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

[Mechanism]

Nice find Dean.  I am not sure what the best solution is for the U.S. but such a contact tracing and rapid case isolation - approach seems sensible.  Of course the issue you raised regarding asymptomatic carriers is a challenging one, hence arguments for as widespread as possible to universal ( at least in some settings or populations ) screening to the extent realistically possible.

Congratulations on your financial move.  I refrained from comment as this is not a financial forum but this is something to celebrate and appreciate.  We all should hopefully have some longer term “fresh powder” liquid assets above and beyond a narrow emergency fund to cover cost of living for extended periods when the market is turbulent to avoid selling low.  Moreover, an evergreen portfolio with the option to ride out the storm for extended periods reduces the probability of poor decision-making in contradistinction with your investment policy statement or personal goals and time horizon.  This is a great time to review the behavioral finance literature and avoid major rash adjustments which unfortunately is far too common during financial crises.

While few today are able to live off the traditional dividends and interest, in contrast cutting expenses Is something we all can do - taking extra care that we are not on the hedonistic treadmill but rather spending mindfully and primarily in accordance with our needs and values.

Edited April 14, 2020 by Mechanism

[Sibiriak]

Quote

[Johns Hopkins National Plan: ]  ( 1) ready access to rapid diagnostic tests for all symptomatic cases or those with a reasonable suspicion of COVID-19 exposure;

(2) widespread serological testing  to understand underlying rates of infection and identify those who have developed immunity and could potentially return to work or school without fear of becoming infected; and

(3) the ability to trace all contacts of reported cases. In order to trace all contacts, safely isolate the sick, and quarantine those exposed, we estimate that
our public health workforce needs to add approximately 100,000 (paid or volunteer) contact tracers to assist with this large-scale effort.

The rationale behind such a plan is clear and has been widely discussed in the media and scientific articles.   There are a number of problems with a widespread test-and-trace program,  some of them mentioned in the full text of the JH plan,  but I won't go into them  at this moment.

It seems to  me that in addition to steps to control the spread of the virus in the general population,    governments need to consider a  systematic program to protect those who are  especially vulnerable.  There needs to be a plan to protect those in nursing homes, and a plan to make sure the elderly elsewhere and those with serious preexisting conditions  have access to all the information and materials (masks etc.) they need to protect themselves.   Increased protection of especially vulnerable people would mean less stress on hospitals and fewer deaths. (Of course, those steps would have problems of their own that would need to be dealt with.)

I also think there should be a plan to make protective materials easily available to practically the entire population.  Wearing  masks in public is very important, imo, if not essential.

Needless to say,  I could be wrong on the above.  Just some things I've been thinking about.

Edited April 14, 2020 by Sibiriak

[Sibiriak]

The Guardian (UK):
 

Quote

Around half of all Covid-19 deaths appear to be happening in care homes in some European countries, according to early figures gathered by UK-based academics who are warning that equal efforts must be made to fight the virus in care homes as in the NHS [...]

Snapshot data from varying official sources shows that in Italy, Spain, France, Ireland and Belgium between 42% and 57% of deaths from the virus have been happening in homes, according to a report by academics based at the London School of Economics.

Published official data for deaths in care homes in England and Wales are believed to significantly underestimate fatalities in the care sector, with the Office for National Statistics currently only accounting for 20 Covid-related deaths in all care homes in the week ending 27 March. Fresh figures are due out on Tuesday, but are unlikely to be be up to date.

Last week the industry body Care England told the Guardian the figure was likely approaching 1,000, with deaths reaching into double figures at numerous homes. Over the weekend fresh death tolls emerged, including 12 fatalities of residents at the 71-capacity Stanley Park care home in County Durham and there have reportedly been five deaths at Almond Court in Glasgow.

 

Quote

42 dead in coronavirus outbreak at Virginia nursing home, more expected

[...] 42 residents of a Virginia nursing home near Richmond have died from the Covid-19 disease pandemic in one of the worst clusters of the new coronavirus in the United States, and officials expect more deaths to come.  

