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

[TomBAvoider]

One thing you can say about COVID-19 is that the virus is highly contagious - apparently you can get it through your eyes, so just covering your face and nose is not going to work, like with traditional masks, you need the whole face one:

https://www.bloomberg.com/news/articles/2020-03-17/europe-s-doctors-getting-sick-like-in-wuhan-chinese-doctors-say

[Clinton]

10 hours ago, Sibiriak said:

At high, sustained doses, there have  been reports of liver toxicity and other issues

Thanks Sibiriak

[Ron Put]

59 minutes ago, Todd Allen said:

Ron, with that growth rate most of the half million would die in the last 3 days of that month not over an entire year.  If it continues for a second month we beat the Spanish flu.

I don't know that such simple conjectures are all that useful. Let's look at the epicenter in China:

"The report out of China now sets the overall death rate in symptomatic cases from COVID-19 disease at 1.4% -- much lower than the 3.4% death rate supplied earlier in the pandemic by the World Health Organization (WHO).

That puts the COVID-19 death rate significantly below that of the 1918 Spanish flu pandemic, ..."
https://www.webmd.com/lung/news/20200319/new-china-report-sets-covid-19-death-rate-at-1437


China traditionally undercounts its influenza mortality, by a whole lot. But here is the best estimate I have been able to find and it would indicate a fairly high rate, especially among the elderly:

"Influenza associated mortality burden in the elderly was higher, with the lowest excess mortality rates of all causes, respiratory and circulatory diseases, pneumonia and influenza being 49.57, 30.80 and 0.69 per 100 000 people, and the highest rates being 228.16, 170.20 and 30.35 per 100 000 people, respectively."

https://www.ncbi.nlm.nih.gov/pubmed/31607054

[Clinton]

55 minutes ago, TomBAvoider said:

One thing you can say about COVID-19 is that the virus is highly contagious

Absolutely.

 It is extremely contagious, but (hopefully) not that dangerous for most.

I am very concerned, now, however for many elderly people I know - and because of that I support self-isolation; not to protect me- but to protect others 

Edited March 20, 2020 by Clinton

[Gordo]

With all of the precautions people are taking (social distancing, hand washing, wiping down surfaces, people staying home when sick, working remote where possible, etc.) and based on data from China, South Korea, and Japan we know this works, infection rates can be managed even without sweeping lockdowns, and the global economy does not need to implode. Furthermore with very high levels of testing (which is now just being made possible in the US) plus highly effective treatments, we can absolutely deal with and manage this  (without destroying the economy and causing extreme pain to half the world).  Stop freaking out about totally unrealistic parabolic death projections, they aren’t happening. My only comparison to the seasonal flu is with regard to total dead by the time this is all over, and I believe it’s still quite possible to have a covid-19 number lower than a bad regular seasonal flu. This is becoming more and more likely every day.

SOME GOOD NEWS ON THE CORONAVIRUS

Edited March 20, 2020 by Gordo

[Todd Allen]

1 hour ago, Ron Put said:

I don't know that such simple conjectures are all that useful.

They suggest what is possible.  What happens depends largely on what actions are taken with early actions having much greater impact.

What looks to many like over reaction is due to this virus exhibiting the capacity for strong exponential growth rates in both infections and deaths. There has been a lot of talk of the flu killing tens of thousands a year. That isn’t scary because it is relatively predictable and spread out over much of the year. This virus on its current growth trajectory could have terrifying daily death tolls soon. There have been 58 Covid-19 deaths in the US today. Going back day by day for the past week the daily body counts were 41, 23, 18, 11, 8, 8 and 3. Projecting forward 1 week the daily body counts could easily be 80, 110, 150, 210, 300, 420, 580. If it continues it won’t take long for as many people to die from this in a day as currently die from flu in a year. This increase in death rate has been occurring due to the increase in cases while our health care system has spare capacity. If the health care system gets overwhelmed the death rate as a percentage of cases could go up by a factor of 10 or more. If the daily number of new cases continues to explode the result could be millions dying this year in the US. Countries with less resources may be at greater risk.

