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Covid 19 virus inpacts sports, NHL,Season Tix other impacts

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3 hours ago, top-shelf-1 said:

I await your reply to my later post, Remkin, because it explains, when you read further down the exact same reference that Red Storm posted and that you reference above, WHY the number of tests alone does not matter, and cannot provide an accurate picture of the virus's spread.

 

Comparing total tests in one country to total tests in another is meaningless, because it includes no control; it is just a raw number. The control is the thing you are testing for: confirmed cases. Getting that accurate picture of the virus's spread requires comparing the number tested to the number of confirmed cases in your country, THEN comparing your country's number to the same number in countries that have succeeded in suppressing the virus. Right now, today, the U.S. is testing 10 times less people per confirmed case (about 5) than the countries that have been most successful at suppressing the virus (over 50).

I think that we might have parallel debates going on here. One is: have we tested enough to have a handle on the epidemiology of this disease in the US? The other is, do we suck at testing? On the first one, I think we agree: no, we need more. I'd argue to really get this we need even more than you are pointing out because we need to test big chunks of asymptomatic people, and big chunks of IgM testing to see who's been exposed and didn't even know it. On the second one, it seems we partially disagree. I think we were too slow to start, but realized it and ramped up, and are now getting much better and soon will be very good. Again, we have to test WAY more people than smaller countries. You actually have to manufacture a massive number of actual physical total tests, collect them, and run them to actually do the theoretic job of testing more people per confirmed case in a country of our population.

 

On the point about tests/confirmed case, again, this can't be assessed in a vacuum. There are two variables pertaining to that variable that make our job much harder than most areas. One: population. Two: density of disease. 

 

The ratio of tests to confirmed positives depends on how much disease is in the area you are testing and how big of an area you have to test (population). If you are testing people during the peak of the pandemic in a hot spot, you will have far more positives (confirmed cases) per 100 tests. If you are testing people in Italy during their outbreak, and up to 35% of the tests are positive, you will have to test a lot fewer people in the denominator to get a high ratio of tests performed to confirmed positives. If your are testing people on some remote island where one guy has the disease you will have to test thousands to get one confirmed case, if you even get one, or say Wyoming.  Also, the smaller the population, the fewer tested needed to get to any number of tests/confirmed case. The fewer tests needed the quicker to get to more tests/positive.

 

As I mentioned in a previous post, one touted country is Iceland. But their population is less than the population of Raleigh. Another one is New Zealand. They've locked down hard and test aggressively. But they're an island nation (as is Iceland), and their population is about that of Los Angeles city limits. The testing we've already done would have tested 78% of New Zealand's entire population. The testing we've already done would have tested Iceland's entire population, then tested them all 9 more times. 

 

On the density issue put to the extremes: If you have 99% of your population with the disease, you will get to a ratio of tests/confirmed case of 99, after testing 100 people. If you have .001% of the population with the disease? You're going to have to test a lot more people. On the total population issue: If your country is San Marino, you'd need only 31,000 tests to test everyone. If your country is India, you need to actually manufacture and run 1,350,000,000 tests, or so. 

 

But my predictions about where this whole thing is headed is based not just on the current testing, but the testing capacity over the next 2-8 weeks (depending on the prediction). Our testing is not only going up fast (the current line here: https://ourworldindata.org/grapher/full-list-total-tests-for-covid-19) , but it's going to get even steeper as all of the tests get ramped up even more as tests are coming on line from different manufactures which will increase testing exponentially in the weeks ahead. 

 

Like everything about this, we can keep going over this stuff, but I'm tired of it on this. (It takes a long time to post these responses, and I need a break!). Let's see how much testing we're doing 2 weeks from now. Every day we see new things. The Neuse Correctional data, the stuff from the Aircraft carrier, showing lots of asymptomatic cases was in the last couple of days, which is part of my theories and isn't even in the mainstream media yet (the Neuse not at all, the carrier, just starting). 

 

At this point, I'll just say, we could have done better, but we are going to be doing much better and we do need to do it because the testing to date has not been as much as we want or need. Until we can request a test for the average person and have it back quickly, there is work to do. I think that's not too far off personally, but time will tell. Let's give it some time and reflect back later.

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On a positive note, if remdesivir turns out to be an effective treatment, that may allow (reasonably) safely opening things up much sooner than might be the case depending on testing or herd immunity alone.  From what I read, anecdotal evidence so far is promising.  Need to be careful about drawing conclusions from anecdotal evidence, but it seems like they're rapidly compiling data from some well controlled trials. Fingers crossed.  

