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

[Sthira]

Wait wait...

Is anyone here actually on calorie restriction?

If so, have you increased your food intake? I am CRed and have been eating more calories — more fruits, vegetables, legumes, nuts, seeds, olive oil — I’m in process of upping my BMI from 18 to ... 

If anyone else out there is on CR, what are you doing?

[Dean Pomerleau]

Hi Sthira, 

I haven't been on absolute calorie restriction for many years as you probably already know. But I am relatively CRed and so far I have not increased my calorie intake and am maintaining my BMI around 19.5. I feel that is a reasonable compromise between maintaining a hypervigilant immune system with CR and being robust enough to weather a serious illness.  YMMV. 

--Dean 

[mccoy]

The mortality ratio in the whole territory of Italy just hit the 9% figure, we are only a little shy of the 10% mortality of SARS. Such a large number is influenced by the Lombardy cluster, which exhibits 12% mortality. I have no clue about this anomalous figure, the strangest thing is that no one even hinted at it in tonight's news.

 

 

[Dean Pomerleau]

On 3/18/2020 at 7:21 PM, Dean Pomerleau said:

But even then, you'll likely only get a prescription for it [chloroquine] if you've tested positive and your symptoms have progressed to the point of being severe enough to warrant treatment with a drug that will likely be in short supply if proven to be effective. 

With all the talk about chloroquine, it looks like supplies are being tapped out already:

https://www.businessinsider.com/chloroquine-hydroxychloroquine-shortage-coronavirus-treatment-lupus-arthritis-2020-3

Demand for malaria pills has skyrocketed on hopes that the drug can treat COVID-19, the disease caused by the new coronavirus. 

Demand has ramped up so much that the drugs chloroquine and hydroxychloroquine are now in shortage, according to a pharmacy group that tracks supplies of medicines.

--Dean

[Ron Put]

2 hours ago, Sibiriak said:

I think you got the wrong link for the 160,000 ventilator number-- it takes me to "Relationship between the ABO Blood Group and the COVID-19 Susceptibility".  

... I'm not defending the details of that article,  but as Dean points out,  there are plenty of indications that hospitals are on track to become overwhelmed-- are you saying there is no danger of that?

I corrected the link, thanks for flagging it.

The point is, again, that the Medium article is using grossly inaccurate numbers and it's disinformation. My guess is that a lot of it election year politics and attacks on Trump, who deserves scorn on many other fronts. But here the government seems to be doing what it needs to do.

I personally doubt that the US healthcare system will become "overwhelmed," although it is likely to happen in certain locales, which I am sure will get most of the coverage :) I base this on previous epidemics, including the deadly 2017-2018 flu season which killed 80,000 Americans and about a million worldwide. And based on older, more severe epidemics which stressed the system, but did not "overwhelm" it. And while these viruses mutate, historically such mutations make them less deadly, not more. And herd immunity is also a real factor which is ignored by the apocalyptic predictions.

 

2 hours ago, Sthira said:

Is anyone here actually on calorie restriction? ... If so, have you increased your food intake?

I am eating normally, which means that based on my 8-hour feeding window I can eat enough to maintain 18.5 to 19 BMI. I feel pretty healthy at this point and don't plan to change it.

 

1 hour ago, mccoy said:

The mortality ratio in the whole territory of Italy just hit the 9% figure, we are only a little shy of the 10% mortality of SARS. Such a large number is influenced by the Lombardy cluster, which exhibits 12% mortality. I have no clue about this anomalous figure, the strangest thing is that no one even hinted at it in tonight's news.

Something is wrong with the official Lombardy's mortality rate. My guess is that there is a much higher infection rate in some regions in Italy than what has been officially detected among the general population, which would also explain the large number of EU and US infections connected to Italian sources. Also, there is a sizable contingent of Chinese workers serving as cheap labor in the Milan area, which would have facilitated transmission from China. NPR reported that it is possible that there were Covid-19 infections in Italy as early as October, which went undetected as the flu season ramped up.

It' worth noting that Italian ICU mortality rates are generally higher than those in the US and other comparable countries even in the best of times -- I am not sure why, but a factor may be that in the US the criteria for ICU admission is considerably lower than in Italy. It may also have a little to do with air pollution.

