Finally read the article I would have written

[McLovin]

If I were a Stanford epidemiology professor

https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-as-the-coronavirus-pandemic-takes-hold-we-are-making-decisions-without-reliable-data/

[sammyg2]

Bingo, finally someone making sense.
Too bad he just committed professional suicide for telling the truth.
It's not PC to go against the hysteria, it's the new trigger.

I especially liked this part:

That huge range markedly affects how severe the pandemic is and what should be done. A population-wide case fatality rate of 0.05% is lower than seasonal influenza.
If that is the true rate, locking down the world with potentially tremendous social and financial consequences may be totally irrational.
It’s like an elephant being attacked by a house cat. Frustrated and trying to avoid the cat, the elephant accidentally jumps off a cliff and dies.

https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-as-the-coronavirus-pandemic-takes-hold-we-are-making-decisions-without-reliable-data/

[Seahawk]

Some other links here:

https://www.powerlineblog.com/archives/2020/03/notes-on-the-pandemic.php

https://www.calcalistech.com/ctech/articles/0,7340,L-3800632,00.html

https://www.meforum.org/60571/itai-bloch-on-israel-covid-19-vaccine

https://ncovdata.info/wp-content/uploads/2020/03/2020.03.04-ScienceDirect-Chloroquine-and-hydroxychloroquine-as-available-weapons-to-fight-COVID-19.pdf

https://www.washingtonpost.com/opinions/2020/03/17/china-cared-more-about-suppressing-information-than-suppressing-virus-thats-why-were-here/

There is no direct correlation between rates of death in different countries, none. Like all data, the second, third and forth level of detail is where the solution resides.

[Mahler9th]

Thanks for posting.

Interesting article, but seems to focus a lot on mortality.

Of course mortality is bad.

But morbidity is bad as well.

And we do have data and evidence on morbidity. In some ways it may be more robust data and creating more concern than mortality.

Here is a quote from the article:

"Yet if the health system does become overwhelmed, the majority of the extra deaths may not be due to coronavirus but to other common diseases and conditions such as heart attacks, strokes, trauma, bleeding, and the like that are not adequately treated. If the level of the epidemic does overwhelm the health system and extreme measures have only modest effectiveness, then flattening the curve may make things worse: Instead of being overwhelmed during a short, acute phase, the health system will remain overwhelmed for a more protracted period. That’s another reason we need data about the exact level of the epidemic activity."

I found that interesting.

Of course in some situations, the high morbidity will cause health care systems to be overwhelmed. And of course if/when that happens, the mortality rates may go up, not only directly related to the Covid-19 disease, but others as well, as the author points out.

For example, just being in an ICU setting creates exposure to HAIs and other never events. In an overwhelmed system, the associated mortality numbers might likely go up.

I think one can theoretically assign a "spillover" additional mortality and morbidity rate if/when health care systems become overwhelmed.

And on the cost side, of course there are high costs associated with morbidity... costs of the care.

And of course there could be costs associated with litigation related to the healthcare decision-making processes regarding who gets care when in an overwhelmed system. And related to never events like HAI's which likely by law are not covered by CMS here in the US (the health care provider like UCSF Medical Center may have to eat those costs).

These costs could be estimated, and so on.

Eliminating or reducing these cost exposures might require laws not on the books in the US.

In a simplistic way, costs can be considered between those associated with the actions currently undertaken (huge) and those likely to occur if only a subset of the actions currently undertaken are employed (also huge).

Folks have been developing models and studying these things for a long time, and of course more recently with respect to the current situation.

And of course it is also likely that folks have studied our legal structures and mechanisms we have to change them-- of course I refer to those here in the US.

Here is a link to a paper on the CDC web site:

"The Economic Impact of Pandemic Influenza in the United States: Priorities for Intervention" (1999)

https://wwwnc.cdc.gov/eid/article/5/5/99-0507_article

This paper is just an example, I am sure there are hundreds, if not thousands with different assumptions and models.

They key to me is understanding that morbidity is a factor as well.

[Zeke]

Here's how I see it going down: many will get sick but given the measures in force, the contamination aspect will be lower than usual. I think anyone can think back a year or more to any previous flu season and remember seeing a LOT of people sniffling and such out in public and around the office. If there were children in the home it seemed every family had its turn. This year people are not comfortable going out when sick, or even going out at all. Can you imagine the reaction you would get if you sneezed once in a grocery store? A riot would break out. People are hopefully constraining their movements if for no other reason — shame.

