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Gordo

Just curious, anyone have a plan, or preps for global pandemic?

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Another explanation which just came up in my mind is the obvious one that while deaths are been counted more or less accurately, many cases of infection are not reported. But this should be a more or less homogeneous situation in Europe, which is not.

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Russia is set to send teams of doctors, protective gear and medical equipment to Italy to help fight the Covid-19 pandemic in the country. It follows an appeal by Italian PM Giuseppe Conte during a phone call with Vladimir Putin.

[...]Eight teams of Russian military medics and virology experts are already on standby and could be deployed  to Italy as early as Sunday...

 

Edited by Sibiriak

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1 hour ago, Sibiriak said:

Russia is set to send teams of doctors, protective gear and medical equipment to Italy to help fight the Covid-19 pandemic in the country. It follows an appeal by Italian PM Giuseppe Conte during a phone call with Vladimir Putin.

[...]Eight teams of Russian military medics and virology experts are already on standby and could be deployed  to Italy as early as Sunday...

Kudos to Putin, that is the positive side of human nature, people helping even if endangering themselves. In Italy an appeal has been launched for 300 medics from all regions wanting to work in the deadly Lombardy cluster. 7000 answered. Besides, it  also makes an excellent CV for young people and gives to any medical professional additional skills and a glimpse into another world, which medical staff didn't know until now. 

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9 hours ago, TomBAvoider said:

...It seems to me there really are no reliable ways to predict what's going to happen, simply because we don't know what the relevant authorities are going to do, and how the populace will react - and those are just two of dozens and dozens of variables, the behavior of most of which it is impossible to forecast.

Bottom line, it seems to me, all projections are hazy affairs wrt. accuracy. We can all argue this way and that, but nobody has a crystal ball here. The situation is serious. OK. But how serious? Who knows. Which is why I guess folks are advocating for taking fairly drastic precautionary measures... how will that shake out? Too many unknowns.

Yup.

Govt's spend decades and billions of $ on supercomputers and techniques to model arguably simpler processes, like weather patterns (tornados, hurricanes), black holes, supernovae, ...and, of course, disease evolution, etc, etc ... and all those REMAIN largely work-in-progresses.

YouTubers like Thunderf00t are entertaining. They may even get it right some of the time (Mr. Tf is Dr. Phil Mason , a research chemist) . For example,  I liked what he did to de-myth the popular and very-high-rated Chernobyl (2019) miniseres .

But pandemics are fairly open-ended and unpredictable event. You can think of them as a sort of Natural correction.

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A few thoughts today...

1) When times are tough, sometimes we just need to be more innovative. Maybe we actually have more ventilators than we think, as in four times more! See: A single ventilator for multiple simulated patients to meet disaster surge. I wonder if any hospital staff even know this is an option? Likewise, to avoid running out of n95 masks you can simply autoclave them and reuse, even rice cookers work! But it sounds like the US manufacturers are already pumping out so many of them now that we won’t run out.

2) I see many comments about mortality rate in Italy being so high - how does anyone know this for sure? What if it had just been spreading like crazy and most people who had/have it just weren’t tested. Maybe half the population at least in hot spot areas, has already been infected? If that turns out to be true, in the coming weeks the new infection rate would fall off a cliff in those areas.

3) I was listening to the latest freakonomics podcast, and one economist was talking about some of the upsides to this pandemic. With the reduction of air pollution in China, significantly more lives were likely saved than were killed by the virus. In other countries like the U.S. we could see a big drop in traffic related fatalities with everyone staying home. There are other potential benefits with regard to remote work in the future, and online learning. Just thought it was worth a mention, nice to see something positive amid all the dread.

4) I’ve noticed it’s finally becoming socially acceptable to wear personal protective equipment (PPE) in public. I saw both customers and workers at grocery stores wearing face masks and nitrile gloves. I think this is a good sign that people are finally taking the pandemic seriously and that when everyone takes all the recommended steps to avoid infections we are going to see a nice drop in new infections. Along the lines of #3 above- all of these changes in behavior will result in a drop of ALL infectious diseases including the seasonal flu - again this could actually result in FEWER deaths for the year than if we never had the pandemic to begin with (Globally, the World Health Organization(WHO) estimates that the flu kills 290,000 to 650,000 people per year, you will never know how many lives were saved because of improved personal sanitation and preventive behavior).