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50 minutes ago, LakeLivin said:

On a positive note, if remdesivir turns out to be an effective treatment, that may allow (reasonably) safely opening things up much sooner than might be the case depending on testing or herd immunity alone.  From what I read, anecdotal evidence so far is promising.  Need to be careful about drawing conclusions from anecdotal evidence, but it seems like they're rapidly compiling data from some well controlled trials. Fingers crossed.  

Two things I'll chime on here Lake, and thanks for that thought. 1st, your comment about remdesivir, AN ANTIVIRAL, is what I've been contending in like forever, in answer to those that keep saying that 'there's 2 ways to open the country/economy/sporting events back up, HERD IMMUNITY or VACCINE".  I've been pointing out this very same thought, but just seems to have been ignored, that no there is a 3rd way, and that would be an ANTIVIRAL that's effective. These antivirals are being produced with much more specificity than remdesivir.

 

The 2nd thing I'll weigh in is regarding "testing".it appears to me that some posting here are enamored with the thought of what is it now, 30+ companies turning out scads of EUA relaxed tests. Much like the saying in statistics (cleaned up for our GP audience), "junk in, junk out", I suggest before we start patting ourselves on the back for testing more than any other country, take a look at accuracy now being seen with these tests? 20-30% in some cases. How good of a test is that about which to study the epidemiology of this disease in this country?  

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3 hours ago, KJUNKANE said:

Two things I'll chime on here Lake, and thanks for that thought. 1st, your comment about remdesivir, AN ANTIVIRAL, is what I've been contending in like forever, in answer to those that keep saying that 'there's 2 ways to open the country/economy/sporting events back up, HERD IMMUNITY or VACCINE".  I've been pointing out this very same thought, but just seems to have been ignored, that no there is a 3rd way, and that would be an ANTIVIRAL that's effective. These antivirals are being produced with much more specificity than remdesivir.

 

The 2nd thing I'll weigh in is regarding "testing".it appears to me that some posting here are enamored with the thought of what is it now, 30+ companies turning out scads of EUA relaxed tests. Much like the saying in statistics (cleaned up for our GP audience), "junk in, junk out", I suggest before we start patting ourselves on the back for testing more than any other country, take a look at accuracy now being seen with these tests? 20-30% in some cases. How good of a test is that about which to study the epidemiology of this disease in this country?  

 

I guess up until now I've viewed an effective antiviral as being a relatively long way away, too far to help with opening up the country as soon as everyone would like (less than a year for a new drug would be astounding, imo).  What makes me more hopeful right now about remdesivir is that it sounds like it's doing well in some of six actual clinical studies in progress, including 2 large Phase III trials by Gilead. I could see it actually getting out to the public much sooner than would be needed for a new, more specific antiviral.  

 

[As compared to the anecdotal reports about the antimalarial hydrochloroquin; encouragement to try that on a wide scale was downright irresponsible, imo.]

 

But your post does remind me of a funny incident very early in my career.  I was in a project team meeting for a drug we were developing for WPW syndrome.  It included a noted cardiologist that Bristol Myers had hired as a consultant.  There was some problem we were discussing (I forget what) and I made a suggestion as to how we might handle it. Crickets.  About 5 minutes later the cardiologist said "what if we did . . .", almost word for word what I had suggested earlier. One of the CRAs burst out laughing; if she had been drinking anything it would have ended up all over the table.  I can empathize with you feeling ignored. :cheers:        

 

edit: and I also agree with you on testing.  There needs to be some centralized leadership.  Just saying "tests are available" and leaving 50 different states to sort it out is another major abdication of responsibility, imo. 

Edited by LakeLivin

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1 hour ago, LakeLivin said:

 

I guess up until now I've viewed an effective antiviral as being a relatively long way away, too far to help with opening up the country as soon as everyone would like (less than a year for a new drug would be astounding, imo).  What makes me more hopeful right now about remdesivir is that it sounds like it's doing well in some of six actual clinical studies in progress, including 2 large Phase III trials by Gilead. I could see it actually getting out to the public much sooner than would be needed for a new, more specific antiviral.  

 

[As compared to the anecdotal reports about the antimalarial hydrochloroquin; encouragement to try that on a wide scale was downright irresponsible, imo.]

