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

[Dean Pomerleau]

Here is a very sobering article from Vox on the coronavirus tragedy that developing countries are facing. Among the causes of their perilous predicament are:

1. Their slums sometimes have population densities 10x that of NYC so they can't effectively social distance or quarantine.
2. They live in cramped, multi-generational households.
3. They often have very poor sanitation and very little clean water.
4. They can't afford to self-isolate at home even if it were possible, since many people have no savings and their governments are too poor to provide any sort of effective safety net.
5. Flattening the curve to avoid overwhelming their healthcare system is a non-starter anyway, since they effectively have no healthcare system to begin with.

Short of some sort of miracle it seems likely that the US won't be #1 in cases and deaths from coronavirus in a couple months, as the virus finds new victims in large developing countries like India, Bangladesh and Nigeria.

--Dean

[TomBAvoider]

Short of some sort of miracle it seems likely that the US won't be #1 in cases and deaths from coronavirus in a couple months, as the virus finds new victims in large developing countries like India, Bangladesh and Nigeria.

Umm... why would the death rate in those countries be any worse than in Sweden which is basically not implementing lockdowns and is counting on herd immunity? True, Sweden has a superior health care system, but (1) it doesn't appear that Sweden thinks it's the health care system that will be the solution, rather it'll just spread and confer herd immunity, and (2) those are vastly younger populations (than Sweden and other developed countries), so a virus that kills more old people should result in relatively fewer deaths.

Cautioun is obviously advised, but I think it's very difficult to predict total deaths with any precision at this time. YMMV.

Edited April 21, 2020 by TomBAvoider

[Sthira]

^ Because shanty towns don’t exist in Sweden

[Todd Allen]

2 hours ago, TomBAvoider said:

Umm... why would the death rate in those countries be any worse than in Sweden which is basically not implementing lockdowns and is counting on herd immunity?

Looks like Sweden is #1 in the world for today's daily Covid-19 deaths per capita.

Sweden, 185 deaths, 18.34 deaths / million
Belgium, 175 deaths, 14.68 deaths / million
UK,           828 deaths, 12.18 deaths / million
Italy,         534 deaths,   8.84 deaths / million

Contrast Sweden with Italy, the world leader in Covid-19 deaths until the US reasserted its world leadership role, Italy for which theories were concocted to explain the high death toll such as an extremely old population living in a polluted industrialized region, Italy's highest daily death toll was 919 on 3/27 was 15.10 deaths/million.

And the US setting a new record daily tally of 2804 deaths, 8.44 deaths / million.

 

Edited April 22, 2020 by Todd Allen

[TomBAvoider]

Because shanty towns don’t exist in Sweden

So what that they don't exist? How is that relevant at all? The only thing shanty towns do is spread the virus faster, not make it more deadly. Whether fast or slow doesn't matter if you end up with the same number of dead, as is the supposition behind the Swedish reaction to the virus. In the Swedish view, yes, they will lead the deaths per capita stats early on, but in time it'll all even out because the secondary waves will bring up the numbers in those countries that eventually have to lift their lockdowns - Sweden is just getting it over with faster. At least that's their theory. Whether it's right only time will tell. In any case, I see no reason why those countries should have a worse outcome than Sweden - and Sweden is willing to live with their per capita numbers. YMMV.

[Todd Allen]

2 minutes ago, TomBAvoider said:

The only thing shanty towns do is spread the virus faster, not make it more deadly.

Some have suggested the reason young healthcare workers die from Covid-19 at higher rates compared to others of similar age and health is due to being subjected to higher initial viral loads giving the virus a better chance to outgrow the host's immune response.  If this is correct, faster spread in a dense population could lead to greater mortality.  There are more possibilities for increased 3rd world death rates such as limited healthcare, malnutrition and synergy between co-infections among populations already burdened with dysentery, hepatitis, tuberculosis, dengue, etc.

 

[Mechanism]

31 minutes ago, Todd Allen said:

Some have suggested the reason young healthcare workers die from Covid-19 at higher rates compared to others of similar age and health is due to being subjected to higher initial viral loads giving the virus a better chance to outgrow the host's immune response.  If this is correct, faster spread in a dense population could lead to greater mortality.  There are more possibilities for increased 3rd world death rates such as limited healthcare, malnutrition and synergy between co-infections among populations already burdened with dysentery, hepatitis, tuberculosis, dengue, etc.

