live and let die?

[elburrito]

Is there any logic to simply allowing SARS-CoV2 to run its course? As pathologists, we are "the doctors doctor", and many of us are involved with COVID testing in our laboratories. However, we are not social engineers. And as physicians, we have to respect patient autonomy. If America is our patient, so to speak, and our patient doesn't wish to shut down again with another national lockdown, or if half the country is unwilling to socially distance, then it woudl appear that our patient wishes to keep smoking and drinking, and perhaps we are left with nature simply taking its course, and life will be a lottery for the next few years. This is little different from our national conversations around gun control. As physicians, we can make technical recommendations, but social decisions are not necessarily within our purview. That being said, the public health is our major concern, and we do have involuntary admissions when patients are danger to themselves or others. Bear in mind, our country has made no shortages of sacrifices and has been more than willing to expend lives in order to fight wars and protect our way of life.

By my calculations, assuming herd immunity is 60% of US population of 340,000,000, and assuming a rate of 100k infections per day, then 0.6* 340,000,000 / 100,000 / 365 = 5.58 years. The public data (which I don't know how much we can trust anymore) indicates ~4,000,000 confirmed infections, though seroprevalance studies suggest and raise the possibility that the actual number of infections may be significantly higher.

And for the record, I consider myself a political independent, I'm not right wing or anti right wing, liberal or otherwise, I feed my brain with a healthy diet of daily propaganda from both huffingtonpost as well as drudgereport.

---

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[Thr0mbus]

I think that is a conversation that should always be considered no matter what point we are in this mess.

From my experience, patients almost always choose quality of life over quantity of life. The current PC/media perspective is to coerce us all to choose quantity over quality.

 

[elburrito]

'Top Gun: Maverick' release date pushed to summer 2021 | CNN

Those feeling the need for speed are going to have to wait until next summer to see “Top Gun: Maverick.”

www.cnn.com

No TOP GUN in theaters this year???!!!! Now they've really crossed the line!!!!

#FireFauci#COVIDHoax
#Sarcasm

 

[ScubaV]

That's essentially what's already happening due to inaction at the federal level. The scattered and partial restrictions are at best a speedbump for national spread. We had a chance to be like Asia or even Europe, but we blew it. If there was a coordinated federal response that gave state level guidance, mobilized PPE and test manufacturing, and outlined and strictly enforced infection control measures like social distancing and mask use, we probably could have either had no lockdown at all (i.e South Korea) or localized and time-limited lockdowns and already been on the other side of this, just spot-treating flare ups. Instead the federal response was initially denial and then active sabotage (ex. confiscating PPE/testing supplies from needy states or framing infection control measures as a political issue instead of a public health one).

This was less like allowing a smoking patient to continue after attempted counseling, and more like telling the smoking patient that it definitely doesn't cause cancer but if it does, you should drink this bleach and it will kill any cancer that does grow.

Unfortunately, it's way too late at this point and the only realistic hope is for a vaccine. We'll have lost hundreds of thousands of lives and untold morbidity from long-term complications that we won't know for years and may not ever fully know and all for what? This isn't even sacrificing grandma to save the economy, because the trillions in economic damage already is way worse than what it would have cost for a coordinated and effective response.

 

[Guest8]

Yep, we're essentially letting it run it's course. Protect yourself and protect your loved ones, every man/woman/child for themselves. And if you're older or have pre-existing conditions, now might be the time to finally make up that will you've been planning to do.

 

[WEBB PINKERTON]

There are going to be resurgences every time we open up. Even Australia is struggling again and they were doing really well. How long should we have locked down? Shutting down till vaccine, if its possible, isn't feasible.

What's that song from Team America? Freedom isn't free.

 

[Thr0mbus]

That's essentially what's already happening due to inaction at the federal level. The scattered and partial restrictions are at best a speedbump for national spread. We had a chance to be like Asia or even Europe, but we blew it. If there was a coordinated federal response that gave state level guidance, mobilized PPE and test manufacturing, and outlined and strictly enforced infection control measures like social distancing and mask use, we probably could have either had no lockdown at all (i.e South Korea) or localized and time-limited lockdowns and already been on the other side of this, just spot-treating flare ups. Instead the federal response was initially denial and then active sabotage (ex. confiscating PPE/testing supplies from needy states or framing infection control measures as a political issue instead of a public health one).

This was less like allowing a smoking patient to continue after attempted counseling, and more like telling the smoking patient that it definitely doesn't cause cancer but if it does, you should drink this bleach and it will kill any cancer that does grow.

