All things political. Coronavirus Edition. (1 Viewer)

[Maxp]

I fear we are really going to be in a bad place due to the obvious cuts to the federal agencies that deal with infectious disease, but also the negative effect the Affordable Care act has had on non urban hospitals. Our front line defenses are ineffectual and our ability to treat the populous is probably at an all time low. Factor in the cost of healthcare and I can see our system crashing. What do you think about the politics of this virus?

 

[JimEverett]

This is an interesting case study on how people perceive risk, and how to mitigate it.

If COVID-19 follows a worst case scenario - which means something like half the world's population catches it with a 10% ending up in ICU and 1% fatality - that's 350 million people in the ICU worldwide and 35 million dying. Obviously, that seems like something to get worked up over right?

If COVID-19 follows a best (realistic) case scenario - that would be something like 30% of the world's population getting it with 3% ICU and .1% fatality. That would be 63 million in ICU and 2.1 million fatalities. What sort of reaction would that be worth?

Now, how do you assess the probability of the various scenarios? What are the ramifications and costs of each scenario? How much are you willing to spend to lower the probability of a particular scenario?

In general, people don't need to panic, in terms of believing they are going to die or become seriously ill from COVID-19. But they should understand that this could be a serious issue for the the public health system and they have a responsibility to act in a reasonable manner to slow the spread of the disease, and government officials absolutely should not be downplaying the risks.

I just find it hard to wrap my head around those numbers. I guess I am missing something huge. China seems to be beyond the worst part of the spread. In a population of 1.4b people they have 3200 deaths.
They may be the "best possible case" or perhaps its South Korea, I don't know. But I think it is fair to say that the U.S. and many other countries will exceed those ratios.

Worst case seems to be Italy, at least for now. In a country of 61 million they have had 830 deaths. That number will no doubt increase and increase substantially. Assuming the same ratio of Italy, but doubling the amount of confirmed cases and keeping a death rate of 6.5% you would get 140,000 infected in the US and less than 10,000 dead. Basically, about a third of the deaths of an average flu season.

Or to put it another way - if the worst case projection were true across every country - that would mean 7 million Chinese deaths. In best case scenario they would have 420,000 deaths. they have had 3200 deaths and the spread is on the decline.

In Italy, worst case would equate to 275,000 people dying. Best case: 16,470 deaths.

Its not as if wild predictions have never happened: there were people claiing the swine flu carried a death rate as high as 15% and that 100,000 or more Americans would die. There was less than 3500 deaths.

 

[SystemShock]

Ok. That's not really what we're talking about and not really the same thing. You're kind of being a little obtuse here, I guess to make a point about medicare-for-all or something.

Not the same thing? Are we not talking about health care system resources?

 

[SystemShock]

I just find it hard to wrap my head around those numbers. I guess I am missing something huge. China seems to be beyond the worst part of the spread. In a population of 1.4b people they have 3200 deaths.
They may be the "best possible case" or perhaps its South Korea, I don't know. But I think it is fair to say that the U.S. and many other countries will exceed those ratios.

Worst case seems to be Italy, at least for now. In a country of 61 million they have had 830 deaths. That number will no doubt increase and increase substantially. Assuming the same ratio of Italy, but doubling the amount of confirmed cases and keeping a death rate of 6.5% you would get 140,000 infected in the US and less than 10,000 dead. Basically, about a third of the deaths of an average flu season.

Or to put it another way - if the worst case projection were true across every country - that would mean 7 million Chinese deaths. In best case scenario they would have 420,000 deaths. they have had 3200 deaths and the spread is on the decline.

In Italy, worst case would equate to 275,000 people dying. Best case: 16,470 deaths.

Its not as if wild predictions have never happened: there were people claiing the swine flu carried a death rate as high as 15% and that 100,000 or more Americans would die. There was less than 3500 deaths.

Every time... swine flu, bird flu, SARS, Ebola, etc... they were all going to decimate the world.

