Covid-19: What to do when you have no meaningful data yet

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Sunday, April 5. 2020

Covid-19: What to do when you have no meaningful data yet

All of the experts, including Dr. Fauci - are bullshitting (pardon my annoyance). Not this guy, because he admits what is unknown. What is known is that this virus can be lethal and it can be completely harmless, and anything inbetween. We know who are most likely to become seriously ill, but what is completely unknown is how often it creates serious illness. Via Powerline, which says:

This video is part of Peter Robinson’s Uncommon Knowledge series. His guest is Dr. Jay Bhattacharya, who is an economist as well as a member of Stanford’s medical school faculty. Dr. Bhattacharya has become somewhat famous as a result of an op-ed in the Wall Street Journal in which he argued that the danger of COVID-19 is probably being overestimated. The conversation is intelligent; Peter is a good interviewer, and Bhattacharya is an excellent teacher. It is a fair, balanced appraisal. I recommend it.

Here it is:

Posted by Dr. Joy Bliss in Hot News & Misc. Short Subjects at 12:18 | Comments (25) | Trackbacks (0)

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It would seem that he failed math. The U.S. had 4000 Covid-19 cases on March 17th, today that number is 325,000. So what does his "uncommon knowledge" make of that? Does he think that trend is just a random aberrant event? Perhaps he thinks it is a lie, a hoax. I encourage him to go look at the refrigerator trailers parked at the hospitals in NY City and video his speculations for us as to what is really in there. Perhaps his "uncommon knowledge" will discover that it is really a storage for the Kansas City Steak Company and inside are Black Angus Steaks just waiting for the barbecue truck to show up. Please do us all a favor and repost this video in a month so we can all look back at those halcyon days when we believed this virus was no big deal.

By the way if his vision turns out to be terribly and disastrously wrong does he still get to label this his "uncommon knowledge series"? Asking for a friend.

#1 Emu on 2020-04-05 12:58 (Reply)

Please have a look at the statistics being reported out of Sweden, Iceland, and the Netherlands. Then go have a lie down until your panic passes.

The case mortality rate is almost exactly the same as the flu, of which some 10 to 20 percent of all flues are corona viruses, once you account for the fact that there are many more infections than are confirmed.

Also have a look at deaths from the flu in previous years.

#1.1 William Hughes on 2020-04-05 13:30 (Reply)

Netherlands is a laugh.
No testing being done anywhere except people admitted to hospital.
Of those, 50% die.

True numbers will never be known because nobody is being tested.
And that includes people who die at home because they too are not being tested for the virus, their deaths instead being written off as whatever else comes to mind.

And a high percentage of the survivors have permanent lung damage as a result.

Sweden is even worse.

It's NOT "just a flu" or "just a cold".

#1.1.1 JTW on 2020-04-05 14:33 (Reply)

(just civil conversation)
Emu, Do you work in the health care industry or something related?

My 85 yo father lives in a home. Last week, he tested negative. 9 residents are positive, 0 workers. None of them are showing dire symptoms. Previously there were 3 positives. 2 were in hospice when tested positive. 1 has passed, the other has not. The 3rd is an active 88 year old not showing symptoms.
Today my Dad is in the hospital with pneumonia. Will see if he does come up positive. No visitors allowed. He already is ready to Die. His body is done. Now with 2 weeks of isolation, his mind is melting for the lack of interaction. Care givers don't have time (bringing food to rooms instead of dining hall) & are not allowed to linger even if they did.
We all have our opinions. Mine is the "cure" is worse than the disease. I have a theory that in the good ole days of bloodletting, your best chance for survival was when the "doctor" fell asleep and you stopped draining.
325,000 is probably several million exposed. Today we are bloodletting on steriods.
Social distancing works.
Shutting down parks & recreation is evil. Sunlight & fresh air cures a lot of problems. We are smart enough to work it out. Maybe not if your park is surrounded by 100,000 people all wanting it at the same time, but not for the more sparsely populated towns.