A second enterprise will be the rush introduction of a vaccine. Some have pointed out that vaccines take years to develop and test and yet a new vaccine is produced each year given predictions of what the flu de jour will emerge. In this case the target is clear and the availability of a vaccine is only dependent on the current ability to manufacture. The way to speed this process is to put all labs on the job and produce regionally. Testing should be limited to one month and then give it out.

Together, these actions should bring this whole thing under control within 2 months.
I guess we can only brace ourselves for the ripple effect that is bringing this country to its knees.

That's gonna be worse than any flu.

[ckissick]

I was talking to a Stanford Hospital emergency room doctor a couple weeks ago who said pretty much the same thing.

[RWebb]

In any emergency, including warfare, decisions are always made without reliable data.

[wayner]

Whats missing from these statistics is just how many otherwise healthy people have needed medical aid in order to not die from this.

From my understanding, many of the people who have survived have done so with some level of medical intervention.

Medical intervention with the flu is often only needed by people who are already frail or have other issues.

[tabs]

It is purely stupid to think that CV is going to be the end of everything...humanity will survive it. The mortality rate is relatively low, that is not the problem. The problem is the contagion of the virus can SWAMP the existing HC system, where people who would have otherwise survived will die for lack of care.

The real question is, what will be the state of humanity be on the other side of the CV? The Global economy is now in the process of seizing up as nations take measures to slow the spread of CV so that their HC systems do not become overwhelmed and collapse. The state of the Global economy along with fiscal and monetary policy was fragile and was in a sharp decline before the CV hit. The biggest causality of the CV most likely will be that the Global economy collapses under Sovereign debt and debasement of the fiat monetary system. The best case scenario is that the Global economy limps away from this malady forever changed. Today the US 10 year Treasury has climbed back up to 1.178% as the cost of the proposed stimulus packages begins to sink in.

[tabs]

Originally Posted by RWebb

In any emergency, including warfare, decisions are always made without reliable data.

That is called the "FOG OF WAR."

[Seahawk]

Originally Posted by RWebb

In any emergency, including warfare, decisions are always made without reliable data.

No they are not "always" made without reliable data.. Some are, some aren't...the CDC failed to prepare for this emergency and was lead footed, still spent over a BILLION dollars a year HIV prevention: Other agencies were not and enacted emergency planning responses.

What is true is that second level analysis, some third level analysis, is being made.

Here is another interesting article about Italy, a country I admire and wish nothing but the best:

https://www.gatestoneinstitute.org/15752/coronavirus-comes-for-europe

No other Western country has been so severely affected by the pandemic as Italy. Why?

First, Italy has an aging population. The median age of Italians is 47.3 years; one in four Italians is over 65. In addition, the country's birth rate is extremely low: 1.29 children per woman. Even before the coronavirus pandemic, Italy was a dying country. Sadly, the virus has accelerated the process.

Second, the authorities and medical personnel apparently underestimated the danger. Although the Italian government had suspended flights for days from China and Hong Kong from January 31, Italian doctors were saying that the illness was just a "bad flu". On March 9, an epidemiologist, Silvia Stringhini, wrote: "The media are reassuring, the politicians are reassuring, while there's little to be reassured of".

Third, the Italian health system is in appallingly bad condition. There are not enough intensive care units and, as everywhere, the possibility of a major crisis simply was not anticipated. In Italy there are 2.62 acute-care hospital beds per 1,000 residents (by comparison, the number in Germany is 6.06 per 1,000 residents). The Italian health system is entirely run by the government. A public health care service (SSN, Servizio Sanitario Nazionale) pays the doctors directly, limits their number, and sets the maximum number of patients they can treat per year (1,500).

Government-run healthcare always ends up being about the government trying to cut its costs rather than to help its citizens. Private clinics do exist, but represent only a small part of the care offered (the public system represents 77% of total health-care spending. (The only country in Europe where the figure is higher is the United Kingdom, where the figure is 79%.) Public hospitals must manage shortages, and when an exceptional situation occurs, rationing care leads to horrific choices. A recent report by Siaarti (Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva) bureaucratically offers "ethical recommendations for admission and intensive treatment in exceptional conditions of imbalance" and speaks of "consensual criteria of distributive justice" to justify not treating certain patients and leaving them to die.

