The reason they aren’t invoking forced isolation (yet) is because they expect this to be a long battle and keeping people looked up isn’t a long term solution.As bad as it sounds, this is beginning to look like the least terrible of really terrible options.
@davefairtex
One assumption that needs some thinking about is translating blood tests in Stockholm to the whole Swedish population. How would that change the model?
Edit: one other thing I’m curious about - in general, I mean, not in your model - is what constitutes a ‘case’ when we fall back on the stat that flu has a CFR of 0.1%? Is it the same definition of case we are currently using around Covid?
http://www.publichealth.lacounty.gov/phcommon/public/media/mediapubhpdetail.cfm?prid=2328
I haven’t had time to research it yet, but I’m curious if they got their antigen test kits from the same China-supplied third part as the Sanford folks.
"Based on results of the first round of testing, the research team estimates that approximately 4.1% of the county's adult population has antibody to the virus. Adjusting this estimate for statistical margin of error implies about 2.8% to 5.6% of the county's adult population has antibody to the virus- which translates to approximately 221,000 to 442,000 adults in the county who have had the infection. That estimate is 28 to 55 times higher than the 7,994 confirmed cases of COVID-19 reported to the county by the time of the study in early April. The number of COVID-related deaths in the county has now surpassed 600."And this:
"The test's accuracy was further assessed at a lab at Stanford University"And, look who it is:
"In addition to Sood and Simon, other authors and institutions contributing to the study include [...] Eran Bendavid and Jay Bhattacharya of Stanford University School of Medicine"
Trying to answer my own question in my previous comment - “what is ‘case’ in flu’s CFR?” - I tried a little digging of my own. (Only a little digging, mind. I still have to work!)
Looking at this CDC page, we have estimated deaths compared to other estimated stats: hospitalisations, medical visits and symptomatic illnesses: https://www.cdc.gov/flu/about/burden/past-seasons.html
Comparing deaths to symptomatic illnesses for the 9 years on this page, I get an average ‘CFR’ of 0.12, which is pretty much on the money for the 0.1% CFR that people typically quote for seasonal flue.
Note that the denominator here is not who was exposed to the flu, but who had a symptomatic illness.
@davefairtex - that might be another thing to factor in to your Sweden model - how many people might experience Covid asymptomatically, or in a truly mild form?
albacore-
After thinking about this…I realize we as a society have two policy choices:
Choice 1) have everyone hide away at home, where everyone tries hard to keep from getting it, until a vaccine appears. That’s 18 months - assuming it even works. We don’t have a working influenza vaccine, for instance. But the plan is to mostly hide for 18 months, only letting people out if they can prove immunity. Odd thing is, people can only prove immunity if they get it, so this kind of morphs into choice #2.
Choice 2) hide away at home ONLY as necessary to avoid swamping the hospital system, but keep most of the economy open, only limiting things when that hospital system swamp threatens, and assume everyone gets it eventually. Note that proving immunity is not required with this plan - although might be required to work in nursing homes, etc.
Those are our two choices. Either avoiding getting it and wait for the vaccine, or assume everyone gets it, but slowly enough to avoid swamping the system.
Many states appear to have selected Choice #1, without fully realizing it. There is no hospital swamp happening anywhere except NYC. So unless we’re selecting Choice #1, the other locations should remain open until such time as a swamp is projected to happen.
Note: we would only deliberately select Choice #1 if the true CFR was “too awful to face.”
We would select Choice #2 if we decided that the costs of hiding (both economic and psychosocial) outweighed the deaths from the true CFR. (Suicide, depression, drug & alcohol abuse, etc).
Note: it is likely if we choose to hide for more than 3 months, we will drop into a “Great Depression”, due to the widespread defaults that will happen as an unintended consequence of shutting down the economy for that length of time.
I believe that the effects of a great depression on the population would far exceed the true CFR of this particular virus. That’s just my guess, based on a cross section of a number of population testing studies which all more or less say the same thing: big percentage of asymptomatic or lightly-symptomatic people means true CFR is a small fraction of what we’re seeing at the hospital, e.g. perhaps a 0.3-0.5% CFR across the whole population.
So. Either we crush our economy (18 months!) to avoid the 0.3-0.5% CFR, or we bite the bullet, reopen, and assume everyone will eventually get it, a fraction of people do die, and we retain much of our economy.
Choice #1 or Choice #2. That’s it.
Please tell me if I’ve missed anything.