Unfortunately, it's way too late at this point and the only realistic hope is for a vaccine. We'll have lost hundreds of thousands of lives and untold morbidity from long-term complications that we won't know for years and may not ever fully know and all for what? This isn't even sacrificing grandma to save the economy, because the trillions in economic damage already is way worse than what it would have cost for a coordinated and effective response.

Are we supposed to sacrifice our way of life and the economy for 1 year? 5 years? 10 years? No one really knows how long this will last.

Kids want to play. People want to vacation. People want to celebrate birthdays, go to school, socialize. Not everyone is happy sitting behind a microscope!

 

[ScubaV]

Are we supposed to sacrifice our way of life and the economy for 1 year? 5 years? 10 years? No one really knows how long this will last.

Kids want to play. People want to vacation. People want to celebrate birthdays, go to school, socialize. Not everyone is happy sitting behind a microscope!

The point is that the sacrifices would have been much smaller if this was handled in an even mediocre fashion. Besides would you be saying the same in any other national crisis? COVID-19 has killed about half as many Americans as combat deaths in WW2 and it's not done yet. But we probably shouldn't have entered the war because sacrificing our way of life by rationing supplies and sending women to work was too much to handle.

 

[Thr0mbus]

The point is that the sacrifices would have been much smaller if this was handled in an even mediocre fashion. Besides would you be saying the same in any other national crisis? COVID-19 has killed about half as many Americans as combat deaths in WW2 and it's not done yet. But we probably shouldn't have entered the war because sacrificing our way of life by rationing supplies and sending women to work was too much to handle.

How do you know that you might just be delaying the inevitable with your plan and shutting down everyone’s lives in the process?

 

[gbwillner]

Is there any logic to simply allowing SARS-CoV2 to run its course? As pathologists, we are "the doctors doctor", and many of us are involved with COVID testing in our laboratories. However, we are not social engineers. And as physicians, we have to respect patient autonomy. If America is our patient, so to speak, and our patient doesn't wish to shut down again with another national lockdown, or if half the country is unwilling to socially distance, then it woudl appear that our patient wishes to keep smoking and drinking, and perhaps we are left with nature simply taking its course, and life will be a lottery for the next few years. This is little different from our national conversations around gun control. As physicians, we can make technical recommendations, but social decisions are not necessarily within our purview. That being said, the public health is our major concern, and we do have involuntary admissions when patients are danger to themselves or others. Bear in mind, our country has made no shortages of sacrifices and has been more than willing to expend lives in order to fight wars and protect our way of life.

By my calculations, assuming herd immunity is 60% of US population of 340,000,000, and assuming a rate of 100k infections per day, then 0.6* 340,000,000 / 100,000 / 365 = 5.58 years. The public data (which I don't know how much we can trust anymore) indicates ~4,000,000 confirmed infections, though seroprevalance studies suggest and raise the possibility that the actual number of infections may be significantly higher.

And for the record, I consider myself a political independent, I'm not right wing or anti right wing, liberal or otherwise, I feed my brain with a healthy diet of daily propaganda from both huffingtonpost as well as drudgereport.

Your maths are off.

If we did nothing (more or less what happened pre-mid-March and the week of July 1), and "let it take its course", we would not have 100K cases per day; that would be day one (our current rate, where we are definitely doing "something"). As we saw at the beginning (death rates DOUBLING every 3-4 days) and now (new case rates DOUBLING every 3-4 days), it would not take 6 years to arrive at heard immunity. If we did NOTHING to prevent spread, and 340M is expected to be the number of people that make up the 60% of people needed to reach herd immunity, we would reach that number in <48 days.

I stopped tracking the numbers on a daily basis because I went on vacation and then was too depressed about it as states opened without reservation and everything we had done to date was turned to sh**. However, I can say that we have a much better understanding of this disease (still very incomplete) than we did back at the beginning. We have had 140K deaths out of 4M confirmed cases, for a CURRENT death rate of 3.5%. Extrapolating this to 340M cases, as you suggest to achieve immunity, means we should be prepared to bury AT LEAST 11.9M Americans. Of course, the data are biased by poor early care, but also by the fact that we have been able to mostly care for all very ill patients. With this kind of spike, we would quickly run out of urgent care facilities and ICU beds, meaning many if not most of these patients would die as well, whereas now about 1/2 recover. This means as many as 20M Americans could die*.

Surely we have to do something. The question is really how much and what are we willing to live with and put up with. I find it very ironic that we made such a fuss about ensuring that we were open for business and minimize financial impact, whereas other countries were far more involved in caring more for their citizens' heath, including not just shut-downs but mandatory home confinement... and now the rest of the world has mostly moved on and has controlled this problem, including open back up for business- except us. Our visas are useless as the rest of the world sees us as a hazard to their health.