Fourth, and rarely mentioned, is that Italy today is evidently home to a large Chinese community (more than 300,000), made up of people who arrived in the past two decades and who work in the textile and leather sector. Many of the Chinese living in Italy are from Wuhan and Wenzhou, and some had just been in Wuhan and Wenzhou for the Chinese New Year on January 25, when the Chinese authorities could not hide the epidemic any longer. These Chinese had returned to Italy from China before the Italian government suspended flights from there. The epidemic emerged in Lombardy; Bergamo, one of the capitals of the Italian textile industry, was one of the first cities affected.

Before the pandemic, the Italian economy was already in a state of stagnation; now, as people stay home and shops shut, it will probably plunge into a recession. Italian banks, since mid-February, have lost 40% of their market value. Major financial upheavals seem on the way.

The Italian government was hoping for help from the European Union, but neither the other member states nor the European Union itself has given any at all. Maurizio Massari, Italy's ambassador to the European Union, said at a recent European summit on the pandemic, that Brussels should go beyond "engagement and consultations", and that Italy needed "quick, concrete and effective actions". He got nothing.

Christine Lagarde, president of the European Central Bank, refused to lower interest rates to help Italy; it was a statement Italian leaders took as a demonstration of contempt. Italian President Sergio Mattarella said that Italy expected "solidarity from the EU institutions," not "moves that could hinder Italy's actions". "Italy," said Matteo Salvini, leader of the Lega party, "has been given a slap in the face".

The dismissive attitude of the EU and the other members states seems to have been dictated by the fear of sliding into a situation as calamitous as that of Italy.

All European countries have an aging population, even if less than Italy's (the median age in Germany is 46.8; in France it is 41.2; in Spain it is 42.3). No country in the European Union has taken a clear, hard look at the danger Europe is facing.

"The coronavirus is very contagious," France's minister of health, Agnes Buzyn, said on January 26, "but much less serious than we thought".

The borders between France and Italy were not closed in time (only Austria and Slovenia closed their borders with Italy early), and Italians who wished to go to France were not stopped. The health systems of other European countries are not better prepared than the Italian one was. In Spain, Insalud (Instituto Nacional de Gestion Sanitaria), an organization equivalent to the Italian system, exists, and shortages and rationed care are the rule. The German (Krankenkassen) and the French (Sécurité Sociale) health insurance systems also operate on the same principles as those in Italy and Spain, and produce similar results. The economies of the main countries of the European Union were in a state of stagnation before the pandemic, and, like the Italian economy, are likely to plunge into a recession soon, too.

At the time of publication, 11,826 people were infected in Spain, 7,695 in France, and 9,360 in Germany. In Spain, 533 people have died; in France, 148 people, and in Germany only 26. As in Italy, the numbers escalate fast.

On March 11, German Chancellor Angela Merkel said to journalists who were accusing her of doing nothing, "60 to 70% of Germans will be infected with the coronavirus". Lothar Wieler, President of the Robert Koch Institute, the German government agency in charge of disease prevention and control, added that it was necessary to "avoid overloading hospitals" and to let the epidemic gain ground slowly over time.

An adviser to French President Emmanuel Macron told a journalist at Le Figaro that the strategy of France was the same as in Germany: the decision was made to "let the epidemic run its course and not try brutally to stop it". He suggested that the official will was to create "herd immunity", a term first used in the United Kingdom by Sir Patrick Vallance, the UK government's chief science adviser. He had said that the aim of the British government was to accept that a significant number of the citizens of a country would be infected, recover, and therefore be immunized. The French and German authorities evidently found inspiration in Sir Patrick's remarks.

The British government, faced with criticism from the World Health Organization, replied that "herd immunity" was not a stated policy, but no statement by the German or French governments said that "herd immunity" was not the policy they chose.

Umair Haque, the British Director of the Havas Media Lab, wrote:

"Herd immunity describes how a population is protected from a disease after vaccination by stopping the germ responsible for the infection being transmitted between people. Letting an entire nation be rampaged by a lethal virus for which there's no vaccine? How much death and mayhem would that cause, by the way?"

"Europe has now become the epicentre of the pandemic, with more reported cases and deaths than the rest of the world combined, apart from China," noted Tedros Adhanom Ghebreyesus, director general of the World Health Organization. "More cases are now being reported every day than were reported in China at the height of its epidemic." Sadly, all available data show that he is right.

