Understand, the main objective of "Flattening the Curve" was to avoid overwhelming our hospitals. Not necessarily eliminate Covid in a few weeks or months.

[BLA + 1,666]

We obviously want to prevent as many deaths as possible. That's a given. 

This virus is extremely contagious. We know the virus has survived up to 17 days on a princess cruise liner before it was sanitized.  

This is a difficult one to outright kill.  May be impossible. 

Some want a nationwide quarantine until the virus is eradicated.  That could last forever.  

Others want to quarantine those over 60. Still others want to test everybody and quarantine only those infected. Certain segments of the population could continue to be quarantined. That can be worked out. 

In the meantime the economy could go into such disrepair it will take many many years to rebound. This could cause more deaths and hardship than one can imagine. 

It's never to early to discuss or plan to "reopen" the economy.  Can't hurt to start. 

Strange as it sounds the different paths have to some extent aligned with various political ideologies. I don't understand.  It's sad . 

 

Edited April 15, 2020 by BLA

[0R0 + 6,251]

Absolutely.

There is no such thing as safe. The virus does not go away. It will be with us like the common cold and the flu. It will cull our population every year just as those diseases do. 

Reopening economic activity should not aim at minimizing the contagion, not to speak of stopping it entirely. The goal is to continue a slow gradual expansion of the virus without large breakouts.  Despite some 80 odd vaccine candidates running in parallel, the conventional vaccine attempts at SARS demonstrate that there is no likely vaccine coming at all unless the new technologies like RNA vaccines are fortunate enough to succeed with good prevention and no side effects, not something we know. Luck is not a projection. Attempts mean something will eventually come. By next year the abject failures will have been weeded out. With likely less than a dozen staying in development. 

The primary goal on the medical side is not testing but treatment. Particularly early stage treatment so that you never develop advanced stages of CV19. We just need to have enough doses of what several treatments prove safe enough and successful enough. HCQ/Z may be good enough. We still don't have a current supply large enough to treat most of the early stage patients at the current rate of 30-40k cases a day, meaning a course of 30 doses per each, or on the order of 1 million doses prescribed per day. That is sort of doable, as Novartis already pledged 130 million. 30 million doses, or 1 million prescriptions were in inventory from Bayer as of two weeks ago. Mylan produces, but I don't know how much, and Bayer may be released to supply outside of Germany again. 

Start containing mass congregations at the level appropriate to each state and regions, do not allow travelers on public transport without masks and gloves. Even give them away at the subway turnstiles and by bus drivers. Everyone else that is not in a risk group should go ahead, while high risk individuals continue being protected so long as it is necessary. 

 Aggressive sanitary practices are necessary and should be easy to apply, even if not that cheaply. Supermarket cart sanitation is just a start. Bathroom sanitation is a must, as is door handles. Once a day is not enough. 

[Gerry Maddoux + 3,627]

16 minutes ago, 0R0 said:

The primary goal on the medical side is not testing but treatment. Particularly early stage treatment so that you never develop advanced stages of CV19. We just need to have enough doses of what several treatments prove safe enough and successful enough. HCQ/Z may be good enough.

It is just one more oddity in this disease that both HCQ and Zithromax cause some degree of QT prolongation in the ECG. In most people this isn't a huge worry; however, the Covid-19 virus tends to strike those with heart disease, and there are some reports that the virus goes to the heart muscle fairly early, so QT prolongation is obviously concerning to the physicians giving this out.

The arrhythmia that is sometimes precipitated by having a long QT (repolarization period) is a really nasty thing called torsades de pointe ("the electrical orientation twists on itself"). Whereas ventricular tachycardia is usually very clean and oriented in one direction (monomorphic), and is also easy to convert with a defibrillator, this one (tdp) is polymorphic and hard to convert.

This doesn't make me pessimistic about the drug(s), but it does tell me why they've been so slowly incorporated into standard medical care for Covid-19. 

[0R0 + 6,251]

24 minutes ago, Gerry Maddoux said:

It is just one more oddity in this disease that both HCQ and Zithromax cause some degree of QT prolongation in the ECG. In most people this isn't a huge worry; however, the Covid-19 virus tends to strike those with heart disease, and there are some reports that the virus goes to the heart muscle fairly early, so QT prolongation is obviously concerning to the physicians giving this out.

The arrhythmia that is sometimes precipitated by having a long QT (repolarization period) is a really nasty thing called torsades de pointe ("the electrical orientation twists on itself"). Whereas ventricular tachycardia is usually very clean and oriented in one direction (monomorphic), and is also easy to convert with a defibrillator, this one (tdp) is polymorphic and hard to convert.

This doesn't make me pessimistic about the drug(s), but it does tell me why they've been so slowly incorporated into standard medical care for Covid-19. 