This virus was a festering wound on our foot from stepping on a rusty nail. We couldn't be bothered going to the doctor because it was too expensive, and it was more important to make sure we went to work at our job in construction to get paid to pay rent and feed the kids, and now the leg is gangrenous and needs to be amputated and we are still trying to rationalize why we should keep ignoring it, and let it "run its course". Surely the infection can't be worse than an amputation? If we get an amputation, how are we going to go to work without a leg? The truth is it can always get worse. How much worse? Let's just keep ignoring the problem and find out!

*- there are a lot of variables at play here that I did not explore. The point is that doing nothing means a metric crap-ton of people are likely to perish

 

[WEBB PINKERTON]

Has the rest of the world really moved on? India? Mexico? Brazil? Even Australia and Hong Kong? How long are people around the world going to tolerate open up, spike, shut down again. Lather rinse repeat. The economic damage is just as deadly.

I am thankful to not be in government at this time.

 

[gbwillner]

Has the rest of the world really moved on? India? Mexico? Brazil? How long are countries going to tolerate open up, spike, shut down again. Lather rinse repeat.

I am thankful to not be in government.

Obviously there are other (sh**hole countries!) that have done a poor job of controlling their disease like us. Nice thing about borders tho- they can be shut down easier than economies, Starbucks, neighborhood pools, schools, and state lines.

 

[ScubaV]

How do you know that you might just be delaying the inevitable with your plan and shutting down everyone’s lives in the process?

Where was it that I laid out a plan again? If you're talking about what we should have done, well all the proof you need is looking around the world at who did something and who didn't.

 

[Allegri]

I think many are being too fatalistic. It is still early in the game. And the US is a huge country. Look at NY, once the posterchild of rampant infection, it now has fewer new daily cases than Australia. I think we have shown that in certain locations (probably inversely correlating well with Trump support), our population may have the discipline and social responsibility necessary to avoid log phase.

 

[deleted314957]

You go to war with army you have, not the army you would like.

This too shall pass.

 

[wholeheartedly]

The failure to appreciate the potential economic price of the short and longterm morbidity of this disease is incredibly shortsighted. Sure the immediate economic pain of shutdowns are real and excruciating, but the morbidity costs secondary to a large number infected due to letting this spread largely unchecked would likely be far more devastating. Just in a more drawn out and subtle way. Healthcare costs, productivity costs due to workers out weeks maybe months, loss or out of commission critical and hard to replace healthcare workers and downstream effects of that and so on.

 

[Spikebd]

The failure to appreciate the potential economic price of the short and longterm morbidity of this disease is incredibly shortsighted. Sure the immediate economic pain of shutdowns are real and excruciating, but the morbidity costs secondary to a large number infected due to letting this spread largely unchecked would likely be far more devastating. Just in a more drawn out and subtle way. Healthcare costs, productivity costs due to workers out weeks maybe months, loss or out of commission critical and hard to replace healthcare workers and downstream effects of that and so on.

Nobody knows how the costs of this will all play out. For all we know medicine as we knew it for the past 60 or so years could all be over if Western civilization goes through a “Great Reset” as told to us by the World Economic Forum.

 

[WEBB PINKERTON]

Any country declaring victory at this point is a having a George Bush "Mission Accomplished" moment. The ballgame is only in the first inning. If the UK and USA had done a better job with long term care facilities, numbers would look a lot better. An older lady at work lost both of her parents in a nursing home to Covid.

Instead, we are more worried about NBA players and athletes getting tests each day. Too bad we weren't this vigilant with workers and residents in high risk facilities.

 

[elburrito]

Your maths are off.

If we did nothing (more or less what happened pre-mid-March and the week of July 1), and "let it take its course", we would not have 100K cases per day; that would be day one (our current rate, where we are definitely doing "something"). As we saw at the beginning (death rates DOUBLING every 3-4 days) and now (new case rates DOUBLING every 3-4 days), it would not take 6 years to arrive at heard immunity. If we did NOTHING to prevent spread, and 340M is expected to be the number of people that make up the 60% of people needed to reach herd immunity, we would reach that number in <48 days.

I stopped tracking the numbers on a daily basis because I went on vacation and then was too depressed about it as states opened without reservation and everything we had done to date was turned to sh**. However, I can say that we have a much better understanding of this disease (still very incomplete) than we did back at the beginning. We have had 140K deaths out of 4M confirmed cases, for a CURRENT death rate of 3.5%. Extrapolating this to 340M cases, as you suggest to achieve immunity, means we should be prepared to bury AT LEAST 11.9M Americans. Of course, the data are biased by poor early care, but also by the fact that we have been able to mostly care for all very ill patients. With this kind of spike, we would quickly run out of urgent care facilities and ICU beds, meaning many if not most of these patients would die as well, whereas now about 1/2 recover. This means as many as 20M Americans could die*.