 

But your post does remind me of a funny incident very early in my career.  I was in a project team meeting for a drug we were developing for WPW syndrome.  It included a noted cardiologist that Bristol Myers had hired as a consultant.  There was some problem we were discussing (I forget what) and I made a suggestion as to how we might handle it. Crickets.  About 5 minutes later the cardiologist said "what if we did . . .", almost word for word what I had suggested earlier. One of the CRAs burst out laughing; if she had been drinking anything it would have ended up all over the table.  I can empathize with you feeling ignored. :cheers:        

 

edit: and I also agree with you on testing.  There needs to be some centralized leadership.  Just saying "tests are available" and leaving 50 different states to sort it out is another major abdication of responsibility, imo. 

Now , see Lake, I have regarded the antiviral route as the quicker of the two methods of SARS-COV-2 control, vaccine vs antiviral? The rational I use here is that an antiviral seems to have more "targets" to attack, namely the well known spike S protein, the protective coating (glycolipid envelope), or even the host receptor site. Also, like your aforementioned Remdisivir, there are several antivirals which have been thru the trial phase so are ready IF the act against this specific virus. The vaccine, on the other hand has got one target, the intact virion, or again the outer coat, and seems to have longer in development in various stages?

 

One other thought I'd like to interject, I sense that several on here are extrapolating from the apparent rapidity of spread "from west to east coast", that this suggests that there are many who contract this virus, and are many fold more who either asymptomatic or have had a very light, subclinical case. Now while I don't disagree with the fact that many are asymptomatic, I don't believe necessarily that SARS-COV-2 being seen so quickly in NYC after it was 1st recognized in Washington State proves this, but rather, that though slight, genomic sequencing has shown a MINOR difference in genes of this virus from the 2 coasts. This has led to the postulation that this disease on the WEST coast derived from China, while that on the EAST coast actually came from Europe (likely Italy). Investigators point out that not to worry as the differences are minor. If true, and who am I to question, I then wonder if that could be the answer to the so called "2nd wave" of the disease?

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11 hours ago, KJUNKANE said:

The 2nd thing I'll weigh in is regarding "testing".it appears to me that some posting here are enamored with the thought of what is it now, 30+ companies turning out scads of EUA relaxed tests. Much like the saying in statistics (cleaned up for our GP audience), "junk in, junk out", I suggest before we start patting ourselves on the back for testing more than any other country, take a look at accuracy now being seen with these tests? 20-30% in some cases. How good of a test is that about which to study the epidemiology of this disease in this country?  

This is a huge point.

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14 hours ago, remkin said:

I think that we might have parallel debates going on here.

I agree that we seem to be talking on the two tracks you mention, and I'll own my part in that, because I very early in the discussion pointed to the failure of leadership which I believe led to this crisis on these shores. I still believe that, but am content to let others debate it. If they sincerely think 40,000 Americans dying is just what happens sometimes and can't be helped, nothing I can say is going to change their minds. I have long since moved on to "how the heck do we fix it?"

 

I think where you and I are talking past each other in relation to tests is embodied in this statement from your latest post:

Quote

The ratio of tests to confirmed positives depends on how much disease is in the area you are testing and how big of an area you have to test (population). If you are testing people during the peak of the pandemic in a hot spot, you will have far more positives (confirmed cases) per 100 tests.

 

Here's the thing: Because we have had and continue to have insufficient testing available, the tests that are available are being rationed. I haven't checked lately, and I'm sure it's gone up somewhat, but as of two weeks ago, Craven County (where New Bern is located) was limited to 12 tests per day, and those tested had to be showing multiple symptoms.

 

That limit was in place long after community spread had been confirmed, and given what we already know about this virus's ability to be spread by asymptomatic people, it is sheer fantasy to think that the current count of confirmed cases in Craven (36) is a true picture of its prevalence in that county, which is home to Cherry Point MCAS. (And isn't it interesting that the total confirmed cases is a multiple of 12, the number of tests being performed? The same is true in Carteret County, right across the county line from Cherry Point, where the current count is 24.)

 

And it is no stretch to to say that county health officials all over the state have been dodgy, at best, about the total number of people tested.

 

So looking again at your statement: "The ratio of tests to confirmed positives depends on how much disease is in the area you are testing," well of course--but you can't know how much disease is in the area when you're not testing enough, and as we both agree, we are not.

 

Way upthread, someone tried to compare the chances of spreading the virus in a stairwell in North Raleigh to New York, and said the two can't be compared as even remotely the same. That is only true if no one with Covid 19 was in that stairwell within the time adjacency required for the disease to transmit to whomever was in that stairwell after them. If someone with the disease was in that stairwell and coughed as they entered, and the whoosh of the stairwell's door carried their cough's droplets throughout the stairwell, and someone else entered the stairwell within the next hour, that person might just as well have been in Manhattan.

