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-> Coronavirus Health Questions
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Amarante
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 Mon, Mar 09 2020, 3:44 pm
| amother [ Jade ] wrote: | | And if the supplies run short because of people panicking and stocking up unnecessarily, then NOBODY will have groceries. That's how the Depression started - had people not panicked, the banks would not have collapsed. |
The Great Depression wasn't caused because people took their money out of banks. There were extremely complex global economic conditions.
The Recession of 2008 wasn't caused by panic either.
And the current market crash isn't caused by panic but by real concerns about the impact of the virus on the global economy.
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amother
Wine
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Mon, Mar 09 2020, 5:43 pm
| elisheva25 wrote: | I didn’t write this, copied from Facebook page: For those that are into numbers, you will understand and appreciate it .
Repost @LizSpecht
I think most people aren’t aware of the risk of systemic healthcare failure due to #COVID19 because they simply haven’t run the numbers yet. Let’s talk math.
Let’s conservatively assume that there are 2,000 current cases in the US today, March 6th. This is about 8x the number of confirmed (lab-diagnosed) cases. We know there is substantial under-Dx due to lack of test kits; I’ll address implications later of under-/over-estimate.
We can expect that we’ll continue to see a doubling of cases every 6 days (this is a typical doubling time across several epidemiological studies). Here I mean *actual* cases. Confirmed cases may appear to rise faster in the short term due to new test kit rollouts.
We’re looking at about 1M US cases by the end of April, 2M by ~May 5, 4M by ~May 11, and so on. Exponentials are hard to grasp, but this is how they go.
As the healthcare system begins to saturate under this case load, it will become increasingly hard to detect, track, and contain new transmission chains. In absence of extreme interventions, this likely won’t slow significantly until hitting >>1% of susceptible population.
What does a case load of this size mean for healthcare system? We’ll examine just two factors — hospital beds and masks — among many, many other things that will be impacted.
The US has about 2.8 hospital beds per 1000 people. With a population of 330M, this is ~1M beds. At any given time, 65% of those beds are already occupied. That leaves about 330k beds available nationwide (perhaps a bit fewer this time of year with regular flu season, etc).
Let’s trust Italy’s numbers and assume that about 10% of cases are serious enough to require hospitalization. (Keep in mind that for many patients, hospitalization lasts for *weeks* — in other words, turnover will be *very* slow as beds fill with COVID19 patients).
By this estimate, by about May 8th, all open hospital beds in the US will be filled. (This says nothing, of course, about whether these beds are suitable for isolation of patients with a highly infectious virus.)
If we’re wrong by a factor of two regarding the fraction of severe cases, that only changes the timeline of bed saturation by 6 days in either direction. If 20% of cases require hospitalization, we run out of beds by ~May 2nd.
If only 5% of cases require it, we can make it until ~May 14th. 2.5% gets us to May 20th. This, of course, assumes that there is no uptick in demand for beds from *other* (non-COVID19) causes, which seems like a dubious assumption.
As healthcare system becomes increasingly burdened, Rx shortages, etc, people w/ chronic conditions that are normally well-managed may find themselves slipping into severe states of medical distress requiring intensive care & hospitalization. But let’s ignore that for now.
Alright, so that’s beds. Now masks. Feds say we have a national stockpile of 12M N95 masks and 30M surgical masks (which are not ideal, but better than nothing).
There are about 18M healthcare workers in the US. Let’s assume only 6M HCW are working on any given day. (This is likely an underestimate as most people work most days of the week, but again, I’m playing conservative at every turn.)
As COVID19 cases saturate virtually every state and county, which seems likely to happen any day now, it will soon be irresponsible for all HCWs to not wear a mask. These HCWs would burn through N95 stockpile in 2 days if each HCW only got ONE mask per day.
One per day would be neither sanitary nor pragmatic, though this is indeed what we saw in Wuhan, with HCWs collapsing on their shift from dehydration because they were trying to avoid changing their PPE suits as they cannot be reused.
How quickly could we ramp up production of new masks? Not very fast at all. The vast majority are manufactured overseas, almost all in China. Even when manufactured here in US, the raw materials are predominantly from overseas... again, predominantly from China.
Keep in mind that all countries globally will be going through the exact same crises and shortages simultaneously. We can’t force trade in our favor.
Now consider how these 2 factors – bed and mask shortages – compound each other’s severity. Full hospitals + few masks + HCWs running around between beds without proper PPE = very bad mix.