#1.2 Jerry on 2020-04-05 14:33 (Reply)

Civil! Of course. My post was sarcastic, it is what I believe but it was an essay in sarcasm. Not a health care worker. I am concerned from what I can see. by the end of the day tomorrow the number of deaths in the U.S. will have doubled in three days. It reminds me of that ancient Indian story where as a reward for his service a man asked only that he be given wheat from the storehouse according to the wheat and chessboard problem. One grain of wheat on the first square, double that (or two) on the second square, double that (four) on the third square until all of the 64 squares had been completed. The ruler laughs it off as a meager prize for a brilliant invention, only to have court treasurers report the unexpectedly huge number of wheat grains would outstrip the ruler's resources. And there you have it.

We of course won't continue doubling the number of deaths forever. It will end as some have said here. Perhaps at 150,000 deaths in the U.S. Or perhaps 300,000, or 600,000 or 1,200,000 or more. No one knows. I don't know where that last death will be and what the total is. By I do know math and I can see the trends NY will begin to taper off; they have 4159 recorded deaths right this minute so by next September they may only have 15,000 or so total (maybe twice that who knows). But Detroit and New Orleans have just begun their excursion on the Covid-19 Express and they might have a mere 15,000 deaths each by September. And of course LA and Chicago will soon begin their "four horsemen of the apocalypse" journey and they too might add another 15,000 or so deaths and eventually all the big cities and most of the smaller cities will ring up their score.

THAT is what the math tells me. I sincerely hope I am wrong. I sincerely hope that our doctors and scientists discover an effective treatment for those who are hit hard by this. But as many have pointed out we lose 60,000 to flu in a bad year (twice that in a really bad year) and we haven't found anything to stop it yet. But hope springs eternal...

As for the economy; I do agree we need to start returning people to work and allowing them to come and go while taking some precautions. If we don't then indeed the cure will be worse than the disease. Since NY was the first to be hit by this perhaps NY will be the first state to begin going back to work. Why not, we cannot sit at home for months, even weeks is killing the economy.

Here is why I am most worried. Right today, April 5, everyone who is going to die on April 19 just got infected and they don't know it. The disease will run it's course and those who are lucky and/or healthy will be cured by then and those who are unlucky and unhealthy will die. Based solely on the math that number in the U.S. could be about 7500 on that one day. They are the walking dead. It wouldn't matter if we continue to shelter in place or all go out and party that 7500 people have already been fated to die on April 19th. Unless we find a cure. And April 20, 21, 22... Don't look to good either.

#1.2.1 Emu on 2020-04-05 15:52 (Reply)

So the counter to the numbers & the checker board is 110 to 140 people die world wide every minute. Which rounding means 26 million since Nov.
Certain death category's will change in this period (gun shots, violent crime Down due to distancing. Up - suicides, effects of hoarding, Lack of treatment (we wouldn't take you in until we know you test neg.)
Dad now has a conundrum. He still does not test positive. May have had a heart attack in past couple days. Too old to bother trying to fix. Since he doesn't have it, is there a fear for ANYBODY to work with him for fear THEY would give it to him?
The best thing for him would be to test positive (and not dissolve into a drowning mass of bloody lungs) so Workers didn't have to tiptoe around worrying about infecting him.
Next best is that he does go down with it, load him up with morphine, and put him out of his misery.
It is a cruel world. We're not going to live forever. To pretend that there are multiple other options is fooling oneself.

#1.2.1.1 Jerry on 2020-04-05 17:23 (Reply)

So why punish someone for murder?
Would you feel different if all deaths were between the age of 1-10 years old?
What if we just nuked New York City and left everyone else alone would that be OK?
What if we did nothing about the Corona virus and it caused the death of most doctors and nurses is that OK too?
After all we all have to die sometime

#1.2.1.1.1 Emu on 2020-04-05 18:19 (Reply)

I think Emu is asking the right questions. I'm still working on the answers.

