Wednesday, April 22, 2020

Housekeeping

As Borepatch mentioned in a recent post, we have maintained a surprising level of civility here on the blog. The comments are mostly on point, disagreements about things do not test Godwin's Law, and value of the feedback helps keep me focused.

One fairly recent example is my deeply held belief that the damage done by criminal penalties on recreational drug use far exceeds the damage done by the drugs themselves. I am not reopening that discussion here, I am just pointing to it so how a topic that many people feel strongly about can be discussed and debated by adults. My mind and position was not changed, perhaps no one's was, but we talked about it without rancor.

We are going to discuss COVID-19 and we are going to discuss it the same way. In the absence of enough data to generate statistically significant conclusions, we are going to wag it, just like our political leaders are. In the last post, I started a list of things we know we don't know. If just the beginning of that list is an accurate assessment of some things we don't know, we are all working on conjecture and opinion.

Disagreeing with an opinion is fine. Offering a counter argument and the reasons for your own opinion is fine. I want you all here, I want you all to comment. Comments are blogger crack. When I write something that stirs people to comment I feel like that was a successful post.

Don't attack each other personally in the comments here. Disagree all you want with me, Borepatch, or other commenters. I am going to leave the current comments on Borepatch's post about being banned from commenting on Aesop's blog Raconteur Report, because while they skirt or cross the line, it was at least related the topic of the post. In the future, ad hominum attacks will be deleted without warning. 

32 comments:

Aesop said...

1) The observed CFR for this virus seems to be running somewhere around 3%, as I originally guesstimated (and clearly identified it as such), based on the 1-5% average of coronavirus fatality in the wild prior to this outbreak.
2) There is no patent cure for this.
3) A functional vaccine will take between 1-∞ years to develop and distribute, IOW, it may never come, but at the rosiest, it'd be next spring.
4a) If the rosiest wild estimates of unvetted tests and peer-unreviewed surveys, using statistically invalid samples are correct, SARS-CoV-2 has penetrated, at most, about 4% of the U.S. population.
4b) A more rational estimate is that it has only penetrated to about 0.5% of the population of the U.S., to date.
5) In a population where it went hog wild, because it was treated as nothing to worry about until it was everywhere, and where things like the subway used by millions daily is still running, it created nearly half of the (currently 45K) deaths experienced.
6) There are about 900K hospital beds in the entire U.S.
7) There are about 70K ICU beds.
8) There are about 60K ventilators.
9) It takes 2-3 years to train a respiratory therapist, and each one can supervise about 4 vents.
10) About 60-75% of the beds available are occupied by other patients 24/7/365, because we run the health care system as lean as a passenger airline (i.e., at <95% occupancy, it goes broke).
11) The average CFR for annual seasonal flu is 0.1%, since ever in living memory.

Those are the facts you have to date.

So plug all that in, and tell me, with existing technology, whether or not you want to kill between 25X and 200X more people, or some smaller amount, by unilaterally ending lockdowns with no universal testing, and why or why not.

If your answers is "Let's not do that", tell me how you do anything more sensible than testing everyone, with a validated and accurate (say >98%) test, to determine who is either clean, or over this and no longer contagious, before letting anyone of them back into the population-at-large pool to play.

That's the actual decision facing both POTUS and 50 governors, right now.

Feel free to bring up the economic factors, which while significant, have killed exactly zero people to date, as opposed to 45K and counting.

Go.

diogenese said...

if you want to stay safe stay at home and let the rest of us get on with life

ambisinistral said...

Of what use, however, is a general certainty that an insect will not walk with his head hindmost, when what you need to know is the play of inward stimulus that sends him hither and thither in a network of possible paths? -- George Eliot

Aesop said...

How did "getting on with life" work out in NYFC?
Asking for 330M friends and neighbors.

"Let them eat cake" plays as poorly in 2020 as it did in 1789.
Ask Ice Cream Nancy about that.

That's the whole point of the discussion.
Typhoid Mary wasn't just a character of legend.

ASM826 said...

All of this belongs either on the previous post or perhaps tomorrow's. But since we are here, I am not suggesting we reopen the country nor am I suggesting we shouldn't. I was pointing just how great the list of unknowns is and suggesting we get busy collecting that data and analyzing it.