 

Sadly you are probably right Todd: https://academic.oup.com/cid/article/46/10/1582/294025

The Interaction between Nutrition and Infection 

Peter Katona, Judit Katona-Apte

Clinical Infectious Diseases, Volume 46, Issue 10, 15 May 2008, Pages 1582–1588, https://doi.org/10.1086/587658

 

The biggest advantage is the lower prevalence of older persons, but comorbidities, crowding and malnutrition are huge problems along with issues around hygiene and simple supportive measures in and outside the minimal or broken health care systems.  The true extent will likely never be known due to anticipated limited testing.  The best estimate would be comparing ( also imperfect) crude all-cause mortality data pre vs post Covid. 

Edited April 21, 2020 by Mechanism

[TomBAvoider]

Some have suggested the reason young healthcare workers die from Covid-19 at higher rates compared to others of similar age and health is due to being subjected to higher initial viral loads

Yes, people have suggested this, and all sorts of other things. But this is not established fact. We won't know such things until much later - if ever. Wrt. the heathlcare industry - I really wonder how relevant it is in this case. The people who end up in the hospital are overwhelmingly older with many co-morbidities, especially diabetes and hypertension, cardiovascular and renal vulnerabilities. But if your population is drastically younger, you simply don't have enough old people to make up those numbers. Yes, Sweden will rescue old people through hospitals, but they may still end up with more old people dying than a country with fewer old people who receive zero help.

As to co-infections and other health status factors: what we know about the CV virus is that it strikes the obese, the diabetic, the cardio-vascular and renal impaired - those are the prominent vulnerabilities, a profile that seems to fit the "affluent country morbidities". As developing countries have fewer of the "afluent morbidities", it should prove (in addition to age) a protective profile against CV. Wrt. co-infections, I have not seen the data, although it does make intuitive sense... however, I've been burned by "intuitive sense" often enough, that I prefer to rely on data. YMMV. 

Edited April 21, 2020 by TomBAvoider

[TomBAvoider]

Btw. here are some statistics wrt. Bangladesh (which country Dean mentioned):

Obesity rate 3.6% in 2016

Which is farcically low compared to the US 

Obesity rate in the U.S. 39.8%

The median age in Bangladesh is 26 years. 

 

[Todd Allen]

6 minutes ago, TomBAvoider said:

But if your population is drastically younger, you simply don't have enough old people to make up those numbers. Yes, Sweden will rescue old people through hospitals, but they may still end up with more old people dying than a country with fewer old people who receive zero help.

As to co-infections and other health status factors: what we know about the CV virus is that it strikes the obese, the diabetic, the cardio-vascular and renal impaired - those are the prominent vulnerabilities, a profile that seems to fit the "affluent country morbidities". 

Tom, the likely reason for those statistics is the virus spreading faster in wealthier countries due to greater connectivity, ie more planes, trains and automobiles.  It could be that morbidities are more critical to Covid-19 mortality than absolute age.  We should soon learn if "poor country morbidities" are as relevant if not more so.

[Dean Pomerleau]

Thanks Todd for addressing Tom's suggestions about the potential death toll in 3rd world countries. Unsurprisingly I agree with you that developing countries have many factors working against them when it comes to covid-19, while acknowledging Tom's point that they don't have high rates of many diseases of affluence which might reduce their baseline risk of mortality/morbidity from the virus. 

But the real reason for this post is to share a disappointing new study on hydroxychloroquine [1]. It wasn't a randomized control trial, but a retrospective trial that looked at 368 patients previously treated with either hydroxychloroquine (HC), hydroxychloroquine + azithromycin (HC+AZ) or standard care alone.

When used alone, HC appeared to increase risk of death compared to standard care (RR=2.61, 95% CI 1.10 to 6.17; P=0.03) and when combined with azithromycin it was non-significantly worse than standard care (RR=1.14; 95% CI, 0.56 to 2.32; P=0.72). 

Here are some subtleties associated with the trial as described in the full text:

This nationwide retrospective study of the largest integrated healthcare system in the United States provides the largest dataset yet reported of the outcomes of Covid-19 patients treated with hydroxychloroquine, with or without azithromycin, anywhere in the world. Specifically, hydroxychloroquine use with or without co-administration of azithromycin did not improve mortality or reduce the need for mechanical ventilation in hospitalized patients. On the contrary, hydroxychloroquine use alone was associated with an increased risk of mortality compared to standard care alone.