 

The problem is that, because of the lack of testing, we still don't know how widespread this is. Two months into this crisis, there is exactly one thing we are absolutely certain of, relative to the virus's spread: Social distancing and the other precautions that public health officials have recommended slow it. That is all.

 

And that is why talk of playing hockey, let alone actually opening businesses like tattoo parlors and hair salons and dine-in restaurants, like Georgia's bonehead governor is doing on Friday, is much, much, much too premature. 

 

Until we are testing at least on a par with South Korea, and by that I mean the number of tests performed per confirmed case, not merely total tests, we will not have anything close to a clear picture of the virus's prevalence in this country. But having 40,000 dead should be more than enough proof that this is not the flu.
 

So if, as the "open it up again" crowd is urging, we begin acting like it is the flu, we are foolish beyond words.

 

Edited by top-shelf-1

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For people under 35 this is the flu. In fact, if the number of asymptomatic carriers in this age group is right, it will turn out to be less impactful than flu for them. If you are under 35, you're probably better off with this than the typical flu. Nearly all of the death and destruction is over 35 and grows with each year and comorbidity. Flu takes young people more often as a percentage than covid does. Deaths in elderly and sick patients is probably higher with covid. That is a concern. But those aren't hockey players. 

 

This disease has at least 4 subtypes, probably more. 

 

1. Asymptomatic/minimal: these people either thought they had a cold or as recent testing of closed populations suggest are completely asymptomatic. Particularly in the under 35 agegroup this could be as much as 100X the number of symptomatic cases, but early testing shows that it's a lot. This is good, but also favors opening things up because it's out there and most people don't even know they've had it. This group could be 70% of the total or more. 

 

2. Flu. The majority, around 85% (5- 20% of all patients) of patients who get knocked down by this get the flu. It sucks to be them, but they will fully recover and not require hospitalization and most of them will never seek medical care (and thus not get tested either).

 

3. Pneumonia. Hospitalized. These people appear to be on a trend line of two subtypes. This one will get better with time or various levels of oxygen.

 

4. Full blown "cytokine storm". These are the people who die. They appear to have a massive immune response that leads to many things none of which are good and several of which kill you. 

 

The game has been about limiting 3 and 4 since there is no cure. 

 

People in the under 35 age group get into that 3-4 group less often than they die of flu. Does it happen? Probably since there have been sensationalized outlier cases which make the news. But if some younger person dies of flu, it doesn't make national news. 

 

Going back to play hockey depends on this in large part. I've put out statistics that the death rate in that age group was listed at around 0.1% in other countries with massive outbreaks. But to the point about testing, there was no screening in these areas (there were small studies late, but no massive population screening). So the true risk, the true death rate or risk of falling into this sickest categories is, as I've been saying since day one, overblown. The only question is by how much. I work in a hospital. I hear cases of seemingly healthy 40 year olds on ventilators. I get the fear. But I don't see the people who never came in. And by definition there are thousands of them for the ones I see. 

 

There is a massive study on this issue going on in Detroit. It will define this issue, and while it will run over a year, we'll know a lot in a month.

 

But the smaller studies are becoming clear. There is a MASSIVE undercurrent of asymptomatic Covid cases. And if we'd have had all the testing that every other much better country had, we'd have STILL MISSED THEM. Because the only way to find them is to test everybody. Or at least everyone in a contained population. Then follow those people for at least two weeks to be sure that they don't get sick. 

 

So far this data:

 

Neuse Correctional: 700 inmates tested, 259 postive. over 90% positive asymptomatic. 

Labor and delivery unit NY Presbyterian/Columbia U. Irving: 15% of women in labor had Covid. 88% had NO symptoms.

USS Theodore Roosevelt: All sailors tested: >40% were asymptomatic.

Diamond Princess: Tested all passengers and crew: over 50% asymptomatic (these are older people too).

Marion Correctional Institute (Ohio): 1828 positive prisoners, 108 positive staff. 78% were asymptomatic.

 

Some of these people are in the incubation period in the early phase studies. But we will be able to watch the cased in the prison, and both ships. However, the large majority of those that might still become symptomatic will have flu symptoms, not have sought medical care and never have been tested even with mass testing. 