This is why some are very concerned and so much has been shut down. Hopefully our measures will start to kick in over the next week or two and mellow our death rate growth trajectory. In China it appears they have beaten this for the moment but their actions were very different. It remains to be seen if our measures will have a similar effect. My guess is our current actions will help but not enough and greater measures closer to China’s will be coming but due to the delay the costs will be vastly higher.

[Sibiriak]

9 minutes ago, Gordo said:

Furthermore with very high levels of testing (which is now just being made possible in the US) plus highly effective treatments, we can absolutely deal with and manage this  (without destroying the economy and causing extreme pain to half the world).  Stop freaking out about totally unrealistic parabolic death projections, they aren’t happening.

Gordo,  I tend to agree about the parabolic death projections,  but on the other hand I waver on  what is the best strategy (degree of lockdown, testing etc./ country dependent) to  minimize the disease-caused pain, suffering and death  while also minimizing the economic fallout,  not to mention the social and political fallout (major ratcheting up state surveillance powers,  restrictions on freedoms,  new censorship paradigms and so on.)   (On the positive side potentially, socioeconomic change away from maximized globalized economic production and growth-- good for the planet; people getting a whole new perspective on the precariousness of the global system, and of life itself, however exaggerated or not the reaction to this particular pandemic turns out to be.)

[Sibiriak]

21 minutes ago, Todd Allen said:

Hopefully our measures will start to kick in over the next week or two and mellow our death rate growth trajectory.

Todd, Gordo, and others looking closely at the infection statistics etc., and the likely time-frames for  development of vaccines and cures -- when would you predict, if you had to,  that the crisis peaks in Europe and the US,  the fear subsides, and the control measures begin to be loosened up?

[Gordo]

Based on China I’d say new infections peak within a month:

 

 

[Todd Allen]

30 minutes ago, Sibiriak said:

when would you predict, if you had to,  that the crisis peaks in Europe and the US,  the fear subsides, and the control measures begin to be loosened up?

I don't think we can predict with any confidence yet.  China if their figures are accurate has largely beaten this for the moment but it could explode there again if they are lying or this explodes in the rest of the world and they fail to isolate themselves sufficiently.  South Korea is doing next best while Europe and the US are doing terribly at the moment.  And most of the rest of the world is flying blind.

We've only begun to implement counter measures and there is lag between the impact on new cases and the death rate as it typically takes a week or two from infection to death.  The new case rate is currently more a measure of growth in testing than spread of disease.  Check back in two weeks.  If the death rate is still increasing significantly we will need to escalate measures.  If it is dropping rapidly we might begin to loosen up.  If flat we can muddle along as is while scaling up a medication cocktail.

Edited March 20, 2020 by Todd Allen

[Sibiriak]

Thanks guys.

 

 

[Sibiriak]

2 hours ago, Todd Allen said:

What looks to many like over reaction is due to this virus exhibiting the capacity for strong exponential growth rates in both infections and deaths

 

And now:

Quote

California has extended its shelter-in-place order to cover the entire state, the governor announced on Thursday, in a dramatic escalation of efforts to battle the coronavirus outbreak.

The order, which will go into force on Thursday evening, requires the state’s nearly 40 million residents to remain indoors and limit outdoor movement to what is “absolutely essential”.

The move came as Newsom on Thursday estimated that 25.5 million people – roughly 56% of California’s population – were likely to become infected with the coronavirus, an alarming projection offered by the governor in a letter to Donald Trump.

 

Is that a major over-reaction?   If so, what is the motive?   The governor wants to appear strong to maintain popularity etc. and/or gain more federal funds and assistance?

Edited March 20, 2020 by Sibiriak

[mccoy]

I really don't know why the influenza issue is brought back again and again. It seems to me like a case of watching the details of every single tree and completely losing track of the forest.

The number may be what they may be, but the results are hugely different. I don't remember influenza ever having overwhelmed hospitals, IC units, and even morgues...