Baseline demographic and comorbidity characteristics were comparable across the three treatment groups. However, hydroxychloroquine, with or without azithromycin, was more likely to be prescribed to patients with more severe disease, as assessed by baseline ventilatory status and metabolic and hematologic parameters. Thus, as expected, increased mortality was observed in patients treated with hydroxychloroquine, both with and without azithromycin.

Nevertheless, the increased risk of overall mortality in the hydroxychloroquine-only group persisted after adjusting for the propensity of being treated with the drug. That there was no increased risk of ventilation in the hydroxychloroquine-only group suggests that mortality in this group might be attributable to drug effects on or dysfunction in non-respiratory vital organ systems. Indeed, hydroxychloroquine use in Covid-19 patients has been associated with cardiac toxicity.

It's just one study, not a randomized trial and the groups weren't well-matched and all were very sick, so it doesn't rule out hydroxychloroquine (with or without azithromycin) as an effective treatment. But it does take a lot of the wind out of the sail for the the pair being the "biggest game changers in the history of medicine" as Trump suggested.

Let's hope the positive early anecdotes for remdesivir turn out better.

--Dean

-----

1] Outcomes of hydroxychloroquine usage in United States veterans hospitalized
with Covid-19
Joseph Magagnoli, M.S.1,2,*, Siddharth Narendran, M.D.4,5,*, Felipe Pereira M.D.4,5,*, Tammy
Cummings, Ph.D.1, James W. Hardin, Ph.D.3, S. Scott Sutton, Pharm.D.1,2, Jayakrishna Ambati,

https://doi.org/10.1101/2020.04.16.20065920

ABSTRACT
BACKGROUND:
Despite limited and conflicting data on the use of hydroxychloroquine in patients with Covid-19,
the U.S. Food and Drug Administration has authorized the emergency use of this drug when
clinical trials are unavailable or infeasible. Hydroxychloroquine, alone or in combination with
azithromycin, is being widely used in Covid-19 therapy based on anecdotal and limited
observational evidence.
METHODS:
We performed a retrospective analysis of data from patients hospitalized with confirmed SARSCoV-2 infection in all United States Veterans Health Administration medical centers until April
11, 2020. Patients were categorized based on their exposure to hydroxychloroquine alone (HC)
or with azithromycin (HC+AZ) as treatments in addition to standard supportive management for
Covid-19. The two primary outcomes were death and the need for mechanical ventilation. We
determined the association between treatment and the primary outcomes using competing risk
hazard regression adjusting for clinical characteristics via propensity scores. Discharge and death
were taken into account as competing risks and subdistribution hazard ratios are presented.
RESULTS:
A total of 368 patients were evaluated (HC, n=97; HC+AZ, n=113; no HC, n=158). Rates of
death in the HC, HC+AZ, and no HC groups were 27.8%, 22.1%, 11.4%, respectively. Rates of
ventilation in the HC, HC+AZ, and no HC groups were 13.3%, 6.9%, 14.1%, respectively.

Compared to the no HC group, the risk of death from any cause was higher in the HC group
(adjusted hazard ratio, 2.61; 95% CI, 1.10 to 6.17; P=0.03) but not in the HC+AZ group
(adjusted hazard ratio, 1.14; 95% CI, 0.56 to 2.32; P=0.72). The risk of ventilation was similar in
the HC group (adjusted hazard ratio, 1.43; 95% CI, 0.53 to 3.79; P=0.48) and in the HC+AZ
group (adjusted hazard ratio, 0.43; 95% CI, 0.16 to 1.12; P=0.09), compared to the no HC group.
CONCLUSIONS:
In this study, we found no evidence that use of hydroxychloroquine, either with or without
azithromycin, reduced the risk of mechanical ventilation in patients hospitalized with Covid-19.
An association of increased overall mortality was identified in patients treated with
hydroxychloroquine alone. These findings highlight the importance of awaiting the results of
ongoing prospective, randomized, controlled studies before widespread adoption of these drugs.

[TomBAvoider]

It could be that morbidities are more critical to Covid-19 mortality than absolute age.  We should soon learn if "poor country morbidities" are as relevant if not more so.

Right, all will be revealed in due time. Wrt. age however, I was struck by what Sweden's leading epidemiologist, the man responsible for Sweden's CV policy, said in an interview I linked to earlier:

https://www.nature.com/articles/d41586-020-01098-x

Quote:

"The big debate we are facing right now is around care homes for older people, where we registered very unfortunate outbreaks of the coronavirus. This accounts for Sweden’s higher death rate, compared with our neighbours.