 

This is another point on the idea that we'd have an idea of this disease if only we'd have tested like X country: on top of all of the asymptomatic patients. The 82% in the "flu" symptom caterory mostly don't seek medical care. Thus the wouldn't get tested either without massive testing that encouraged people to come out while sick and get tested. 

 

How do I know? Well this is my area. How do I know how many patients are presenting for testing or treatment both in the ED AND in our clinic. It's a drop in the bucket. It's killing us actually. In my clinic, which we own, we are working for free. Our biggest expense is labor. But we employ PA's to make it work, and they make too much to qualify for payroll protection, so we either furlough them, or we work for just about free. We see enough patients to pay staff and the PA. Not us. We've chosen to stay open, and risk catching the disease to keep our staff employed, and provide the community service. Look, I'll be fine. I have enough savings. But it is ironic that hospitals (ours is losing $1.5M/week) and providers and clinics are taking massive losses while being on the front line. $2.2 Trillion was it? Over half went to huge corporations, but oddly, not hospitals or providers. 

 

Anyways, of all of those studies are correct, then around 50-90% of all covid patients are asymptomatic (In the younger age group it's closer to the 90%) and another 82% are flu-like.

 

BTW we hardly even hear about Covid in our pediatric patients. I'm unaware of any study looking at them. Here's another prediction: when someone finally does that, the asymptomatic or minimally symptomatic group in the under 18 will be 95% and the 5% will have nothing more than flu. This will drive the overall mortality down even more. And kids DO die of flu. 

 

Finally, the people in the younger age group that were tested even in the vaunted countries were still symptomatic. Again, not even Iceland or New Zealand or pick your favorite country did wide spread screening of asymptomatic patients. So the death rate listed in that age group was in symptomatic patients, which new evidence is suggesting is a subset that could have missed up to 99 patients for every positive, but at least 50. If the denominator is 50X bigger than the experts thought, and again everyone, including the experts has been wrong over and over on this. Then the death rate drops from 1/1000 to 1/50,000, but probably more like 1/100K, because again selection bias is only finding the sickest patients. I've pointed it out before but there are many risks we take every day that are much, much bigger. Especially if you are a hockey player.

 

And that's the risk with whatever affect from not testing, and a combination of no or current social distancing. If the NHL players had to clear testing and fever checks and quarantine? It can be done. Will it? Who knows? I'm saying yes. 

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Anyways, heading back into work after a couple of post night shift recovery days where this debate has killed time. At this point I'll just update new information as it comes in. 

As of right now: predicted covid patients on ventilators: 30. Actual: 1. I'll keep people posted if a bigger wave comes. I hope not. 

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7 hours ago, remkin said:

For people under 35 this is the flu. In fact, if the number of asymptomatic carriers in this age group is right, it will turn out to be less impactful than flu for them. If you are under 35, you're probably better off with this than the typical flu.

But those people under 35, particularly the asymptomatic (who we are nowhere near testing--yet) can spread it to the rest of the population. Or are you suggesting isolating based on age?Because if you seriously think elders are going to remain inside once "the kids" are sprung, particularly in view of the ongoing blasé attitude of many tons of them, I've got a flash for ya. Ain't gonna happen.

 

Here in the East, they are still going out, and congregating in grocery store aisles, and playing pickleball, and hugging, and catching up with each other--without masks--like everything's hunky dory. In my little town, which sees a large influx of itinerant sailors spanning all ages at this time of year, and where many from the Triangle come to their second homes to infect us escape the threat, the places which remain open are simply mind-boggling.

 

Hockey with players from all the over the (infected) world? I don't think so. The DOD just extended limits on military personnel movements through June. Tells me all I need to know.

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Tells me that this spread could never be contained just slowed down until we had more information on it and more preparation.  Now we move forward. We have no choice. The youngins are going to have to go out and win this war. Just like all wars. The enemies just change. If you are at risk you will have to be more careful until a vaccine is ready. We now

know without a doubt the morbidity of this disease is no way as bad as we thought. Infectious yes. But survivable for most. 

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This debate started with could, would or should the NHL play in closed arenas, but these things drift. Drifting into should we open things up in the economy/society, which like everything these days is a more politically charged issue. The whole point of the under 35 cutoff was suggested entirely because the vast majority of NHL players are under 35 and markedly healthy and they're the ones that would be playing in closed arenas. The risk to them would be very small. Coaches and others would have to take the same precautions that everyone is already taking when they go to Costco, or that I take seeing patients with Covid (not full PPE BTW). 