 

[Matt]

Coronavirus Ravages 7 Members of a Single Family, Killing 4

The matriarch of the large New Jersey family died Wednesday night without ever knowing that her two oldest children had died before her.

 

Article here: https://www.nytimes.com/2020/03/18/nyregion/new-jersey-family-coronavirus.html

 

[Sibiriak]

Matt, thanks for the video.  Frightening.  But that's northern Italy. Ron Put says the US will be different,  because of the high number of ICY beds  and ventilators per capita.

I can't access the NYT article directly (I'll try later another way).  Large family.

[Sibiriak]

Regarding ICU beds/ventilators in the US,  it has been argued that it's not just a matter of the number per capita ,  but also of their availability and the sufficiency of medical staff  to make them functional.

Is U.S. Health Care Well-Equipped for the Coronavirus? (March 13)

Quote

[...]Breaking out the density of beds devoted to acute care from the OECD’s total provides a clearer picture of the intensive care (ICU) and intermediate care (IMCU) hospital beds that are most useful during an outbreak. While ventilator-equipped ICU beds will be most crucial, IMCUs can play a useful secondary role by allowing for coordinated monitoring of patients who may develop severe symptoms.

An estimate of the excess bed capacity that can be devoted to coronavirus response in the United States can be produced by combining the density of acute care beds with their utilization rate. When the type of hospital bed and pre-existing level of utilization are accounted for, the US has significantly more acute care beds available for patients than Italy, although many fewer than South Korea. In fact, Korea has far more acute care bed capacity than any other OECD country, which may be a factor behind their success in reducing COVID-19’s lethality.

 

Source: OECD – Acute Care Beds & OECD – Acute Care Bed Utilization

 

 

Quote

US Workforce Limitations Pose Greatest Risk

While the US benefits in terms of disaster-preparedness as a consequence of heavy investments in high-intensity health care services such as ICU beds and ventilators, there are other margins where we risk falling short. 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. And improper ventilator usage can result in serious complications if operated by untrained hands.

The physician workforce of the United States is smaller than in most rich countries. This may make it more difficult to reallocate physician capacity toward the treatment of COVID-19 than in other countries. Policies that increase the practice authority of nurse practitioners and physician assistants are therefore a promising strategy for bolstering disaster-preparedness. 

The United States is likely better prepared for the coronavirus than was Italy. The United States health care system has invested heavily in high-intensity medical care including ventilators and ICUs, which should make a breakdown in treatment less likely. The much more worrying bottleneck is simply the insufficient supply of skilled staff in the face of emergency levels of demand.

 

[Gordo]

Financial markets are worth watching because they more accurately reflect probabilities than news outlets or consensus public opinion.

Some positives in the market yesterday, there was an important divergence in the Russell 2000 which was up almost 7%, and oil finally turned and is up a convincing 30% from its low already! These are important key developments.  Oh and even stupid bitcoin rallied 20% in the last 24 hours - another probable sign. Finally, The market will bottom long before the coronavirus epidemic peaks.

Markets all around the world are surging higher today, the first time this has happened since the pandemic was declared, after a prior upmarket day. We shall see if this holds but it’s an encouraging sign so far.

I took a 401k account yesterday that I had 100% in an inflation protected bond fund for months (before covid-19 was a thing) and put that money (all of it) to work in equity funds that had been beaten down. Time will tell if that was a good move...

p.s. I watched that vid from Italy above and cringed when the doc touched his face & glasses with gloved hand mid-interview— don’t think that guy is going to make it through this without becoming infected.  Also the reporter was better protected than medical staff.

[Sibiriak]

3 hours ago, Gordo said:

Time will tell if that was a good move...

Since you're young, well-ensconced,  and on track to live 100+ years,  presumably,  you will not need to cash out in the near future for retirement or whatever.   That's the biggest potential problem--finding oneself forced to  sell  at a really bad moment.  Of course, diversification is critical.

