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PurpleDawg

COVID19 Thread

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TCU-specific COVID-19 Updates

https://www.tcu.edu/news/coronavirus

 

 

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Very interesting thread about running the numbers of various factors re: the virus. Stark. Only about a 7 minute read, but worth it.

 

I think most people aren’t aware of the risk of systemic healthcare failure due to #COVID19 because they simply haven’t run the numbers yet. Let’s talk math. 
 
Let’s conservatively assume that there are 2,000 current cases in the US today, March 6th. This is about 8x the number of confirmed (lab-diagnosed) cases. We know there is substantial under-Dx due to lack of test kits; I’ll address implications later of under-/over-estimate. 
 
We can expect that we’ll continue to see a doubling of cases every 6 days (this is a typical doubling time across several epidemiological studies). Here I mean *actual* cases. Confirmed cases may appear to rise faster in the short term due to new test kit rollouts. 
 
We’re looking at about 1M US cases by the end of April, 2M by ~May 5, 4M by ~May 11, and so on. Exponentials are hard to grasp, but this is how they go. 
 
As the healthcare system begins to saturate under this case load, it will become increasingly hard to detect, track, and contain new transmission chains. In absence of extreme interventions, this likely won’t slow significantly until hitting >>1% of susceptible population. 
 
What does a case load of this size mean for healthcare system? We’ll examine just two factors — hospital beds and masks — among many, many other things that will be impacted. 
 
The US has about 2.8 hospital beds per 1000 people. With a population of 330M, this is ~1M beds. At any given time, 65% of those beds are already occupied. That leaves about 330k beds available nationwide (perhaps a bit fewer this time of year with regular flu season, etc). 
 
Let’s trust Italy’s numbers and assume that about 10% of cases are serious enough to require hospitalization. (Keep in mind that for many patients, hospitalization lasts for *weeks* — in other words, turnover will be *very* slow as beds fill with COVID19 patients). 
 
By this estimate, by about May 8th, all open hospital beds in the US will be filled. (This says nothing, of course, about whether these beds are suitable for isolation of patients with a highly infectious virus.) 
 
If we’re wrong by a factor of two regarding the fraction of severe cases, that only changes the timeline of bed saturation by 6 days in either direction. If 20% of cases require hospitalization, we run out of beds by ~May 2nd. 
 
If only 5% of cases require it, we can make it until ~May 14th. 2.5% gets us to May 20th. This, of course, assumes that there is no uptick in demand for beds from *other* (non-COVID19) causes, which seems like a dubious assumption. 
 
As healthcare system becomes increasingly burdened, Rx shortages, etc, people w/ chronic conditions that are normally well-managed may find themselves slipping into severe states of medical distress requiring intensive care & hospitalization. But let’s ignore that for now. 
 
Alright, so that’s beds. Now masks. Feds say we have a national stockpile of 12M N95 masks and 30M surgical masks (which are not ideal, but better than nothing). 
 
There are about 18M healthcare workers in the US. Let’s assume only 6M HCW are working on any given day. (This is likely an underestimate as most people work most days of the week, but again, I’m playing conservative at every turn.) 
 
As COVID19 cases saturate virtually every state and county, which seems likely to happen any day now, it will soon be irresponsible for all HCWs to not wear a mask. These HCWs would burn through N95 stockpile in 2 days if each HCW only got ONE mask per day. 
 
One per day would be neither sanitary nor pragmatic, though this is indeed what we saw in Wuhan, with HCWs collapsing on their shift from dehydration because they were trying to avoid changing their PPE suits as they cannot be reused. 
 
How quickly could we ramp up production of new masks? Not very fast at all. The vast majority are manufactured overseas, almost all in China. Even when manufactured here in US, the raw materials are predominantly from overseas... again, predominantly from China. 
 
Keep in mind that all countries globally will be going through the exact same crises and shortages simultaneously. We can’t force trade in our favor. 
 
Now consider how these 2 factors – bed and mask shortages – compound each other’s severity. Full hospitals + few masks + HCWs running around between beds without proper PPE = very bad mix. 
 
HCWs are already getting infected even w/ access to full PPE. In the face of PPE limitations this severe, it’s only a matter of time. HCWs will start dropping from the workforce for weeks at a time, leading to a shortage of HCWs that then further compounds both issues above. 
 
We could go on and on about thousands of factors – # of ventilators, or even simple things like saline drip bags. You see where this is going. 
 
Importantly, I cannot stress this enough: even if I’m wrong – even VERY wrong – about core assumptions like % of severe cases or current case #, it only changes the timeline by days or weeks. This is how exponential growth in an immunologically naïve population works. 
 
Undeserved panic does no one any good. But neither does ill-informed complacency. It’s wrong to assuage the public by saying “only 2% will die.” People aren’t adequately grasping the national and global systemic burden wrought by this swift-moving of a disease. 
 
I’m an engineer. This is what my mind does all day: I run back-of-the-envelope calculations to try to estimate order-of-magnitude impacts. I’ve been on high alarm about this disease since ~Jan 19 after reading clinical indicators in the first papers emerging from Wuhan. 
 