 

I can tell you that at that as of right now, what has happened is that we have flattened the curve. It worked, or something did. However, if you live in 95% of the country not white hot for various reasons, then it has worked too well. The point of the curve flattening was to avoid overrunning hospital capacity. That was the point. It was a good point. But the restrictions have overshot everywhere but NYC and areas that flooded over from NYC, and maybe briefly in a couple of other areas. Everywhere else hospitals and ED's are empty*. O.R.'s are empty. People are not getting needed, but non emergent surgeries and treatments while surgeons are bored and anesthesiologists are trying to make work by promising to be the rapid response intubators for the hospital. Nice idea, but they are sitting around waiting for one or two patients to worsen, and we ED docs did most of these intubations anyways. 

 

So what? These are rich doctors. True, but the hospital revenue also pays everyone else: Nurses, lab techs, ultrasound techs, radiology techs, nurses aids, transporters, cafeteria workers, physical plant workers, and a hundred job descriptions. And that's just in the hospital. Still, ironic, that the very place on the front line of this battle is losing $1.5M/week due to this plan. The very "heroes" people are buying lunch, are being furloughed and cut even as they risk their health to fight this.

 

Still, that's just the health care economy. (But I can't help but continue to have the irony of that slap me). There is a cost on both sides of the ledger on lockdowns. Hopefully that doesn't come out too political. It's pretty obvious fact really. There are two sides to the ledger. The shut down is not free. Time will show this to be obvious to everyone if it isn't already. One can think it's worth it, but not that there is no cost.

 

Look, the plan was good. In our case it would have handled the 60 ventilated patients we were TOLD were coming (and yes this was AFTER social distancing and shutdowns were factored in). We were ready. But it never came. Not even in the #1 Covid county in the state. Hey, nothing wrong with that. It's good really. And plus, no one knew. But now we do know one thing. It WAY overshot. I'm not talking about fine tuning. I'm talking devastatingly wrong. Again, two weeks ago, social distancing and shut down baked in, the mensa types that make these models told us that we WOULD get overrun so badly that we'd have 30 Covid patients in our OR areas on ventilators. I mentioned yesterday we had 1. Well great news: After 15 days on the ventilator that patient was extubated yesterday and is doing well. So we now have zero. To keep planning for an onslaught that isn't coming is foolish beyond measure.

 

*Pull up the US Covid map on John Hopkin's site and look at the region (Virginia/NC) at a level you can see counties. There is one county that sticks out as purple. Not Wake, Not Durham, Not Mecklenburg, nope Wayne County. My hospital is Wayne UNC. We were the most Covid county per capita, we are now the most Covid county period. Sure most of those cases are at Neuse Correctional, but so what? Where do you think they bring those prisoners when they get sick? They're ours. And we are experiencing continued volume drop offs in the ED over half, and we have zero intubated patients right now. We have only ONE admitted patient from Neuse and he's in his 60's and not on a ventilator. 

 

Thinking we need to stay in lockdown for a long time when the primary peak got to about 5% of our plan's capacity? Not smart. Could there be a secondary peak? Sure. But we can handle it (and easily). (Again, this was THE point of the lockdown and it's no longer valid). To stay locked down would leave us in this state: with OR's shut down and all precautions in full force for....for how long? A year? Not doable. If there is a secondary peak it will not overrun the system, which was the point of the shutdown. One of my partners thought 2 weeks ago that we should add a second doctor to our night shifts to handle the coming onslaught of sick patients. 3 nights ago I spent most of my shift waiting for patients after sending two providers home that we usually need for normal volume because even that isn't coming.

 

The plan was reasonable. We needed to have it in place. It probably worked in a couple of hot spots which is good. But it was possibly never even needed most other places and has definitely massively overshot its intention. To stay with it now is wrong. To stay with it past the next couple of underwhelming weeks is insane. The second peak will be smaller than the first (if it happens at all), and the first was no where near anything we can't handle and frankly is better now than just dragging it out for months since there will be no vaccine before then (at least thats' what we're told).

 

Do we open up major venues tomorrow? Heck no. But in about 2 weeks if the curve continues to flatten and drops, we can start opening up other things in a smart way. Testing will be majorly ramped up by then, which should help the ideas of the stricter lockdown people, and make the plan more tailorable. But even without that, by then some opening should still happen. We need mainly to protect the most vulnerable and keep nursing homes and older people in precautions. Probably their best hope is that the rest of us get enough immunity to slow the wider spread and eventually have it remote or done, since again, an effective vaccine is a year out if it even works. That may sound harsh, but its reality. Without a vaccine, they would be at risk for a year, and no matter what anyone might think we are not locking down for a year. 

