Model Is Likely WAY OffOxford Epidemiologist: Here’s Why That Doomsday Model Is Likely WAY Off

      He's attacking the Imperial College model. The problem is that policy makers have to make decisions before all that serological testing (which I have touted as possibly very helpful) gets done. Trump doesn't have the luxury that these guys will have of hindsight.

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    6. BTW, Paul Krugman is highly credentialed and is presumably well aware of the potentional reputational consequences if/when he's way off base.

      Just sayin' ... :-)

      The notion that scientists are impartial arbiters of facts, well ...

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    7. Krugman = Touché

      But your argument, taken to its logical conclusion, would...well...obviate all expert opinion.

      Surely, Mark, you don't disagree that we don't actually know the mortality rate...and it may turn out to be less than 1%...

      At the end of the day that's all Bendavid and Bhattacharya are saying. They conclude:

      "We should undertake immediate steps to evaluate the empirical basis of the current lockdowns".

      That's more constructive than anything Krugman has said in the last 15 years!

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    8. I don't argue against using expert opinions, just that we should not give experts carte blanche to form our opinions and dictate policy. That's the progressive way of "settled science" which really equals CW. "Science" is replete with examples.

      First you say that all they're saying is that we don't know the mortality rate and that it may turn out to be under 1%. They're hardly out front leading with that view, and of course I don't disagree with it.

      But they're actually saying far more than that. They're saying that 6M Americans have already been infected, and presumably more all the time. What they leave unsaid is that natural "herd" immunity is well on its way to spreading throughout the population as a result.

      And based on that "surmise" they want "immediate steps" to be taken to "evaluate the empirical basis of the current lockdowns". As if none of the epidemiological experts advising the government bothered to evaluate the empirical basis for their recommendations.

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  9. I understand the need for action to minimize the spread of this virus, but it has been reported that the reason why NY City has the most cases and most deaths is population density. Seems that more density should require a higher level of restrictive controls, where lower population density could have more relaxed controls without aggravating the situation. Maps showing number of "cases" by state are all over the place. Texas is shown on par with NY, but has a lot more square miles! I would like to see a map of cases and deaths by county (parish?) or by zip code. I would postulate that imposing restrictions on this basis would help the economy substantially while still exerting restrictive control where they are needed.

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    1. Of course we know that that capability is available--and is likely being used by government agencies. Transparency hasn't gotten that far in the US. In places like Taiwan, otoh, that info was very quickly made available to the public and was kept updated.

      Your idea of imposing restrictions based on such information may already be in the works. I read this morning that New Yorkers who travel are being asked to self quarantine. That could be a first step to a more specific approach.

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    2. "Texas is shown on par with NY"

      Not sure what you mean by that. TX is way down the list of states. Here's what I use for stats:

      https://www.worldometers.info/coronavirus/country/us/

      New York 26,430
      Texas 1,023

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    3. At what point will we know we have prevented hospitals from being overwhelmed?

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    4. We're not close in the US. I believe the number of critical care Covid-19 cases in the whole US yesterday was about 1100. The US has the most per capita ICU beds in the world. However, I have heard that NY has farmed out some cases to CT and possibly some other nearby states. But that's a very localized problem.

      If conditions remain pretty much the same for another two weeks or so we'll have a pretty good idea that the increase is arithmetic (<1.10) and not exponential. That would mean hitting an 'inflection point,' shifting from an exponential curve to a logistic curve. Tweaking the strategy based on relevant factors may well be in order at that point. That 2 week wait--which Trump has mentioned--is in my understanding based on the data that I've mentioned many times pointing toward an end of January beginning in the US. It takes into account both lagging and leading indicators--incubation period, etc.

      The relevant factors may well differ from one locality to another, but from the maps we've all seen it's apparent that NY is far and away the major 'hotspot.' I believe this country is large and dispersed enough that we can make those distinctions safely. However, you don't want to take your foot off the brake too soon and allow this to become endemic, like the flu. If that happens the problem is likely to grow and recur.

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    5. It appears, from this rather morbidly fascinating article on one man’s COVID-19 illness, written by his wife (a NYT editor), that in NYC doctors are keeping patients at home, with very close monitoring, only recommending hospitalization if a respirator is required for impaired breathing. This article is graphic - from the man’s condition to what his wife and teenaged daughter are having to do. After reading it, I wondered how many would employ such discipline. I have doubts.

      https://www.nytimes.com/2020/03/24/magazine/coronavirus-family.html?campaign_id=9&emc=edit_NN_p_20200325&instance_id=17048&nl=morning-briefing&regi_id=108256783&section=topNews&segment_id=22795&te=1&user_id=68ed15cee0a36f3326a30763880aebdb

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    6. Re: "Texas is on par with NY" here is link to map I was considering: https://www.nbcnews.com/health/health-news/coronavirus-u-s-map-where-virus-has-been-confirmed-across-n1124546

      This may be part of NBC's infamous sensationalizing the news. NY is reported at 271 deaths, to Texas 11, but the colorizing is the same. North Carolina, my home state, is second level color, but reports 0 deaths (I believe NC actual deaths is 1).

      "If it bleeds, it leads."

      This is why I read your blog and not NBC's!

      Keep up the good work.

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    7. Oh, I see. NY is in a class by itself, so yeah that's misleading. Tx.

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  10. I've been teleworking, and, other than seeing my wife, pretty much having zero physical contact. We go for a walk in the afternoon, weather permitting. In the evening, we go for a short drive.

    Vehicular traffic is 50%, or less. Many businesses are closed. Jimmy John's is closed. Dollar Tree is open. Popeye's is open for drive thru only. Surprisingly to me, the walk-up Dairy Queen(remember those?) is open.

    We watched Mass on the internet over the weekend. We only have television via rabbit ears, no cable or satellite. There's a lot of junk on TV. Modern programs I don't follow, so I'm limited to the oldies such as The Andy Griffith Show.

    We sit outside around our fire bowl. The grass will need cutting soon and I've been working behind our fence which borders an active railroad. I have to fight invasive species such as bush honeysuckle and other noxious weeds such as polk weed, wild grapevine and Johnson grass. Other nuisances are black locust saplings and box elder trees. Bush honeysuckle blooms early, grows quickly and crowds out the competition. It's the last to lose its leaves. It's spread by the birds. They eat the berries in fall and spread seeds in their droppings.

    Sorry for the diversion but life is still occurring. I am bored, although I am carrying on.

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