How long should the lock down last?

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Not even worth working in New Zealand. I don't love medicine enough to work for what they are paying, and to pay the taxes. Retirement or doing another profession would be better options.
New Zealand is too close to China to be safe.
The home-school experience this spring was miserable, so you up and moved to New Zealand as a result? Seriously?
For NZ wages*, why not just work a few locums shifts here and there in the USA and then just kind of live off the grid somewhere?

We've known too many folks who came down for a ... working holiday of sorts ... in NZ and greatly enjoyed it, so, why not now? It's obviously not an decision isolated to school closures, but more a happy coincidence. Level 1 without masks, open restaurants, risk-free domestic travel ... hopefully they can keep it this way.

NZ is not much closer to China, eh? It's ~9000 km to Hong Kong-area China from Auckland, and ~9000 km from San Francisco to Shanghai.

NZ wages are definitely lower – until you start to compare the hourly work to university academic medicine. The district health board doctors are unionized here and 30+% of the salaried time is non-clinical by contract. If I compare back to my academic shift load and then all the responsibilities on top of that and think about how many hours a week I used to work on a academic salary ... and then think about the equivalent of 10 weeks vacation we have here ... it's not too bad! But, yes, clearly most ED docs in the U.S. make far more.
 
We've known too many folks who came down for a ... working holiday of sorts ... in NZ and greatly enjoyed it, so, why not now? It's obviously not an decision isolated to school closures, but more a happy coincidence. Level 1 without masks, open restaurants, risk-free domestic travel ... hopefully they can keep it this way.
I hope you like it. At a minimum, it's likely to be a worthy adventure!
 
NZ is not much closer to China, eh? It's ~9000 km to Hong Kong-area China from Auckland, and ~9000 km from San Francisco to Shanghai.


I jest. But still.

Anyways, super envious. If the remnants of the Dux de Lux (Dux Central | Craft Beer | New Zealand) are as good as the original, be sure to check it out. I fell in love with the South Island following a contract at Vostok many years ago.
 
1.1% GDP spent on defense!!!

It's basically like going to war with Oregon, tho.
True. They could spend a little more. When I went to Antarctica the NZ C130s really were under equipped on communications. HF radio only (frequently blocked by solar flares leading to aborted supply flights), whereas the US C130s just switched to satellite comms. It's not like this was some super duper death ray, it was just a plodding cargo plane.

That being said, NZ did a very impressive job with rather limited resources. The hut system for tramping was amazing!
 
This is the post where I point out that Miami-Dade County is still at over 100% ICU capacity... and this is counting all of the converted beds as actual "ICU beds." I mean... sure... we have nights where the ICU nurses are 4:1 and I have ICU beds without central monitoring in the nursing station (they're "monitored" by the same tele techs as the tele floors), but this is totally normal right?

I guess we should have just taken our hydroxychloroquine like Dr. Trump and Dr. Demon Seaman told us too. Let's ignore the fact that the Federal Government and Republican governors are doing their best to downplay or block any bad news. Heck, the President just blasted one of his own top doctors today. 'merica!

 
This is the post where I point out that Miami-Dade County is still at over 100% ICU capacity... and this is counting all of the converted beds as actual "ICU beds." I mean... sure... we have nights where the ICU nurses are 4:1 and I have ICU beds without central monitoring in the nursing station (they're "monitored" by the same tele techs as the tele floors), but this is totally normal right?

I guess we should have just taken our hydroxychloroquine like Dr. Trump and Dr. Demon Seaman told us too. Let's ignore the fact that the Federal Government and Republican governors are doing their best to downplay or block any bad news. Heck, the President just blasted one of his own top doctors today. 'merica!


Any luck with steroids?
 
Any luck with steroids?
On one hand it's hard to say because where I did fellowship (fresh out July 1st and seeing 50 patients with 2 NPs... wee!) we've been using dexamethasone since the beginning. I think I'm seeing benefit with the higher doses that there are case series (and a retrospective now). The other observational (so biased as hell) thing I've seen is when we're more forcefully weaning FiO2 patients seem to get better quicker (the RTs and RNs are content to leave people at FiO2 of 100%, unfortunately, so it tends to be us doing the weaning for BiPAP and vents). This makes sense given that there's always this somewhat hypothetical discussion about reactive oxygen species and atelectasis at FIs greater than 70. I think this is one of the few times that you see it play out in real time... which makes sense given the inflammatory nature. Of course you go with what FI you need though.
 