And quote:

We know that COVID-19 is extremely dangerous for very old people, which is of course bad. But looking at pandemics, there are much worse scenarios than this one. Most problems that we have right now are not because of the disease, but because of the measures that in some environments have not been applied properly: the deaths among older people is a huge problem and we are fighting hard.

So the excess deaths per capita that Sweden recorded compared to the neighboring countries - and which was widely reported upon - was all due to deaths among the old. That would seem to argue that age is a key factor, whether inherently or because of co-morbidities. And as he keeps pointing out, that CV is dangerous for "very old people". So again, age seems to be a key factor (perhaps through the mechanism of co-morbidities). 

Sweden has had higher per capita CV mortality because they mishandled the spread among old people. Bangladesh has a miniscule (comparatively speaking) "very old" (Swedish epidemiologist's term), and thus should not experience the excess mortality that Sweden did. 

Now I'm not by any means claiming this is going to be dispositive - possibly other factors, such as the co-infections you mention might tilt the numbers in disfavor of Bangladesh, but I don't see immediately - at least not at this moment based on the data available - why Bangladesh should experience greater per capita CV deaths than Sweden. YMMV. 

Edited April 21, 2020 by TomBAvoider

[Todd Allen]

Poorer countries may be failing to count Covid-19 victims.  Here is a story from Brazil which is struggling to cope with a Covid-19 crisis much larger than indicated by official statistics. 

After burial boom, Manaus opens collective graves for victims of covid-19:

https://noticias.uol.com.br/saude/ultimas-noticias/redacao/2020/04/21/apos-boom-em-enterros-manaus-abre-covas-coletivas-para-vitimas-de-covid-19.htm

Here's a google translated excerpt:

Quote

Between April 12 and April 19, 656 bodies were buried in cemeteries administered by the Manaus City Hall, according to a survey by the Municipal Department of Urban Cleaning obtained exclusively by the report. An average of 82 funeral ceremonies per day, compared to the 28 daily burials recorded on average in 2019. It is not possible to directly link this burial increase to covid-19 alone. But there is no other element that justifies such an expressive and abrupt growth in the movement of public cemeteries in Manaus. Authorities admit that corpses are taken to graves without undergoing tests to check for contagion.

 

[BrianA]

Looks like this virus is stable in air for over 16 hours... actually likely longer than that because that was only as far as this study tested. I can't recall if I posted it here, but there also was a study from China recently that showed essentially 100% of traced cases were initially infected indoors, not outdoors, with something like over 80% of those either happening at home or on public transit. Moral of the story is avoid poorly ventilated airspace and/or wear masks.

 

Comparative dynamic aerosol efficiencies of three emergent coronaviruses and the unusual persistence of SARS-CoV-2 in aerosol suspensions

https://www.medrxiv.org/content/10.1101/2020.04.13.20063784v1.full.pdf

 

Coronavirus is not behaving in the air the way scientists expect

https://www.theage.com.au/national/warning-light-coronavirus-can-last-longer-in-air-than-first-thought-20200420-p54li8.html

[BrianA]

Autopsy results confirm the virus definitely can infect endothelial cells.

 

Endothelial cell infection and endotheliitis in COVID-19

https://www.thelancet.com/action/showPdf?pii=S0140-6736(20)30937-5

[Sibiriak]

44 minutes ago, BrianA said:

Moral of the story is avoid poorly ventilated airspace and/or wear masks.

Yes,   multiple lines of evidence have been presented here that  support that point.

[Sibiriak]

4 hours ago, Dean Pomerleau said:

a disappointing new study on hydroxychloroquine [1]. It wasn't a randomized control trial, but a retrospective trial that looked at 368 patients previously treated with either hydroxychloroquine (HC), hydroxychloroquine + azithromycin (HC+AZ) or standard care alone. 

I haven't been following the hydroxychloroquine saga too closely,  but I was wondering, what happened to the idea that  hydroxycholoroquine should be accompanied by zinc to get more zinc into cells etc.?   Also: that hydroxychoroquine +   needed to be administered before a case becomes really severe?

Quote

 the pair being the "biggest game changers in the history of medicine" as Trump suggested. 

To be fair,  Trump said it had a chance to be a game changer,  not that it definitely was one. 