Surely we have to do something. The question is really how much and what are we willing to live with and put up with. I find it very ironic that we made such a fuss about ensuring that we were open for business and minimize financial impact, whereas other countries were far more involved in caring more for their citizens' heath, including not just shut-downs but mandatory home confinement... and now the rest of the world has mostly moved on and has controlled this problem, including open back up for business- except us. Our visas are useless as the rest of the world sees us as a hazard to their health.

This virus was a festering wound on our foot from stepping on a rusty nail. We couldn't be bothered going to the doctor because it was too expensive, and it was more important to make sure we went to work at our job in construction to get paid to pay rent and feed the kids, and now the leg is gangrenous and needs to be amputated and we are still trying to rationalize why we should keep ignoring it, and let it "run its course". Surely the infection can't be worse than an amputation? If we get an amputation, how are we going to go to work without a leg? The truth is it can always get worse. How much worse? Let's just keep ignoring the problem and find out!

*- there are a lot of variables at play here that I did not explore. The point is that doing nothing means a metric crap-ton of people are likely to perish

The above calculation arriving at 11.9 million deaths is based on CASE FATALITY rate. Seroprevalence studies are suggesting that infection rate might be greater than or equal to 10x or more that of PCR confirmed case incidence.

fuzzy logic...based on INFECTION MORTALITY rate.

assume 4,000,000 infections by pcr...assume true infection incidence is 40,000,000 for the 140,000 deaths thus far.

140,000/40,000,000= 0.35% infection mortality rate.

assume heard immunity is achieved

Your maths are off.

If we did nothing (more or less what happened pre-mid-March and the week of July 1), and "let it take its course", we would not have 100K cases per day; that would be day one (our current rate, where we are definitely doing "something"). As we saw at the beginning (death rates DOUBLING every 3-4 days) and now (new case rates DOUBLING every 3-4 days), it would not take 6 years to arrive at heard immunity. If we did NOTHING to prevent spread, and 340M is expected to be the number of people that make up the 60% of people needed to reach herd immunity, we would reach that number in <48 days.

I stopped tracking the numbers on a daily basis because I went on vacation and then was too depressed about it as states opened without reservation and everything we had done to date was turned to sh**. However, I can say that we have a much better understanding of this disease (still very incomplete) than we did back at the beginning. We have had 140K deaths out of 4M confirmed cases, for a CURRENT death rate of 3.5%. Extrapolating this to 340M cases, as you suggest to achieve immunity, means we should be prepared to bury AT LEAST 11.9M Americans. Of course, the data are biased by poor early care, but also by the fact that we have been able to mostly care for all very ill patients. With this kind of spike, we would quickly run out of urgent care facilities and ICU beds, meaning many if not most of these patients would die as well, whereas now about 1/2 recover. This means as many as 20M Americans could die*.

Surely we have to do something. The question is really how much and what are we willing to live with and put up with. I find it very ironic that we made such a fuss about ensuring that we were open for business and minimize financial impact, whereas other countries were far more involved in caring more for their citizens' heath, including not just shut-downs but mandatory home confinement... and now the rest of the world has mostly moved on and has controlled this problem, including open back up for business- except us. Our visas are useless as the rest of the world sees us as a hazard to their health.

This virus was a festering wound on our foot from stepping on a rusty nail. We couldn't be bothered going to the doctor because it was too expensive, and it was more important to make sure we went to work at our job in construction to get paid to pay rent and feed the kids, and now the leg is gangrenous and needs to be amputated and we are still trying to rationalize why we should keep ignoring it, and let it "run its course". Surely the infection can't be worse than an amputation? If we get an amputation, how are we going to go to work without a leg? The truth is it can always get worse. How much worse? Let's just keep ignoring the problem and find out!

*- there are a lot of variables at play here that I did not explore. The point is that doing nothing means a metric crap-ton of people are likely to perish

The above 11.9 million deaths appears to be based on CASE FATALITY rate inferred from 140k deaths over 4,000,000 cases. Seroprevalence studies suggest that PCR might underestimate the true incidence of infection by greater than or equal to 10x.

fuzzy logic...

assume infection rate of 40,000,000 cases, and 140k deaths = 0.0035 INFECTION MORTALITY rate. If 240,000,000 cases are required for herd immunity, then 0.35% of 240,000,000 = 840,000, which spread over 5 years, is approximately 168,000 deaths per year.

I’m certain our military planners have calculated this. And im certain they have decided that this is a lower cost than the fallout from weakening our economy and consequently our military superiority in the world. That is the true unacceptable outcome.

 

[WEBB PINKERTON]

No one has moved on from this virus.