Chris Nelson said...

Basically the "leadership" stuck a stick in the bicycle spokes of civilization in order to come to a stop.

Now it's likely we are headed toward a depression and civil unrest/war soon. How many lives will that cost? Did they save a few million lives and doom hundreds of millions?

Aesop said...

ASM, I noticed I posted my original response to this post, instead of where it was intended.
Error rectified.

Obama's boyfriend said...

Gee all those drug lords who sell recreational drugs that have destroyed countless families know that the penalities imposed by heartless governments are unfair and constitute cruel and unusual punishment. Druggies and potheads agree. Who cares about the harm they cause in their quest for their next high. I mean c'mon man. emember how dull it was in the fifties before we got high?

Glen Filthie said...

I’ve noticed a trend amongst the RN’s, outlined at my blog in a way that might not sit well here... but I believe it’s valid. While we scratch our heads at the inconclusive and contradictory data - they know it all! And in the midst of all this mayhem and carnage, the brave nurses regularly post dance and twerk vids on social media, (while their patients die in the background?), and bravely stand up to oppose ignoramii like us who dare to protesta govt that won’t let us make a living. The tempers flare because this is going from the ridiculous to the sublime. How do these people expect to do their jobs when I, as a tax payer, can’t fund their wages or facilities? The foreclosures will start any day now, and the divorces and suicides won’t be far behind. Those deaths will probably be ascribed to the virus too, depending on who is making out the death certificates and how she feels that day.

The country is going to open up, regardless of what the self proclaimed experts say. They’ve had their fun, their 15 minutes of fame... but the rest of us have work to do, and we’re fed up to the gills with virtue signalling fake heroes.

NITZAKHON said...

I think there's an important point to be made here. Before I make it, understand, I value my life and that of my family, and certainly do not want to be among the casualties of this.

There is a difference between individual survival and societal survival.

Up until the advent of modern medicine (and Aesop, I've started to read your piece about that and will get back to it later today - and apropos that, the book "The Body is the Hero" was my first layman's introduction to immunology) there really wasn't much one could do. Yes, ships were quarantined, city-states attempted to do that too. But realistically there were no real treatments. One made it, or one didn't. (Another aside: my late father - born early 20th century - described how his grandmother got some bad infection, and the doctor said "Stuff her to the gills with blue cheese".)

The big question is society. As I outlined in an essay* a huge factor is the society's confidence. And I would argue we're past the peak on that.

* https://redpilljew.blogspot.com/2020/03/the-true-enemy-is-not-virus.html

McChuck said...

Marion County, Ohio COVID-19 totals:
Infected (test results): 2137
Hospitalized: 21
Deaths: 3

McChuck said...

Marion State Pen, where every single person was tested, is a terrific Petri dish.

Prisoner population of 2564, 1828 infected (71%), 2 deaths.

Staff population unlisted, 109 infected, 1 death.

Total infected: 1937
Total deaths: 3
CFR: 0.155%

Note that only 21 people in the entire county are hospitalized for COVID.

Borepatch said...

It's been pretty amazing to watch the comments here - people are smart and passionate, but keep it focused on the issues, not on personalities.

I'd forgotten the war on drugs posts - you're right that it was the same then.

Weetabix said...

I'm not sure how to post this fuzzy question in my mind, but here goes:

1. OMG! Everyone it going to get it! There's nothing we can do to stop it! We must flatten the curve to protect the healthcare system!

2. Slam the lid on the world. Shut everything down.

3. Hospitals have crickets chirping in the halls the nurses aren't dancing in. Nurses laid off or on reduced hours. Hospitals are struggling financially.

Clearly, #2 was exercised too hard.

My question: What is the appropriate level of shutdown?

Aesop said...

@Weetabix,

1) Clearly, more than NYFC.
2) Serious question: How many people should be allowed to get it, knowing >90% will be minimally affected, but 3% will probably die a slow, agonizing death?
3) Explain how you arrived at the number for #2.
Your answers to those questions will tell you how far to turn the screws. Or, not.

Weetabix said...

