COVID19 Factors We Should Consider/Current Events

[ltomo]

At least Itomo made it pretty clear (if I understood him correctly) that there is no number -- no number of cases, deaths, ICU patients, businesses destroyed forever or anything else -- that would justify the government demanding that people should self-quarantine. That's an irrational position, but at least it's a consistent one.

That is my position. It's only irrational if a person thinks their constitutionally guaranteed rights should be thrown away just because a governor is afraid he might lose an election. Gun stores in California are being told that they are non-essential, so think about that.

This is probably behind a paywall for many, but it's a good article about why I and many others have no faith in what the experts are predicting.

The Coronavirus May Make Trump Stronger - WSJ

[porcopedico]

Another thing I keep hearing is that we're "two weeks behind Italy". If you look at the WHO data, two weeks ago Italy had 463 deaths and now we have 471. So that actually does make it look like we're two weeks behind Italy. Of course, two weeks ago they had 9172 cases and now we have 42164, so are we actually two weeks ahead of Italy?

Mortality rises out of proportion when hospitals get overwhelmed. So you can't compare mere numbers, distribution of cases is important. Italy had most cases concentrated in one area, and so are deaths

Same in Spain

In the states first to be in trouble will probably be New York. Long before total numbers reach critical points.

[abduality]

More food for thought from John Ioannidis:

Coronavirus disease 2019: the harms of exaggerated information and non-evidence-based measures

[Mark Rippetoe]

Source? 30 weeks is ridiculous.

A guy in Utah who knows these things. Same guy has been getting calls and emails for machine tools on sale at half price. Do you understand what this means?

Mortality rises out of proportion when hospitals get overwhelmed. So you can't compare mere numbers, distribution of cases is important. Italy had most cases concentrated in one area, and so are deaths

Same in Spain

In the states first to be in trouble will probably be New York. Long before total numbers reach critical points.

$1000, doctor.

[David Kirkham]

Utah Plan
Utah Leads Together Plan by Utah Governor's Office of Economic Development - Issuu

Urgent Phase
8-12 weeks
Aggressive social distancing measures maintained.

Stabilization Phase
10-14 weeks stabilization
Review curbside/drive-through/spaced in-house dining measures
Telework continues, but many return to offices.
Short term layoffs and furloughs continue, but at a slower pace.

Recovery Phase
8-10 weeks workers return to work, with precautions.
Telework is expanded because of lessons learned.
Retail, entertainment, tourism, cultural, and other industries begin to recover.
COVID-19 layoffs end.

If layoffs are ending in 26-36 weeks then we are going to have an extremely serious economic problem on our hands.

Please forgive typos if I made any--I have to get back to work...while I can.

[Matt James]

Here in MN, the governor is implementing a 2-week shelter in place. The idea being that it buys time to expand ICU capacity in the state and for 3M (et al) to ramp up PPE production. I'm not sure I agree with it, but he seems to be taking a more level-headed approach than some places.

[Johnsonville]

Why do people fail to acknowledge what happens when capitalism dies? If our system is held up for the 18 months it takes to make a vaccine and we nationalize these industries a lot more people will be harmed than over this virus. You people do know not even 50 years ago 18-45 MILLION people fucking starved to death letting their government control their industries.

[lazygun37]

By way of a summary, here are, in my view, the most serious problems surrounding our governments' responses:

Thank you for putting together such a substantive post. I know how much effort it takes. As will be clear to everybody by now, my view of this situation is data-driven and quantitative, so I'll just comment on what the key points are for me.

• There are absolutely no reliable statistics about the virus's case-fatality ratio.

I do understand where you are coming from, but while I would agree we don't know the CFR *precisely*, we do know it's high enough to be a real problem. As an example, in the Italian village of Vo, they tested *all* of the ~3300 inhabitants (twice, with a time gap of 9 days) after the first death from COVID-19 in Italy was reported there. (This massive testing protocol allowed them to quarantine infected people and suppress the outbreak there.)

In total, they apparently found 89 infections, of which the majority -- about 70% I believe -- were asymptomatic (I don't know if they all remained asymptomatic). Now 70% is a high number, but it's not high enough to change the conclusion that the CFR is significantly higher than, say, the flu. It's worth noting that 1 death in 89 cases is ~1%, but as I have stressed several times, you can't really take such small numbers and make a meaningful estimate out of it (it's also a bit biased because the testing was done *because* of that first death).

Also, no CFR for a country where the number of deaths is already large enough to allow an estimate is anywhere near the flu, including countries with lots of testing. E.g. in Germany, everybody's poster child in this context, the current CFR is 0.48% and on an increasing trend.

All that said, I certainly *hope* the CFR will turn out to be <1% -- I just don't think there is evidence to support a number near, say, 0.1%.

• The published death figures are also unreliable in absolute terms because no causality is being established.

I completely agree that causality is an important issue. But I think we do know that the vast majority of the people who are reported as having died from COVID-19 were hospitalized and in ICU care at the time, because of respiratory problems associated with COVID-19. So pretty much by definition these patients wouldn't have died in the absence of the infection.