Coronavirus Is Back With a Vengeance in Places Where It Had All but Vanished

 

[ScubaV]

I wonder if some of you would still be so callous if it was your own family getting sick. "Sucks you're dying Mom, but thankfully I can get my hair cut and go to the bar! Catch you on the flip side!"

Look, I get it. I agree the economy is important and you can't have a total lockdown forever. It's obvious that people have a pretty low tolerance for disruptions to their daily lives without coercion. It's also pretty obvious that this virus is hard to control under the best circumstances and under the worst circumstances (good old USA) there's no putting the genie back in the bottle. Still, studies have shown infection control measures like masks to be very effective at limiting person to person spread.

When people whine about "MUH FREEDOMS! MUH ECONOMY!" and refuse to suffer a minor inconvenience (this doesn't even come close to a level that warrants the word sacrifice) such as wearing a mask, or only being able to pick up food from restaurants then it's pretty clear that the root issue is not about personal freedom or saving the broader economy. It's a callous disregard for the health and safety of themselves, their own families, and their community because of selfishness. "I want to live my life the way I used to and if people including my own family get sick and die because of it, I am okay with it."

Like I said before, this is a national crisis comparable to WW2 in terms of American deaths and people can't deal with some fabric and not being able to boss around a restaurant server? People like to complain about entitled millennials, but it's become very clear who the real entitled folks are (of any age).

 

[y2k_free_radical]

I wonder if some of you would still be so callous if it was your own family getting sick. "Sucks you're dying Mom, but thankfully I can get my hair cut and go to the bar! Catch you on the flip side!"

Look, I get it. I agree the economy is important and you can't have a total lockdown forever. It's obvious that people have a pretty low tolerance for disruptions to their daily lives without coercion. It's also pretty obvious that this virus is hard to control under the best circumstances and under the worst circumstances (good old USA) there's no putting the genie back in the bottle. Still, studies have shown infection control measures like masks to be very effective at limiting person to person spread.

When people whine about "MUH FREEDOMS! MUH ECONOMY!" and refuse to suffer a minor inconvenience (this doesn't even come close to a level that warrants the word sacrifice) such as wearing a mask, or only being able to pick up food from restaurants then it's pretty clear that the root issue is not about personal freedom or saving the broader economy. It's a callous disregard for the health and safety of themselves, their own families, and their community because of selfishness. "I want to live my life the way I used to and if people including my own family get sick and die because of it, I am okay with it."

Like I said before, this is a national crisis comparable to WW2 in terms of American deaths and people can't deal with some fabric and not being able to boss around a restaurant server? People like to complain about entitled millennials, but it's become very clear who the real entitled folks are (of any age).

It is not a minor inconvenience to those without a pay check or having to close their business.Most of the hard extended lock down proponents are still receiving an income.Are we sure a hard lock down will ultimately significantly reduce the number infected.

 

[Allegri]

Scuba, there are a lot of people sacrificing and struggling beyond the mask wearing thing. And it looks like it's going to get worse.

y2k, please look at some graphs of infection over time of various countries and states. Many European countries, and even NY state, look like an inverted V. Yes we are still early, but if those places can keep those graphs relatively flat for the next year and a vaccine becomes available, that is a huge number of lives saved. Compare that with a graph that looks like a constant upward trajectory. At whatever time T, the second graph will have more dead.

 

[gbwillner]

The above calculation arriving at 11.9 million deaths is based on CASE FATALITY rate. Seroprevalence studies are suggesting that infection rate might be greater than or equal to 10x or more that of PCR confirmed case incidence.

fuzzy logic...based on INFECTION MORTALITY rate.

assume 4,000,000 infections by pcr...assume true infection incidence is 40,000,000 for the 140,000 deaths thus far.

140,000/40,000,000= 0.35% infection mortality rate.

assume heard immunity is achieved

I acknowledged there are many caveats not fully explored; for example, if seropositive rates show us we are undercounting cases (towards the 60% estimated for herd immunity). If you are correct that the true infection rate is 10x that what is known based on testing, than you are still looking at 1.9M deaths to get there at a minimum if we do nothing. The other thing this does is considerably move up the clock. But these estimates are probably themselves not very good representatives of actual infection rates (yet), nor will this matter much as critical care facilities are overwhelmed since many states like FL, AZ, and TX are already at capacity.

 

[elburrito]

I acknowledged there are many caveats not fully explored; for example, if seropositive rates show us we are undercounting cases (towards the 60% estimated for herd immunity). If you are correct that the true infection rate is 10x that what is known based on testing, than you are still looking at 1.9M deaths to get there at a minimum if we do nothing. The other thing this does is considerably move up the clock. But these estimates are probably themselves not very good representatives of actual infection rates (yet), nor will this matter much as critical care facilities are overwhelmed since many states like FL, AZ, and TX are already at capacity.