 

[UncleTrvlingJim]

I just find it hard to wrap my head around those numbers. I guess I am missing something huge. China seems to be beyond the worst part of the spread. In a population of 1.4b people they have 3200 deaths.
They may be the "best possible case" or perhaps its South Korea, I don't know. But I think it is fair to say that the U.S. and many other countries will exceed those ratios.

Worst case seems to be Italy, at least for now. In a country of 61 million they have had 830 deaths. That number will no doubt increase and increase substantially. Assuming the same ratio of Italy, but doubling the amount of confirmed cases and keeping a death rate of 6.5% you would get 140,000 infected in the US and less than 10,000 dead. Basically, about a third of the deaths of an average flu season.

Or to put it another way - if the worst case projection were true across every country - that would mean 7 million Chinese deaths. In best case scenario they would have 420,000 deaths. they have had 3200 deaths and the spread is on the decline.

In Italy, worst case would equate to 275,000 people dying. Best case: 16,470 deaths.

Its not as if wild predictions have never happened: there were people claiing the swine flu carried a death rate as high as 15% and that 100,000 or more Americans would die. There was less than 3500 deaths.

I get what you're saying. I think when people talk about worse case scenarios, they're talking about if we do nothing, what are the various scenarios.

There are lots of cognitive biases at play of course. An epidemiologist might be pre-disposed to seeing things in worse case scenarios and will be more risk averse. I honestly don't remember predictions for the swine flu, I certainly don't remember whole countries shutting down, which suggest to me that people in authority now believe this is more serious than what people in authority at that time thought would happen. So that's an indicator of something.

There are lots of unknowns, and I find it interesting to see how different people react to unknowns and how they evaluate risk. I'm generally of the opinion that most people evaluate risk poorly.

This is one of those cases that I think that government officials should be taking this very seriously and the general public should just be aware and take reasonable precautions, but until the past 2 days it was the opposite, and now we have government officials scrambling to catch up.

 

[UncleTrvlingJim]

Not the same thing? Are we not talking about health care system resources?

Yes, but I said insuring more people will not strain resources because they don't increase the number of seriously ill people. This does increase the number of seriously ill people.

We already have a universal health care system in that if you need to go to a hospital you can whether you can pay for it or not. Covering people does not suddenly make people need hospital care because they can already get hospital care without it. Further, we already have an example of adding 10 million people to the insured ranks -- that happened in 2013 when Obamacare went into effect, and the sickest people who couldn't get insurance because of pre-existing conditions could not get insurance... and that didn't strain the health care system. You didn't make a case why now insuring the last 10 million people would.

 

[coldseat]

Not the same thing? Are we not talking about health care system resources?

It's not the same thing. Just spend some more time thinking about it and you'll get there. Or read UTJ's post on top of mine.

 

[UncleTrvlingJim]

I should add that Italy should give you an indication that this is worse than the regular flu, or is at least adding severe strain to the health care system. They are at the point where some hospitals have to start deciding who they should treat because they don't have enough capacity to treat everyone. Since the flu also exists in Italy, that should be an indicator that this is adding a significant strain in some localities above the flu, right?

Now, we have more capacity than Italy, so we might not ever reach that same breaking point, but we do have evidence that this is worse than a normal flu.

 

[Lapaz]

There probably wasn't anything he could say to improve things. He has handled this situation horribly from the get go. His actions speak louder than words and even then, they fumbled the speech completely and caused more uneasiness. He has downplayed this from the beginning and he is going to reap what he sowed. From not filling the pandemic team he fired 2 years ago, to not having more tests manufactured a month or two ago when the WHO and CDC said this is going to make it to the US, be ready. Remember earlier he said it would all go away when it warms up. Which is partially true, but should we just let people get infected until then.

He only became concerned about it after the market started tanking. Imagine that.

I don’t think this will go away when it warms-up, because there are a lot of cases in the Southern Hemisphere right now, and it is much warmer there.