On March 11, President Donald Trump announced that the US was suspending all flights between the United States and Europe, a decision fully justifiable to save American lives. The next day, nevertheless, the heads of the European Union could not resist trying to maul the president: "The EU disapproves of the fact that the U.S. decision to impose a travel ban was taken unilaterally and without consultation," they said.

It is to be hoped that by now notions of ​​"herd immunity" have been abandoned, and that the EU gets back to salvaging for Europe whatever it can.

[sammyg2]

Originally Posted by wayner

Whats missing from these statistics is just how many otherwise healthy people have needed medical aid in order to not die from this.

From my understanding, many of the people who have survived have done so with some level of medical intervention.

Medical intervention with the flu is often only needed by people who are already frail or have other issues.

It's estimated that 80% of all people who contract covid-19 do not require any medical care and recover after relatively mild symptoms.
See if this sounds familiar.

Flu Pandemic Morbidity / Mortality
Pandemic years are associated with many more cases of influenza and a higher case fatality rate than that seen in seasonal flu outbreaks. It is common to encounter clinical attack rate ranges for seasonal flu of 5% to 15% in the literature. For pandemic flu, clinical attack rates are reported in the range of 25% to 50%.

During a typical year in the United States, 30,000 to 50,000 persons die as a result of influenza viral infection. Frequently cited numbers are 20,000 deaths each year, and 37,000 annual deaths. About 5-10% of hospitalizations for influenza lead to fatal outcome in adults.

In normal years, although most influenza infection is in children, the serious morbidity and mortality is almost entirely among elderly people with underlying chronic disease. During influenza epidemics from 1979-80 through 2000-01, the estimated overall number of influenza-associated hospitalizations in the United States ranged from approximately 54,000 to 430,000/epidemic. An average of approximately 226,000 influenza-related excess hospitalizations occurred per year, with 63% of all hospitalizations occurring among persons aged > 65 years.

Influenza-related deaths can result from pneumonia and from exacerbations of cardiopulmonary conditions and other chronic diseases. Deaths of older adults account for > 90% of deaths attributed to pneumonia and influenza. In one study of influenza epidemics, approximately 19,000 influenza-associated pulmonary and circulatory deaths per influenza season occurred during 1976-1990, compared with approximately 36,000 deaths during 1990--1999. Estimated rates of influenza-associated pulmonary and circulatory deaths/100,000 persons were 0.4--0.6 among persons aged 0-49 years, 7.5 among persons aged 50--64 years, and 98.3 among persons aged > 65 years.

A different pattern may emerge in a pandemic. The 1918-19 pandemic affected mainly healthy young adults and seemed to spare those at the extremes of life. In the USA, the mortality rate during the 1918 pandemic pandemic was around 2.5%. Similarly, in 1957, the brunt fell on schoolchildren and young adults.

The number of hospitalizations and deaths will depend on the virulence of the pandemic virus. Estimates differ about 10-fold between more and less severe scenarios. Published estimates based on extrapolation of the 1957 and 1968 pandemics suggest that there could be 839,000 to 9,625,000 hospitalizations, 18-42 million outpatient visits, and 20-47 million additional illnesses, depending on the attack rate of infection during the pandemic. Estimates based on extrapolation from the more severe 1918 pandemic suggest that substantially more hospitalizations and deaths could occur. The demand for inpatient and intensive-care unit (ICU) beds and assisted ventilation services could increase by more than 25% under the less severe scenario.

Because the virulence of the influenza virus that causes the next pandemic cannot be predicted, two scenarios were presented by CDC, HHS and DHS based on extrapolation of past pandemic experience. The DHS estimates are suspect, since they appear to derive from a 1999 analysis that was based on the 1997 US population of 265 million. By 2005 the US population was about 295 million, so the DHS estimates are about 10% low simply due to the growth in population.

According to the Centers for Disease Control and Prevention (CDC), it has been estimated that in the absence of any control measures such as vaccination and drugs, a "medium-level" influenza pandemic in the United States could kill 89,000 to 207,000 people, affect from 15 to 35 percent of the U.S. population, and generate associated costs ranging from $71 billion to $167 billion. Another Centers for Disease Control and Prevention (CDC) estimate suggested that, in the United States alone, up to 200 million people will be infected, 50 million people will require outpatient care, two million people will be hospitalized, and between 100,000 and 500,000 persons will die. These numbers are significantly higher than the estimates used by the Deparment of Homeland Security. The HHS notes that the death rate associated with the 1918 influenza applied to the current population would produce 1.9 million deaths in the United States and 180 million to 360 million deaths globally. It is most noteworthy that the "Low" scenario presented by HHS corresponds to the "High" scenario presented by DHS.