My brother is a ER Doctor in a busy urban center in the South. That is exactly what he told me. While we theorize from our armchairs about true infection mortality rates and incidence, the Harsh reality Trumps all theoretical considerations...ERs And ICUs are getting over run with patients presenting with ARDS or who are unable to ween from ventilator for extended periods. I think God is testing all of us right now. How will we respond to the image of death. Will we do it in a way that reflects compassion and empathy? Or will we simply double down on our own ways of thinking and living, where the suffering of our neighbors and elders becomes merely but an abstraction? Im not a religious person, but I have a feeling that there will be a reckoning yet to come.

 

[gbwillner]

OK, I had to look again at the data. This time I limited myself to FL as a microcosm of what is happening in the South. I am reporting here in a standard plot new cases, deaths, new hospitalizations, and current hospitalized patients. You will see the trends are neither good nor flat.

There is apparent exponential growth of new cases and new hospitalizations. you may be able to rationalize the growth of new cases to increased testing- there is some mild effect due to this (previously discussed), but this is not the main driver nor a major cause (spread of virus is). On this plot, new positive cases and current hospitalizations are on the right axis, whereas new hospitalized cases and deaths are on the left.

The explosion is clearly correlated with relaxing social distancing and economic restraints near the end of June. As we saw from many prior examinations of the data, deaths tend to lag new cases and hospitalizations by about 7-10 days. New cases appear accelerating from mid June to mid July, and it seems to have possibly plateaued or reversed. However, new hospitalizations enter this phase at the very end of June and are only maybe now starting to slow. Based on this plot, new + cases were likely growing exponentially from mid to late June, and new admissions were growing exponentially from late June to mid July.

FL is currently seeing 450 daily new COVID-19 admissions per day, up from about 150 at the beginning of July. The most worrying part is the trajectory is still rocketing up. Deaths followed as expected, and start to raise about 7/10. It does not appear to be in log phase however, but there is not as much data here to be certain. FL is currently seeing about 140 confirmed deaths per day, and this is still rising.

 

[elburrito]

OK, I had to look again at the data. This time I limited myself to FL as a microcosm of what is happening in the South. I am reporting here in a standard plot new cases, deaths, new hospitalizations, and current hospitalized patients. You will see the trends are neither good nor flat.

There is apparent exponential growth of new cases and new hospitalizations. you may be able to rationalize the growth of new cases to increased testing- there is some mild effect due to this (previously discussed), but this is not the main driver nor a major cause (spread of virus is). On this plot, new positive cases and current hospitalizations are on the right axis, whereas new hospitalized cases and deaths are on the left.

The explosion is clearly correlated with relaxing social distancing and economic restraints near the end of June. As we saw from many prior examinations of the data, deaths tend to lag new cases and hospitalizations by about 7-10 days. New cases appear accelerating from mid June to mid July, and it seems to have possibly plateaued or reversed. However, new hospitalizations enter this phase at the very end of June and are only maybe now starting to slow. Based on this plot, new + cases were likely growing exponentially from mid to late June, and new admissions were growing exponentially from late June to mid July.

FL is currently seeing 450 daily new COVID-19 admissions per day, up from about 150 at the beginning of July. The most worrying part is the trajectory is still rocketing up. Deaths followed as expected, and start to raise about 7/10. It does not appear to be in log phase however, but there is not as much data here to be certain. FL is currently seeing about 140 confirmed deaths per day, and this is still rising.

Is there cause for concern around the validity of the data, now that it haS been publicly stated that local health department data will now be shunted to health and human services rather than the CDC?

What Is the responsible thing for us to do as pathologists in service to the public good? How can we educate the public, when conspiracy theories are being actively promulgated by the highest levels of government and quackery is given a platform via national news media outlets? I’m worried there is an active disinformation campaign to obfuscate the truths around a bungled centralized response. I’m worried that when science speaks inconvenient truths to power, power is fighting science back with pseudo-science.
I’m worried that the central powers will only wish to prioritize the semblance of normalcy at all costs.

I’m worried that the discrediting of reason and the rendering of truth and scientific fact as mutable were critical milestones in the mainstreaming of naziism and the cultural revolution.

 

[gbwillner]

Is there cause for concern around the validity of the data, now that it haS been publicly stated that local health department data will now be shunted to health and human services rather than the CDC?