Edited March 20, 2020 by Sibiriak

[Sibiriak]

What Are The Best Materials for Making DIY Masks?

Nice charts, tips and discussion of issues like breathability.

 

The First U.S. Company Has Announced an Upcoming Home COVID-19 Test

 

 

Edited March 20, 2020 by Sibiriak

[mccoy]

2 hours ago, Gordo said:

Markets all around the world are surging higher today, the first time this has happened since the pandemic was declared, after a prior upmarket day. We shall see if this holds but it’s an encouraging sign so far.

The rise in the markets may be due to the massive amount of quantitative easing that has been implemented by many central banks, including the European one...

[Ron Put]

1 hour ago, mccoy said:

The rise in the markets may be due to the massive amount of quantitative easing that has been implemented by many central banks, including the European one...

My guess is much of the stimulus is already priced in. The reason for the yo-yo movement is that the markets don't know how to price this yet, so it's likely to continue. I thought the market was way overpriced, with a relatively small number of large stocks driving the indexes, and it was due for correction before the virus. With the impact on the economy shaping up to be significant, this is unlikely to be the bottom, but what do I know.

And while I rarely agree with Trump, the comparisons with the flu are not necessarily unwarranted. I am sure that there were heart-wrenching family stories about death during the 2017-2018 flu season, when 80,000 Americans died, too. It's just that even if it made the paper back then, it was the devil we all know, so few paid much attention. This will hopefully be no worse, especially with all the forces marshalled to contain and stop it -- Korea's mortality rate is less than half of even Wuhan's downward revised rate of 1.4. And since the Korean testing was cohort-concentrated, it is likely that it did not account for all infections, anyway.

The constant goading to do more in terms of closures and spending may make some feel better now, yet it will likely have a significant and yet unknown long impact. And if we don't achieve herd immunity, this is likely to just come back, and then what? An effective vaccine is unlikely for at least a year. California's Democratic governor's public dire letter to the Republican President are a worse case scenario and is mostly a political showmanship and pressure for federal funding -- if the federal government does not respond with huge funding, every death in the state will be pinned on Trump personally. But as I pointed out before, liberal democracies by nature wash their dirty laundry in public and authoritarian regimes never fail to use it for propaganda purposes.

My point is that the constant posting and sharing of apocalyptic stories is not doing anyone any good and it's just creating panic. The family story posted by Matt above is tragic, but the reason it made the news is because it is an aberration.

Edited March 20, 2020 by Ron Put

[AlPater]

I thought that https://www.worldometers.info/coronavirus/#countries was useful to compare how countries fared.  It seems to be even more up-to-date than the latest numbers from the CBC on Canadian statistics.

My take on how high the death to infection rate is suggests it is quite high based on the world's recorded cases and deaths, and most cases have not resolved yet so their ultimate fates remain unknown.

[mccoy]

And Boris Johnson at last, after seeing today's figures, has given up and ordered the lockdown of most public businesses... Maybe he woke up to the fact that his very position of PM was at stake.

[TomBAvoider]

Gordo, you may be right that this is the bottom for stocks, but nobody really knows, because it entirely depends on what the government does going forward and who can predict that? It's not pure economics - it's politics, which is inherently less predictable. If the government doubles down on closures - the governor of CA just announced in-place sheltering for the entire population of CA, this might get much, much worse economically. Remember, CA is the 5th largest economy IN THE WORLD. This will have an impact. In Europe, close to 20 million people who work in car production associated industries have just been sent home. It seems to me the markets are pricing in a scenario where things will return to normal fairly soonish. If we do NOT return to mostly "normal" within the next 3-4 months, the economy will take a nosedive and I don't believe the markets have priced that in.

What scenario is going to happen is inherently unpredictable. There are too many dynamic factors which are impossible to forecast. Honestly, trying to time this market is just pure gambling, more roulette than poker. 