Edited March 21, 2020 by Ron Put

[Ron Put]

1 hour ago, Dean Pomerleau said:

Ron, 

You quote credible sources projecting we'll need nearly 20x more ICU beds than the total number we have in this country, ...

And yet you keep calling out people for scaremongering....

When a viral social media article uses grossly inaccurate numbers to create a grossly exaggerated scary scenario, it is scaremongering and disinformation. What else would you call it?

If you follow the citation for the worse case scenario, it will take you to a NYT article which speculates on leaked "worse case" scenarios, which are effectively "war game" contingency plans, similar to the US plans for war with Canada which leaked a few years ago. 

This one seems to be assuming an unmitigated 1918 Influenza model, which had 10% mortality rate and which most sane people do not consider likely in this case.

Also, how did you come up with your 20x claim? Even the worst case scenario assumes 960,000 ICU admissions, so if we take the 100,000 to 116,000 ICU beds number, it's about 9x. And it assumes that the demand will be instantaneous, and no mitigation, and again, a 1918 kind of epidemic....

 

Edited March 21, 2020 by Ron Put

[Clinton]

1 hour ago, mccoy said:

The mortality ratio in the whole territory of Italy just hit the 9% figure, we are only a little shy of the 10% mortality of SARS. Such a large number is influenced by the Lombardy cluster, which exhibits 12% mortality.

 

Unbelievable!! That’s extremely high.

So sorry to hear this.  Stay safe, McCoy.

[Todd Allen]

Dr. Peter Attia is regularly releasing interesting podcasts on Covid-19.  Here's his most recent:

https://peterattiamd.com/peterhotez2/

One surprising bit of news for me was that ICUs in several countries such as Italy, the UK and the US are beginning to admit significantly more young and middle aged people.  And perhaps because they aren't dying they are filling up an increasing percentage of beds perhaps over a third now in some places.

[Sibiriak]

1 hour ago, Ron Put said:

I personally doubt that the US healthcare system will become "overwhelmed," although it is likely to happen in certain locales

I wrote, "hospitals could become overwhelmed. "    What that might mean concretely:
 

Quote

[..] New York prepares guidance on how to deploy vital ventilators amid a widespread shortage of key equipment that also includes masks and surgical gloves, and medical supplies such as blood.

The draft guidance on ventilators, prepared by a state taskforce in 2015 for a possible influenza pandemic, has reportedly been updated for the coronavirus crisis, though new guidelines have not been finalized.

According to Sam Gorovitz, a professor of philosophy at Syracuse University and member of the taskforce, the revisions to the ventilator allocation guidelines include the formation of designated triage committees to determine which critically ill patients will or will not receive life-supporting respiration.

Gorovitz told the Guardian he is “100% certain” that New York health administrators will face ethical decision-making in the near future about whom to ventilate – just as it is now making decisions about the allocation of masks and protective equipment.

“Consider a patient, 85 years old, on a ventilator, out of hospice care. Along comes a 45-year-old, with a family, and in fundamentally good health and a good prospect of full recovery from coronavirus if treated with the best available treatment.

“Is it not only acceptable but ethically necessary to take grandpa off the ventilator and switch him to palliative care, wipe away the tears, and switch the ventilator to the younger patient?” he said.

“These decisions are already being faced with regard to protective equipment that are inadequately supplied,” Gorovitz said. “That’s not the same as ventilator allocations, but everyone knows it’s coming and those decisions are likely being made right now.”

At a press conference on Saturday New York state governor Andrew Cuomo said that his administration was “literally scouring the globe looking for medical supplies”.

[...]The announcement came as New York state recorded 10,000 infections.

https://www.theguardian.com/us-news/2020/mar/21/coronavirus-new-york-disaster-ventilators

 

Is that all "scaremongering" and  "election year politics"?

Edited March 21, 2020 by Sibiriak

[Dean Pomerleau]

45 minutes ago, Ron Put said:

Also, how did you come up with your 20x claim? Even the worst case scenario assumes 960,000 ICU admissions, so if we take the 100,000 to 116,000 ICU beds number, it's about 9x. And it assumes that the demand will be instantaneous, and no mitigation, and again, a 1918 kind of epidemic....

Ron,

Read your own post and my highlight of it more carefully. I'll repeat it here:

2 hours ago, Dean Pomerleau said:

[Ron wrote:] A recent AHA webinar on COVID-19 projected that 30% (96 million) of the U.S. population will test positive, with 5% (4.8 million) being hospitalized. Of the hospitalized patients, 40% (1.9 million) would be admitted to the ICU, and 50% of the ICU admissions (960,000) would require ventilatory support...." 