HCWs are already getting infected even w/ access to full PPE. In the face of PPE limitations this severe, it’s only a matter of time. HCWs will start dropping from the workforce for weeks at a time, leading to a shortage of HCWs that then further compounds both issues above.
We could go on and on about thousands of factors – # of ventilators, or even simple things like saline drip bags. You see where this is going.
Importantly, I cannot stress this enough: even if I’m wrong – even VERY wrong – about core assumptions like % of severe cases or current case #, it only changes the timeline by days or weeks. This is how exponential growth in an immunologically naïve population works.
Undeserved panic does no one any good. But neither does ill-informed complacency. It’s wrong to assuage the public by saying “only 2% will die.” People aren’t adequately grasping the national and global systemic burden wrought by this swift-moving of a disease.
I’m an engineer. This is what my mind does all day: I run back-of-the-envelope calculations to try to estimate order-of-magnitude impacts. I’ve been on high alarm about this disease since ~Jan 19 after reading clinical indicators in the first papers emerging from Wuhan.
Nothing in the last 6 weeks has dampened my alarm in the slightest. To the contrary, we’re seeing abject refusal of many countries to adequately respond or prepare. Of course some of these estimates will be wrong, even substantially wrong.
But I have no reason to think they’ll be orders-of-magnitude wrong. Even if your personal risk of death is very, very low, don’t mock decisions like canceling events or closing workplaces as undue “panic”.
These measures are the bare minimum we should be doing to try to shift the peak – to slow the rise in cases so that healthcare systems are less overwhelmed. Each day that we can delay an extra case is a big win for the HC system.
And yes, you really should prepare to buckle down for a bit. All services and supply chains will be impacted. Why risk the stress of being ill-prepared?
Worst case, I’m massively wrong and you now have a huge bag of rice and black beans to burn through over the next few months and enough Robitussin to trip out.
One more thought: you’ve probably seen multiple respected epidemiologists have estimated that 20-70% of world will be infected within the next year. If you use 6-day doubling rate I mentioned above, we land at ~2-6 billion infected by sometime in July of this year.
Obviously I think the doubling time will start to slow once a sizeable fraction of the population has been infected, simply because of herd immunity and a smaller susceptible population.
But take the scenarios above (full beds, no PPE, etc, at just 1% of the US population infected) and stretch them out over just a couple extra months.
That timeline roughly fits with consensus end-game numbers from these highly esteemed epidemiologists. Again, we’re talking about discrepancies of mere days or weeks one direction or another, but not disagreements in the overall magnitude of the challenge.
This is not some hypothetical, fear-mongering, worst-case scenario. This is reality, as far as anyone can tell with the current available data.
That’s all for now. Standard disclaimers apply: I’m a PhD biologist but *not* an epidemiologist. Thoughts my own. Yadda yadda. Stay safe out there. |
If getting sick is inevitable it makes more sense to get sick now while there are still hospital beds...
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IrenaFr
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Mon, Mar 09 2020, 5:47 pm
| amother [ Wine ] wrote: | | If getting sick is inevitable it makes more sense to get sick now while there are still hospital beds... |
In Italy they finished all their beds very quickly, two weeks ago there were only 200 cases .
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amother
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Mon, Mar 09 2020, 5:50 pm
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two people form westchster have it and are in the hospital one is a lawyer from new rochlle and another at phelps hospital they had no connection to each other
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Rappel
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Mon, Mar 09 2020, 5:57 pm
| elisheva25 wrote: | I didn’t write this, copied from Facebook page: For those that are into numbers, you will understand and appreciate it .
Repost @LizSpecht
I think most people aren’t aware of the risk of systemic healthcare failure due to #COVID19 because they simply haven’t run the numbers yet. Let’s talk math.
Let’s conservatively assume that there are 2,000 current cases in the US today, March 6th. This is about 8x the number of confirmed (lab-diagnosed) cases. We know there is substantial under-Dx due to lack of test kits; I’ll address implications later of under-/over-estimate.
We can expect that we’ll continue to see a doubling of cases every 6 days (this is a typical doubling time across several epidemiological studies). Here I mean *actual* cases. Confirmed cases may appear to rise faster in the short term due to new test kit rollouts.
We’re looking at about 1M US cases by the end of April, 2M by ~May 5, 4M by ~May 11, and so on. Exponentials are hard to grasp, but this is how they go.