 

Gradual reopening, ideally backed by testing has to be the first step. The healthcare system can then wait to make sure we can handle any second wave. Then we need to get back to business too. 

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BTW for those interested, go to the John Hopkins Map for the curve of new cases by country:  https://coronavirus.jhu.edu/data/new-cases

 

The new cases in the US has flattened and headed down since April 1. We've had over two weeks of less new cases. (Note that there was a massive uptick in testing to account for that second peak up. That is artifact. The true picture is to project that first peak higher because it was there, just not being tested). If one projects that first peak up as it would have been had testing been constant, it's obvious that the curve is heading down at least the past 2 weeks. And that's with more testing not even accounted for outside of that first peak.

 

If one looks at total cases (instead of new cases), the curve is just starting to flatten, but as the decreased newer cases start to fold in, AND the effect of massively more testing starts to fill in, that curve will flatten. It will be understated vs. reality as more as more tests are done, but this is again an artifact of increased testing that the modelers will have to factor in. But even with that, it should flatten.

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And now..........They(all media) begin to project and worry about what will happen when the new flu/covid/insert disease season happens .    Another news generator.  Perhaps we get by this current event and maybe learn a few new things. Like....................divesting from our enemy China. Yes I said enemy.  They are responsible totally for this. Most especially the scope by keeping us in the dark for critical weeks.   All that debt they have bought up in this country? Kiss it goodbye. They owe us.

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2 minutes ago, cc said:

And now..........They(all media) begin to project and worry about what will happen when the new flu/covid/insert disease season happens .    Another news generator.  Perhaps we get by this current event and maybe learn a few new things. Like....................divesting from our enemy China. Yes I said enemy.  They are responsible totally for this. Most especially the scope by keeping us in the dark for critical weeks.   All that debt they have bought up in this country? Kiss it goodbye. They owe us.

About a zero percent chance that China erases that debt. It is China’s one bargaining chip for us not mandating more American manufacturing  and tolerating their cyber attacks.  Maybe we cant force companies from manufacturing in China but we sure could tariff China exports more and tax companies using Chinese manufactured goods more.  We are joined at the hip with China because we have zero bargaining power over them. 

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1 minute ago, gocanes0506 said:

About a zero percent chance that China erases that debt.  

World opinion is enough.  The debt can be erased unilaterally. Their bargaining chips evaporated when they lied about this disease and allowed it to propagate with international flights to the US , Italy and everywhere else. When the scale of their deception is truly known it will be staggering.

        Bring factory production back home.  We have the US consumer base as bargaining chips.  China trade without US will end their economy. It is 19% of their overall exports (2018 data).    The change in trade policy was moving in this direction.  Put it on steroids.

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2 hours ago, cc said:

World opinion is enough.  The debt can be erased unilaterally. Their bargaining chips evaporated when they lied about this disease and allowed it to propagate with international flights to the US , Italy and everywhere else. When the scale of their deception is truly known it will be staggering.

        Bring factory production back home.  We have the US consumer base as bargaining chips.  China trade without US will end their economy. It is 19% of their overall exports (2018 data).    The change in trade policy was moving in this direction.  Put it on steroids.

The Chinese government, like any other, can claim that they did everything right and this happened due to the fault of an individual. There will be little evidence to support anything else.

 

they can claim that they were still in development of this disease and had no idea of its affects.  
 

Deny, deny, deny. Its easy when you control the evidence.  

Edited by gocanes0506

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6 hours ago, remkin said:

BTW for those interested, go to the John Hopkins Map for the curve of new cases by country:  https://coronavirus.jhu.edu/data/new-cases

 

The new cases in the US has flattened and headed down since April 1. We've had over two weeks of less new cases. (Note that there was a massive uptick in testing to account for that second peak up. That is artifact. The true picture is to project that first peak higher because it was there, just not being tested). If one projects that first peak up as it would have been had testing been constant, it's obvious that the curve is heading down at least the past 2 weeks. And that's with more testing not even accounted for outside of that first peak.

 

If one looks at total cases (instead of new cases), the curve is just starting to flatten, but as the decreased newer cases start to fold in, AND the effect of massively more testing starts to fill in, that curve will flatten. It will be understated vs. reality as more as more tests are done, but this is again an artifact of increased testing that the modelers will have to factor in. But even with that, it should flatten.

