A fiasco in the making? As the corona virus pandemic takes hold, we are making decisions without reliable data.

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/

Also a lot of information on the site.

It is nice to see some 'responsible' scientists (i.e.; people who are good at math) noting how absurd this whole panic is.

Quote:

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The one situation where an entire, closed population was tested was the Diamond Princess cruise ship and its quarantine passengers. The case fatality rate there was 1.0%, but this was a largely elderly population, in which the death rate from Covid-19 is much higher.

Projecting the Diamond Princess mortality rate onto the age structure of the U.S. population, the death rate among people infected with Covid-19 would be 0.125%. But since this estimate is based on extremely thin data there were just seven deaths among the 700 infected passengers and crew the real death rate could stretch from five times lower (0.025%) to five times higher (0.625%). It is also possible that some of the passengers who were infected might die later, and that tourists may have different frequencies of chronic diseases a risk factor for worse outcomes with SARS-CoV-2 infection than the general population. Adding these extra sources of uncertainty, reasonable estimates for the case fatality ratio in the general U.S. population vary from 0.05% to 1%.

...

In the most pessimistic scenario, which I do not espouse, if the new coronavirus infects 60% of the global population and 1% of the infected people die, that will translate into more than 40 million deaths globally, matching the 1918 influenza pandemic.

The vast majority of this hecatomb would be people with limited life expectancies. That's in contrast to 1918, when many young people died.

One can only hope that, much like in 1918, life will continue. Conversely, with lockdowns of months, if not years, life largely stops, short-term and long-term consequences are entirely unknown, and billions, not just millions, of lives may be eventually at stake.

If we decide to jump off the cliff, we need some data to inform us about the rationale of such an action and the chances of landing somewhere safe.

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Thought this was an interesting take:

School closures, for example, may reduce transmission rates. But they may also backfire if children socialize anyhow, if school closure leads children to spend more time with susceptible elderly family members, if children at home disrupt their parents ability to work, and more. School closures may also diminish the chances of developing herd immunity in an age group that is spared serious disease.

This has been the perspective behind the different stance of the United Kingdom keeping schools open, at least until as I write this. In the absence of data on the real course of the epidemic, we don't know whether this perspective was brilliant or catastrophic.

The article is just reiterating a lot of what has been said. However, people are throwing around the word 'test' like it was something already available to us. It's a novel virus, meaning tests didn't exist until recently.

I agree that we need the information to truly make informed decisions, but in the absence of data it would be irresponsible to not take any precautions at all. The testing should start ramping up and we should starting getting more meaningful data soon. Until then, what choice does our government have other than to play it safe?

I head one infectious disease expert say that if you sit around waiting for perfect data and pontificating about the proper course of action, you've already lost and the virus will already be out of control.

The people on the Princess Cruise ship were ordered to quarantine in their rooms. That's the primary reason it wasn't as deadly.

Moxley,
With all due respect, what the heck are you talking about? The article is clearly based off the mortality rate from the infected passengers (There were 700 infected and 7 that died). Your comment has zero relevance to the article and represents the kind of misunderstanding of the facts that is threatening to plunge this country into a recession.

I have read some of the author's previous work as it is related to my own field of study. He is someone that is highly regarded and I have a lot of respect for. I agree with his overall sentiments although I take issues with some of what he says. My biggest critique is that even if the mortality rate is much lower than initial indications, one of the moderating factors is how widely this spreads. A 1% mortality rate isn't too bad if 1% of the population gets the disease. But if 30% of the population gets it it way more people die and it's much worse based on that alone. So it's not just about mortality rate but also about how many get infected. And how many get infected will be a moving target and almost impossible to predict prospectively because it is affected by the steps we take to mitigate spread and how well those measures work. Thus that's the reason we are taking such drastic steps. You can't wait to gather and look at mortality rate data and then enact social distancing measures based off results because the virus will have already beat you.

We actually have been polishing a slightly different model than yours for a couple weeks:
Media Revenue Model +
Tort Law Liability +
Data opacity
=
Mass Rule decisions

This is not a legitimate form of government in case anyone was wondering.

There's an old brain teaser that goes like this: You have a pond of a certain size, and upon that pond, a single lilypad. This particular species of lily pad reproduces once a day, so that on day two, you have two lily pads. On day three, you have four, and so on.

Now the teaser. "If it takes the lily pads 48 days to cover the pond completely, how long will it take for the pond to be covered halfway?"

The answer is 47 days. Moreover, at day 40, you'll barely know the lily pads are there.

This is what also happens with a virus that spreads easily. It exponentially explodes. In one day you could have more new cases than you had the past 2 weeks.

Here's a website that has some useful visuals tracking the virus over time. You have to at least start with attempts to contain and slow the spread. If it doesn't work, fine, switch strategies. But you have to start with the most aggressive strategy. If you abandon that strategy there's no going back.

https://www.worldometers.info/coronavirus/country/us/

_mpaul said:

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I head one infectious disease expert say that if you sit around waiting for perfect data and pontificating about the proper course of action, you've already lost and the virus will already be out of control.