Certainly that's my reading of the data here: https://www.cdc.gov/mmwr/volumes/69/...mm6912e2-H.pdf
If you think I am reading this wrong, or if you know of other specific evidence that shows that a significant fraction of reported deaths were mild or asymptomatic cases, I definitely want to know about that.

• There is no indication that the draconian measures implemented in Italy and China have slowed the spread of the virus or saved lives. ... In fact, if the recent Oxford modelling, indicating that the virus has been around for much longer and is much more widespread than originally thought, is correct, then these measures had no hope of working in the first place because far too many people are already infected. ... We should also point to nations like Japan and South Korea, who have not enacted such measures and appear to have performed similarly well. [/B].

Could you link to the Oxford modelling you mention?

Regarding your other points, I'm not sure I understand them. China managed to completely suppress the outbreak, and Italy seems to be just about now managing to turn things around as well, based on the slowing of the increase in the daily new cases.

Your point about nations like Japan and South Korea is sort of valid (I would add Singapore to the list). But as I mentioned before, my understanding is that they instituted a massive testing and tracing protocol early enough -- when the number of cases was small enough to allow it. As a result, they were able to suppress without Draconian measures. Again, if you think I'm wrong about this, a reference would be helpful so we can quantify this.

Ok Professor, this is getting tiresome.

Do you know the difference between a point estimate and a confidence interval? Because the author(s) of the paper don’t. They used the point estimate as the lower bound and completely made shit up for the upper. They took the same numerator and used a different denominator and called that the upper bound. Either you don’t know the difference either, or you didn’t read the footnote under the table you just copy pasted.

You're right, this *is* getting tiresome. I do know the difference, and I did read the footnote.

You might have noted that I didn't say those bounds were confidence intervals. I didn't for a reason, because they aren't.

There is also an excellent reason I quoted these bounds as I did (and I suspect the reason the authors quoted them as they did). It is the same key point that I've now pointed out several times, to you and others: the type of statistical random errors for which it makes sense to quote confidence intervals are not the dominant source of uncertainty here. Instead, the dominant source are systematics -- i.e. exactly the sort of problems with the data that everybody here, and especially you, are concerned about. The "bounds" these guys used represent an effort to take the worst of these into account -- namely under-reporting.

Just in case you still think I don't know what I'm talking about, here is an example: the 95% statistical confidence interval on the 4.9% ICU-rate is 4.1% - 5.8%. This is not tiny, but compare this to the difference between 4.9% and 11.5%, which are the bounds quoted from the systematics. The latter dominate. By a lot.

It would really be helpful to the level of discourse here if you could at least acknowledge that perhaps you screwed up.

[Yngvi]

Here is a fellow who thinks Papa Giovanni XXIII Hospital had no ventilators "in the first place". He also thinks his ideas about medical equipment usage are more sound than the entire medical establishment.

Shortages exist right now. HCWs in the US are reusing disposable N95s, rated for a maximum of 8 hours, for days at a time - putting themselves at great risk. In order to make this dire situation legal, the CDC was forced to change its guidelines, weeks ago. PPE-intensive procedures, like elective surgery, are cancelled indefinitely. Yet, because there is still a week's worth of N95s in the supply closet (under lock and key, in most hospitals), you blissfully declare there is no shortage.

Unlike toilet paper, actual usage of PPE has increased dramatically. Many more staff have to follow contact and droplet precautions, more of the time.



PPE predictions are for the next 1 or 2 weeks out. These predictions come from different data, and from different people, than the epidemiological predictions which have been (rightfully) maligned.

Again, you are lying about what your information source states. It says nothing about the availability of ventilators at major hospitals. It only mentions unavailability at hospitals or clinics in smaller, outlying regions.

Another appeal to authority. This is the crux of the problem. Fear makes many people stop thinking. They want to entrust that a higher power has all of the answers.

I respect people who disagree with me, regardless of if they are wrong or right. I do not respect people who refuse think for themselves.

[lazygun37]

That is my position. It's only irrational if a person thinks their constitutionally guaranteed rights should be thrown away just because a governor is afraid he might lose an election. Gun stores in California are being told that they are non-essential, so think about that.

Thanks for confirming, and you're right that I shouldn't have said "irrational" in an absolute sense. What's rational or not depends on the value one attaches to various things or outcomes. Your position is rational from your perspective/value system, almost by definition.

My point was just that you and I are at an impasse where we simply have to agree to disagree, because our value systems are so different. Knowing that clarifies things and allows people to move on.

By contrast, what I find frustrating is when people who, I suspect, simply share your value system make incredible logical contortions to avoid having to say that. Rip, for example, has two or three times now asked people to consider data that *he* chose. Yet when those people did, and he didn't like the results, he just moved on to the next justification, without even acknowledging that he was wrong (at least on whatever narrow point was being argued at the time). That's unhelpful.