#1.2.1.1.1.1 Texan99 on 2020-04-06 08:25 (Reply)

Oh relax Emu. Go out and let the spring blossoms cough all over your paranoia.

#1.3 Gerard vanderleun on 2020-04-05 14:36 (Reply)

You state the number of cases as though that is the number of infected people. The number of known cases is obviously dependent the number that is tested. With tests being more available, it's not a surprise that there would be more cases. Then there is no way to count the number who have or have had the virus but were not tested. That number could be very substantial since worldwide, 95% of known cases are mild and it's likely there are a lot of people who don't get tested because they didn't bother to go to a doctor.

Beyond that, there is a lot of variability in counting deaths attributable to this virus. If you look at the deaths reported by Germany and France, there is a large difference in fatalities. In Germany, they count a coronavirus death when it can be unambiguously attributed coronavirus. The standards in other countries is more relaxed. In Italy, 99% of deaths were from patients who had other complicating conditions. How many of those who are listed as coronavirus deaths actually died of something else and the virus was just a contributory factor. Add the apparent elevated workload of healthcare workers and the incentive of federal money for more coronavirus deaths and it seems likely that deaths are likely over-reported to some degree.

One of the main points he made was that we do not know the situation. While we probably have a decent (if flawed) handle on the numerator, we have only a very vague idea of the denominator. The resulting fraction has huge implications on how it is treated socially and economically.

#1.4 mudbug on 2020-04-05 17:28 (Reply)

The answer to this is actually very simple and it requires zero convincing on my part. Wait one month and if this still looks like no big deal then you are absolutely correct and we should have never shut down our economy. If on the other hand it is obviously much worse than you anticipated then you were wrong. I sincerely hope that I am wrong.

#1.4.1 Emu on 2020-04-05 18:28 (Reply)

IMHO waiting is the problem. We are social distancing, we are counting the infected and mourning the dead, we are working feverishly on a vaccine (that cannot possibly be used for at least eighteen months). All that is good but we need to be active rather than reactive.

We have treatments that are potentially very valuable - one in particular is not only as a possible cure but also a possible preventative. In the case of Hydroxychloroquine, it is old and well known, it is given freely to people expected to be exposed to malaria, it's contraindications and side-effects are well known, and it has been used with resounding success against COVID-19 in smaller studies. We should be aggressively dispensing it to large numbers of appropriate patients fully documenting the patients and results. This is a very low risk/potentially high reward strategy. And it turns out there are other drugs already in common use, so they don't need to go through the baroque FDA testing either, that show potential against COVID-19.

My only disagreement with Bhattacharya is his (almost) dismissive attitude to this treatment.

#1.4.1.1 mudbug on 2020-04-05 19:59 (Reply)

Agree 100%. And now there are indications that ordinary heartworm preventative could be effective. That, too, has been given to large numbers of people safely for a long time, to treat things like river-blindness and other parasites.

There are an extraordinary number of people bottlenecking potential treatments, as if we had all the time in the world while we wreck the economy.

#1.4.1.1.1 Texan99 on 2020-04-06 08:28 (Reply)

A new drinking game: you take a shot every time someone in a video about COVID-19 touches their face.

#2 Andrew Stanton on 2020-04-05 13:51 (Reply)

We can only manage what we can measure. Saying that COVID-19 is going to worse than imagined, or that we are over-reacting and killing the economy, are both unsubstantiated opinions whose only value is adding to the noise - we don't know the number of actual infected cases, and we don't know where our present "Here & Now" lands on the bell curve. The people to listen to are probably the ones who say up front, "I'm not sure yet"

But we do know that every country has a recorded flu season history. What Italy is suffering through at the present moment: Does it look like that? No, accounts say it's much worse. What NYC is going through at the present moment: Is it worse or better than the average flu season? We shall see this week.