Hi, Aesop-

I agree, more than NYFC. But I think I must have been unclear as I feared I might be.

To your question 2: We have to use the same assumptions. As I understood it, the shut down to flatten the curve assumed everyone would get it and there was no way to stop that. So, "how many should be allowed to get it" didn't ever appear to be involved in the question of a shut down - it was assumed to be 100% as I understood it.

Assuming the following (since that appears to be how it was presented):
- everyone will get it
- the healthcare system will be overwhelmed and break
- some level of shut down is necessary to prevent healthcare system breakdown

Then noticing that the healthcare system, taken as a whole, is NOT overwhelmed, but is in fact underwhelmed, it appears to me that the "some level of shut down" chosen was too high a level.

It appears to me that it would make sense to reduce the "some level of shut down" to a degree that the healthcare system is back up to a sustainable level of operation. Otherwise, it appears to me that as hospitals shut down, they won't be there for the OTHER important issues they treat. And more people, it can be reasonably reasonably assumed, will die of the secondary effect of not enough treatment available.

Did that make my question make sense?

KDKong said...

Aesop,
Show me where lockdown has stopped the virus. Compare Michigan vs. Sweden numbers. You won't stop it. The hospital over the hill here has 30 operating theaters. They are utilizing 2. Outpatient surgery is shut down UFN, which could be another 8 weeks plus. That is where they are (were) making their money. They have reassigned outpatient staff to keep them employed (for now). Routine diagnostic testing is unavailable. How many people are you willing to have die because they could not get routine testing and treatment for everyday diseases (heart disease, cancer, stroke, etc.) because you want to shut down the world? Would they be justified shooting you in the face because you denied them medical care? Just curious.

Weetabix said...

Submitted for consideration:

"Lockdowns don't work" - https://www.thepublicdiscourse.com/2020/04/62572/

NITZAKHON said...

@KDKong:

As Thomas Sowell is famous for saying, there are no solutions, only tradeoffs. For consideration:

https://summit.news/2020/04/23/professor-warns-cancer-deaths-due-to-covid-disruption-will-be-greater-than-deaths-from-coronavirus/

https://townhall.com/tipsheet/bronsonstocking/2020/04/22/so-130-million-people-could-starve-because-of-the-lockdowns-n2567446

https://gunfreezone.net/guillotine-sales-are-going-to-do-well-in-new-york/

An argument can be made to "get it over with" because of things like this:

https://www.blazingcatfur.ca/2020/04/23/fears-grow-for-the-nations-food-supply-as-tyson-halts-operations-and-processing-plants-become-coronavirus-hotspots/

Let me be crystal clear. I do not have the data, bandwidth, or the background in multiple fields to be able to make these decisions... but more importantly, I don't think anyone - or any multiple ones - do either.

There will be people dying NO MATTER WHAT. And reasonable people can and will leverage their own sets of expertise to come to conclusions that will, by necessity, differ from others' conclusions. And really, aren't we just playing an exercise. Unless I'm way off my mark, NONE of the people commenting here have the ears of those in the corridors of power.

And again I state: while we bicker and alienate each other, our enemies cackle and advance.



Rick C said...

Aesop,

I have some serious questions for you. We're up to 26 million unemployed. As the lockdown continues that number will only go up. How many people have to lose their jobs before the cure is worse than the estimated 2 million dead? 50 million? 100 million?

I lost my job after 9/11, was out of work for 6 months, and then the best job I could find for another year and a half was working at a convenience store. It took me several years to get out of that financial hole.

Of the people who lose their jobs, many will lose their houses. Many businesses will close forever. It may take those people years to recover from the financial hit. How many man-years of that will it take to outweigh the deaths? 10 million? 50 million? Half a billion?

There are people out there on TV saying we could need a year and a half of lockdowns. Are you OK with that? At what point is your "cure" worse than the disease?

Knucklehead said...

We cannot keep "non-COVID" healthcare shut down much longer. It has probably been shut down too long as it is. Outpatient and "Elective" do not always, or even mostly, mean unimportant, unnecessary, or "can be indefinitely postponed." People need medical attention for issues other than COVID.