Btw,  French President Macron  has also called for hydroxychoroquine trials:
 

Quote

Emmanuel Macron called for clinical trials of a controversial coronavirus “cure” as he hailed the French infection specialist who promoted it as a great scientist. 

The French president said on Wednesday [April 15] that he would like the treatment, which was backed by Didier Raoult, tested rigorously as soon as possible.

[...] Macron’s comments are likely to ignite fresh controversy over Raoult, whose research has been boosted by populist leaders, such as Donald Trump and Jair Bolsonaro, but which is regarded with scepticism by other members of the medical establishment.

“I’m convinced that he’s a great scientist, and I’m passionate about what he explained,” Macron told RFI radio.

 

Edited April 22, 2020 by Sibiriak

[Sibiriak]

15 hours ago, TomBAvoider said:

why is Sweden doing what it is doing - a 15 minute interview with a Swedish epidemiologist,

I agree with many of the criticisms of severe lockdown strategies,  however, this point at least is problematic:

Quote

The correct policy is to protect the old and the frail only

What about the large numbers of people of all ages with dangerous pre-existing conditions (especially in countries such as the U.S.)?   They need to be identified and protected as well.  Talking only about "the old and the frail" (Wittkowski does the same) risks underestimating  the size of the vulnerable population as well as the difficulties in protecting them.

Note also  the  position of epidemiologist Anders Tegnell,  the architect of Sweden's strategy:

Quote

As in many other countries, we aim to flatten the curve, slowing down the spread as much as possible — otherwise the health-care system and society are at risk of collapse.  

That's in stark contrast to the extreme positions of Wittkowski et al.

Quote

Wittkowski:  Well, what people are trying to do is flatten the curve.  I don't know why.

 

And certainly, important differences between countries should not be overlooked when comparing strategies.

Letter from Stockholm: Social distance, Swedish style

Quote

As other European governments introduce draconian measures at breakneck speed, leaving their populations shell-shocked (and possibly better-protected), Sweden has stayed remarkably calm in the midst of a full-blown global pandemic.

How come? Set aside the fact that we’re a country known for its cool — some would say downright cold — temperament, where showing strong emotions is considered a social faux pas. In truth, we were practicing the coronavirus lifestyle long before the virus hit.

Geographically, Sweden is the third-largest country in the EU, but its population stands at just over 10 million; the main boulevards of our largest cities are always almost empty. (That’s why the xenophobic, far-right Sweden Democrats get ridicule from local comedians for their oft-repeated mantra: “Sweden is full!”)

In fact, according to figures from 2018-19, the majority of Swedish households are single-person households without children. A dramatically different society from Italy’s, for instance, where different generations live under the same roof, not only for financial reasons.

Swedes also like to keep a remarkably wide so-called interpersonal distance. You know the “my space, your space” scene in "Dirty Dancing?" Now, place Baby and Johnny in opposite corners of the room. That’s better. Not so awkward, see? This rule has long applied to all aspects of everyday Swedish life, from navigating the supermarket aisles to waiting at the bus stop [...]

 

Anders Tegnell:

Quote

What every country is trying to do is to keep people apart, using the measures we have and the traditions we have to implement those measures. And that’s why we ended up doing slightly different things.

 

Edited April 22, 2020 by Sibiriak

[Gordo]

Yea I don't think that study on hydroxychloroquine is necessarily all that meaningful, anecdotes from doctors say it should be combined with zinc and prescribed as quickly as possible.  Once the patient already has pneumonia and lung damage, you may not really even be treating "the virus" per se at that point, but the person's immune response to the virus that is wreaking havoc?  I'm interested in the results of the many trials underway with zinc + hydroxychloroquine for prophylaxis.  I saw the buzz about Rendesivir last week, but when I investigated it, I actually found that it was a classic options expiration pump perpetrated by a repeat fraudster (as far as I know, that story never made it to the mainstream press?), Gilead themselves came out and damped optimism since then.  Results so far don't seem all that impressive, and it's also an infusion, which gives it limited applicability and probably very high cost.