A long Island nursing home infectious disease guy treated his largely octogenarian patients in a breakout of 40 some with HCQ and Doxycycline with much better results than average for the age group with the comorbidities they had. 

[Gerry Maddoux + 3,627]

It's wild, some of my old comrades are reportedly using Ivermectin, a horse-worming medication, as it seems to prevent ingress into the cell. The statistics are so awful on men over age 60 that doctors are desperate. 

If you go onto a ventilator, there's almost a 75% mortality, so that's pretty much out.  

These drugs that prevent entry into the cell or damage once inside are going to be simple drugs that have been around for a long time, it would appear. From desperation comes ingenuity. 

Well, keep up the good work. I enjoy reading your informative messages and can tell you're being careful with what you say.

[Enthalpic + 1,496]

3 hours ago, Gerry Maddoux said:

It's wild, some of my old comrades are reportedly using Ivermectin, a horse-worming medication, as it seems to prevent ingress into the cell. The statistics are so awful on men over age 60 that doctors are desperate. 

If you go onto a ventilator, there's almost a 75% mortality, so that's pretty much out.  

These drugs that prevent entry into the cell or damage once inside are going to be simple drugs that have been around for a long time, it would appear. From desperation comes ingenuity. 

Well, keep up the good work. I enjoy reading your informative messages and can tell you're being careful with what you say.

I might inject myself with veterinary medicine (probably not that) if I have too; any farmer can buy meds around here.  Rancher I know has loads of stuff on hand.

I have a good stock of I.V. and other fluid resuscitation supplies (not home made).  My sister is nurse and one of my best friends is a phlebotomist.  I can get good shit and knowledge.

My home-made oxygen generator is well on track... 

Not going to hospital... I'll die at home if I have to.

[Enthalpic + 1,496]

I also found a powerful UVC light in my storage shit! Sweet germicidal stuff.

https://en.wikipedia.org/wiki/Ultraviolet_germicidal_irradiation

Edited April 15, 2020 by Enthalpic

[Douglas Buckland + 6,308]

What’s with the quarantining of 60 year olds now? Last I heard it was the 80+ crowd at risk.

I would be willing to bet that a large portion of the population 60-65 are in better shape than a similarly large portion of the sedentary, digital, non-physically fit recent generations.

Edited April 15, 2020 by Douglas Buckland
Ggg

[Enthalpic + 1,496]

The science boxes I've collected over the years are fun during self-isolation

 

[Enthalpic + 1,496]

7 minutes ago, Douglas Buckland said:

What’s with the quarantining of 60 year olds now? Last I heard it was the 80+ crowd at risk.

I would be willing to bet that a large portion of the population 60-65 are in better shape than a similarly large portion of the sedentary, digital re

People who are very, very old might be better to handle this stuff; if you lived through a world war and former plagues you just have the survivor stuff.

https://www.ctvnews.ca/health/coronavirus/second-world-war-veteran-99-heads-home-after-beating-covid-19-1.4891475

“He’s fought to get better. He wanted to get back home. He’s pretty amazing.”

Edited April 15, 2020 by Enthalpic

[Enthalpic + 1,496]

Some people just have the will to live

[BradleyPNW + 282]

20 hours ago, BLA said:

In the meantime the economy could go into such disrepair it will take many many years to rebound. This could cause more deaths and hardship than one can imagine.

Neither economists nor infectious disease experts agree. I don't know where the thesis of "a bad economy will kill more people than the virus" originated but it is totally false. 

https://review.chicagobooth.edu/economics/2020/article/don-t-fall-false-trade-offs-covid-19-policy
 

[BLA + 1,666]

22 minutes ago, BradleyPNW said:

Neither economists nor infectious disease experts agree. I don't know where the thesis of "a bad economy will kill more people than the virus" originated but it is totally false. 

https://review.chicagobooth.edu/economics/2020/article/don-t-fall-false-trade-offs-covid-19-policy
 

Are you an economist or an infectious disease expert.   .   .  .  .  .  . 

Or just a an academic living in your academic world ?

[Geoff Guenther + 317]

With any reopening we'll have some sort of restrictions, the question is what restrictions are we willing to live with in the meantime to get an R0 of less than 1. So long as the average infected person passes the virus off to 1 or less the pandemic can stay under control.

Everyone wants kids back in schools ASAP and most on this site want their pubs open again, so what are the other things we're willing to trade off to open the economy as much as possible? No one action will reduce the R0 below one, so we pick and choose actions to get them into that range and then add and remove measures depending on the new infection rate.

The goal should NOT be to get an R0 of 0.5. That is economically harmful, reduces our freedom, and it's doubtful that it would save many lives.

In all of this the governments have to be transparent otherwise people will be disincentivised by following inconvenient measures. For the government to be transparent this means a huge amount of test and trace. I did think the items below were a decent list of various measures. All of them have costs, be that freedom restrictions or money, so a balance needs to be kept.