It's fair analysis to be sure - I think the 1% case fatality rate is probably a best figure, all things considered (though 1% is 5x the CFR for H1N1 and something like 10x seasonal flu). The contagiousness analysis is based on a lot of extrapolation, it's hard to really be that confident about it. It's clear that the virus is substantially contagious, but only during the symptomatic phase - which makes it much easier to mitigate.

I think it's important for the response to remain factual - and I don't think that appropriate efforts to mitigate the spread should be seen as "panic." But I think that saying "don't be worried because you're not likely to die" results in an under-appreciation of the risks that are there, and the need for people to embrace the mitigation effort.

And for that, I think there are two items in particular that are under-appreciated in that article::
(1) The case fatality rate for people over 70 is significantly higher (believed to be approx. 5%) and for over 80 it is substantially higher (perhaps north of 15%). . . and when you add underlying medical conditions (which can by anything from diabetes to respiratory conditions like asthma) the at-risk age gets younger. We can't just tell the 70+ to stay in their homes for a year while the rest of us suffer mild illness and get on with it. Either it's mitigated or it isn't.

(2) The article fails to mention, at all, the rates of hospitalization and the burden it has on the healthcare system in any given community where case-load exceeds hospital capacity. As we learn more about how the western countries are handling it, we are seeing more and more focus from the medical and infectious disease experts that rates of hospitalization (and ICU needs) are much higher than other respiratory illness and when a given hospital or hospital runs out of ICU space or out of ventilators, it becomes really problematic. And the quality of outcomes goes down.

Taking this seriously isn't panic. But treating it as mostly benign enhances risk.

The notion that this virus has a large number of asymptomatic people is very speculative, and is belied by the report that I heard yesterday. There was a doctor on CNN yesterday that has a patient that just recovered. His patient was 1 of 13 people that went skiing together, most of which were in their 40s and 50s, although one of them was over 80. All 13 got sick, and most are still sick. If this disease does indeed have a large percentage of asymptomatic carriers, it is likely to only be the case among the very young, because the likelihood that all 13 probably healthy adults would get sick with a disease that results in a high number of asymptomatic people is very, very low. This outcome suggests to me that at least for middle aged people, almost 100% will present symptoms. So while people are taking comfort that many people may be asymptomatic in order to surmise that the mortality rate is much lower, I don't think we know, and I'm concerned that this isn't the case for anyone that's at least 40.

Many European countries have almost the same number of people that have recovered as have died. Granted that 99% of deaths are for people that are at least 50 years old, and I suspect that the vast majority of symptomatic people are also over 50, but once you get symptoms, this disease is very lethal.

Coronavirus Age, Sex, Demographics (COVID-19) - Worldometer

Age, sex, demographic characteristics such as pre-existing conditions, of coronavirus cases of patients infected with COVID-19 and deaths, as observed in studies on the virus outbreak originating from Wuhan, China

www.worldometers.info

Per, https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19 , 87% of people that presented symptoms were at least 30. If indeed young people don't present symptoms, they're still vectors to infect their parents and grandparents. The recent NBA players were probably under 30, and probably healthy, although the NBA is taxing on the immune system. This report also stated that in a small Chinese sample of 24 unsymptomatic and confirmed people, only 5 of them developed a fever. The report didn't clarify the ages of these people, but it wouldn't surprise me if the vast majority of those 5 were over 50.

 

[JimEverett]

I don’t think this will go away when it warms-up, because there are a lot of cases in the Southern Hemisphere right now, and it is much warmer there.



The notion that this virus has a large number of asymptomatic people is very speculative, and is belied by the report that I heard yesterday. There was a doctor on CNN yesterday that has a patient that just recovered. His patient was 1 of 13 people that went skiing together, most of which were in their 40s and 50s, although one of them was over 80. All 13 got sick, and most are still sick. If this disease does indeed have a large percentage of asymptomatic carriers, it is likely to only be the case among the very young, because the likelihood that all 13 probably healthy adults would get sick with a disease that results in a high number of asymptomatic people is very, very low. This outcome suggests to me that at least for middle aged people, almost 100% will present symptoms. So while people are taking comfort that many people may be asymptomatic in order to surmise that the mortality rate is much lower, I don't think we know, and I'm concerned that this isn't the case for anyone that's at least 40.