What Is the responsible thing for us to do as pathologists in service to the public good? How can we educate the public, when conspiracy theories are being actively promulgated by the highest levels of government and quackery is given a platform via national news media outlets? I’m worried there is an active disinformation campaign to obfuscate the truths around a bungled centralized response. I’m worried that when science speaks inconvenient truths to power, power is fighting science back with pseudo-science.
I’m worried that the central powers will only wish to prioritize the semblance of normalcy at all costs.

I’m worried that the discrediting of reason and the rendering of truth and scientific fact as mutable were critical milestones in the mainstreaming of naziism and the cultural revolution.

I am similarly worried about all those things. I have seen a deterioration of public discourse over the last decade. I thought the internet would enlighten us with information available instantly. Instead it has spread disinformation; and foreign and political powers how really figured out how to manipulate us with it.
We should all be entitled to our own opinions. What we cannot be entitled to is our own facts. People have proven themselves to be poor critical thinkers and judges of quality of evidence. They often cannot or will not look beyond their own biases, and now, thanks to the internet and 24-hr news cycle propaganda channels, never have to experience getting their worldview challenged, even when it is completely insane and based entirely on conspiracy theories.

What can we do? Speak factually. be respectful of opinion but NOT of false information. Explain the limitations of our understanding and that we must operate with incomplete data sets. But always act with honesty and integrity. Speak truth to power, when power is clearly misrepresenting or falsifying fact. How sad is it that we are talking about not trusting HHS data to be valid, and not because of possible accidental error in accounting? My fear is that the idea of American Exceptionalism is dying.

 

[Guest8]

My fear is that the idea of American Exceptionalism is dying.

It was never alive to begin with. There's nothing magical about what we do here compared to other developed nations, we just think there is because this is our nation so we view it with rose-colored glasses. People in other Western democracies are just as happy in their countries, if not more so. American Exceptionalism is a concept we made up to make ourselves feel good. It isn't based in reality.

 

[Allegri]

The US doesn't have to be magical to be exceptional. And it's not about happiness. At least as far as science and culture from the early 20th century to now, no other country comes close in accomplishments and influence. Interestingly, this despite the longstanding undercurrent of anti-intellectualism in this country, which with the help of Trump and our propaganda silos has in recent years mushroomed.

 

[ScubaV]

You can argue whether America is (was?) truly exceptional, but I think the idea of America being a special place has historically been a reality. For all the anti-immigrant sentiment that has waxed and waned forever and is resurging now, the US has attracted immigrants from all over the world seeking a better life, most of whom probably dealt with longer or more difficult journeys than another wealthy nation might have presented. Those very same immigrants have kept the US population rising, despite birth rates being below replacement level since the 70s. Those immigrants also have contributed enormously to the cultural and scientific accomplishments Allegri mentioned (your Einsteins and Teslas and the like).

We are definitely in a low period as a country in terms of real and perceived influence abroad and cohesion at home, and regardless of what happens in November I don't see that changing quickly. I just hope we can recover and it's not the start of a long, slow decline a la so many other dominant empires in history.

 

[Spikebd]

You can argue whether America is (was?) truly exceptional, but I think the idea of America being a special place has historically been a reality. For all the anti-immigrant sentiment that has waxed and waned forever and is resurging now, the US has attracted immigrants from all over the world seeking a better life, most of whom probably dealt with longer or more difficult journeys than another wealthy nation might have presented. Those very same immigrants have kept the US population rising, despite birth rates being below replacement level since the 70s. Those immigrants also have contributed enormously to the cultural and scientific accomplishments Allegri mentioned (your Einsteins and Teslas and the like).

We are definitely in a low period as a country in terms of real and perceived influence abroad and cohesion at home, and regardless of what happens in November I don't see that changing quickly. I just hope we can recover and it's not the start of a long, slow decline a la so many other dominant empires in history.

A lot of people feel America isn’t in an expansionist phase any longer and needs to find a way to re-invent itself or else collapse like the Ottoman Empire. What values does current USA hold that would give them an advantage in the future? Unlimited immigration?

 

[LADoc00]

Anyone a virologist here or do graduate level virology? I did 2 years as a post doc in a multi-disciplinary Vir lab so Im not claiming to be Paul Berg but....

Questions that are curiously often not answered in any serious sense currently:
1.) How long is our immunity to COVID-19 lasting? Answer: likely 6-8 weeks.
2.) Can we be infected after this period? Answer: yes.
3.) On repeat infection, is there evidence it is doing incremental damage? Answer: yes.
4.) How many effective vaccines of coronaviridae have ever been created? Answer: none. (and yes we have been trying for several decades)

Now journey down my rabbit hole folks...
IF we can be reinfected AND the virus is doing incremental vascular and pulmonary damage each time we are infected AND each incremental damage accumulation raises your mortality risk AND no effective vaccine is possible THEN how is this not a legit existential threat to the human civilization given the R0 we are seeing?