Okay rem, and I'm only quoting this most recent statement because the others would take up too much space reposting them. But, I'm wandering back out on that "island" that you were so famous for years ago, and I hung on WITH YOU UNTIL THE BITTER END.While your reasoning and logic thru all this, combined with the "facts" you brought forward are sound, what I believe at this still neophyte point in understanding this disease, is that NONE of us know jack squat? Not the mensaas, geneticists, virologists, infectious disease experts, electron microbiologists, xray diffraction specialists, pulmonologists, cardiologists, gastroenterologists, statisticians, or our learned politicians. Problem is, in this day and age of rampant mass media coverage, now everyone is an expert!! This becomes the main problem as now there's a mishmash of truth, half-truth, myths and just plain lies, all making the man on the street an expert?

 

Now, undoubtedly, and this is coming from my field of expertise, the most critical fly in the ointment so to speak, early on, was being unable to critically test for this viral scourge. At least, even though viral origin, specifics of the virion structure and the disease it causes, understanding of the autoimmune component ("cytokine storm"), treatments to attack it, etc, would likely have been lacking earlier, had we had at least a way to detect the damn thing, we likely would have been able to avoid complete financial gridlock? In the early days of testing, not only were the very primitive methodologies wanting and components to perform them often in short supply or completely lacking, but a "turn around time" of days to a week, was a joke. Apparently, the infectivity of this virus, still not completely understood, but likely not quite so rapid as measles, as well as what you keep reminding us of, those either asymptomatic or sub-clinical, together with now known "early infectious viral shedding" combine to make it paramount to have a test with rapid TAT (turn around time).

 

To make matters even worse, with the mounting pressures to give us that critical data, now you get a plethora of poorly verified "tests" in most cases, whose results further propagate misunderstanding, rather than clarify conclusions. And from the point of view of my small place in the universe, tests that are reliable are sold to be used on Rolls Royce machines that we here cannot afford. Not only that, but the critical reagent(s) to run those expensive machines are relegated/rationed to "hot spots".

 

Now, I see your angst and agree with the apparent overkill of medical resources diverted to what now is appearing to be a true viral "bogeyman", but I ask you, based on the horror which APPEARED to be associated with this COVID 19 disease in the Far East and Europe, and the relative ignorance of it in this country, how could we have prepared in a responsible way any differently? One other factor here if one paid attention to the rhetoric, was unfortunately this disease arose DURING AN ELECTION YEAR, and God forbid we put the welfare of this country ahead of which party is in office? 

 

And, I'll make one last statement and be quiet, MY UNBRIDLED HOPE from this pandemic, despite the financial strain this country and world has experienced, is that this event is a trial run preparing humankind for waves of possibly more lethal disease we are being warned about. Please let's learn from it and prepare ourselves should we have to face it again.   

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This thread is building Great Walls of text that could compete with the one in China.

 

Had an interesting (and distanced) discussion with a neighbor who said they couldn't wait til this was over and things were normal.  Since there's no evidence yet that people who have COVID-19 get any immunity from it, if they do it may only be a SARS-like 0 to 2 years, and even then there's a likelihood of different strains in play.. I asked them to consider that this might *be* the new normal.

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Our ancestors dealt with the potential for catching the plague, small pox, dysentery, consumption, yellow fever, leprosy and all manner of pestilence.  If they’d have locked themselves up until it was over, we’d probably still be playing hockey with wooden sticks... 😜

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The word "quarantine" comes from the Italian word for "40-day time period", as they would stop all commercial traffic during the Black Plague until the sailors had been shown to be healthy for 40 days.

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12 hours ago, Red_Storm said:

Our ancestors dealt with the potential for catching the plague, small pox, dysentery, consumption, yellow fever, leprosy and all manner of pestilence.

With all due respect Red, no, they didn't. They merely died from those things until they ran their course, and only because they did. There is no indication whatever that this virus has a fixed course to run--all indications are that it will be become endemic: an ongoing threat, until a vaccine is in place.

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1 hour ago, top-shelf-1 said:

With all due respect Red, no, they didn't. They merely died from those things until they ran their course, and only because they did. There is no indication whatever that this virus has a fixed course to run--all indications are that it will be become endemic: an ongoing threat, until a vaccine is in place.

While true top, oddly this virus' cousins, MERS and SARS seem to have petered out for unknown reasons?

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1 hour ago, KJUNKANE said:

While true top, oddly this virus' cousins, MERS and SARS seem to have petered out for unknown reasons?

SARS patients were not infectious during the incubation period.

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