Very good discussions. Thank you guys. DaveF said:
We need the denominator. (Total numbers who have been infected)But we are not going to get the denominator. The testing infrastructure, test kits and money is not there. (And I suspect that the will to find this number is not present.) As Les has pointed out--
So, being really generous, let’s say we are testing 50,000 people per day. The math: 329,546,904 population / 50,000 tests per day / 365.25 days per year = 18.04 years to test everyone in the US.The logistics of finding the denominator in the USA are insurmountable, IMHO. ------------- And the disease distribution is PATCHY making all of the average numbers meaningless for a specific location. Policy based on average numbers will be wrong for specific locations. Disease dynamics in densely packed cities with subways will be very different from car-centric suburbs and farming communities. Managing the disease with skill would need very different approaches for different locations. ------------ Just count the dead So, lets simplify. Just count the dead (and the nearly dead--ICU admissions). And make it location specific. Forget cases, numbers infected, test kit accuracy, immunity, antibodies, cumulative all cause deaths, etc. etc. Just today's deaths for each specific location. Lots and lots of people are going to die of this. This is the foreseeable result of having some of the best scientific minds work on the task of combining genetic material from various coronaviruses seeking ever more virulent infections. (here and here for example). Then we have the problems of
- dismantling of the National Center for Medical Intelligence (NCMI), "the pandemic early warning system" part of Defense Intelligence Agency in the months JUST PRIOR to the pandemic onset. [See Scott Ritter's article here]
- failure to halt incoming flights from the center of the pandemic,
- failure to start mask usage, and
- emergency orders by state governors banning the prescribing of the few medications helpful at disease onset.
- and conspicuously heavy handed lockdown policies guaranteed to elicit resistance from people.
- and an utter failure to deliver stimulus money to small businesses and the unemployed in adequate amounts to buy food and in a timely manner.
Yes, Chris is wicked smart, I know that and you know that. The Stanford study was wrong and Chris showed the errors in logic and calculations, that needed to be done. But as a member of almost poor class. I have to wonder, how does that affect or help us? The question that pops into my head is so what. Why is that important to us, we are lied to every day, all day. Whats one more wrong study. Sorry Chris I am not part of your group think guys.
Here is our reality. You know its much better that you stay home and watch your kids be hungry, homeless, stressed and afraid than risk some elderly person with health problems from getting ill. We poor and middle class get the message. The only people who matter are those who might get this disease. Those being evicted, they don’t matter, the person unemployed, they don’t matter, the highly stressed, they don’t matter, the broke and hungry they don’t matter. Yep, be a prisoner, shut the f-up and take it, cause we said so. This is what some, probably a lot of the poor, working class are thinking.
And how are those portfolios looking? Your garden? Like your electric coffee pot and that nice cup of hot coffee in the morning? Enjoy them. The harder the jackboot of oppression is used on the poor and middle class the less likely it is you will be able to fully enjoy those luxuries in the future.
Katness to Panam in the movie The Hunger Games “If we burn - you burn”.
AKGrannyWGrit
I’ve said this before, just think about who is threatened by this illness:
Older, fat, diabetic, heart issues, hypertension, weakened immune systems.
How many of our elite fit this description. Most of them? All of them?
Might that be driving the enthusiasm for widespread lockdowns?
“Holy crap. I might actually die. Everyone has to stop doing everything. NOW. Until I SAY DIFFERENT.”
[Now where’s my $13 chocolate?]
https://www.youtube.com/watch?v=xRCgyg_2E4s
Worst - yet most truthful - video interview ever given by our Speaker of the House.
[Note: this experience is actually bipartisan, but - I couldn’t resist picking on Nancy]
Ever wonder why Congress is not in session? They’re terrified, that’s why. They all are directly targeted by this illness. It has them all in the crosshairs. 10% CFR. Or worse, since half of them don’t dare take HCQ, because it might be validating Trump by accident.