At least 127 elderly people out of the 163 residents of the Canterbury Rehabilitation & Healthcare Center in Henrico County have tested positive for the new coronavirus in recent weeks, said its medical director Dr. James Wright

Germany

Quote

The virologist Hendrik Streeck from the University Hospital Bonn is currently carrying out a unique examination in the district of Heinsberg - the epicenter of the coronavirus [...]

* * * * * *

[...]A very good way to contain the virus effectively: do a lot of tests like South Korea did. "If they tested people positively and found a cluster, then they contained the area there," says Streeck. A nationwide curfew was not necessary there. “In my eyes, this is a very good strategy and also a strategy that is feasible in Germany. Because we have the options. "

The virus is really dangerous for the risk groups, so "when it comes to the hospital, nursing home and old people's home," said the doctor. It is therefore very important to effectively protect particularly vulnerable people, with weekly corona tests for medical and nursing staff, for example. Such pool procedures are already used in transfusion medicine to test blood. So you are not new.

Edited April 14, 2020 by Sibiriak

[Sibiriak]

 

Morgan Stanley Timeline

[Gordo]

 

 

[Sibiriak]

Thanks Gordo.    (I posted previously:  most coronavirus patients who end up on ventilators go on to die.)   The Dr. Berg video also had a few interesting things to say about hydroxychloroquine and zinc, starting at 7:10.

 

Edited April 14, 2020 by Sibiriak

[Gordo]

IMF says the world will ‘very likely’ experience worst recession since the 1930s

I don't think the above will surprise anyone, but what I continue to be fascinated by is the extent to which wall street seems to have brushed aside downside risk.  I'm seeing so many companies issuing high yield debt (junk bonds) to stay afloat, some of which are dilutive (convertibles), I'm seeing many announcements related to higher pay (cost of labor going up) which is what happened after the 1918 pandemic, overall I think corporate profits will take much longer to recover than consensus view.  And yet here we sit near epic all time high valuations as a whole.  I know many believe it is not a good idea to time the market, just ride everything out, there is no way to consistently beat the averages.  Ironically there is a bubble in passive investing too, so maybe even that notion is due to be challenged.  I don't know, we'll see what happens, should be interesting to watch.  I think some of these high yield bonds may be better investments than stocks.  

We are in a new deleveraging phase, this is what many have not realized yet:

 

A Second Round of Coronavirus Layoffs Has Begun. No One Is Safe.

Edited April 14, 2020 by Gordo

[Dean Pomerleau]

The US stock market does seem to very pollyannish over all this. 

The Financial Times has some of the best graphics I've seen on the current state of the outbreak. Here are some screen captures. It was impressive how quickly the daily new cases and deaths decreased in Wuhan due to China's severe lockdown.

It will be interesting to see if other countries follow that steadily downward trajectory or simply level off at a relatively high rate of new cases and deaths each day, like Iran and Italy appear to be doing.

--Dean

[Dean Pomerleau]

The IHME model has been updated again (yesterday) but is still badly underestimating the tail of the graph, especially in Italy. As you can see below, yesterday the model predicted 192 deaths in Italy today (95% CI 85-385) while in fact Italy reported 602 deaths today, back up to the level its been hovering around for about a week.

The total deaths in Italy by Aug 4th is now predicted to be 21,130 which is an upward revision by ~1000 since the last update four days ago. But is still badly underestimating what will be the true final death toll, since worldometer reports the total deaths in Italy as of today is already 21,067.

 

The model is beginning to realize it is overestimating the speed of the decline in the tail of the curve, as reflected in an upward revision of US total deaths through Aug 4th from ~61K four days ago to ~69K now.

--Dean 

[Gordo]

There are some deep thoughts buried in this April 9th interview with billionaire investor Ray Dalio that I think some here may appreciate.  Unfortunately the TED folks were not on the same level and couldn't keep up.  He thinks we are in a multi-year depression.  But "cash is almost the worst investment". He thinks our monetary system may break down. "Diversify well, be humble, don't market time"

Edited April 14, 2020 by Gordo

[Dean Pomerleau]

New York City just added 3,700 cases of "presumed covid" deaths to their count based on their inability to test everyone with symptoms before (or after) they died, according to the New York Times. That amounts to about a 50% increase and brings NYC's death toll to over 10,000. It doesn't look like this upward revision is reflected in the worldometer statistics yet and certainly not in the IHME projections. It will be interesting to see if/when they are updated. When these extra deaths do get added to the New York State death toll it will bring it very close to the IHME's projection for total deaths in New York State by August 4th of ~14,800.