Many European countries have almost the same number of people that have recovered as have died. Granted that 99% of deaths are for people that are at least 50 years old, and I suspect that the vast majority of symptomatic people are also over 50, but once you get symptoms, this disease is very lethal.

Coronavirus Age, Sex, Demographics (COVID-19) - Worldometer

Age, sex, demographic characteristics such as pre-existing conditions, of coronavirus cases of patients infected with COVID-19 and deaths, as observed in studies on the virus outbreak originating from Wuhan, China

www.worldometers.info

Per, https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19 , 87% of people that presented symptoms were at least 30. If indeed young people don't present symptoms, they're still vectors to infect their parents and grandparents. The recent NBA players were probably under 30, and probably healthy, although the NBA is taxing on the immune system. This report also stated that in a small Chinese sample of 24 unsymptomatic and confirmed people, only 5 of them developed a fever. The report didn't clarify the ages of these people, but it wouldn't surprise me if the vast majority of those 5 were over 50.

If there are not many asymptomatic people with the disease then that means the disease is relatively hard to spread, correct? Relative to the flu, lets say. Although far far more deadly, based on the numbers from China and elsewhere it would seem overall this is not as "bad" as the flu. While the fatality rate is exponentially higher than the flu, the likelihood of contracting COVID-19 is far less than that of the flu - again, assuming that there are not many more cases than those cases that have been confirmed.

 

[Heathen]

Don't worry guys we do have healers:

 

[samiam5211]

Earlier today I was reading about past epi/pandemics and realized how far we’ve come in the past 300 years.

Then when I got home from work spent an hour on the phone with my mother arguing about whether or not hand sanitizer or washing your hands makes any difference and trying to convince her to not attend the crawfish boil that is still inexplicably planned at her church tomorrow night.

After failing to stop my mother from attending a crawfish boil with unwashed hands, I realized that too many of us haven’t come far enough since smallpox.

The most vulnerable of our population are the least prepared for the reality that is upon us.

The US hasn’t had a shared experience like this since 911, and there has never been a global shared experience like what we are going through now in recorded history.

Every one of us will know someone personally who will die from this. We can’t imagine the impact that is going to have on the collective consciousness.

 

[BobE]

FYI, CNN will be having a Corona town hall at 10pm EST tonight. Not sure if it is a new one or the one from last week.

 

[Mr. Blue Sky]

I don’t think this will go away when it warms-up, because there are a lot of cases in the Southern Hemisphere right now, and it is much warmer there.



The notion that this virus has a large number of asymptomatic people is very speculative, and is belied by the report that I heard yesterday. There was a doctor on CNN yesterday that has a patient that just recovered. His patient was 1 of 13 people that went skiing together, most of which were in their 40s and 50s, although one of them was over 80. All 13 got sick, and most are still sick. If this disease does indeed have a large percentage of asymptomatic carriers, it is likely to only be the case among the very young, because the likelihood that all 13 probably healthy adults would get sick with a disease that results in a high number of asymptomatic people is very, very low. This outcome suggests to me that at least for middle aged people, almost 100% will present symptoms. So while people are taking comfort that many people may be asymptomatic in order to surmise that the mortality rate is much lower, I don't think we know, and I'm concerned that this isn't the case for anyone that's at least 40.

Many European countries have almost the same number of people that have recovered as have died. Granted that 99% of deaths are for people that are at least 50 years old, and I suspect that the vast majority of symptomatic people are also over 50, but once you get symptoms, this disease is very lethal.