1.9M / 108K = 18x, which I said called "nearly 20x".

Regarding all this being "worst case scenario", from this NYT article:

In the absence of public projections from the C.D.C., outside experts have stepped in to fill the void, especially in health care. Hospital leaders have called for more guidance from the federal government as to what might lie in store in the coming weeks.

Even severe flu seasons stress the nation’s hospitals to the point of setting up tents in parking lots and keeping people for days in emergency rooms. Coronavirus is likely to cause five to 10 times that burden of disease, said Dr. James Lawler, an infectious diseases specialist and public health expert at the University of Nebraska Medical Center. Hospitals “need to start working now,” he said, “to get prepared to take care of a heck of a lot of people.”

Dr. Lawler recently presented his own “best guess” projections to American hospital and health system executives at a private webinar convened by the American Hospital Association. He estimated that some 96 million people in the United States would be infected. Five out of every hundred would need hospitalization, which would mean close to five million hospital admissions, nearly two million of those patients requiring intensive care and about half of those needing the support of ventilators.

This is not a "worst case scenario" - this the "best guess" projection of a top infectious disease public health professional. He's saying it will be 5 to 10x the burden of a severe flu season and two million patients will require admission to intensive care. 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. 

So again, your apparent confidence that it won't get that bad seems wildly optimistic to me, given what credible experts are saying. I agree it might not get that bad if we suddenly become really serious about extreme social distancing, travel restrictions, quarantining, contact tracing, etc. But it doesn't seem like we are moving very fast in that direction, even in those places (like NY) where widespread testing has shown the magnitude of the problem.

--Dean

[Ron Put]

38 minutes ago, Sibiriak said:

Is that all "scaremongering" and  "election year politics"?

LOL, you tell me.... The Guardian couldn't find anyone better than a philosophy prof from Syracuse to talk about triage?! For what it's worth, triage is common in emergency rooms all over the world and decisions to let some die are made every day. So, yeah, I am "100% certain" that it will happen, too.

And also, right now the governors in both NY and California are warring with the Trump Administration, which translates in some clearly political attacks. I'd imagine that if Biden was president, a Texas panel will push a similar narrative. As I mentioned before, political factions in liberal democracies quarrel very publicly., as opposed to places like China or Russia.
 

35 minutes ago, Dean Pomerleau said:

... Read your own post and my highlight of it more carefully. I'll repeat it here:

1.9M / 108K = 18x, which I said called "nearly 20x" ...

I stand corrected, didn't read carefully. But the numbers are still based on a 1918 scenario, which the guy from Nebraska may think are OK, but the guy from UCLA thinks are crazy. I am with Otto Yang from UCLA.

Bottom line is, the original article was scaremongering and disinformation and used grossly inaccurate numbers to produce a scaremongering scenario. Deflecting from it doesn't make it more accurate.

Is this a thread for the most dire and often unfounded grim speculations? It seems like a lot of people enjoy doom and gloom scenarios, no matter how bizarre :) It'd be more productive to rewatch The Walking Dead.

But stuff like this has consequences, which is why rogue states weaponize it to destabilize others.

Edited March 21, 2020 by Ron Put

[mccoy]

39 minutes ago, Clinton said:

So sorry to hear this.  Stay safe, McCoy.

Likewise, Clinton, it seems that USA is taking off as well, although with much lower mortality. Maybe someone will be eventually able to explain such differences (the amount is a ratio not an absolute number).

[Todd Allen]

1 hour ago, Ron Put said:

Something is wrong with the official Lombardy's mortality rate.

One thing apparently wrong is they are counting people dying in hospitals but increasing numbers aren't getting into them in time.

https://www.reuters.com/article/us-health-coronavirus-italy-homes-insigh-idUSKBN2152V0

Quote

While no detailed data is available, officials, nurses and relatives say there has been a spike in nursing home deaths in the worst affected regions of northern Italy since the virus emerged, and they are not showing up in coronavirus statistics.

“There are significant numbers of people who have died but whose death hasn’t been attributed to the coronavirus because they died at home or in a nursing home and so they weren’t swabbed,” said Giorgio Gori, mayor of the town of Bergamo.