--Dean

The numbers brought into clearer focus the staggering toll the virus has already taken on the largest city in the United States, where deserted streets are haunted by the near-constant howl of ambulance sirens. Far more people have died in New York City, on a per-capita basis, than in Italy — the hardest-hit country in Europe.

The revised death toll renewed focus on shortcomings in testing that have hamstrung city and state officials since the beginning of the outbreak. A limited number of tests have been available, and until now, only deaths where a person had tested positive were counted among those killed by the virus in New York.

But for weeks, the Health Department also had been recording additional deaths tied to the virus, according to two people briefed on the matter. Those cases involved people who were presumed to have been infected because of their symptoms and medical history.

They were not included in the counts given publicly by Mayor Bill de Blasio because no tests had confirmed that the victims had the disease, Covid-19.

Mr. de Blasio decided, after another round of briefings over the weekend, to release the presumptive cases, the people said. Most of the added deaths took place in hospitals, according to the data. Others occurred in nursing homes or other long-term care facilities and in residences.

[Todd Allen]

4 hours ago, Dean Pomerleau said:

It doesn't look like this upward revision is reflected in the worldometer statistics yet and certainly not in the IHME projections.

Without the correction the US already set a new high today for daily Covid-19 deaths of 2376 2407 significantly greater than the previous daily high of 2035 and well in excess of the IHME projected peak of 2150 for yesterday.  I expect we will see many more substantial corrections as several countries in Europe have also issued them in the past couple weeks.

Many countries lack the capacity or motivation to produce accurate death counts.  There are numerous stories suggesting gross under counting in countries of South America, Asia and Africa.

https://www.theguardian.com/global-development/2020/apr/04/medics-in-brazil-fear-official-coronavirus-tally-ignores-a-mountain-of-deaths

https://www.msn.com/en-za/news/coronavirus/coronavirus-nearly-800-bodies-collected-by-police-from-homes-in-ecuadors-virus-epicentre/ar-BB12zViN?li=BBqfWMJ

https://www.reuters.com/article/us-health-coronavirus-india-testing-idUSKCN21W236

https://www.bbc.com/news/world-middle-east-52223193

https://www.msn.com/en-sg/news/other/coronavirus-algeria-becomes-africas-worst-affected-country-as-fears-grow-over-impact-on-continent/ar-BB12zGPb

Edited April 15, 2020 by Todd Allen

[Mechanism]

The greatest common denominator in diverging data appear to be assumptions and interpretation of poor data.  We are moving in the right direction, but painfully slowly --  

Sadly, this video - produced in late March and calling for higher quality data to guide policy "within 2-3 weeks" of that release is as relevant now as ever.  Sadly it is going to take a lot longer.

This thread has already cited the Ioannidis publication described here,  however I have to say that I found this video surprisingly even more polished and overall quite balanced handling this delicate, ambiguous, and high-stakes crisis.  You may remember his vocal attention to the problem of publication bias and false positives across the clinical sciences long before the CoVid-19 pandemic - another challenging controversy requiring nuanced consideration.

I can not recommend it enough as a starting point before digging deeper into updated data and substantive discussions around Covid-19 policy. 

 

 

Edited April 15, 2020 by Mechanism

[Sibiriak]

San Francisco plans to trace every coronavirus case and contact

Quote

The San Francisco task force will use an online and phone-based contact tracing application developed by Dimagi, based in Cambridge, Massachusetts, to manage cases and ongoing care. Among other things, it will send daily text messages to potentially exposed people, asking if they’ve developed symptoms. If so, it’ll flag workers to follow up and provide additional guidance.

The team will also ask patients for permission to look at their phone location data, which can help to provide a fuller picture of where they’ve been and moments when they may have been in crowded areas. But without access to population-wide phone data, the team won’t be able to see every time they crossed paths with others, or who those people were.