As the healthcare system begins to saturate under this case load, it will become increasingly hard to detect, track, and contain new transmission chains. In absence of extreme interventions, this likely won’t slow significantly until hitting >>1% of susceptible population.
What does a case load of this size mean for healthcare system? We’ll examine just two factors — hospital beds and masks — among many, many other things that will be impacted.
The US has about 2.8 hospital beds per 1000 people. With a population of 330M, this is ~1M beds. At any given time, 65% of those beds are already occupied. That leaves about 330k beds available nationwide (perhaps a bit fewer this time of year with regular flu season, etc).
Let’s trust Italy’s numbers and assume that about 10% of cases are serious enough to require hospitalization. (Keep in mind that for many patients, hospitalization lasts for *weeks* — in other words, turnover will be *very* slow as beds fill with COVID19 patients).
By this estimate, by about May 8th, all open hospital beds in the US will be filled. (This says nothing, of course, about whether these beds are suitable for isolation of patients with a highly infectious virus.)
If we’re wrong by a factor of two regarding the fraction of severe cases, that only changes the timeline of bed saturation by 6 days in either direction. If 20% of cases require hospitalization, we run out of beds by ~May 2nd.
If only 5% of cases require it, we can make it until ~May 14th. 2.5% gets us to May 20th. This, of course, assumes that there is no uptick in demand for beds from *other* (non-COVID19) causes, which seems like a dubious assumption.
As healthcare system becomes increasingly burdened, Rx shortages, etc, people w/ chronic conditions that are normally well-managed may find themselves slipping into severe states of medical distress requiring intensive care & hospitalization. But let’s ignore that for now.
Alright, so that’s beds. Now masks. Feds say we have a national stockpile of 12M N95 masks and 30M surgical masks (which are not ideal, but better than nothing).
There are about 18M healthcare workers in the US. Let’s assume only 6M HCW are working on any given day. (This is likely an underestimate as most people work most days of the week, but again, I’m playing conservative at every turn.)
As COVID19 cases saturate virtually every state and county, which seems likely to happen any day now, it will soon be irresponsible for all HCWs to not wear a mask. These HCWs would burn through N95 stockpile in 2 days if each HCW only got ONE mask per day.
One per day would be neither sanitary nor pragmatic, though this is indeed what we saw in Wuhan, with HCWs collapsing on their shift from dehydration because they were trying to avoid changing their PPE suits as they cannot be reused.
How quickly could we ramp up production of new masks? Not very fast at all. The vast majority are manufactured overseas, almost all in China. Even when manufactured here in US, the raw materials are predominantly from overseas... again, predominantly from China.
Keep in mind that all countries globally will be going through the exact same crises and shortages simultaneously. We can’t force trade in our favor.
Now consider how these 2 factors – bed and mask shortages – compound each other’s severity. Full hospitals + few masks + HCWs running around between beds without proper PPE = very bad mix.
HCWs are already getting infected even w/ access to full PPE. In the face of PPE limitations this severe, it’s only a matter of time. HCWs will start dropping from the workforce for weeks at a time, leading to a shortage of HCWs that then further compounds both issues above.
We could go on and on about thousands of factors – # of ventilators, or even simple things like saline drip bags. You see where this is going.
Importantly, I cannot stress this enough: even if I’m wrong – even VERY wrong – about core assumptions like % of severe cases or current case #, it only changes the timeline by days or weeks. This is how exponential growth in an immunologically naïve population works.
Undeserved panic does no one any good. But neither does ill-informed complacency. It’s wrong to assuage the public by saying “only 2% will die.” People aren’t adequately grasping the national and global systemic burden wrought by this swift-moving of a disease.
I’m an engineer. This is what my mind does all day: I run back-of-the-envelope calculations to try to estimate order-of-magnitude impacts. I’ve been on high alarm about this disease since ~Jan 19 after reading clinical indicators in the first papers emerging from Wuhan.
Nothing in the last 6 weeks has dampened my alarm in the slightest. To the contrary, we’re seeing abject refusal of many countries to adequately respond or prepare. Of course some of these estimates will be wrong, even substantially wrong.
But I have no reason to think they’ll be orders-of-magnitude wrong. Even if your personal risk of death is very, very low, don’t mock decisions like canceling events or closing workplaces as undue “panic”.
These measures are the bare minimum we should be doing to try to shift the peak – to slow the rise in cases so that healthcare systems are less overwhelmed. Each day that we can delay an extra case is a big win for the HC system.