5) So far I only have limited anecdotal evidence, but I think obese Americans are losing weight during the pandemic and eating at home far more often now, also eating healthier. About 647,000 people die from heart disease every year in the US, it will be interesting to see it that number also goes down.

 

 

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Edited by Gordo

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I see many comments about mortality rate in Italy being so high - how does anyone know this for sure? [...]

Eh? C'mon. If you are saying that the mortality rate in Italy may NOT be high, then that also implies that there are no dramatic differences between infection/mortality rates among nations. But we know that can't be true - what would account for freakish stats like the ones coming out of Taiwan, where you have very few infected and a grand total of 1 dead (at least as of yesterday). Germany has a drastically lower mortality rate (mortality to infection ratio), and I don't think mccoy is right that Germans are somehow massaging their numbers. Clearly there are differences. Some mentioned age (Italy is the second oldest country) - but Japan is even older by population and they don't have the same numbers of either sick or mortality rate. Some have suggested a different strain of the COVID-19, but as far as I know they've only identified two strains so far.

Agreed on the effects of this social distancing etc. - flu, colds and communicable (at least by air/contact) should drop.

Re: PPE becoming more socially acceptable - welcome to the club... this has been standard for most of Asia, although the reasons were slightly different, as they were more meant to abate pollution.

Re: benefits - yes, true, but not all of it is so sunny some is quite grim. There's some grim talk about benefits to various social safety nets and health systems long term. That's the context of a joke I heard from a friend in Poland. The joke goes that ZUS (which is the equivalent of Social Security that pays retired people some basic income) is organizing a fully paid two week vacations for seniors to go on a nice trip to Italy and visit the fascinating Lombardy region. 

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1 hour ago, TomBAvoider said:

Eh? C'mon.

Not sure why you scoff at the idea that Italy may not have as high a mortality rate as many presume. If you don’t know how many are infected then you don’t know the true mortality rate. Remember that 80% of the infected need no medical treatment whatsoever, they have either mild symptoms like a cold or sometimes no symptoms at all.  So why would Italians have a much higher infection rate vs. other countries? https://www.thelocal.it/20170706/how-to-do-the-italian-cheek-kiss-greeting-italy

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UK  (not in USA):

 

NHS hospitals likened to war zones as doctors prepare to make grim decisions

Quote

NHS hospitals are in urgent need of ventilators and are approaching full capacity because of the Covid-19 outbreak... [...]they expect beds in its intensive care unit to be full by 30 March, with one source describing its A&E unit as “like a war zone”.

[...] NHS staff have expressed concern about a shortfall of ventilators and correct protective personal equipment (PPE), with photographs circulating of staff creating their own makeshift items, including with clinical waste bags. [...]Staff at the Royal London hospital in east London told the Guardian that the number of patients there is doubling every five days and will exhaust the current capacity in nine days’ time.

[...]Doctors are having to take decisions about who to treat and who to abandon already. Operations are being cancelled, and we are nowhere near the height of the crisis.”   Managers are looking at options to expand intensive care into theatres, recovery anaesthetic rooms and specialist wards.

[...]there are fears about how staff will cope with the extra patients. A nurse at the hospital, who did not want to be named, said: “The problem as well is nursing staff levels. We are expanding to 35 beds but then we will be short of staff.  [...]the government had received prototypes of new ventilators and should begin production soon. However, NHS staff have said there must be sufficient people trained to operate them too.

Edited by Sibiriak

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At last a reasonable explanation of Italy's and above all Lombardy's high mortality ratio came up. It came from professor Crisanti, a virologist in Veneto, the Italian region just est of Lombardy. Because of the nearness and the similar urban, social and economic conditions the epidemiologic data should be homogenous. They aren't.

March 21st, as I wrote previously, Lombardy exhibited a mortality of 12%. In the same day though, Veneto exhibited a figure of 3%. Now Veneto has followed a very extensive testing strategy, testing not only the ones with symptoms, but the relatives, the coworkers and so on. In one town in particular, Vò Euganeo, the very first outbreak in Italy, all citizens were tested.

So, it seems to be a case of undersampling (undertesting), as Gordo correctly suspected. In Lombardy, they only sample those with significant symptoms and who declare it. This has a double effect:

  1. less sampling on general population, but full sampling on deaths: many infected ones are not confirmed and the numerator in the ratio remains artificially low, hence the artificially high mortality ratio.
  2. Less control of the SARS-COV2 propagation, since those who are not confirmed, are no quarantined (unless they were very close to some confirmed cases and choose voluntarily to shelter all the time).