This is the post where I point out that Miami-Dade County is still at over 100% ICU capacity... and this is counting all of the converted beds as actual "ICU beds." I mean... sure... we have nights where the ICU nurses are 4:1 and I have ICU beds without central monitoring in the nursing station (they're "monitored" by the same tele techs as the tele floors), but this is totally normal right?

I guess we should have just taken our hydroxychloroquine like Dr. Trump and Dr. Demon Seaman told us too. Let's ignore the fact that the Federal Government and Republican governors are doing their best to downplay or block any bad news. Heck, the President just blasted one of his own top doctors today. 'merica!


So what would you have done differently?
 
So what would you have done differently?

For one I wouldn't have gone from locked down to "lulz, open everything up!" over the span of a week (seriously in less than a week the Federal Government's position went from phased reopening to "Liberate Michigan")

Now if you mean the long run, I don't know... actual testing strategy right off the bat, more targeted locked downs, testing kits that actually worked, opening up testing to any lab that has the equipment (including university and vet labs) so we don't have this useless week plus turn around time, leveraged the purchasing power of the Federal Government to assist with PPE instead of forcing states to bid against each other for it (and then have the US government steal it anyways when the shipment arrived). What I definitely wouldn't have done was think I could pray the problem would go away "like a miracle."


...but hey, I hope everyone stocked up on hydroxychloroquine, because that's totally the cure. The "Liberate Michigan" man, and his "lizard people run the government" doctor said so.
 
This is the post where I point out that Miami-Dade County is still at over 100% ICU capacity... and this is counting all of the converted beds as actual "ICU beds." I mean... sure... we have nights where the ICU nurses are 4:1 and I have ICU beds without central monitoring in the nursing station (they're "monitored" by the same tele techs as the tele floors), but this is totally normal right?

I guess we should have just taken our hydroxychloroquine like Dr. Trump and Dr. Demon Seaman told us too. Let's ignore the fact that the Federal Government and Republican governors are doing their best to downplay or block any bad news. Heck, the President just blasted one of his own top doctors today. 'merica!


Yea there is no point. There are a group of people on this thread who consistently favor making the last dollar possible over dead bodies. They will not change. They care not if their neighbors are dropping dead as long as they can go to Billie D's NightClub. They care not if their mom and dad croak as long as they can go to Applebees.
 
For one I wouldn't have gone from locked down to "lulz, open everything up!" over the span of a week (seriously in less than a week the Federal Government's position went from phased reopening to "Liberate Michigan")

Now if you mean the long run, I don't know... actual testing strategy right off the bat, more targeted locked downs, testing kits that actually worked, opening up testing to any lab that has the equipment (including university and vet labs) so we don't have this useless week plus turn around time, leveraged the purchasing power of the Federal Government to assist with PPE instead of forcing states to bid against each other for it (and then have the US government steal it anyways when the shipment arrived). What I definitely wouldn't have done was think I could pray the problem would go away "like a miracle."


...but hey, I hope everyone stocked up on hydroxychloroquine, because that's totally the cure. The "Liberate Michigan" man, and his "lizard people run the government" doctor said so.

There is lots of stuff do to differently. Even though cases are going up in other countries...we still look like a bunch of buffoons here with our out of control spread. You take the virus seriously, develop a cohesive, appropriate response from government, and we would end up having something that looks like:

sample new cases.jpg


There are probably 75 countries that have a graph that looks like this.
 
Oh, interesting now from the WHO.

After several direct statements, the WHO appears to be a lockdown skeptic - “What we at the WHO would invite countries is to do everything possible to not have these complete lockdowns... We think the Swedish approach has a lot going for it.”

 
Oh, interesting now from the WHO.

After several direct statements, the WHO appears to be a lockdown skeptic - “What we at the WHO would invite countries is to do everything possible to not have these complete lockdowns... We think the Swedish approach has a lot going for it.”



You have gone against orthodoxy. You could be banned for a post like that!
 
Oh, interesting now from the WHO.

After several direct statements, the WHO appears to be a lockdown skeptic - “What we at the WHO would invite countries is to do everything possible to not have these complete lockdowns... We think the Swedish approach has a lot going for it.”