 

Massachusetts Recruits 1,000 ‘Contact Tracers’ To Battle COVID-19

 

Quote

The Baker administration, which says it plans to spend $44 million on the contact-tracing project, is looking at setting up isolation units in dormitories and hotels. People in quarantine as well as those in isolation will need food delivery, possibly child care, and lots of additional help so that they don’t interact with others and spread the virus.

Quote

[...]Massachusetts may be rolling out the most robust expansion of contact tracing so far, but Utah, North Dakota and other states are also launching projects. The CDC’s Redfield said his agency has 600 staffers doing this work and plans to add more.

 

In other news:

Woman fined €400 for breaking Italy's quarantine to walk her turtle

Edited April 15, 2020 by Sibiriak

[Gordo]

Empire State manufacturing index plunges to record low in April
...conditions index plummeted a record 57 points to -78.2 in April, the regional Fed bank said Wednesday. That’s the lowest reading on record. Economists had expected a much smaller decline to -35

Retail sales in the U.S. plummet a record 8.7% in March at start of coronavirus crisis
The numbers: The onset of the coronavius pandemic triggered a record 8.7% slump in sales at U.S. retailers — and there’s no light at the end of the tunnel. Sales fell for the second month in a row in what’s likely to be a prolonged period of agony for an industry that still relies heavily on lots of foot traffic and customers bunched together when they shop.

This debacle is just getting started and yet investors have been pretending its almost over.  

Many companies have just drawn down their entire credit lines to stay solvent (buy time), these lines are held by banks and this is happening as business is drying up like never before, the oil sector in the US is imploding (they use massive debt, which is held by banks), there will be a surge of defaults on debt that hasn't happened yet. A very large percentage of people just stopped paying their rent or mortgage. Next it will become 'not paying credit card bills' followed by a wave of personal bankruptcies (banks take the hit). Commercial real estate is imploding. Things are about to get ugly for the financials. This isn't like the 2009 bottom, its more like 2007 before they blew up but you could see what was coming. At every major market top you have a "this time is different" argument. This market's very VERY popular belief is that Fed printing will ensure the market doesn't go down. It's a beautiful fairy tale bolstered by an epic but not at all unexpected 50% retracement rally. I say, "Good luck with this time being different".

The market sell off last month was basically a blip in the larger context. If we are in a bear market (which is still debated) then things will get very interesting as we will not only hit the lows of last month, which will probably suck in massive amounts of buying by everyone who "missed the bottom" last month, then we'll plunge to far lower lows.
 

Edited April 15, 2020 by Gordo

[KHashmi316]

Food flow maps for USA:

 

 

This map, courtesy of "Food flows between counties in the United States," shows America's food supply chain. The top map shows food flows between states and some cities. The bottom map shows food flows between counties. (Courtesy of Megan Konar / Environmental Research Letter)

 

https://iopscience.iop.org/article/10.1088/1748-9326/ab29ae/meta

[TomBAvoider]

Which is why... they'll have to end the lockdown and restart the economy, regardless of what's happening with the virus. It's not sustainable economically, and therefore politically. The Fed is printing and congress is passing relief bills, but so what - not only is it ultimately a drop in the bucket, but there are serious difficulties distributing the money as is, and even unemployment agencies across the country are overwhelmed and grinding to a halt; folks either can't apply because the websites and phone lines are busy or because they can't be processed fast enough. Meanwhile, delaying the cash to consumers has a devastating impact - and we're talking delays by mere days or weeks. Tons of people have no savings and can't last more than a couple of weeks at most. This will be forced by the public - already there are protests demanding to lift the lockdowns. By the end of April, there will be more desperation - that's just a couple of weeks away. Then rent and mortgages are due in the first week of May. When even more people miss those, the financial system will start getting affected. Now imagine that this lockdown lasts through May, when tons of companies are barely hanging by their fingernails. It's not sustainable. Originally I thought the economy can last at the very worst through June. Now I'm not sure it can last beyond May without people rioting in the streets. We'll see. It looks a bit grim.

[Ron Put]

15 hours ago, Mechanism said:

The greatest common denominator in diverging data appear to be assumptions and interpretation of poor data. ...