Here is our reality. You know its much better that you stay home and watch your kids be hungry, homeless, stressed and afraid than risk some elderly person with health problems from getting ill. We poor and middle class get the message. The only people who matter are those who might get this disease. Those being evicted, they don’t matter, the person unemployed, they don’t matter, the highly stressed, they don’t matter, the broke and hungry they don’t matter. Yep, be a prisoner, shut the f-up and take it, cause we said so. This is what some, probably a lot of the poor, working class are thinking.Hey Granny - I'm not taking any of this personally because I can recognize wounded projection when I see it. You are taking offense where none exists, you have a wound around being poor, down-trodden. I get that. I think we all get that. My very serious questions to you are, "how does holding tightly to that mindset serve you?" and "What do you get from casting yourself into and living into the role of victim?" Because, you might hate hearing this, but it's a choice. People can be poor and happy. I know, because I was among them. For much of my late teens and early 20's I was living on very little. At one point I was a climbing bum, living on (I shit you not) $5/wk. Refried beans, tortillas, and government cheese. That was one of the happiest periods of my life. I was totally unconcerned with "not having enough" or what rich people might have thought of me. Didn't concern me in the slightest. Still doesn't. Probably why I can do what I do. I'm not dependent on outside approval to be who I am. My economic status and my happiness were not interconnected. Relatedly, I was just talking with someone yesterday who was speaking with their sister who themselves was on their sixth episode of the The Office at 2:00 in the afternoon, thinking about baking another rack of cookies because, who cares, already too fat already. My friend asked his sister if she'd thought about using her time differently, perhaps learning a new language, or an instrument. She flew off the handle, yelled at him and hung up. Not because he was wrong, but he was right and she knew it. She was her own prisoner, and nobody else's. The moral of this story is, you are the master of your own ship. Nobody else. The lesser point is that your words are totally ineffective on me because I have no ability or any interest in taking on your pain as something that I have any control over or responsibility for. I'm old enough and wise enough to know that there's nothing I can do to ease your inner pain. So, no thanks, you can keep that monkey. I have gotten to where I am in life through hard, persistent work. I worked hard. I started from pretty much nothing except a decent upbringing. Because of this, any attempts to try and shame me into thinking that this was wrong, or at the expense of others really aren't going to work. But I can sense that you are really stressed. I get that. What can I (we) do to help?
SP-
We can calculate an approximate (or, “accurate enough”) denominator by doing a reasonably-reliable survey of the population (maybe 1000-2000 people, in 5-6 regions), testing everyone twice to deal with test flaw issues.
Then we offset by the lag (average time to fatality for the COVID deaths - from point of detection through death), and then divide the lagged number of COVID deaths in those regions by the region’s approximate denominator. Bang, we get the True CFR ™.
With the True CFR ™, we can have a rational policy discussion.
Give me a few million bucks and I could make it happen. Only run the second test if the first comes up positive. That should satisfy Mr Bayes, for the most part.
Once we have True CFR, we have the rational conversation.
Note I’m sidestepping all the rest of the tinfoil hat stuff; there is probably a pony in there somewhere, but going there won’t get us to that rational conversation any faster.
@davefairtex
I’m finding it so hard to have meaningful discussion here. You start a discussion about Sweden, ask the group if there’s any assumptions you missed, I highlight a couple that might be interesting, and straightaway you’re on a different tack, asking me to choose between the only two options you can imagine we have.
Who says there’s only two options? That’s another assumption.
Then another assumption: “elites” have comorbidities, that explains why they’re responding like this. Surely that’s an empirical question, and based on my limited understanding of poverty and health I would expect the poor to have much more to fear from this virus than the rich.
Another one (following Granny): it’s either screw the poor or back to work. But why can’t the poor get the bailout, rather than the rich? Other countries are providing much more support to their populations than the US - doesn’t that provide a different way of addressing the challenge? As Chris said in the video (paraphrasing): I wonder what they mean by ‘Be Like Sweden’?
Perhaps the best we can hope for from BTL commenting is to challenge each others’ assumptions. That could be a valuable thing. I don’t know, I’m just feeling a little ground down by it all.
I am impressed by the math ability of people here. I agree with Sandpuppy that death rates can be used to estimate overall infection rate. Since we don’t trust data from China, I think the New York data when the death rate goes down to double digits could be useful to determine the final CFR. The current rate is a little less than 500 per day for the state. They still are not adding deaths at home of those who aren’t tested as far as I know so the data will be a little off. They are doing “random sampling” of antibodies to get 3000 people tested and it should prove interesting in understanding total infected in a highly congested area. People in more rural areas should have a much slower progression obviously. They haven’t announced publicly where the antibody testing is being done but have heard supermarkets anecdotally. Our final death rate with this first wave, since this thing was running around for quite a while before the lockdown, should give guidance on what to expect at the END of this wave elsewhere. Hotspots could adjust their guidelines and hopefully intelligent people will demand masks for all and keep it at that. The deaths from poverty, suicide, unemployment, substance abuse and delays in treatment for other conditions will have a very long tail in this situation…masks masks masks.
Limited, but interesting study on OB patients, most testing positive were asymptomatic, published in the New England Journal of Medicine
https://www.nejm.org/doi/full/10.1056/NEJMc2009316
I don’t know what is wrong with us but as you explained in your podcasts there are two problems.
One the virus.