By 2005 the observed human avian flu case fatality rate declined to 34% (16/47) in northern Viet Nam, but was 83.3% (20/24) in southern Viet Nam. The case fatality rate in Thailand was 71% (12/17) and 100% in Cambodia (4/4) in 2004. The case fatality rate was 89% among those younger than 15 years of age in Thailand. Death occurred an average of 9 or 10 days after the onset of illness (range, 6 to 30) and most patients have died of progressive respiratory failure.

Avian Influenza (H5N1) viruses isolated from humans in Asia in 2004 exhibited increased virulence in laboratory test mammals compared to the viruses isolated from 1997 human cases. By one authoritative estimate, an H5N1 avian influenza that is transmittable from human to human could be devastating: assuming a mortality rate of 20 percent and 80 million illnesses, the United States could suffer 16 million deaths.

Undetected cases might imply that infections with H5N1 influenza may be more common than previously thought, suggesting that the overall case fatality rate may not be as high as previously suggested. It also raises the question of whether mild and/or asymptomatic cases of avian flu allow the virus more opportunities to mix, or "re-assort," with human-adapted flu viruses. This genetic mixing increases the likelihood of generating a virus that is able to efficiently spread from person to person.





Based on the DHS estimates, the economic impact, in 2004 US dollars, would range from $87 billion (15% gross attack rate) to $203 billion (35% gross attack rate). These estimates include a value for time lost from work but do not include any estimate due to economic disruption or long-term health care costs.

Property damage is minimal. Service disruption, however, could be severe due to worker illness. Health care systems will be severely stressed, if not overwhelmed, and first responders are also likely to be severely strained.

https://www.globalsecurity.org/security/ops/hsc-scen-3_flu-pandemic-deaths.htm

[wayner]

Here is a video of an actual survivor who was in China at the time.
After the fact it wasn't but a thing.

How would that have played out without his hospital visit (one that he barely managed to drag himself into a taxi to get to a hospital because he was so sick and weak and may have died in his apartment without the necessary medical treatment of antibiotics), and if he didn't manage to get there then, how long before he would have been on a respirator.

Now, how likely is it that you will get neat a hospital or doctors office to get simple antibiotics in time in the event of a total outbreak?

Thats the risk to healthy people.





This one is more telling

[Tobra]

I would argue that morbidity is more important than mortality.

Dead people use far less resources, especially if they start going to ambient temperature with alacrity.

McLovin, if you were a Stanford Epidemiology Prof, you would not be here. You would have a Prius and never would have heard of this place.

[varmint]

More people are going to die from the destroyed economy.

[Mahler9th]

"More people are going to die from the destroyed economy."

Couldn't it be true that the estimated/modeled costs related to mortality and morbidity COMBINED are larger than the estimated/modeled costs related to the steps folks in the government have undertaken here?

Is that possible?

Is it possible that public health and other government officials are considering these things?

I think so.. I think it could be. But I haven't looked for any information about models for that. Likely there are plenty of published papers.

I have seen papers that compare estimated/modeled costs related to mortality and morbidity to estimated/modeled costs related to vaccination.

[wdfifteen]

Originally Posted by RWebb

In any emergency, including warfare, decisions are always made without reliable data.

The author of the article used a lot of words and beat around the bush a lot to say basically that.

[Por_sha911]

I understand the need to be overly cautious because of potential risk but there is no solid data on who is infected already, how long the person is a carrier, and how long it takes to recover. Are we call going to shut down the economy for 6 months?

[93nav]

It takes a while for them to die. Two weeks or more in the ICU?????

Originally Posted by Tobra

I would argue that morbidity is more important than mortality.

Dead people use far less resources, especially if they start going to ambient temperature with alacrity.

McLovin, if you were a Stanford Epidemiology Prof, you would not be here. You would have a Prius and never would have heard of this place.

[tcar]

Originally Posted by wayner

.... may have died in his apartment without the necessary medical treatment of antibiotics), and if he didn't manage to get there then, how long before he would have been on a respirator.

Now, how likely is it that you will get neat a hospital or doctors office to get simple antibiotics in time in the event of a total outbreak?....

This is puzzling.

As we all know, ANTIBIOTICS are useless in the treatment of viral diseases such as the flu...

They only work with bacterial infections, not viruses.