Thanks for the video interview. I’ve always respected Ioanidis and now respect him even more. What I find very troubling and sad is that those who challenged the political hysteria, like Ioanidis, were effectively silenced by the media and many political “leaders,” and their arguments were often mocked and denigrated, and still are.

Instead, there is cheering for the purely political death counting shenanigans employed by those like de Blasio, which depart from established past practices in an attempt to artificially increase the official death toll in New York. The same happened in Italy and is happening in the UK. Those who were the most vocal in their calls for following the China model of “lock-downs” are now the most active in changing counting methods to increase the death toll and thus justify their actions. While the number of Covid-19 deaths still pales compared to the number of flu deaths, if the de Blasios can get it close, then they can proclaim themselves as “saviors” instead of being rightly judged as political opportunists who caused the economic disaster.

Even with the grossly inflated numbers appearing over the last few days, the US death toll from Covid-19 is still at a little more than a third of the death toll from the 2017-2018 flu season. It is also still less than the death toll from the current flu season (even as some flu deaths are certainly counted as Covid-19 deaths in places like NY).  And worldwide, the Covid-19 death toll is about one ninth of the death toll from the 2017-2018 flu season.

I will repeat, this was never really a health crisis, it was primarily a political crisis. Now we are entering the period of heavy spin by those who implemented lock-downs to try and convince enough of the population that their “leadership” proved them to be “saviors,” instead of destroying the economy for political gain.

Edited April 15, 2020 by Ron Put

[Dean Pomerleau]

New data published in Nature (pdf) on when infected people are contagious. Unfortunately the researchers found that infected people are most contagious before symptom onset and that 44% of the transmissions studied happened while the patient was pre-symptomatic. Below is a summary. No wonder this virus is hard to stop once it gets going in a population. 

--Dean 

TEMPORAL DYNAMICS OF VIRAL SHEDDING A Brief Communication article published in Nature presents analysis on temporal trends in viral shedding in COVID-19 patients. The study included data from 94 laboratory-confirmed COVID-19 patients in Guangzhou, China—including 414 total throat swabs taken as long as 32 days after symptom onset—to analyze trends in SARS-CoV-2 viral load.The study also included information on 77 identified transmission events, from both inside and outside China, to analyze SARS-CoV-2 transmission dynamics. The researchers observed high viral load in COVID-19 patients immediately after symptoms presented, which tapered off over a period of approximately 21 days. The researchers concluded that the viral load could potentially peak around the time symptoms present, or possibly slightly earlier.

Based on the viral load data and case data from the 77 transmission events, the researchers estimated that 44% of the transmissions occurred during the index case’s pre-symptomatic period and that COVID-19 patients become infectious 2.3 days before symptom onset, with a peak in infectiousness around 0.7 days before symptom onset. The study does not evaluate transmissibility of individuals with asymptomatic infection, and the viral load data may not directly correlate to an individual’s degree of infectiousness. Additionally, the article notes that clinical treatment could affect viral load in COVID-19 patients.

[Mike41]

2 hours ago, Ron Put said:

Thanks for the video interview. I’ve always respected Ioanidis and now respect him even more. What I find very troubling and sad is that those who challenged the political hysteria, like Ioanidis, were effectively silenced by the media and many political “leaders,” and their arguments were often mocked and denigrated, and still are.

Instead, there is cheering for the purely political death counting shenanigans employed by those like de Blasio, which depart from established past practices in an attempt to artificially increase the official death toll in New York. The same happened in Italy and is happening in the UK. Those who were the most vocal in their calls for following the China model of “lock-downs” are now the most active in changing counting methods to increase the death toll and thus justify their actions. While the number of Covid-19 deaths still pales compared to the number of flu deaths, if the de Blasios can get it close, then they can proclaim themselves as “saviors” instead of being rightly judged as political opportunists who caused the economic disaster.

Even with the grossly inflated numbers appearing over the last few days, the US death toll from Covid-19 is still at a little more than a third of the death toll from the 2017-2018 flu season. It is also still less than the death toll from the current flu season (even as some flu deaths are certainly counted as Covid-19 deaths in places like NY).  And worldwide, the Covid-19 death toll is about one ninth of the death toll from the 2017-2018 flu season.