Frustratingly, this is infectious enough that we'll end up (hopefully temporarily) giving up more freedoms than any of us would like.

[Gerry Maddoux + 3,627]

14 hours ago, Douglas Buckland said:

What’s with the quarantining of 60 year olds now? Last I heard it was the 80+ crowd at risk.

I would be willing to bet that a large portion of the population 60-65 are in better shape than a similarly large portion of the sedentary, digital, non-physically fit recent generations.

You're probably right but I'm reading this message off my texts, from the hospital where I worked for a long time: "Over the age of 60 on the vent, 85% die." 

This virus, for whatever reason, favors those with hypertension, overweight or obesity, heart disease, diabetes, or smokers. In America, that would include about 75% of men over age sixty.

Additionally, there are too many quirks to sort out the virus. For example, if you're air-hungry and cyanotic, it sounds like you're better off getting flipped over onto your belly than being put on a ventilator. On a lighter note, while NYC was bellowing for ventilators, they should have been putting out bonus packages for strong young men to act as flippers.  

[0R0 + 6,251]

1 hour ago, BradleyPNW said:

Neither economists nor infectious disease experts agree. I don't know where the thesis of "a bad economy will kill more people than the virus" originated but it is totally false. 

https://review.chicagobooth.edu/economics/2020/article/don-t-fall-false-trade-offs-covid-19-policy
 

It takes 750k lifetimes of income per month to keep the economy closed.

If you are not close to that many deaths, you have made a giant economic and human error. 

These costs do not go away because congress waved its hands. They remain and weigh heavily on the individuals and companies that make our lives possible. Ergo, they make life possible for fewer people, and fewer people have a life they are willing to contemplate. 

Agree that it is not a one to one tradeoff. But it is a tradeoff. 

That is particularly the case because no rational allocation of risk is associated with any of the particular activities shut down nor was there any attempt made to protect high risk groups while, nor allowing the rest to get the disease over with and gain immunity. Nor was any effort made to restrict particular environments where transmission is intensely concentrated, namely public transport, other than bars and large congregations universities and schools. 

If anything was arbitrary capricious and antiproductive an American governor was sure to do it.

The important thing to have learned from China was not to do total lockdowns even where it seems rational. 

 

[BradleyPNW + 282]

1 hour ago, BLA said:

Are you an economist or an infectious disease expert.   .   .  .  .  .  . 

Or just a an academic living in your academic world ?

You didn't even bother to check the author of the article I posted? That's literally the first thing I do when I read an article, check credentials. Also, what I said was fact. Not even a controversial fact. The consensus is totally lopsided in favor of keeping the economy closed by both economists and infectious disease experts. Of course, I'm sure the genius hosts of Fox & Friends have different ideas from the people who have devoted their lives to studying the topics. 

https://www.chicagobooth.edu/faculty/directory/m/neale-mahoney

[BradleyPNW + 282]

17 minutes ago, 0R0 said:

That is particularly the case because no rational allocation of risk is associated with any of the particular activities shut down nor was there any attempt made to protect high risk groups while, nor allowing the rest to get the disease over with and gain immunity.

How do you know there is a lasting immunity? You don't because COVID19 is a novel disease and SARS-CoV-2 is a novel virus (meaning, it's new and we don't understand either yet.) For all we know the immunity might only last three months. 

We already know there have been at *least* three variants of the virus as it has mutated through infected populations. That fact alone throws into question the idea of post-infection immunity. And you'd make the evolution of the virus more varied if you encouraged it to infect even larger numbers. 

Every single year we give a new flu shot. Why? Because the virus mutates. And our flu shots aren't even effective against all strains. They just choose to manufacture the vaccine they think will protect the most people based on their research. 

[Geoff Guenther + 317]

2 hours ago, BradleyPNW said:

Neither economists nor infectious disease experts agree. I don't know where the thesis of "a bad economy will kill more people than the virus" originated but it is totally false. 

https://review.chicagobooth.edu/economics/2020/article/don-t-fall-false-trade-offs-covid-19-policy

Funny, I've only come across the flip side - if we let the virus run rampant it will be more damaging to the economy than shutting it down short term. A destroyed economy will kill more people than the virus. but it's that a virus could destroy the economy than that shutting down the economy for two months would.

So yes, there are two big questions to answer: when do we reopen, and what measures need to be in place.

To your other point: yes, the virus will mutate, however it is mutating more slowly than your typical flu virus. It's still entirely possible that a single vaccine will be effective against all mutations.