Nothing in the last 6 weeks has dampened my alarm in the slightest. To the contrary, we’re seeing abject refusal of many countries to adequately respond or prepare. Of course some of these estimates will be wrong, even substantially wrong. 
 
But I have no reason to think they’ll be orders-of-magnitude wrong. Even if your personal risk of death is very, very low, don’t mock decisions like canceling events or closing workplaces as undue “panic”. 
 
These measures are the bare minimum we should be doing to try to shift the peak – to slow the rise in cases so that healthcare systems are less overwhelmed. Each day that we can delay an extra case is a big win for the HC system. 
 
And yes, you really should prepare to buckle down for a bit. All services and supply chains will be impacted. Why risk the stress of being ill-prepared? 
 
Worst case, I’m massively wrong and you now have a huge bag of rice and black beans to burn through over the next few months and enough Robitussin to trip out. 
 
One more thought: you’ve probably seen multiple respected epidemiologists have estimated that 20-70% of world will be infected within the next year. If you use 6-day doubling rate I mentioned above, we land at ~2-6 billion infected by sometime in July of this year. 
 
Obviously I think the doubling time will start to slow once a sizeable fraction of the population has been infected, simply because of herd immunity and a smaller susceptible population. 
 
But take the scenarios above (full beds, no PPE, etc, at just 1% of the US population infected) and stretch them out over just a couple extra months. 
 
That timeline roughly fits with consensus end-game numbers from these highly esteemed epidemiologists. Again, we’re talking about discrepancies of mere days or weeks one direction or another, but not disagreements in the overall magnitude of the challenge. 
 
This is not some hypothetical, fear-mongering, worst-case scenario. This is reality, as far as anyone can tell with the current available data. 
 
That’s all for now. Standard disclaimers apply: I’m a PhD biologist but *not* an epidemiologist. Thoughts my own. Yadda yadda. Stay safe out there. /end
 

 

Original tweet (with many interesting replies from non-aholes/deniers):

 

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Would love to hear from @tcudoc and other people on our board who are experts in fields related to the virus and the response to it. Plus, how is it affecting people already? Anyone you know who is sick? Has your work instituted changes in travel or offered work from home options?

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Statement from the American Veterinary Medical Association about COVID19. Basically summed up as follows...

 

At this time, experts have not expressed concern about transmission to or from animals. Multiple international health organizations have indicated that pets and other domestic animals are not considered at risk for contracting COVID-19.

 

https://www.avma.org/blog/what-do-you-need-know-about-coronavirus

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I've been telling anyone who will listen 2 things: 1. Don't panic as that doesn't help anything. 2. Do realize that in the next 3 to 12 months minimum things are likely to get serious and if so, serious actions and consequences will ensue. Or maybe the virus will mutate. Has happened. But most basically there is a bad time likely coming we will have to get together and work through it.

 

Much time has been lost by groups far more interested in maintaining their own power than the good of the populations involved. You probably know, for example, that British Columbia alone has tested more people than the entire USA--let alone Washington state--as they prepared a lot better. They're still getting hit but the extra info is basic to attempting to limit further spread. Testing and public health measures to limit spread are going to be the sole methods available for a goodly while yet. The USA is not presently set up as well as might be desired along those 2 in my opinion. Better than Iran, maybe, but that's a pretty low bar.

 

One ASAP thing to do: Communicate, explore, cajole, or downright legislate ways in which workers and their families can live through extended quarantines. The sick leave issue is going to bite BIG time and preparations need to begin now. I see no progress to date on this except a few proposals to subsidize travel industry owners, execs, and corps but not workers. As Obi-wan would say: This is not the approach you are looking for.

 

 

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6 minutes ago, Rothbardian said:

I supposed to be in St. John, USVI over Easter y'all...


I can top that.  I’m supposed to board a cruise in Galveston in a week.

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Just now, Newbomb Turk said:


I can top that.  I’m supposed to board a cruise in Galveston in a week.

Just think of all the posts you can generate while shut up in your cabin for a couple of weeks!

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After being on hold for most of last night, giving up, and calling back this morning, we were able to cancel for a future fare credit.
 

Royal Caribbean is handling this very responsibly, IMHO.  If you reschedule, you get a dollar for dollar fare credit.  You can book a new cruise any time before 12/31/21.  The cost of any prepaid services like internet, ship’s tours, and shore excursions get credited directly to your credit card.

 

I REALLY wasn’t looking forward to being in a human petri dish for a week, then being held offshore indefinitely.

 

So TurkVision will be covering all three Maryland games next weekend.

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Really relieved to hear you're not going cruising, Newbomb. All the experts I've read and heard in the past several days have said re-think overseas travel ( @Rothbardian) and getting on a cruise ship. It's an inconvenience and a big bummer for Spring Break and summer plans, but as Newf said, everyone is going to have to pitch in to get through this.

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So is this worse than Swine Flu...or Zika...or Bird Flu...or SARS?  I cannot tell anymore.

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10 hours ago, Army Frog Fan said:

So is this worse than Swine Flu...or Zika...or Bird Flu...or SARS?  I cannot tell anymore.

 

It's more like measles than flu in terms of its population infection capabilities (infectivity in epidemiology jargon). And it's about 20x more lethal than aggregated flus.