I will repeat, this was never really a health crisis, it was primarily a political crisis. Now we are entering the period of heavy spin by those who implemented lock-downs to try and convince enough of the population that their “leadership” proved them to be “saviors,” instead of destroying the economy for political gain.

Interesting post Ron. https://www.cdc.gov/flu/about/burden/past-seasons.html. I am posting the death rates and cases of influenza for the United States. I am a bit bewildered by this. It seems that at least so far this is a bad flu season, so why all the fuss. I suppose the fuss is because it could much worse. But the fact that just two years ago 61, 000 Americans died and 45,000,000 were infected is a bit weird when we hardly even knew it was going on. What I would point out as a counter to case Ron is the fact that the co vid appears to be much more lethal on a case by case than the influenza and so potentially a greater concern and justifying the current lockdown. 

Edited April 15, 2020 by Mike41

[Saul]

On 4/13/2020 at 3:59 PM, Dean Pomerleau said:

Wuhan (a city of 11M) employed 9000 contract tracers to get its outbreak under control.

It's risky to trust statements from the People's Republic: BBC World News sent a reporter to Wuhan, who found that residents were (contradictionally) "exuberent and terrified".

[Gordo]

Interesting data out on essentially random community testing in New York City:

https://www.livescience.com/coronavirus-in-pregnant-woman-high-nyc.html

(although not exactly "random" as they tested only pregnant women, who may be at higher risk if they were doing doctor interactions / office visits, during their pregnancy).

But the results basically match the random testing done in Germany that was previously linked:
COVID antibody test in German town shows 15 percent infection rate

With these pregnant women researchers were surprised to find that 15% (same exact number from the Germany study!) had been infected.

But perhaps even more interesting, 88% of those that tested positive (29 out of 33 women) never had any symptoms.  So basically there is no way to stop this thing from spreading, but thankfully it isn't very deadly.  If docs would give patients treatment meds shown effective, immediately, and for bad cases in hospital ICSs, make sure people are on their stomachs, and stop using ventilators, we could probably keep the deaths down to a minimum (hopefully not much worse than a very bad flu season).  The vulnerable population should basically just interact only with people who have already had it and stick with the extreme measures of mitigation until most have already had it.

Still if you extrapolate out the numbers, it could mean that to reach herd immunity levels without a vaccine, we would have to see about 4 times the number of deaths that we've seen so far in New York City (implying that 60% of the population there has had COVID-19).  Multiply that across the whole country and world, and you are still talking about a very large number of likely deaths before we hit herd immunity.

Edited April 15, 2020 by Gordo

[Ron Put]

1 hour ago, Mike41 said:

... What I would point out as a counter to case Ron is the fact that the co vid appears to be much more lethal on a case by case than the influenza and so potentially a greater concern and justifying the current lockdown. 

In the video posted by Ioanis mentions an extrapolated mortality rate of less than 0.5%, which is similar to a bad flu season. Which is significant, of course, but it does not justify the politically-driven panic and lock downs.

 

37 minutes ago, Gordo said:

... But the results basically match the random testing done in Germany that was previously linked:

COVID antibody test in German town shows 15 percent infection rate

With these pregnant women they were surprised to find that 15% (same exact number from the Germany study!) had been infected.

But perhaps even more interesting, 88% of those that tested positive (29 out of 33 women) never had any symptoms....

This jives with the German and cruise ship data, which we know is much better than anything out of China, or New York for that matter.

Ironically, because of the high R0 ov Covid-19, it is likely that it spreads even easier than the flu, which means that containment is not practical (as is the case with the flu viruses). There is no evidence that I have seen of significant differences in infection rates between similar, and even adjacent locales, regardless of implemented lock-downs or standard social distancing measures.

Edited April 15, 2020 by Ron Put

[Ron Put]

Here is an interesting interview with Prof. Wittkowski:

 

 

Edited April 16, 2020 by Ron Put

[KHashmi317]

Thunderf00t's now-daily updates on his second YT vlog (VoT) seem to be on track...

 

Edited April 15, 2020 by KHashmi317