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Good post. Worth repeating.

As if that doctor, and I, don't know how exponential growth occurs. You insinuate that intelligent people don't know how to do basic math, and that's why we arrived at our asinine opinions. That doesn't do much to further the conversation or find a solution, but you're a doctor and know everything.

Here's some basic math for you:

Option 1:

We delay the virus spread as long as possible over the course of a year. 2.2 millions Americans die, but our hospitals are over-run with 2x the normal deaths as usual in this country. 3000 additional Americans die / day over those 12 months.

In addition, we fall into a recession that lasts for 2 years. Over those 2 years, reduced income for patients, and closed doctors offices, and out-of-date medical equipment results in an annual increase in 1 million deaths / year.

5.2 million Americans die as a result of CV.

Option 2:

We let the virus run it's course over a few months, build herd immunity, and overload our medical system for 3 months. 2.2 million Americans die + 10000 additional Americans / day over those 3 months.

3 million Americans die as a result of CV.

Which was the better outcome?

NASAg03 said:

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As if that doctor, and I, don't know how exponential growth occurs. You insinuate that intelligent people don't know how to do basic math, and that's why we arrived at our asinine opinions. That doesn't do much to further the conversation or find a solution, but you're a doctor and know everything.

Here's some basic math for you:

Option 1:

We delay the virus spread as long as possible over the course of a year. 2.2 millions Americans die, but our hospitals are over-run with 2x the normal deaths as usual in this country. 3000 additional Americans die / day over those 12 months.

In addition, we fall into a recession that lasts for 2 years. Over those 2 years, reduced income for patients, and closed doctors offices, and out-of-date medical equipment results in an annual increase in 1 million deaths / year.

5.2 million Americans die as a result of CV.

Option 2:

We let the virus run it's course over a few months, build herd immunity, and overload our medical system for 3 months. 2.2 million Americans die + 10000 additional Americans / day over those 3 months.

3 million Americans die as a result of CV.

Which was the better outcome?

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Are these numbers completely made up?

I disagree with your option 1. Our medical professionals will beat this. And we will bounce back much better than that.

AvidAggie said:

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NASAg03 said:

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As if that doctor, and I, don't know how exponential growth occurs. You insinuate that intelligent people don't know how to do basic math, and that's why we arrived at our asinine opinions. That doesn't do much to further the conversation or find a solution, but you're a doctor and know everything.

Here's some basic math for you:

Option 1:

We delay the virus spread as long as possible over the course of a year. 2.2 millions Americans die, but our hospitals are over-run with 2x the normal deaths as usual in this country. 3000 additional Americans die / day over those 12 months.

In addition, we fall into a recession that lasts for 2 years. Over those 2 years, reduced income for patients, and closed doctors offices, and out-of-date medical equipment results in an annual increase in 1 million deaths / year.

5.2 million Americans die as a result of CV.

Option 2:

We let the virus run it's course over a few months, build herd immunity, and overload our medical system for 3 months. 2.2 million Americans die + 10000 additional Americans / day over those 3 months.

3 million Americans die as a result of CV.

Which was the better outcome?

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Are these numbers completely made up?

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Yes, he's just spewing made up garbage. Both scenarios are just baseless assumptions.

Mine are made up. It's a thought experiment, a hypothetical to evaluate alternate options. Just like the current numbers of "80% of those infected are asymptomatic" and "the mortality rate is 0.4% in China, or 0.9% in S. Korea, or 9% in Italy."

They are all numbers without context, which are meaningless.

The context is exponential curves built on testing of maybe 5000 samples per 100,000 people. The delay is 10 to 15 days for symptoms, and another week for deaths. So we drag our feet waiting for more data.

We have case studies of cruise ships and other theories, yet they are thrown out because they aren't considered applicable.

If the "curve" had some real numbers, maybe people would take this more seriously. But it doesn't. And anyone that tries to say otherwise, or provide context, or estimate values, is a naysayer and a risk to public health.

When the economy crashes, and hospitals close, and doctors go out of business or retire, and people die as a result, maybe then people will understand that economics do matter to public health.

****, we have to do something! Just run!!!! Wait, we are running towards a cliff! We don't have time to reassess, keep running!

Or we take strong, aggressive, early action in testing and social distancing the way South Korea, Taiwan, and Korea did and we limit the number of deaths severely and resume a more normal lifestyle faster. The analogs are South Korea and Italy. Both started growing at the same initial pace. South Korea took dramatic strong actions and they are on the flat part of the curve. In fat, the US already has more cases and deaths than South Korea. On the other hand, Italy has 500 people dying a day now and growing

Halconblack said:

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We actually have been polishing a slightly different model than yours for a couple weeks:
Media Revenue Model +
Tort Law Liability +
Data opacity
=
Mass Rule decisions

This is not a legitimate form of government in case anyone was wondering.