Of course the consequence of this is that in Lombardy the number of infected cases would be 100 000 and not 25 000 as officially stated. Italy would be on top of China by far. the restricted sampling was probably a politic decision,  not to let the  numbers of confirmed cases inflate too much. But that has backfired, worsening the outspread and also giving unnecessary concern that a new deadly strain had arisen.

The above leaves some unexplained issues though. for example, America has undersampled and the actual infected are probably many more than the official cases, as it is becoming manifest. Death ratio though is not very high. But, as we discussed previously, spatial distribution governs the statistics, so the clusters should be examined more closely. Also, some deaths at the beginning may not have been corectly diagnosed as COVID-19.

Other unexplained issue is the excessively low mortality of Germany, that data remains a mystery unless they oversampled plus they did not attribute all deceased with Covid-19 as caused by Covid-19.

 

 

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I'm going to link the webpage where Dr. Crisanti's reasonings on the Lombardy anomaly have been published, that's in Italian but the google translator today is usually all right.

https://www.globalist.it/science/2020/03/22/crisanti-epidemia-di-coronavirus-in-italia-numeri-inesatti-male-contenimento-e-monitoraggio-di-positivi-2054890.html?www-globalist-it-pub=p2a1kmf6dv70p5n9p8ecfqcg3p

Edited by mccoy

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5 hours ago, mccoy said:

So, it seems to be a case of undersampling (undertesting), as Gordo correctly suspected. [...] Other unexplained issue is the excessively low mortality of Germany, that data remains a mystery unless they oversampled plus they did not attribute all deceased with Covid-19 as caused by Covid-19.

Thanks for the report.

There's a freewheeling democratic debate going on in Russia about whether under-testing and/or non-Covid-19 diagnoses are responsible for the low official numbers. (438  infections reported,  one death.)

 

"Alexander Chepurnov, a virologist at the Russian Academy of Sciences, told state television that Russia is three weeks behind Italy in terms of coronavirus infections and that it can expect to see a similar spike in cases as those seen across Europe."  😮

Edited by Sibiriak

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On 3/22/2020 at 5:09 AM, Dean Pomerleau said:

We only have ~100K intensive care beds, with most of them already occupied (and likely to remain so) by people who don't have coronavirus.  

An important point.  In terms of ICU capacity,  occupancy rates need to be considered along with the total number of beds.  This 2013 study found greater excess capacity than expected:

ICU Occupancy and mechanical ventilator use in the United States

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Despite an overall occupancy estimated at 68% in 2005, many clinicians and policymakers, and perhaps even patients, perceive that the supply of US ICU beds is still insufficient to meet normal temporal variation in critical care demand (6)

 

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Discussion  

In providing national estimates of real-time ICU occupancy and mechanical ventilator use in the US, this study yields four primary findings. First, at any given time, approximately two thirds of ICU beds are occupied, and approximately one third of these beds are occupied by patients requiring mechanical ventilation.

These results suggest greater excess capacity in the US critical care supply than many have imagined. Second, this excess in critical care supply is increased if one considers the large proportion of potentially “discretionary admissions”.

Staffing and other issues  need to be considered as well ( as noted previously.)

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 A lack of appropriately-trained staff able to manage and provide the necessary care is more likely to be our limiting factor than fixed-cost supplies. Studies find that mass emergency care often requires scaling up the medical workforce to such an extent that it may prove difficult in the US.

Assessing the capacity of the healthcare system to use additional mechanical ventilators during a large-scale public health emergency

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Components necessary to provide mechanical ventilation

The four key components necessary to provide ventilation therapy to a patient include the necessary equipment such as ventilators and ancillary supplies including circuits and bacterial filters (supplies), hospital beds equipped for ventilation and comprehensive critical care (space), and specialized medical personnel to manage patients on mechanical ventilators (staff). (3) There is also a need for readily accessible and exercised plans to rapidly increase capacity for patients that require mechanical ventilation (systems) (Figure 1).

 

image.png.f1fa4d7bc0409b78e10f0f54d5cb5c3b.png

 

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The objective of this assessment was to provide a method for projecting the capacity of the U.S. health care system to effectively use stockpiled mechanical ventilators in preparation for a large-scale PHE such as an influenza pandemic.