Tom - don't want to go off topic, but your partisan analysis of debt leaves much to be desired.  California has one of the highest state+local debt per capita's in the entire country, plus a serious pension crisis, they are in very big trouble longer term.  Not sure what good a "rainy day fund" is when your mountain of debt far exceeds it.  9 out of the top 12 highest state+local debt per capita states have a democrat governor by the way. 4 of the top 5 states with the worst underfunded public pensions are also run by Democrats (and now some of them are even asking for Federal bailouts! Do you want to pay for their abuses at the expense of your own future?).  Also when it comes to presidents, remember that only CONGRESS has the authority to control spending, produce a budget, change tax laws, etc.  The president is merely a cheerleader for various ideas.  Under Clinton, there was NEVER an actual surplus, in ANY fiscal year (budget surplus is not the same as an actual surplus) but the best years were when Republicans controlled congress.  This is clearly shown on the department of treasury website (see debt by year data).  That said, both parties spend like drunken sailors, the total national debt DOUBLED during the Obama years, the Trump years are just off the charts nuts.  Part of me says "Yes, of course its ridiculous to cut taxes when we have massive debts and deficits" and another part of me says "The more you give these idiots, the more they spend, so let's starve the beast and go ahead and cut those taxes".   Eventually that Elizabeth Warren "wealth tax" idea will probably prevail, and all those tax cuts will be taken back by force in a sweeping populist tide so in the end, maybe it doesn't matter that much, after all we pay virtually no interest on the debt.

I've also been wondering what the pandemic will do in 3rd world countries, I'm not sure yet, obviously younger (age) countries will do better than older.  There seem to be many different factors converging however, that could contribute to pain:

Coronavirus pandemic will cause global famines of 'biblical proportions,' UN warns

Unrelated, but there have been some interesting reports about COVID-19 and blood clots.  I stumbled upon that after reading: 

Broadway star Nick Cordero to have leg amputated in COVID-19 complication

This is another possible way the virus could impact younger people.

 

Edited April 23, 2020 by Gordo

[Mike41]

22 hours ago, TomBAvoider said:

Something very important to keep in mind for everybody (myself included):

Why Most Post-Pandemic Predictions Will Be Totally Wrong

This is sooooooo true! Our minds are like this on a personal level and of course that translates to an overall societal level. This is one for a mindfulness class discussion!

[TomBAvoider]

You're right Gordo, this is not the place for this discussion so I won't go into any detail, but I'm well aware of the issues you mention. CA has the debt you mention, but why not ask how it got that way (Repubs love creating deficits, as our Swartzenegger did the second he got in power), and more importantly that debt is now historic - but since Brown we've been digging ourselves out of this, which would not happen with a Repub in charge. You can poo-poo the rainy day fund, but you'd have a giant hole with the Repubs instead. As for presidents - just go down the line for debt and defiticts from Carter on - look what Reagan started. And we can dismiss Clinton's budget surplusess, but we'd have giant deficits with Repubs in charge instead - which is better? "Starve the beast" is how we got here. And I wouldn't be so sure about the fate of the wealth tax and the supposed backlash once you immiserate enough of the middle class for the sake of the 0.01%  (which Repubs love to do) - you might just see the kind of explosion that would end up with a wholesale wipeout of the tiny top... guilottines were not fiction and arose for a reason and now might stage a comeback (at least figuratively speaking)... as they say, keep f***ing around and find out :) You can only press people so much, before uncontrollable stuff happens - and it happens a lot faster than anyone would suppose (age old cry "never would I have believed!"). The inequality index has been zooming up and up - until it can do so no more. We'll see.

Edited April 22, 2020 by TomBAvoider

[KHashmi317]

1 hour ago, Mike41 said:

23 hours ago, TomBAvoider said:
Something very important to keep in mind for everybody (myself included):

Why Most Post-Pandemic Predictions Will Be Totally Wrong

-------

This is sooooooo true! Our minds are like this on a personal level and of course that translates to an overall societal level. This is one for a mindfulness class discussion!

Back in the early 80s, Charles Perrow did extensive research into "Normal Accidents" which led to the book of the same name.

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

Although Perrow's book addressed mostly synthetic (man-made) events, a pandemic certainly qualifies as: "A system accident (or normal accident) -- an "unanticipated interaction of multiple failures" in a complex system. https://en.wikipedia.org/wiki/Complex_system

 

[Ron Put]

Poor Sweden, it finds itself in the unusual position of being under attack by the left in both the UK and in the US, and by much of the media which pushed the WHO/China narrative and cheered the lock-downs.

It’s absolutely crazy to see how some gloat over every excess death in Sweden and talk up the 1000 or so extra deaths Sweden has compared to locked up Denmark. Yet, the total Covid-19 deaths in Sweden are still far fewer than the excess mortality Sweden experienced during the 2018 flu pandemic.