Two the economy.
Our reaction to the virus was supposed to help us get the health system back under control.
As you explained - I thought very well - the Oil market situation is a terrible sign of our economic health. I hope some of the people on this blog could talk about it - the economy - because the two are linked now, and we desparately need to get them uncoupled. The world economy seems about to fail. If there is nowhere to store oil - in a very short time almost all US based oil production will be landlocked - confined to “la maison” just like me. I don’t think that the FED has any levers for that type of problem.
We live in a cast system.
The lower cast, hourly wage, service providers, typical blue collar workers are more vulnerable. So your two choices do not apply evenly to the population. Choice #2 is the only choice for us.
Really, how can an hourly worker, say a hairdresser survive? If they don’t work they don’t get paid. Remember sick leave does not exist for the self employed unlike the corporate worker. Paid vacation, nope, paid floating personal days, not for the small self employed. Two week vacation, save up for that. 18 month quarantine? Where do we find thick cardboard boxes to live in. Begging in the streets, I know the new “Reality TV Series - we could call it “Lets Watch Them Suffer”. Homeless camps, evictions, where to find a bathroom. A lot of rich stories to tug at peoples heart strings. It could be a hit. The people in the most pathetic and gruesome circumstances could be showered with money and prizes and the viewers clap and cheer and feel warm and fuzzy when they switch off the power. Yeah, that could work.
Anyway not so sure your analysis provides for a fair representation of the entire population.
AKGrannyWGrit
albacore-
Yeah, sorry about that, I started to answer, and then got this mind-picture of where we were in this whole process that sort of took over my brain.
One assumption that needs some thinking about is translating blood tests in Stockholm to the whole Swedish population. How would that change the model?We can get to a true CFR using just the blood tests. Definitely sorting out "distance to herd immunity" is a regional thing, and would require wider testing outside the main cities. Presumably, there is less infection in the countryside.
Edit: one other thing I’m curious about – in general, I mean, not in your model – is what constitutes a ‘case’ when we fall back on the stat that flu has a CFR of 0.1%? Is it the same definition of case we are currently using around Covid?I was assuming a case was actually an infection, rather than someone showing up with symptoms at a hospital. Maybe cases for flu really are people showing up at hospitals. Although if you have to go to a hospital for your flu, my goodness, I bet fatality rates are higher than 0.1%. It is an interesting question though. I remember looking at a NAC study that ran through a flu season, and noted that 25% of the control group tested positive for the flu, but showed no symptoms at all. (50% of people taking NAC showed no symptoms either). Both groups got flu in the same amount, FWIW - just the NAC group didn't notice, and/or the symptoms weren't as bad. Just to say that flu has asymptomatic people too. So chasing down what 0.1% really means might be useful as well.
Granny-
I agree with everything you said about the situation of typical blue collar workers.
Here’s my point: I’m hypothesizing that policy is being set by the elites, to serve their own needs of avoiding infection and possible death. Nancy can eat chocolate and avoid infection for the next 18 months until the vaccine arrives. Her lifestyle will not be impacted much, if at all. She’ll probably get fatter, but that’s about it.
Your blue collar service industry workers will all basically end up in cardboard boxes, and then they’ll die of poverty, as the economy plunges into a great depression.
If put to a vote, I’m guessing your group would wholeheartedly vote to risk the virus (they tend to be exposed to more risk every day anyway - crime, poverty, illness, etc) rather than cower at home and end up for sure living in that cardboard box, which is the sure next step to an unpleasant death.
I am a fire fighter in the San Francisco Bay Area. My Fire Department was the first in the east bay to implement a public testing facility. There are some interesting N=1 points I would like to share:
-Members 0f the Fire Department have all been tested numerous times over the last 4 weeks, ZERO positives out of appox 400 tests
-At the test site, approx 10% positives, those who get tested are healthcare workers, first responder, law enforcement and those who pass a general screening(fever, contact with COVID 19, etc.)
-We come in contact with Positive Covid 19 daily, sometimes numerous patients
-Everyday I go to work and interact with 15 people, all of us have been in direct contact with Covid-19 patients. Until recently, most did not adhere to strict PPE measures. Ex. just gloves and surgical mask, walk into a infected convalescent home, treat patients, come back to the fire station, cook, exercise in common area and perform daily activities.
- If this gets into a advanced care facility, it seems to infect over half the people, high percentage don’t make it.