[Ward Smith + 6,615]

45 minutes ago, BradleyPNW said:

You didn't even bother to check the author of the article I posted? That's literally the first thing I do when I read an article, check credentials. Also, what I said was fact. Not even a controversial fact. The consensus is totally lopsided in favor of keeping the economy closed by both economists and infectious disease experts. Of course, I'm sure the genius hosts of Fox & Friends have different ideas from the people who have devoted their lives to studying the topics. 

https://www.chicagobooth.edu/faculty/directory/m/neale-mahoney

The second I read the word "consensus" I know the BS is going to be knee deep, at least. 

The last non liberal economist is dead, so any "consensus" is coming from the mutual admiration society who produced a certain New York Times editorialist who has never been right. You'd think a guy like that would be hiding in a basement instead of continuing to publish his claptrap. But yeah, credentials over substance because appeal to authority is so compelling

[0R0 + 6,251]

7 minutes ago, BradleyPNW said:

How do you know there is a lasting immunity? You don't because COVID19 is a novel disease and SARS-CoV-2 is a novel virus (meaning, it's new and we don't understand either yet.) For all we know the immunity might only last three months. 

We already know there have been at *least* three variants of the virus as it has mutated through infected populations. That fact alone throws into question the idea of post-infection immunity. And you'd make the evolution of the virus more varied if you encouraged it to infect even larger numbers. 

Every single year we give a new flu shot. Why? Because the virus mutates. And our flu shots aren't even effective against all strains. They just choose to manufacture the vaccine they think will protect the most people based on their research. 

We don't know what the dominant  immunity mechanism is among the young, but it appears not to be focused on the production of copious amounts of antibodies. A T-cell response is most likely. 

The older people who do have symptoms produce enormous amounts of antibodies. Indeed, the main determinant of their death is that their immune system goes into a cytokine storm. 

So while we don't know exactly what sort of immunity is gained by the young, we do obviously see it in real life for 99% or more of infections, while the high risk group by age produce copious antibodies and they last just as do those for flu and flu vaccines. 

If the antibodies are not there, then neither is the possibility of a vaccine, and we should just let the disease roll through as soon as viable treatments are available, as they are now. 

Each generation of the virus retains most of its proteins, so a large portion of the population is immune to it as they have antibodies to any of the several possible proteins on the virus. Only protein vaccine makers have a general problem with the flu shot antibodies as they are either a single protein that remains intact from the virus, or several bits most of which will not produce antibodies. Ask Gerry Maddoux for the details. 

As is usual, they also miss more often than not. The emerging viruses they  choose for the vaccine are not often those that go on to reach the public during flu season a few months later. 

You seem to have a fear response without any counterbalance. Think it through.

[BLA + 1,666]

1 hour ago, BradleyPNW said:

You didn't even bother to check the author of the article I posted? That's literally the first thing I do when I read an article, check credentials. Also, what I said was fact. Not even a controversial fact. The consensus is totally lopsided in favor of keeping the economy closed by both economists and infectious disease experts. Of course, I'm sure the genius hosts of Fox & Friends have different ideas from the people who have devoted their lives to studying the topics. 

https://www.chicagobooth.edu/faculty/directory/m/neale-mahoney.

 

Edited April 15, 2020 by BLA

[BLA + 1,666]

48 minutes ago, BradleyPNW said:

How do you know there is a lasting immunity? You don't because COVID19 is a novel disease and SARS-CoV-2 is a novel virus (meaning, it's new and we don't understand either yet.) For all we know the immunity might only last three months. 

We already know there have been at *least* three variants of the virus as it has mutated through infected populations. That fact alone throws into question the idea of post-infection immunity. And you'd make the evolution of the virus more varied if you encouraged it to infect even larger numbers. 

Every single year we give a new flu shot. Why? Because the virus mutates. And our flu shots aren't even effective against all strains. They just choose to manufacture the vaccine they think will protect the most people based on their research. 

Brad

The virus has mutated 3 times ?  Is this documented somewhere ?   Thanks.

[Rob Kramer + 696]

I dont have alot to offer here but i do just want to say I added up the average times between possibly getting it to feeling bad enough to go to a hospital and average time in hospital and it came to 17 days  ... so why self quarantine for 14? I see BLA has another area that's 17 days of spreadablility

 

[BLA + 1,666]

1 hour ago, Geoff Guenther said:

Funny, I've only come across the flip side - if we let the virus run rampant it will be more damaging to the economy than shutting it down short term. A destroyed economy will kill more people than the virus. but it's that a virus could destroy the economy than that shutting down the economy for two months would.

So yes, there are two big questions to answer: when do we reopen, and what measures need to be in place.

To your other point: yes, the virus will mutate, however it is mutating more slowly than your typical flu virus. It's still entirely possible that a single vaccine will be effective against all mutations.

You know attempts to create a vaccine for Sars a close cousin has failed.

Could be the development dragged on for too long and the money dried up. 

There is no guarantee a vaccine will ever be developed for Covid.

Edited April 15, 2020 by BLA