And yes, you really should prepare to buckle down for a bit. All services and supply chains will be impacted. Why risk the stress of being ill-prepared?
Worst case, I’m massively wrong and you now have a huge bag of rice and black beans to burn through over the next few months and enough Robitussin to trip out.
One more thought: you’ve probably seen multiple respected epidemiologists have estimated that 20-70% of world will be infected within the next year. If you use 6-day doubling rate I mentioned above, we land at ~2-6 billion infected by sometime in July of this year.
Obviously I think the doubling time will start to slow once a sizeable fraction of the population has been infected, simply because of herd immunity and a smaller susceptible population.
But take the scenarios above (full beds, no PPE, etc, at just 1% of the US population infected) and stretch them out over just a couple extra months.
That timeline roughly fits with consensus end-game numbers from these highly esteemed epidemiologists. Again, we’re talking about discrepancies of mere days or weeks one direction or another, but not disagreements in the overall magnitude of the challenge.
This is not some hypothetical, fear-mongering, worst-case scenario. This is reality, as far as anyone can tell with the current available data.
That’s all for now. Standard disclaimers apply: I’m a PhD biologist but *not* an epidemiologist. Thoughts my own. Yadda yadda. Stay safe out there. |
This is very well written. The one place I disagree: there is already evidence that one can catch this virus more than once, and that there was at least one major gene mutation already. If both are true, then there will be no herd immunity, and it will be very hard to create a preventative/cure. This is the epidemic we've all known is coming. I pray the toll won't be too high, yet I fear that it is already.
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mamma llama
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Mon, Mar 09 2020, 6:46 pm
| Rappel wrote: | | This is very well written. The one place I disagree: there is already evidence that one can catch this virus more than once, and that there was at least one major gene mutation already. If both are true, then there will be no herd immunity, and it will be very hard to create a preventative/cure. This is the epidemic we've all known is coming. I pray the toll won't be too high, yet I fear that it is already. |
Do you have a source for this or just a rumor that you heard?
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mamma llama
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Mon, Mar 09 2020, 7:38 pm
Oh wow. I was hoping you didn't have a source about this...!  
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mamma llama
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Mon, Mar 09 2020, 9:07 pm
| amother [ Mustard ] wrote: | | But the stronger strains have a harder time surviving. |
Kind of ironic that the stronger strains aren't able to survive as long...
| amother [ Mustard ] wrote: | | Also it sounds like ppl have recaught same strains. |
You mean even after someone gets better, they don't develop any antibodies against it?
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Rappel
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Mon, Mar 09 2020, 10:04 pm
| mamma llama wrote: | | You mean even after someone gets better, they don't develop any antibodies against it? |
I don't know if there are no antibodies, since I haven't been able to find a medical research paper analyzing it, but some of the cases are repeats - that's from the WHO. And that's why it's alarming.
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ora_43
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Mon, Mar 09 2020, 11:32 pm
| amother [ Jade ] wrote: | What do we gain from this?
If we say that indeed it is a doomsday scenario, and thousands of seniors are going to be left to die, what do we gain?
Are we going to impose more quarantines? We're already doing that!
Get more people to stockpile masks, Purell, and toilet paper? Who does that help?
Get everyone to listen to the CDC? We're doing that too.
Follow instructions? Of course. But how does the panic BENEFIT anyone? |
I don't think that literally a single person has RECOMMENDED panic.
Panic is an emotion that some people are naturally experiencing in response to scary news.
If we say that their response isn't helpful, well - so what??
Are we going to insist they stop being scared at the thought of a potential global pandemic? Are we going to demand that news outlets only publish the more optimistic reports - yes, they can report on what's happening in South Korea, no, they can't mention Italy or Iran? Are we going to forbid any discussion of the impact this could have on individual communities, on the health system, on the world economy?
The truth is what it is. How people react to it is up to them.
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WhatFor
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Tue, Mar 10 2020, 4:14 am
| mamma llama wrote: | Kind of ironic that the stronger strains aren't able to survive as long...
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It's not ironic. It evolved to survive that way. The stronger strains hit ppl stronger so they couldn't walk around with it as much. They were incapacitated and often passed away and therefore it didn't spread as much.
The reason this one is so prolific is precisely because in a lot of people it's milder, hence they can walk around and spread it to more people and the virus has a longer life. Survival of the fittest virus.
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