...

With the health system pushed to its limits and funeral services overwhelmed by the hundreds of dead every day, there is no capacity to conduct autopsies or test bodies for coronavirus.

 

Edited March 21, 2020 by Todd Allen

[Sibiriak]

Ron, with all due respect, I think you're a bit too focused on your  political theories--whether about attacks on the Trump administration (yes, that's happening), or your vision  of Russian "peasants" being whipped into nationalist fervor  (not happening) --and losing sight of the real human drama unfolding at ground level.

(There is no shortage of political debate on this issue in Russia at the moment, and very little blame of "external enemies".  Yes, you can cherry pick a story here and there,  as you could in the US or Europe,  but it's not pervasive.  Hardly anyone believes those theories. And since Russia is not, apparently, suffering from the pandemic as many other countries,  there is no need to blame "external enemies", even  if the government were inclined to that, which it isn't.  For a fairly balanced view on what's happening here, see https://edition.cnn.com/2020/03/21/europe/putin-coronavirus-russia-intl/index.html.  For example, " News reports of shortages in protective equipment have also fueled skepticism. And some experts have raised doubts about the reliability of Russia's testing system, which depends on a single laboratory.  [...]Anastasia Vasilyeva, a doctor for Russian opposition figure Alexey Navalny and leader of the Alliance of Doctors union, made headlines with a series of videos in which she claims the authorities are covering up real coronavirus numbers by using pneumonia and acute respiratory infection as a diagnosis. "  )

On ground level:

Quote

A doctor who spent nine hours moving critically ill Covid-19 patients around London has issued a plea to the British public.

Natalie Silvey (@silv24)

This is the face of someone who just spent 9 hours in personal protective equipment moving critically ill Covid19 patients around London.
I feel broken - and we are only at the start. I am begging people, please please do social distancing and self isolation  pic.twitter.com/hs0RQdvsn3  March 21, 2020

Anaesthetic registrar Natalie Silvey posted the image of her face – reddened after hours spent wearing personal protective equipment – to Twitter on Saturday.

She said: “Those red/purple marks across my face are from my mask and are deeper than you think. Today I have seen just what Covid-19 is doing and now I just want to scream at people to listen to us.

“I volunteered to do this. The consultant anaesthetist I was with volunteered. This is bringing out the best of us. Now can the rest of the country please bring out their best and listen! #covid19”

Edited March 22, 2020 by Sibiriak

[Sibiriak]

56 minutes ago, Ron Put said:

The Guardian couldn't find anyone better than a philosophy prof from Syracuse to talk about triage?!

 

This is why he was chosen, no doubt:
 

Quote

 

The draft guidance on ventilators, prepared by a state taskforce in 2015 for a possible influenza pandemic, has reportedly been updated for the coronavirus crisis, though new guidelines have not been finalized.

According to Sam Gorovitz, a professor of philosophy at Syracuse University and member of the taskforce...

 

 

[Todd Allen]

5 hours ago, Ron Put said:

what is your basis for assuming unmitigated exponential growth?

 

5 hours ago, Ron Put said:

And here is the CDC page tracking infections: 

https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html?CDC_AA_refVal=https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html

 

The CDC page lists 15,219 cases.  But they went home on Friday and were reporting day old numbers.  Look at current data such as at https://www.worldometers.info/coronavirus/ and you will see the case count has already nearly doubled in the last 2 days.  I think the rate of growth in cases is a product of the rate of growth in testing and doesn't yet cast much light on the rate of spread of this virus.  Much better but still imperfect is to look at death rates.  In the world as a whole and most countries other than China and South Korea with significant statistics for at least a week you can see death rates doubling every 4 to 6 days.  I think doubling in 4 days may be a typical unmitigated growth rate and in 6 is a mitigated rate of growth when the mitigations are the weak unfocused social distancing strategies most countries began adopting a couple weeks ago.  There is quite a bit of lag between infection and death so new measures that slow the rate of spread now won't show any effect for 2 or 3 weeks, likely after several more doublings.

 

[KHashmi317]

Thunderf00t's sobering message .... 

 

[TomBAvoider]

OK, so what's the worst that can happen? How many deaths are we looking at world-wide? I mean if we "do nothing" and COVID-19 becomes established in the U.S., does that mean that countries that got control of it ("control" insofar as we know at the moment, or trust) like South Korea and China would then attempt to ban visitors from the U.S., and for that matter would Europe too? Is Italy the "worst case" scenario?