Comments that other countries are not having a problem can only be properly re-stated: They are not having a problem as of yet. One can disagree with that by providing accurate numbers for their current infection rate and position on the projected bell curve to prove their point. These numbers are unknowns. A few days makes a big difference on the bell curve roller coaster.

Currently Texas is tracking alignment pretty well with the model in number of cases and deaths - but we're only starting up the big first hill. So are many other states: https://covid19.healthdata.org/projections

I am extremely proud of the efforts people are making to mitigate the effects of this disease. It's going to be a painful few months when the effects of this absence of labor hits the supply chain and then the economic effects start to take hold. But if the efforts are sustained I think the startup rationale will make itself apparent and we will be gradually returning as a function of risk, both geographically and demographically, shortly after the end of the month. That is my noise contribution. I think we will look back on the past few years as an unprecedented period of consumer power and product availability when we were spoiled for choice, the likes of which won't be seen again anytime soon.

#3 Aggie on 2020-04-05 13:59 (Reply)

I wonder what the recovery (which I expect) will look like. Will a lot of idle people like myself roar out of retirement to produce the things to which we assign completely new values? Less lying around drinking beer, and more medical supplies? Lots more prepping? More research? More home security? More serious schools? More homeschooling, more local agriculture?

#3.1 Texan99 on 2020-04-06 08:31 (Reply)

From Powerline:

Coronavirus Infectious Disease Modeling: What’s the Track Record?

QUOTE:

But the Times goes on to ask an important question that I have not previously seen raised: do disease modelers have a track record that deserves to inspire the remarkable confidence that is being reposed in them?

. . . I conclude with the famous words of Freeman Dyson, one of the 20th centuries most eminent scientists: “Science is the belief in the ignorance of experts.”

https://tinyurl.com/uj7ebve

#4 feeblemind on 2020-04-05 14:20 (Reply)

It's Feynman, actually:
http://www.feynman.com/science/what-is-science/

Poweline can sort it out on their own...

#4.1 Jeff Allen on 2020-04-05 14:37 (Reply)

Thank you for saying it. Until there is an antibody test given to enough people to have a freaking idea of how many people are infected all of the "experts" are just making wild ass guesses.

I understand bending the curve to prevent overwhelming the system, but does bending the curve change the total area under the curve or are we kicking the can down the road? What stops this virus from running through the entire population without treatment or a vaccine?

#5 Ralph Carbone (Link) on 2020-04-05 15:08 (Reply)

bending the curve does not reduce cases. it just makes it easier on medical care.

#5.1 BD on 2020-04-05 15:27 (Reply)

There is an antibody test. I have a kit.

#5.2 Stu Cook on 2020-04-05 21:47 (Reply)

Reasoned? Balanced? Fair? How dare you!

#6 tim ferrell on 2020-04-05 16:23 (Reply)

The purpose of bending the curve is multi-fold. The biggest one is to spread out the disease so the health care system is not overwhelmed. 100,000 people needing ventilators and care in one month is worse than 20,000 each month for five months. This also allows a better chance for everyone to get the care they need. During that time it also allows for some amount of herd immunity to develop. It also allows time for scientists to develop a treatment and or cure. It may reduce the total number of cases or it may actually cause more cases since the virus s active longer. The negative of course is the economic and psychological damage of a recession and or depression. Those also cause deaths just not as dramatically as a disease and they are far harder to count.

#7 Andrew Stanton on 2020-04-05 16:41 (Reply)

I think we are going to get to the point where the government is going to order people to be intentionally exposed to this in batches, probably chosen by lottery. That is the only way to beat this other than a vaccine. Otherwise, we will be sheltering in place permanently. In Europe they are already talking about issuing special identifications to people who have gotten and survived the virus, because they can go back to work.

#8 Jim on 2020-04-05 21:37 (Reply)

All this debate over the numbers and data. It is wise to remember the "you cannot fatten a hog by weighing it."

#9 Blick on 2020-04-06 10:44 (Reply)

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Sunday, April 5. 2020

Covid-19: What to do when you have no meaningful data yet