This assessment showed that the number of additional mechanical ventilators that could be effectively used during the peak of a severe influenza pandemic ranged from approximately 26,200 to 56,300. This range represents the projected number of additional mechanical ventilators that could be effectively used by the U.S healthcare system at the lower boundary of contingency and crisis capacity levels.

As we approach the upper boundary of the range at 56,300 ventilators, subject matter experts interviewed as part of this project expressed concern that various components of the health care system would become stressed and there is uncertainty that health care services could be effectively delivered.

Edited by Sibiriak

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Regarding the stock market, Political Calculations is a blog I track that uses dividend futures to try and guesstimate where the market may be heading. Lately as you can see in this post, particularly the 2nd chart, the futures for upcoming quarters have really dropped a ton, pointing that the market may continue to head a bit lower than it currently is in the coming weeks.

 

https://politicalcalculations.blogspot.com/2020/03/s-declines-as-instant-recession-arrives.html

 

They update this data regularly and do a fresh post each week.

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Antonio Guterres, the United Nations secretary general, has appealed for an immediate global ceasefire, calling on an end to all armed conflicts so that the world can instead focus on fighting Coronavirus.   He assured all the parties involved that the ceasefire would be temporary,  and that once the crisis had ended,  they would be given the green light to resume their activities.

 

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6 hours ago, Sibiriak said:

"Absolutely massive! ” Unbelievable!  "Unprecedented" “Shock and awe! 

U.S Federal Reserve  promises unlimited bond purchases  (QE) and a massive flood of credit.

And yet,  the stock market opens lower.

 

At some point I basically expect to see, without any actual articulation, "OK, the market is down 50%, I'll see you and raise you by bringing the dollar down 50+%"

The level of government spending is going to be breathtaking on this one.  They are talking about trillions $ in rescue packages, unemployment, SNAP, disability, interest free loans to businesses to "not fire anyone" (one senator said today the goal would be to forgive these interest free loans - as in, this money does not have to be paid back).  We are living through a dollar devaluation event that may be more rapid than anything ever attempted before.  Not really sure what would be the best way to preserve one's buying power, but I can sort of see the argument that stocks / S&P500 look pretty cheap when you factor in a large dollar devaluation and assume runaway inflation for the next 10 years.  Oil and other commodities are insanely cheap but aren't very practical as investments in and of themselves.

Edited by Gordo

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Last night I did a quick search to see what was the estimated mortality rate for Europe during the 2017-2018 flu season.

Here is what I found:

""The European number of deaths attributable to influenza was estimated to be 152 thousand persons." 

https://www.sciencedirect.com/science/article/pii/S1198743X19300588

Note that the peak mortality concentrated within about a four week period. Imagine if the headlines led each day's news with the death toll and the number of newly infected.

BTW, Italy generally appears to have a higher influenza-related mortality rate than Europe in general. I didn't have time to search more thoroughly, but here is data which does NOT include the particularly deadly 2017-2018 flu season (which was in turn significantly less deadly when compared to 1969):

"In the winter seasons from 2013/14 to 2016/17, an estimated average of 5,290,000 ILI cases occurred in Italy, corresponding to an incidence of 9%.

More than 68,000 deaths attributable to flu epidemics were estimated in the study period.

Italy showed a higher influenza attributable excess mortality compared to other European countries. especially in the elderly."

https://www.sciencedirect.com/science/article/pii/S1201971219303285

None of this means that this is not a significant outbreak. But it doesn't seem to justify the draconian measures which will have an enormous impact on the economy and will likely cause much more lasting damage than the virus. To me, it appears that much of the histeria is politically driven, fed by fear and reflected in the social media and unfortunately, regular media coverage.

Imposing the toughest restrictions possible is suddenly the safest way for politicians in the world's democracies, otherwise they will be painted by the opposition with the blood of every death. Thus, here we are.

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Here is a nice, frequently updated log-scale graph of deaths by country. It helpfully shows the point at which various countries instituted stay at home policies, and how long it is taking for the curve to start bending down subsequently. 

https://www.ft.com/coronavirus-latest

Here is the the graph as it stands today.  Thankfully Italy appears to be flattening out. 

Screenshot_20200323-155652_Chrome.jpg

--Dean

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32 minutes ago, Ron Put said:

... it doesn't seem to justify the draconian measures which will have an enormous impact on the economy and will likely cause much more lasting damage than the virus.