Plus, before this correction, stocks were quite expensive by P/E measure. There's been a lot of talk about how historic P/E levels are no longer relevant, because markets are being driven not by return seeking, but by a desire to park capital, in which case P/E is irrelevant. But when there's a global decline like this, parked money gets unparked - and suddenly P/E becomes relevant again. And it's been very high. But like I said in another post a decline in P is doesn't make the stock cheaper if the E declines too - and when the economy crashes, so E too will crash. So those "cheap" stocks are not so cheap after all. Bottom line, it all depends on what happens to the economy and that in turn depends on what happens politically driven by panic or cooler heads in charge... and who can predict that?

[Dean Pomerleau]

Here is a preprint of a study [1] out of China. It looked at the blood types of ~2200 covid-19 patient from three hospitals in Wuhan. It found that A blood type folks were 20% more likely than non-A's and O blood type folks were 33% less likely than non-O's to come down with covid-19. This relationship was largely independent of age and gender.

I wonder why blood type would impact susceptibility to covid-19.

--Dean

----------------------------------

[1] Relationship between the ABO Blood Group and the COVID-19 Susceptibility

Jiao Zhao, Yan Yang, Han-Ping Huang, Dong Li, Dong-Feng Gu, Xiang-Feng Lu, Zheng Zhang, Lei Liu, Ting Liu, Yu-Kun Liu, Yun-Jiao He, Bin Sun, Mei-Lan Wei, Guang-Yu Yang,  View ORCID ProfileXinghuan Wang, Li Zhang, Xiao-Yang Zhou, Ming-Zhao Xing,  View ORCID ProfilePeng George Wang

doi: https://doi.org/10.1101/2020.03.11.20031096

This article is a preprint and has not been certified by peer review [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.

Abstract
OBJECTIVE To investigate the relationship between the ABO blood group and the COVID-19 susceptibility. DESIGN The study was conducted by comparing the blood group distribution in 2,173 patients with COVID-19 confirmed by SARS-CoV-2 test from three hospitals in Wuhan and Shenzhen, China with that in normal people from the corresponding regions. Data were analyzed using one-way ANOVA and 2-tailed χ2 and a meta-analysis was performed by random effects models. SETTING Three tertiary hospitals in Wuhan and Shenzhen, China. PARTICIPANTS A total of 1,775 patients with COVID-19, including 206 dead cases, from Wuhan Jinyintan Hospital, Wuhan, China were recruited. Another 113 and 285 patients with COVID-19 were respectively recruited from Renmin Hospital of Wuhan University, Wuhan and Shenzhen Third People's Hospital, Shenzhen, China. MAIN OUTCOME MEASURES Detection of ABO blood groups, infection occurrence of SARS-CoV-2, and patient death RESULTS The ABO group in 3694 normal people in Wuhan showed a distribution of 32.16%, 24.90%, 9.10% and 33.84% for A, B, AB and O, respectively, versus the distribution of 37.75%, 26.42%, 10.03% and 25.80% for A, B, AB and O, respectively, in 1775 COVID-19 patients from Wuhan Jinyintan Hospital. The proportion of blood group A and O in COVID-19 patients were significantly higher and lower, respectively, than that in normal people (both P < 0.001). Similar ABO distribution pattern was observed in 398 patients from another two hospitals in Wuhan and Shenzhen. Meta-analyses on the pooled data showed that blood group A had a significantly higher risk for COVID-19 (odds ratio-OR, 1.20; 95% confidence interval-CI 1.02~1.43, P = 0.02) compared with non-A blood groups, whereas blood group O had a significantly lower risk for the infectious disease (OR, 0.67; 95% CI 0.60~0.75, P < 0.001) compared with non-O blood groups.In addition, the influence of age and gender on the ABO blood group distribution in patients with COVID-19 from two Wuhan hospitals (1,888 patients) were analyzed and found that age and gender do not have much effect on the distribution. CONCLUSION People with blood group A have a significantly higher risk for acquiring COVID-19 compared with non-A blood groups, whereas blood group O has a significantly lower risk for the infection compared with non-O blood groups.