- It has not seemed to effect the homeless like we thought it would, not sure whats going on here. They often live in close proximity, with high drug use, not exactly healthy people. Maybe being outside has something to do with it. Not sure
Personally, I can’t believe our departments infection rate is zero. It seems strange with how infectious this seems to be. Not sure whats going on here. Its not a lack of testing issue. Until recently, last 2 weeks, responders have not taken full PPE and Decon measures. Besides the Care homes, it does not seem to be making a run in our city. Of the nurses I have talked to they definetly have lots of Covid 19 positive patients, mostly from care homes.
Anyway thought I would share.
Chris you mis-interpret my post. It is an opportunity to open the door wide and say “this is why it matters that the narratives are wrong”! Lets connect the dots so we can make decisions based on the data. If the data says this we can conclude (blank) and that is how it affects the larger picture. If we conclude the numbers in the document are wrong it means (X) and that says something entirely different about the larger picture.
You are taking offense where none exists, you have a wound around being poor, down-trodden. I get that. I think we all get that. My very serious questions to you are, “how does holding tightly to that mindset that serve you?” and “What do you get from casting yourself into and living into the role of victim?”Why are you placing me in the role of the victim? This site caters to the wealthy and I am bringing in some dialogue about how this Pandemic situation and heavy handed tactics affects the poor. Just because I can relate to the poor, know and understand them does not mean I see myself as a victim. I am not taking this personally either because if I were I would be offended that the subject is turned into a post about me when it is emphatically not!
That was one of the happiest periods of my life. I was totally unconcerned with “not having enough” or what rich people might have thought of me. Didn’t concern me in the slightest. Still doesn’t. Probably why I can do what I do. I’m not dependent on outside approval to be who I am. My economic status and my happiness were not interconnected.Great, I am happy for you. Now, please just try to put yourself in the shoes of a single mother who has no job, no income and no savings. And no prospects. Is she just supposed to what, don’t worry, be happy? I don’t think you are understanding the enormity of stress, terror, anxiety and despair that people are going through.
Relatedly, I was just talking with someone yesterday who was speaking with their sister who themselves was on their sixth episode of the The Office at 2:00 in the afternoon, thinking about baking another rack of cookies because, who cares, already too fat already. My friend asked his sister if she’d thought about using her time differently, perhaps learning a new language, or an instrument. She flew off the handle, yelled at him and hung up. Not because he was wrong, but he was right and she knew it. She was her own prisoner, and nobody else’s. The moral of this story is, you are the master of your own ship. Nobody else.So the message is, if a person can’t feed their kids it’s their fault, if they don’t have a job it’s their fault, if they have run out of money it’s their fault? Are you suggesting that like Janet Yellen suggested they should have chosen better parents? Remember this post is not about me its about the enormous amount of people who are barely holding on. And blaming the poor for being poor does not help or is it accurate.
I have gotten to where I am in life through hard, persistent work. I worked hard. I started from pretty much nothing except a decent upbringing. Because of this, any attempts to try and shame me into thinking that this was wrong, or at the expense of others really aren’t going to work.But I can sense that you are really stressed. I get that. What can I (we) do to help? Again, my post was not about you and it was not about me. I am happy you work hard and are successful! You chose to see my post about shaming, it wasn’t. What can you do to help? Have compassion for the thousands, maybe millions of people who are being devastatingly affected by this situation. Relate your YouTubes to real people. What real people care about is can I feed, cloth, protect and provide for my children and family? I know ever so many here love the analysis. For real people, they only want to survive another day, to eat, be safe and have some dignity. People should not have to beg! Nor should they be blamed for their dire circumstances. Analysis means little when your belly is empty and your afraid. I simply want you to see, acknowledge and hopefully feel some of the pain that is pervasive, right now. I am not a victim I am a voice for the many that few are listening to. AKGrannyWGrit
Here is our reality. You know its much better that you stay home and watch your kids be hungry, homeless, stressed and afraid than risk some elderly person with health problems from getting ill. We poor and middle class get the message. The only people who matter are those who might get this disease. Those being evicted, they don’t matter, the person unemployed, they don’t matter, the highly stressed, they don’t matter, the broke and hungry they don’t matter.I’m with you except for the “some elderly person” part. First, it’s not just elderly people, as we’ve heard over and over again. Second, how is placing a higher value on children vs elderly people any different than placing a higher value in a person because of their race or sex? I’m certainly not a saint in that respect. They say obesity is the number one risk factor, followed by other “co-morbidities.” I have to check myself when I think about people with self inflicted co-morbidities. It’s easy to think, well, you did it to yourself. I’m attempting to stay out of the personal worth value judgment mental game. But you are, I think, right. I believe the price of shutting down the world economy is going to be completely unprecedented.