[...]Imposing the toughest restrictions possible is suddenly the safest way for politicians in the world's democracies, otherwise they will be painted by the opposition with the blood of every death. Thus, here we are.

Where  are the health experts, economists,  social scientists et al. opposing these extreme measures-- authorities that  might  lend legitimacy and credibility to politicians who might be inclined to do the same?

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10 minutes ago, Sibiriak said:

Where  are the health experts, economists,  social scientists et al. opposing these extreme measures-- authorities that  might  lend legitimacy and credibility to politicians who might be inclined to do the same?

I don't have the time right now to debate this, but why are you not focusing on the numbers provided, instead of deflecting?

The numbers are:

2017-1018 Flu season in Europe: 152,000 dead

Italy generally has higher mortality rate than the rest of Europe.

I did post experts, the last one from UCLA. But such experts get drowned by the much more vocal doomsdayers. Not so different than here....

If I were a politician, I'd go with the flow, too. It's not my money, but it's my career. Joining the herd is safer than being in opposition, particularly in the new era of populism.

Anyway, I have to run. Keep watching the blow by blow....

BTW, the Russian take on this is funny.
 



 

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1 hour ago, Gordo said:

 

At some point I basically expect to see, without any actual articulation, "OK, the market is down 50%, I'll see you and raise you by bringing the dollar down 50+%"

The level of government spending is going to be breathtaking on this one.  They are talking about trillions $ in rescue packages, unemployment, SNAP, disability, interest free loans to businesses to "not fire anyone" (one senator said today the goal would be to forgive these interest free loans - as in, this money does not have to be paid back).  We are living through a dollar devaluation event that may be more rapid than anything ever attempted before.  Not really sure what would be the best way to preserve one's buying power, but I can sort of see the argument that stocks / S&P500 look pretty cheap when you factor in a large dollar devaluation and assume runaway inflation for the next 10 years.  Oil and other commodities are insanely cheap but aren't very practical as investments in and of themselves.

Gordo, sorry to disagree a bit. When you talk about dollar devaluation, you must take into account several factors. One - as against other currencies. I don't see this. Do you imagine that somehow the exchange rates will be drastically affected? Why? What reason is there for the Euro, or Yen, or Renminbi to rocket up against the dollar? Smaller currencies (Brit. Pound, Aus $, Can $, Swiss Franc etc.) are irrelevant because they don't have the volume to have global impact. Purchasing power - this only matters if the price of goods goes up. But what makes you think those prices will go up? You yourself pointed out that oil and other commodities are insanely cheap. And if demand for consumer goods remains low, and it will, because people who are out of work are people who are broke, then there is no pricing power. That means consumer goods prices will be low - hence no dollar inflation. Real Estate - when the economy crashes, commercial RE is going into the toilet, meanwhile in a nationwide crisis where incomes are disappearing, you are not going to have big returns or big demand for rental properties, so what other RE are you going to generate demand for so that it spurs dollar inflation?

Sorry I don't see it. In fact the dollar has appreciated wildly, thus proving definitively that devalution is not the direction. What you are talking about is opening the money spigot - but this is not simply printing money a la Zimbabwe. The targeted distribution is money that will be spent, as you put it: "They are talking about trillions $ in rescue packages, unemployment, SNAP, disability, interest free loans to businesses to "not fire anyone"" - that is money that will be used so that the economy doesn't crash from collapsed demand - which is the opposite problem, like during the Great Depression (or any depression) the problem is not inflation, it's deflation. The only part that makes this risky is the part that you put in parenthesis "(one senator said today the goal would be to forgive these interest free loans - as in, this money does not have to be paid back)". If you do this, you're an idiot. You'll destroy the financial system. You cannot do this. The loans must be on terms and the terms cannot be less than zero interest. You bail out GM or Ford, or financial institutions, but they MUST PAY BACK. If they don't, kiss your financial system goodbye. Who is the moron who advocated not paying back the loans? The only scenario where loan forgiveness makes any kind of sense is for individuals who owe government student loans - the government is in a position to forgive those, and you can make an economic case for that (Bernie Sanders etc.). To simply bail out a business and not have them pay back is not only a massive financial malpractice and moral hazard, it is politically stupid - welcome to every tom dick and harry to turn to the government for a handout in perpetuity. 

Anyway, discussing the economy in these threads is not feasible, all I'm gonna say is that if the businesses have no earnings, then stocks are not "cheap", and P/E still applies. 

Edited by TomBAvoider

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