So we pretty much crashed the economy into a deep covid 19 recession for essentially misguided reasons simply because we saw what China did and thought it could work
 
So we pretty much crashed the economy into a deep covid 19 recession for essentially misguided reasons simply because we saw what China did and thought it could work

We don't know what China did. We don't know what their real numbers are. Basing any of our reactions to this virus on China was a mistake.
 
So we pretty much crashed the economy into a deep covid 19 recession for essentially misguided reasons simply because we saw what China did and thought it could work

Look man, this is a new virus, and in the early stages, there were so many unknowns. I'm pretty sure seeing the impact of the virus in places like china, italy, spain in the early stages scared the crap out everyone. You don't know what you don't know. Given the situation, I would give people the benefit of the doubt about taking an abundance of precaution. It is now becoming clear that total lockdowns, even temporary ones, are not the best idea. But hindsight is always 20/20.

I know there are others here who were adamant that this was a bad idea. But I'm 100% convinced that they too didn't know what we were up against. How could they?
 
Look man, this is a new virus, and in the early stages, there were so many unknowns. I'm pretty sure seeing the impact of the virus in places like china, italy, spain in the early stages scared the crap out everyone. You don't know what you don't know. Given the situation, I would give people the benefit of the doubt about taking an abundance of precaution. It is now becoming clear that total lockdowns, even temporary ones, are not the best idea. But hindsight is always 20/20.

I know there are others here who were adamant that this was a bad idea. But I'm 100% convinced that they too didn't know what we were up against. How could they?

I've been largely against lockdowns since back in Feb so nothing really changed in my views. Although i was hoping for better covid response when early cases were rising and that didn't happen (if anything, it got a lot worse unnecessarily in some states). The rare times i gave lockdowns any benefit of doubt are cases when they're employed extremely fast and immediate with the population supported heavily with basic incomes and other economic benefits from the governments. Pro-lockdown states had often sloppily implemented lockdowns so late that they made me even more averse to them completely.

I get wanting to be safe and cautious but implementation matters.
 
Look man, this is a new virus, and in the early stages, there were so many unknowns. I'm pretty sure seeing the impact of the virus in places like china, italy, spain in the early stages scared the crap out everyone. You don't know what you don't know. Given the situation, I would give people the benefit of the doubt about taking an abundance of precaution. It is now becoming clear that total lockdowns, even temporary ones, are not the best idea. But hindsight is always 20/20.

I know there are others here who were adamant that this was a bad idea. But I'm 100% convinced that they too didn't know what we were up against. How could they?

I totally get that. Faced with a 3% mortality rate, extreme measures might have been justified. I'm mystified though, that now we know the fatality rate is <1%, and it targets a relatively predictable subset of the population why we are still talking about lockdowns? The Federal Reserve Chair for Minnesota states on the news he wants Trump to enact a 4 month total lockdown in the country!
 
We don't know what China did. We don't know what their real numbers are. Basing any of our reactions to this virus on China was a mistake.

Yeah exactly, if IRAN covered up this many deaths, how bad do you think China really was? And keep in mind Iran also did not have good testing infrastructure, so the number of true deaths is likely, traigcally, multiples that of the official numbers.


"The number of deaths from coronavirus in Iran is nearly triple what Iran's government claims, a BBC Persian service investigation has found."

The government's own records appear to show almost 42,000 people died with Covid-19 symptoms up to 20 July, versus 14,405 reported by its health ministry.

The number of people known to be infected is also almost double official figures: 451,024 as opposed to 278,827.



 
Yeah exactly, if IRAN covered up this many deaths, how bad do you think China really was?

Look man, this is a new virus, and in the early stages, there were so many unknowns. I'm pretty sure seeing the impact of the virus in places like china, italy, spain in the early stages scared the crap out everyone. You don't know what you don't know. Given the situation, I would give people the benefit of the doubt about taking an abundance of precaution. It is now becoming clear that total lockdowns, even temporary ones, are not the best idea. But hindsight is always 20/20.

I know there are others here who were adamant that this was a bad idea. But I'm 100% convinced that they too didn't know what we were up against. How could they?

I disagree.

You had multiple case studies like the Princess cruise in Feb/March where the median age was like 59, and >50% got the virus, and yet mortality was like 1% for the old geezers on the ship.

Yet nobody in power and none of the scummy epidemiologists wanted to take those cold hard facts into account, that the mortality rate of COVID was gonna be like the flu based on the numbers back then. Everyone took the "3+% mortality rate" at face value.
 
I disagree.