Closing out entire society and economy is unsustainable. Continuing to do so indefinitely will cause many other serious problems. We need to come to grips with the tradeoffs between this disease and socio-economic health and start making them soon.

Rick C said...

Huh--check out this new data: https://covid19.healthdata.org/united-states-of-america

Nearly every state appears to be at or past peak cases. They project a total estimate of 67,641 deaths by august 4. 67K deaths is a year of the flu, but we put 26 million people and counting out of work, so there's that.

KDKong said...

I concur. My original post stated that the medical people looked at this problem only from their area of expertise and did not take into account the wide reaching, long term and likely devastating effects of the lockdown. I believe that a more reasoned approach would have been beneficial to the high risk population without wrecking the rest of the healthcare system and the general economy in the process. You are right, there are no good choices here, only trade-offs, and there are now serious consequences we have to deal with.
Stay well, good fortune to you and yours.

Wendy (KekistanTrans) said...

@Aesop
"2) Serious question: How many people should be allowed to get it, knowing >90% will be minimally affected, but 3% will probably die a slow, agonizing death?"
"3) Explain how you arrived at the number for #2."

My reply: "How many children must be crippled or killed by gunfire before you are finally willing to give up your guns?" My answer is that number.

My more detailed answer would be that at some point in the future when the numbers of deaths seem to be dropping, then gradually restart things. It would be nice if they had an accurate test for everyone but we're apparently not going to be there any time soon. So choices will have to be made based on best guesstimates of when the benefits outweigh the risks.

I think that asking people to come up with a specific number of acceptable deaths an unfair way of trying to force someone into answering a question that is unanswerable, in order to force them to either accept your restrictions or look like someone who is uncaring.

According to the video of the RT at WRSA, apparently anyone with respiratory problems - even someone dying of stage 4 lug cancer is marked as a COVID19 case. So the number of COVID19 deaths is never going to be zero anyway.

At some point things are going to need to be restarted.

Or we could just keep the lock-down forever until we are absolutely sure the COVID19 is burned out, and if the store shelves all run bare first then after a fashion we'll be able to finally get back to you when the deaths from the resulting lock-downs (due to starvation, rioting, etc.) exceeds the COVID-19 deaths. Of course at that point the civil unrest is going to go on until it burns out. and by the time that is over we'll have people dying of things like cholera and typhoid due to lack of clean water and basic sanitation and no antibiotic meds available.

I'd prefer to err on the side of going back to work a bit too soon but getting the food growth, processing and distribution system back up and running before serious food shortages take place.

As a side note, I personally am following your advice in your "FFS, Go Clean Your Garage" April 4 post. Makes sense to keep active and get done what needs to be done and to improve what can be improved.

Also I figure this lock-down is a mixed blessing - a pain in the ass yes, but a bit of practice for spicy times (probably not going to be a lot of stores open or people going outside in the daytime if a Rwanda X Bosnia scenario kicks off). So I figure count our blessings and make the most of what we have and can get done under the circumstances.

But we are going to have to get back to work at some time, sooner or later.

dakotared said...

I love reading all you brilliant people. The free ice cream and contentious opinions are very entertaining. 40years as an RN in a specialty unlike Aesops as well as 24 years in the military starting as a medic at the end of Viet Nam I have to chime in. Much of what is said about flattening the curve is true. The medical system could never handle a true pandemic. It would crash but no more than the whole country and world would. The energy grid needs to be maintained, the trucks need to keep running, etc., etc. The world would crash. We were lucky. This was and is a light weight trial run. The "facts" as presented are all guesstimates. 3%, 1.5%, 0.15% CFR are all that. Too many factors play in to make a true reading of the 'true" covid deaths. It was stated that there are no deaths because of the economic factors. I think all the smart people here would agree that that is no more fact than the true number of covid deaths. No body knows and nobody can know. This country is too big, too diverse and dispersed for that to be possible. Everyone knows the old catch about statistics. Having done studies myself I would be the first to say that most data is suspect. I give no one the benefit of the doubt when it comes to biases. Especially in this day and age. This is a special flu. Not and end of the world flu. If we are unlucky we may yet live to see one.

Rick C said...