 

Maybe this thread is best kept as low key, objective, and factual as possible?

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1 hour ago, NewfoundlandFreeFrog said:

 

It's more like measles than flu in terms of its population infection capabilities (infectivity in epidemiology jargon). And it's about 20x more lethal than aggregated flus.

 

Maybe this thread is best kept as low key, objective, and factual as possible?

 

Is it that much more lethal though?  Last time I read about it (maybe a week ago), it was mentioned that a decent portion of folks who get the virus have no symptoms.  If that is the case, then we really have no idea how many people have it.  Obviously all deaths (the numerator) are accounted for, but if the infected population (the denominator) is much larger than just those who have been tested positive, then the lethality is much less than what is reported..

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4 hours ago, Army Frog Fan said:

 

Is it that much more lethal though?  Last time I read about it (maybe a week ago), it was mentioned that a decent portion of folks who get the virus have no symptoms.  If that is the case, then we really have no idea how many people have it.  Obviously all deaths (the numerator) are accounted for, but if the infected population (the denominator) is much larger than just those who have been tested positive, then the lethality is much less than what is reported..

Personally I'd say for now we probably ought to accept what professionals are saying about numerators and denominators in this thread at least.

 

It is possible the virus will mutate towards less lethality. Most do as too high an infectivity and lethality effectively destroys an outbreak too. Though at a cost to the host population in the short term.

 

But think for now in threat terms. Hopefully the maximum threat will not actually occur. But prep for it is necessary in any case. Your own professional training says much the same as well in your own area of expertise, I think. (Though I am not such an expert and so cannot be completely sure.)

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@Army Frog Fan It's more lethal than flu because there is no vaccine (and won't be for about a year) and we have no immunity to it. To equate Corona virus to any other malady that we have inoculations for is to miss the point. There is no way to avoid this thing completely unless you stay holed up 24/7 for the next several months. 

 

If you haven't read anything about it for a week, you're way behind, friend. And, don't expect to get the best information from anyone in the White House, including the VP, who is in charge of the country's response. They've completely politicized it, all for the best chance at getting Trump reelected.

 

For some sobering thoughts on how bad this thing can get really quickly, read that post at the top of this thread. We don't have the capacity to care for all the people who are going to get very sick, and that's coming from many experts. 

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I read somewhere that they were having success treating with drugs used to combat malaria.

 

Also, I herd there was a possibility of two strains and the lesser of does not make you immune to the greater...

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1 hour ago, Rothbardian said:

I read somewhere that they were having success treating with drugs used to combat malaria.

 

...

 

Let's keep WhatsApp and Nigerian scams and other disinformation out of this thread at least! https://factcheck.afp.com/chloroquine-has-not-been-approved-treatment-covid-19

 

Try God Save Us for such things? Or start a  Covid: Scams, Disinformation, and Misinformation thread? Or is it OK with everyone to mix factual stuff with politics, jokes, and scams?

 

 

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1 hour ago, NewfoundlandFreeFrog said:

 

Let's keep WhatsApp and Nigerian scams and other disinformation out of this thread at least! https://factcheck.afp.com/chloroquine-has-not-been-approved-treatment-covid-19

 

Try God Save Us for such things? Or start a  Covid: Scams, Disinformation, and Misinformation thread? Or is it OK with everyone to mix factual stuff with politics, jokes, and scams?

 

 

 

You can be such an ***...sorry you are an ***.

 

https://nypost.com/2020/02/14/doctors-attempt-to-battle-coronavirus-with-medications-for-hiv-ebola-and-malaria/

 

https://www.latimes.com/science/story/2020-02-13/fighting-covid-19-with-drugs-targeting-hiv-malaria-ebola

 

https://www.scientificamerican.com/article/to-fight-coronavirus-outbreak-doctors-deploy-drugs-targeting-hiv-malaria-and-ebola/

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1 hour ago, Rothbardian said:

 

There is no success being reported in articles 1 and 3 (can't seem to access #2), only normal research where researchers screen out a large number of possible drugs as possibilities. Citing such normal prelim research as "they were having success treating with drugs used to combat malaria" is more than a bit preliminary at best. Asinine, even. When anything actually works, we'll find out pretty quick. Antivirals may form part of any treatment for certain cases, but disease prevention with them is not at all likely. They cannot be used that way across whole populations.

 

It is simply a gigantic and misinforming leap from, as SciAm says, "Despite flimsy evidence, trying these drugs in humans is the only way to know if they will work against COVID-19" to docs are "having success". But have your dudgeon if it makes you feel better.

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1 hour ago, Rothbardian said:

 

Are you still happy my wife is dead too? 

 

Anyway, don't you think it's time to get back on topic? I'm simply suggesting that one thread should be straightforwardly objective and verifiable. Other covid threads are fine as well but I'm suggesting we keep one clean one. 

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I think this thread needs to be quarantined.  

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1 hour ago, Army Frog Fan said:

image.jpeg.889c483ae8e998c9d5dd444cb4ea1965.jpeg

Natural selection?

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Suspected case in Collin County, pt had recent travel to California. 

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