You had multiple case studies like the Princess cruise in Feb/March where the median age was like 59, and >50% got the virus, and yet mortality was like 1% for the old geezers on the ship.

Yet nobody in power and none of the scummy epidemiologists wanted to take those cold hard facts into account, that the mortality rate of COVID was gonna be like the flu based on the numbers back then. Everyone took the "3+% mortality rate" at face value.
Your numbers are a bit off. Only 19% of the people on that ship got the virus.

It also had a 1.97% death rate.
 
Your numbers are a bit off. Only 19% of the people on that ship got the virus.

It also had a 1.97% death rate.


I don't recall the numbers exactly off the top of my head. But I confused the stat of 50% of crew being tested were positive with overall people.

And you're using CFR, i'm talking about back in March, people were already correctly estimating the IFR to be much lower - like this study, estimating it at 1.3%. Estimating the infection and case fatality ratio for coronavirus disease (COVID-19) using age-adjusted data from the outbreak on the Diamond Princess cruise ship, February 2020

A major lesson the world should have learned. We should never fall into the trap of using CFR to scare ourselves like the politicians and mass media did
 

I don't recall the numbers exactly off the top of my head. But I confused the stat of 50% of crew being tested were positive with overall people.

And you're using CFR, i'm talking about back in March, people were already correctly estimating the IFR to be much lower - like this study, estimating it at 1.3%. Estimating the infection and case fatality ratio for coronavirus disease (COVID-19) using age-adjusted data from the outbreak on the Diamond Princess cruise ship, February 2020

A major lesson the world should have learned. We should never fall into the trap of using CFR to scare ourselves like the politicians and mass media did
Of course I'm using CFR, that's what everyone should be/mostly is using.

1.X% is better than the initial 3%, but it's still roughly 10X that of flu.

That said I bet it's actually lower now than back in March since we've gotten better at treating this and most hospitals aren't overwhelmed like they were then in Italy and NYC.
 
Of course I'm using CFR, that's what everyone should be/mostly is using.

1.X% is better than the initial 3%, but it's still roughly 10X that of flu.

That said I bet it's actually lower now than back in March since we've gotten better at treating this and most hospitals aren't overwhelmed like they were then in Italy and NYC.

IFR of covid is likely around 0.10%, at MOST 0.3%. You can quote me on that once full studies are out years from now. See below; that's gonna fall further when we have enough data proving that asymptomatic infections are much higher than currently estimated by CDC



" Median corrected IFR was 0.10% in locations with COVID-19 population mortality rate less than the global average (<73 deaths per million as of July 12, 2020), 0.27% in locations with 73-500 COVID-19 deaths per million, and 0.90% in locations exceeding 500 COVID-19 deaths per million. "
 
IFR of covid is likely around 0.10%, at MOST 0.3%. You can quote me on that once full studies are out years from now. See below; that's gonna fall further when we have enough data proving that asymptomatic infections are much higher than currently estimated by CDC



" Median corrected IFR was 0.10% in locations with COVID-19 population mortality rate less than the global average (<73 deaths per million as of July 12, 2020), 0.27% in locations with 73-500 COVID-19 deaths per million, and 0.90% in locations exceeding 500 COVID-19 deaths per million. "
I don't like this reliance on antibody testing given the high false positive rate. In my state, which is one of the hot spots, the PPV of antibody testing is right at 25%. So basing your IFR on that seems unwise.
 
Of course I'm using CFR, that's what everyone should be/mostly is using.

1.X% is better than the initial 3%, but it's still roughly 10X that of flu.

That said I bet it's actually lower now than back in March since we've gotten better at treating this and most hospitals aren't overwhelmed like they were then in Italy and NYC.

No it's not 10X that of the flu. A cruise ship is a worst case scenario for non-nursing home people susceptible to this virus. The fact that it wasn't much higher, among one of the oldest, unhealthiest, most obese cohorts I can imagine astonishes me.
 
Where did you get the PPV for this?
Math?

The requirement for EUA for antibody testing is 90% sensitivity, 95% specificity. My state has a prevalence of around 1.9%.

Even if we up the sen/spe to 98% and prevalence to an even 2% the PPV is still only 50%.
 
No it's not 10X that of the flu. A cruise ship is a worst case scenario for non-nursing home people susceptible to this virus. The fact that it wasn't much higher, among one of the oldest, unhealthiest, most obese cohorts I can imagine astonishes me.
CFR has nothing to do with location. It matters for infection rate, but once infected the location where you got it doesn't matter.