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Legitimate or not, it's the one we have.

You idiots that wanted safety and security traded away your liberty for a bottle of snake oil.

I am thrilled by one thing. People are starting to see this for what it is.

More people need to speak up and demand that our elected officials start having some courage and stop panicking like children.

Lot of people assuming there wouldn't be an economic panic/recession with millions of Americans dying unexpectedly this year. Nothing says if you let them die now that it will pull the economy out of a nosedive.

News flash: if people see the bodies stacking up, they're going to shelter-in-place of their own volition. No one is eating at Texas Roadhouse if it means potentially catching a deadly disease from the guy chortling loudly in the next booth.

a few thousand lives? I don't know any respected model that says that is what would happen if we didn't take aggressive action. Even with aggressive action we will likely be at "a few thousand" by mid April.

Hop said:

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agsalaska said:

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I disagree with your option 1. Our medical professionals will beat this. And we will bounce back much better than that.

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Will the medical professionals fix the resulting broken economy that could take years to rebuild? We are looking at "whatever it takes to stop the virus" and shutting down our economy to save a few thousand lives, but at what cost? Sending more than half of the population into debt and poverty? I don't know the answers. Maybe it is worth it to save a few thousand lives, but at the very least it is valid to ask questions of the economists and weigh the different outcomes without being shouted down by the "do whatever it takes" crowd who think medical professionals have all the answers. They have answers for only part of the equation....how to stop the virus. They don't know what the economic consequences will be to our society from their recommendations.

Our politicians and public policy leaders should be encouraged to at least have that discussion and weigh both sides. That isn't happening now. Good to see a few articles in major newspapers starting to discuss this issue.

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Someone talk Hop into running for office. One vote here.

jj9000 said:

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Hop said:

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agsalaska said:

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I disagree with your option 1. Our medical professionals will beat this. And we will bounce back much better than that.

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Will the medical professionals fix the resulting broken economy that could take years to rebuild? We are looking at "whatever it takes to stop the virus" and shutting down our economy to save a few thousand lives, but at what cost? Sending more than half of the population into debt and poverty? I don't know the answers. Maybe it is worth it to save a few thousand lives, but at the very least it is valid to ask questions of the economists and weigh the different outcomes without being shouted down by the "do whatever it takes" crowd who think medical professionals have all the answers. They have answers for only part of the equation....how to stop the virus. They don't know what the economic consequences will be to our society from their recommendations.

Our politicians and public policy leaders should be encouraged to at least have that discussion and weigh both sides. That isn't happening now. Good to see a few articles in major newspapers starting to discuss this issue.

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Would it be worth it to save your (Hop's) family?

No need for a paragraph.

A simple yes, or no will be sufficient.

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Are you for real? Governments exist to kill people. Good governments try their incompetent best to kill only the right people for the right reasons as often as possible.

Macro economic decisions kill people and ruin lives. Always.

Is it better to destroy the country and economy (which will also kill people and ruin lives) to save x number of lives? Thats the equation and x has to be a damned big number to justify what is going on. Millions of times greater than current us covid deaths.

jj9000 said:

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Hop said:

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agsalaska said:

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I disagree with your option 1. Our medical professionals will beat this. And we will bounce back much better than that.

---

Will the medical professionals fix the resulting broken economy that could take years to rebuild? We are looking at "whatever it takes to stop the virus" and shutting down our economy to save a few thousand lives, but at what cost? Sending more than half of the population into debt and poverty? I don't know the answers. Maybe it is worth it to save a few thousand lives, but at the very least it is valid to ask questions of the economists and weigh the different outcomes without being shouted down by the "do whatever it takes" crowd who think medical professionals have all the answers. They have answers for only part of the equation....how to stop the virus. They don't know what the economic consequences will be to our society from their recommendations.

Our politicians and public policy leaders should be encouraged to at least have that discussion and weigh both sides. That isn't happening now. Good to see a few articles in major newspapers starting to discuss this issue.

---

Would it be worth it to save your (Hop's) family?

No need for a paragraph.

A simple yes, or no will be sufficient.

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No.

Sometimes you need to remove yourself from emotion in a crisis to make rational decisions for the good of all those impacted by that decision. If it means 20% unemployment for our country and a prolonged depression, then I say no, not worth it. And I'll say the same thing if I live to be that age.

The thing is, we don't have reliable data on either side of these assumptions. Some of us just want to see the economic side be considered (and it sure felt like it wasn't being considered or even mentioned in most articles). I'm not even placing blame on anyone or saying the escalation of action over the past week wasn't warranted. It's the safest short term play until we get better data.

The manner in which decisions are communicated is driving panic as well. Decisions made only 4 hours earlier are erased and replaced with more stringent measures. Cities/counties/states are publishing guidelines or issuing decrees one after the other in rapid succession of increasing levels of restriction. Even if these are all the correct, thoughtful decisions, they're not being communicated as such. From the outside looking in, their communications portray the message of chaos in the decision-making room.