Coronavirus Age, Sex, Demographics (COVID-19) - Worldometer

Age, sex, demographic characteristics such as pre-existing conditions, of coronavirus cases of patients infected with COVID-19 and deaths, as observed in studies on the virus outbreak originating from Wuhan, China

www.worldometers.info

Per, https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19 , 87% of people that presented symptoms were at least 30. If indeed young people don't present symptoms, they're still vectors to infect their parents and grandparents. The recent NBA players were probably under 30, and probably healthy, although the NBA is taxing on the immune system. This report also stated that in a small Chinese sample of 24 unsymptomatic and confirmed people, only 5 of them developed a fever. The report didn't clarify the ages of these people, but it wouldn't surprise me if the vast majority of those 5 were over 50.

Good info... but i find it interesting that so much of the news regarding Covid 19 is focusing on age, rather than health.. almost every story i see talks about how if you’re over 40, or 50, or 60 your likelihood of death goes up from this , etc.. but i feel like , with most diseases, mortality is more tied to whether you’re obese, or a smoker, or get very little exercise.. i personally know 50 year olds who are in much better shape than most 30 year olds, maybe it’s just the circles i run in.. Are people just thinking in vast generalities, or could there be some particular reason that this virus is more lethal for older people vs just less-healthy people? An ageist virus??

 

[GMRfellowtraveller]

Earlier today I was reading about past epi/pandemics and realized how far we’ve come in the past 300 years.

Then when I got home from work spent an hour on the phone with my mother arguing about whether or not hand sanitizer or washing your hands makes any difference and trying to convince her to not attend the crawfish boil that is still inexplicably planned at her church tomorrow night.

After failing to stop my mother from attending a crawfish boil with unwashed hands, I realized that too many of us haven’t come far enough since smallpox.

The most vulnerable of our population are the least prepared for the reality that is upon us.

The US hasn’t had a shared experience like this since 911, and there has never been a global shared experience like what we are going through now in recorded history.

Every one of us will know someone personally who will die from this. We can’t imagine the impact that is going to have on the collective consciousness.

Just well actuallying a bit
While there wasn’t a specific epidemic (and probably not in most of our lifetimes), I would say the period from ‘68-‘72 (thereabouts) had very volatile moments in many places throughout the world
As a planet we did not handle that time very well

 

[Beach Friends]

I went and bought every package of toilet paper and every last bottle of water at my local market, so I feel pretty good about having done my part.

 

[bdb13]

I went and bought every package of toilet paper and every last bottle of water at my local market, so I feel pretty good about having done my part.

I think I saw you.

 

[SystemShock]

Yes, but I said insuring more people will not strain resources because they don't increase the number of seriously ill people. This does increase the number of seriously ill people.

Seriously ill, or just enough ill, a hospital bed doesn't care; a heartbeat monitor doesn't care, a hospital room doesn't care, the hours in the day don't care... they all are resources that are used.

We already have a universal health care system in that if you need to go to a hospital you can whether you can pay for it or not. Covering people does not suddenly make people need hospital care because they can already get hospital care without it.

That's not entirely true, is it? That's not where it ends. If we already have a universal health care system that we all can freely use without cost, then what's Sanders et al are blabbering about health care costs?

Further, we already have an example of adding 10 million people to the insured ranks -- that happened in 2013 when Obamacare went into effect, and the sickest people who couldn't get insurance because of pre-existing conditions could not get insurance... and that didn't strain the health care system. You didn't make a case why now insuring the last 10 million people would.

The ACA was a step in the right direction, in that it provided more affordable health insurance to 10 million people, but even with the ACA, there are costs, and people still can go bankrupt with a bad illness.

 

[SystemShock]

The US hasn’t had a shared experience like this since 911, and there has never been a global shared experience like what we are going through now in recorded history.

You surely jest. WWI, WWII, the Bubonic plague, the 1918 influenza pandemic... just to name a few, those don't ring a bell?

And you are comparing a virus to terrorists hijacking airplanes full of people and slamming them into buildings? An act that still results in the deaths of first responders today?

Shame on you.

This is the type of rhetorical bullshirt that really irks me.