While screaming about the “failed” Swedish policy, the same lot still continues to exalt and hail as heroes the “experts” who predicted millions of deaths in the US and 200,000 deaths in the UK. These “experts” floated up in the media cycle for purely political purposes, to enable the likes of Cuomo, de Blasio and Newsom to shut down their state economies, in the name of “strong leadership” and to embarrass Trump (as if he needs help).

Why aren’t the front pages screaming that the most deaths are within the most tightly locked areas? There is absolutely no evidence that Covid-19 is contained by the lock-downs, even if those who imposed them count every heart attack as Covid-19 death….

Why isn’t it on the front pages that 2020 has lower excess mortality so far than the last few years in the United States, the UK and in Europe in general? Instead, they feature the peak pandemic week or day death toll and compare it to a normal day in the past, for maximum fear effect. Yep, it’s spin and manipulation and it finds its way in this thread, too. And it explains why the public’s opinion of the media is as low as it gets.

Why isn’t it on the front pages that the California lockdown was at least one month after the first Covid-19 deaths in the state, which means that a sizable portion of the population was already infected before the shut down of the economy, especially if the R0 of the virus is indeed 5? We destroyed the Western economies because clearly bad data was misused by populist politicians and I hope we hold those who led us here accountable.

I will repeat, because it is worth repeating, this is not a health crisis and never was. The numbers support the argument that this was a somewhat heavy flu-like pandemic, which will be visiting us again in a few months and will become endemic, just as the previous corona viruses did. But when the virus returns, many will be unemployed and government will have little room to do anything about it.

Covid-19 became a political crisis partially because of WHO’s leadership political biases and mistakes: remember, WHO's Tedross claimed that Covid-19 is NOT contagious and thus can be contained through China's methods, unlike the flu. Then there was disinformation from China. And Russian trolls and the media had helped so polarize politically the liberal democracies, that large portions of their societies chose to promote Russian or Chinese narratives and propaganda to destroy their internal opposition.

Edited April 23, 2020 by Ron Put

[Todd Allen]

COVID-19 Numbers Are Bad In Ecuador. The President Says The Real Story Is Even Worse

Quote

Ecuador has one of the highest rates of COVID-19 in all of Latin America – with 10,128 cases and 507 deaths in a country of just 17 million people.

But the situation may be far worse than what the official numbers show. In fact, one Ecuadorian official says it appears that thousands more people may have died of the disease than his government is reporting.

Jorge Wated, who heads a government task force charged with collecting and burying bodies in Guayaquil, the epicenter of the outbreak, said that in the first 15 days of April, 6,703 people had died from either COVID-19 or natural causes. Previous to the coronavirus outbreak, he said, the monthly figure was around 1,000.

 

[TomBAvoider]

Wrt. wrong predictions etc., there's also a well-known tendency of people feeling competent despite having few objective reasons for that feeling (and of course, we're all familiar with the Dunning-Kruger effect). There's a particular personality type that feels impelled to express opinions (very prevalent type online!) even as they have no grounds to do so. Anyhow, I saw a humorous remark somewhere to the effect: "I see that all of January's Constitutional experts have now become epidemiologists by March".

Meanwhile there's a fascinating book on the subject of people's expertise and predictions:

https://davidepstein.com/the-range/

The basic idea is that an individual is actually LESS able to accurately predict events within their field of expertise, as well as outside of it, as that individual's knowledge grows - which is extremely paradoxical. Research shows that the reason for this is that old bugaboo, the "sunk cost" fallacy - essentially, as your expertise grows, you develop a more and more elaborate (and intellectually costly to maintain) framework to see your field through. When you are attempting to make a prediction, you naturally gravitate to your very costly (sunk costs) developed framework for guidance rather than look at the data anew. Basically, imagine that you've built a round hole framework - along comes a square peg... and of course rather than spend a huge amount of intellectual capital developing a brand new square hole framework, you try to twist the peg into a round hole, with disastrous results for your prediction accuracy.

This is also the reason why large crowds of amateurs - "crowd wisdom" - have traditionally absolutely crushed in accuracy the predictions of solitary "experts" - because they have less attachment to any one framework they can draw upon a very wide variety of knowledge to arrive at a more accurate prediction.

Anyhow, I think this subject is super interesting - and something we all can benfit by. Being less sure of one's conclusions and more sef-questioning can only improve one's performance. YMMV.