"It was stated that there are no deaths because of the economic factors."

I haven't seen any citations but I've heard several people say calls to suicide hotlines are up drastically, and so are suicides.

Ah, wait, a bit of searching found a data point: https://mynbc15.com/news/local/mobile-sees-increase-in-suicide-attempts-amid-coronavirus-closures

52 calls in Mobile Alabama for attempted suicide in April vs 32 in March. That's thin, but it also says there have been two more actual suicides this year than through the same point last year.

Something more: https://thehill.com/changing-america/well-being/mental-health/494170-how-does-the-coronavirus-pandemic-affect-suicide

"During March 2020, the Disaster Distress Helpline saw a 338 percent increase in call volume compared with February 2020."

Aesop said...

I'm not advocating a total, nor endless lockdown.
And waiting for a vaccine is ridiculous; it may never happen.
Since, as noted in another thread, my actual salary is paid by the health insurance of working people, not the government, I'm mightily anxious for as many folks as possible to get back to work as soon as is reasonable.

But before we decide seven whole weeks of lockdown is the entire economic problem, and lifting the lockdown will solve it, could we perhaps note the example of the Great Depression, where things were far worse, and everyone went out and killed themselves and starved to death because...oh, wait, none of that happened. So maybe stop talking the economic consequences as being more dire than they are, thus far, wouldn't be amiss.

Economic pain is not going away simply by lifting lockdowns.
I seem to recall this wee $11.5T stock market crash thingie, that may have some small bit to inform how things go.
Oil, airline travel, resort/hotels, amusements, and public sports, etc. are pretty much cooked for the rest of the year regardless.

And there are, at the moment, 50K people dead from the current outbreak. Any prediction positing 67K, total, is from someone smoking hopeium by the wheelbarrow load. We won't hit 67K by Aug 4th, we'll probably be there inside 2 more weeks. So closer to May 4th, on my calendar.

And, as sure as God made little green apples, the 49 states that didn't act like NYFS are going to spike cases, and deaths, upwards, about 11-21 days after lockdowns are lifted.

I'm fine with opening things up, but let's try a few things:
1) Universal testing, to see how widely it's spread, and do actual "stay your @$$ at home" quarantines on infected/infectious persons, until they're actually cleared.
2) Let's start with states with small populations, both because you can test their entire populations quicker, and because if we see we're getting it wrong, fewer people will be at risk.
3) Knowing there will always be a 10% Gilligans factor, how about requiring PPE in public universally, and giving people the ability and responsibility to protect themselves, and yet still be out and about?
4) Per GFZ's post and a recent WH briefing, summer-strength sunlight and temperature seems to kill this thing in about a minute on surfaces and in air. So opening outdoor recreation areas and beaches should be a priority. The bathrooms there, and indoor air-conditioned venues, not so much.

Start there, and work forward.
Throwing open the floodgates overnight unilaterally just makes 49 more NYFCs, and won't fix the economy either. Lose-lose.

Rick C said...

"Any prediction positing 67K, total, is from someone smoking hopeium by the wheelbarrow load."

Someone notify the IHME their predictions are wrong again!

Rick C said...

Also, I guess you didn't click my link, Aesop, because the range of that prediction was 48K-120K or so. 120K is a bad flu year.

Do you think 120K is a "reasonable" projection for total death count? If so, do you think throwing 26 million people and counting out of work is a reasonable reaction? Or are you still sticking by your 2 million deaths number?

Aesop said...

No, Rick.
20K is an avg. flu year.
50K is a bad flu year.
120K is what you get from people who suggest numbers of deaths from second hand smoke, medical misadventure, or anthropogenic global warming. The source for those numbers, invariably, is somewhere between their left butt cheek, and their right butt cheek.
I don't have any such "2M death number", as if that were some gypsy prognostication.
Deaths will be CFR(X) x number exposed (Y).
X x Y = Z.
X is running roughly at 3%. You can quibble that up or down a tad, with minimal impact.
Y is where the money is.
Tell me what Y is, and you can tell what Z will or might be.