And for older age groups, you're correct its not 10X. Flu death rate for 65+ is around 0.83% based on the 2018-2019 season (the most recent with non-preliminary data). So the 1.9% on that cruise is only 2X flu. But you have to remember that not everyone who got sick on that cruise was over 65. Of the 712 cases, 145 were in the crew (median age 36). The median age of the passengers was 69.

Beyond that, most of those who died were from Japan where the obesity rate is 3% so this isn't your typical Bahama cruise cohort.
 
Math?

The requirement for EUA for antibody testing is 90% sensitivity, 95% specificity. My state has a prevalence of around 1.9%.

Even if we up the sen/spe to 98% and prevalence to an even 2% the PPV is still only 50%.
All kidding aside, even if the PPV was higher, using antibody testing alone while ignoring T cell immunity, won't tell you how many people have had COVID-19. I posted a study a while back that showed for every one recovered COVID-19 patient that had a positive antibody, 2 recovered patients had responsive T-cells but no antibodies. So, there's still a lot of fuzzy math here, until we learn more about this thing.
 
All kidding aside, even if the PPV was higher, using antibody testing alone while ignoring T cell immunity, won't tell you how many people have had COVID-19. I posted a study a while back that showed for every one recovered COVID-19 patient that had a positive antibody, 2 recovered patients had responsive T-cells but no antibodies. So, there's still a lot of fuzzy math here, until we learn more about this thing.
Right, that's another reason I don't trust the antibody tests - we just don't know enough about how accurate they actually are or how long they stay accurate.
 
Thought of the Day:

There's no reason to think that any country, state or city that has a handle on Coronavirus, will keep it.

Yet USA bashing and raging anti-American sentiment on social media (esp Twitter and Reddit) and on news media (see WashPost and Financial Times) is widespread.
 
Math?

The requirement for EUA for antibody testing is 90% sensitivity, 95% specificity. My state has a prevalence of around 1.9%.

Even if we up the sen/spe to 98% and prevalence to an even 2% the PPV is still only 50%.

Correct these antibody testing numbers are highly sensitive to prevalence. If the prevalence goes from 2% to 10%, there is a marked increase in PPV. From 10% - 20% and they end up being extremely accurate.
 
Thought of the Day:

There's no guarantee that any country, state or city that has a handle on Coronavirus, will keep it.

Thought of the Day, Part 2:

There’s no guarantee that any of the 10 main posters on this thread will ever change their opinions in the next 12 months, and in fact opinions will remain entrenched and there will be a record amount of feces-flung during that time.
 
Correct these antibody testing numbers are highly sensitive to prevalence. If the prevalence goes from 2% to 10%, there is a marked increase in PPV. From 10% - 20% and they end up being extremely accurate.
Maybe. We actually don't have any good evidence that they are as accurate as their makers claim.
 
What do you think about this? Seems like memory t-cells must help with immunity given that antibodies seem to wane and we haven’t seen a large of amount of reinfections (if any).

 
What do you think about this? Seems like memory t-cells must help with immunity given that antibodies seem to wane and we haven’t seen a large of amount of reinfections (if any).

It makes sense to me. I’ve been posting studies and comments discussing pre-existing t-cell cross-immunity to Covid-19 for months now. It’s as good as an explanation for what some (most) people are so easily able to fight off coronavirus, as any.
 
What do you think about this? Seems like memory t-cells must help with immunity given that antibodies seem to wane and we haven’t seen a large of amount of reinfections (if any).


Are you in someway suggesting that, despite the fact that this is a nOvEL viRuS, our immune system somehow behaves in the exact same way as it does for every other virus we encounter?

Heresy!
 
Are you in someway suggesting that, despite the fact that this is a nOvEL viRuS, our immune system somehow behaves in the exact same way as it does for every other virus we encounter?

Heresy!

I think he should be banned from SDN. Any news that suggests the virus isn't that bad, or that draconian (and unconstitutional) measures are inffective has no place here.
 
I think he should be banned from SDN. Any news that suggests the virus isn't that bad, or that draconian (and unconstitutional) measures are inffective has no place here.
Well, statistically, the person only posts two times per year, so, this person really doesn't add much to the rich tapestry of SDN. That's not saying that others with more posts are qualitatively better, but broken clocks, twice a day, &c.
 

This will totally stop the new surge in cases in Australia
 
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