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.

[Shezian]

22 hours ago, Sibiriak said:

Bondi Beach, Australia   Friday, March 20

The Beach is set to be closed down  today after outrage was expressed at images showing large numbers of youthful, carefree beachgoers ignoring public health advice .

it has been closed yesterday, finally some action here in Australia. 

[BrianA]

Here's another online company trying to provide some realtime US data, this one is a smart thermometer company trying to mine their anonymized customer base for hotspots over and above typical annual flu levels. Looks like Florida might be picking up? But oddly the west coast isn't too bad.

 

https://healthweather.us/

[BrianA]

Here's a website that uses basic models along with state data to let you click on a US state, and then see visually the expected results of different approaches to controlling the virus along with at what date the hospital system of that state becomes overwhelmed.

 

https://covidactnow.org/

[Sibiriak]

3 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.   [...] all projections are hazy affairs wrt. accuracy.

I agree.  I also agree with Ron Put that "exponential growth" is an unlikely worse case scenario (and I agreee with some of his criticisms of  Tomas Pueyo's modeling.)

This article might be of interest for those who (unlike me) are looking  deeply into the statistics and epidemiology 

Graph theory suggests COVID-19 might be a ‘small world’ after all

The media regularly refers to "exponential" growth in the number of cases of COVID-19 respiratory disease, and deaths from the disease, but the numbers suggest something else, a "small world" network that might have power law properties. That would be meaningfully different from the exponential growth path for the disease.

 

[Sibiriak]

9 hours ago, Ron Put said:

For what it's worth, triage is common in emergency rooms all over the world and decisions to let some die are made every day. So, yeah, I am "100% certain" that it will happen, too.

C'mon Ron,  the issue isn't common ER room triage , but specifically triage determining who gets ventilators.
 

Quote

Gorovitz told the Guardian he is “100% certain” that New York health administrators will face ethical decision-making in the near future about whom to ventilate – just as it is now making decisions about the allocation of masks and protective equipment.

“Consider a patient, 85 years old, on a ventilator, out of hospice care. Along comes a 45-year-old, with a family, and in fundamentally good health and a good prospect of full recovery from coronavirus if treated with the best available treatment.  “Is it not only acceptable but ethically necessary to take grandpa off the ventilator and switch him to palliative care, wipe away the tears, and switch the ventilator to the younger patient?” he said.

“These decisions are already being faced with regard to protective equipment that are inadequately supplied,” Gorovitz said. “That’s not the same as ventilator allocations, but everyone knows it’s coming and those decisions are likely being made right now.”

You are welcome to criticize Gorovitz,  but  pointing to common ER room triage tells us nothing about potential ventilator shortages.

It's not  clear if you are saying that  ventilator shortages are unlikely to occur,  or that,  yeah, they probably  will occur, but  who cares?

Edited March 22, 2020 by Sibiriak

[mccoy]

10 hours ago, Todd Allen said:

One thing apparently wrong is they are counting people dying in hospitals but increasing numbers aren't getting into them in time.

The above would mean that the h ratio should be even higher, over 10%, not lower! I don't know if we can confirm the possibilities of such high mortalities.

Other people say exactly the opposite, that too many elders who were already on the verge of death and died with Covid-19 but not strictly because of it were counted into the covid19 deaths so the mortality ratio has been artificially increased. But this would imply that the counting procedures are very different from country to country.

Again, the absolute number of infected people does not mind, the ratio of total deaths to total confirmed cases is the parameter of interest. If the absolute number increases, the ratio should remain the same, but in Italy, it has not been so and so far I have not heard one plausible explanation about that. One hypothesis I may venture is that medical staff are starting being very tired and making errors, lots of them, but this is only pure guesswork. Or maybe the exclusion protocols have started because of a lack of ICUs but nobody wanted to say that.

But maybe I should wait for the next reports and see if the ratio increase is a fluke or not.

Different ratios in different nations may imply different counting procedures. A lower ratio is less alarming, so nations such as UK and Germany may have been tempted to adopt some protocol which decreases such number, it's not difficult. Germany keeps having such a ridiculously low mortality that it is not credible.

 

Edited March 22, 2020 by mccoy

[mccoy]

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.