You can even do it simpler, if you're willing to play with actual numbers.
The rosiest NYFC projections are this has exposed 20% or so there.
That's 1.8M people.
They have 16K dead.
I don't know if that yields the actual or theoretical CFR, under lab conditions, but that's how it's worked out in the field, IRL.
So they can go anywhere up to 80K dead, depending on how far along the continuum from 20% exposure to 100% exposure they're willing to go.
For NYFS, the number of dead is 4K now, with less than 4% exposure.
So for 100% exposure, they top out at 100K dead. Real world reality.
So NY is looking at 192K dead, worst case, if they manage to expose everyone there. They're at 20K dead now.

Do that 49 more times, and you can figure the range this can realistically achieve nationwide, but you have to state Y, for any given answer.

So tell me what Y you choose...?

If NYFCs field-actual CFR holds nationwide, that'd be up to nearly 3M dead, with 100% exposure.
With 4% exposure, it's 117K dead. We're already halfway there, now.
If we emulate NYFC, and achieve 20% exposure, it'd be somewhere around 500K dead.
That's your range and tick marks of how far up the stick the shit goes.
If NYFCs field-actual death rate holds everywhere.
There are tickles that there are multiple versions of this bitch, already.

And IHME isn't coming down from Sinai with their numbers graven on stone tablets either.
When they pick a number for 4 months away that experientially we're liable to tag up on and blow by in about 2 weeks, they're quite simply full of shit.
If deaths crater in that time, call me. I'll pop the champagne.

Rick C said...

Well, we *may* get 2M deaths, worst-case. We've already got 26 million people out of work. I wonder what the numbers will be in a month.

I saw this on Instapundit tonight:

"Seven weeks ago, March 4, 2020, I had cataract surgery on my left eye.

Then our AZ government closed my eye doctor as "non-essential." My followup appointments were delayed two weeks, then another two weeks then four weeks. Then they shortened the closure and this last Monday (Apr 20th) I received a text that said "We're reopened for appointments!"

My first appointment was today, five days later. My eye was bothering me somewhat.

The doctor tried to prescribe a lens so I could focus the left eye. Didn't work. He then took multiple tests.

He looked the tests over and said, and I quote, "SHIT! Your retina is swollen! We should have gotten on this a month ago!" He wrote a prescription for eye drops, which CVS did not have but Walgreens did. I'm hoping for the best.

So now I may lose sight in my left eye because we shut down eye doctors and dentists as "non-essential" while leaving grocery stores, hardware stores, animal feed stores, liquor stores and fast food drive-throughs open.

This has gotten very personal. We have 59 cases of Wuhan CCP virus in our entire county.

This kabuki theater may cost me my sight."

Aesop said...

Touching and heart-rending, obviously.
If that county had gotten 1000 cases, and 30 deaths, should I be happier that anyone there is still facing partial blindness?
Would he be?

If anyone is expecting perfect decisions, that stand the scrutiny of flawless hindsight and Monday morning quarterbacking, they will face a lifetime of serial disappointments.

You might as well post sob-inducing letters from people whose 401K folded last month, because their broker never warned them the market was going to tank over this.

Should that broker be shot/flogged/tarred-and-feathered for lacking omniscience?

I'm fine with wanting anyone making decisions to make the best ones possible, based on the information and resources available to them at the time.
What are you asking for?

Blindness = bad.
Dead people = bad.
Pick one.
Show all work.

Do you want to sit in the big chair and decide who gets which outcome?

Or can you live with trying to get the best people in earthly jobs, and living with their best decisions, even when it doesn't work out for everyone the way we'd like?

Doing what I do, I've bagged and tagged a lot of people over the years. I think my personal tally is somewhere around two to three dozen. Maybe more, I haven't kept a log. I know the youngest was under 6 months old.

They all piss me off. I don't like the Kobayashi Maru scenario. I don't like being helpless to do anything other than hold the hands of family members while their spouses and relatives leave this earth. It flat out sucks.

But I don't lose any sleep over them, because when they died, I know everything humanly possible was done, and despite that, we don't always win.

If shaking your fist at the heavens gets you a better outcome, or helps you to cope with life, go ahead on. Be ready if the heavens answer. The 38th chapter in the Book of Job comes to mind.