When do you legitimately "head to the bunker"? 5 million dead? 20 million? When Portland, Minneapolis AND Los Angeles are just smoking rubble?

What is everyone's drop dead indicator where reading glass slides is merely rearranging the deck chairs on the Titanic as it sinks?

I know mine: 3 medical staff I work with dead of COVID, once that happens, I'm audi.

 

[elburrito]

Anyone a virologist here or do graduate level virology? I did 2 years as a post doc in a multi-disciplinary Vir lab so Im not claiming to be Paul Berg but....

Questions that are curiously often not answered in any serious sense currently:
1.) How long is our immunity to COVID-19 lasting? Answer: likely 6-8 weeks.
2.) Can we be infected after this period? Answer: yes.
3.) On repeat infection, is there evidence it is doing incremental damage? Answer: yes.
4.) How many effective vaccines of coronaviridae have ever been created? Answer: none. (and yes we have been trying for several decades)

Now journey down my rabbit hole folks...
IF we can be reinfected AND the virus is doing incremental vascular and pulmonary damage each time we are infected AND each incremental damage accumulation raises your mortality risk AND no effective vaccine is possible THEN how is this not a legit existential threat to the human civilization given the R0 we are seeing?

When do you legitimately "head to the bunker"? 5 million dead? 20 million? When Portland, Minneapolis AND Los Angeles are just smoking rubble?

What is everyone's drop dead indicator where reading glass slides is merely rearranging the deck chairs on the Titanic as it sinks?

I know mine: 3 medical staff I work with dead of COVID, once that happens, I'm audi.

A conservative pathologist whom I respect had described this at the beginning as “culling the herd,” and seemed totally comfortable with however Gods will should prevail. That was back when we were looking at possibly 2 million dead based on Worse case projections based on case fatality rate known at the time from Italy. Many on the conservative right have developed an idea that a mask represents a “compliance device”, or that it somehow is the mark of the beast or something. the president describes the virus as merely appearing problematic due to over testing (even though per capita testing rate in US is lower than other countries). At this point, I’m convinced the government that brought us “duck and cover” is now also, looking towards self preservation and preserving at all costs only the semblance of normalcy...Thou Shalt Not Bear False Witness...it is a doomed strategy. May God have Mercy on their souls.

 

[Spikebd]

LADoc, I imagine you own a parcel of land in a rural zone fully stocked with military-grade gas masks, storable food, weapons, etc... maybe a greenhouse as well. If so, I’m jealous.

 

[Spikebd]

Live updates: SpaceX Dragon Crew returns to Earth

NASA astronauts Robert Behnken and Douglas Hurley are returning home from the International Space Station aboard their SpaceX Crew Dragon capsule.

www.google.com

Maybe the International Space Station is actually Noah’s Ark and all of us are about to be left behind while Elon Musk and Bill Gates watch us suffocate on Earth?

 

[gbwillner]

For those of you that saw no difference between this administration and others, or thought that there was no way to have done anything different; or that the CDC had bungled this rather than the political appointees and government officials that oversaw such institutions and changed their guidance and findings for political purposes... here is more evidence of the level of corruption of the current government. Expect it only to grow as the end comes for this current crop.

Government Scientist Adds To Whistle-Blower Complaint And Quits NIH

Lawyers for Rick Bright wrote in the addendum to his May filing that "the work of scientists is ignored or denigrated to meet political goals and to advance President Trump's re-election aspirations."

www.npr.org

 

[Allegri]

I agree with the general thrust of this comment, but. . . these two are not mutually exclusive: 1. CDC and FDA massive fails, and 2. stunning levels of government idiocy and corruption. These are both true. And why have there not been more resignations?? That's what I don't get.

 

[Thr0mbus]

All the governments are corrupt. Look how Obama sold his health care scheme. Get a grip!

 

[gbwillner]

I agree with the general thrust of this comment, but. . . these two are not mutually exclusive: 1. CDC and FDA massive fails, and 2. stunning levels of government idiocy and corruption. These are both true. And why have there not been more resignations?? That's what I don't get.

Most people, maybe in particular those that work for the government as civil servants, don't have the intestinal fortitude to make a principled stand and quit their jobs over issues like injustice or corruption. Most people are more likely to keep their heads down forever and hope that the problems don't force them to act in an immoral fashion. And then they have another choice to make.

 

[LADoc00]

LADoc, I imagine you own a parcel of land in a rural zone fully stocked with military-grade gas masks, storable food, weapons, etc... maybe a greenhouse as well. If so, I’m jealous.

Im going on Sunday to look at a place with 70+ acres, massive water supply with water rights, 4 houses on site and a massive viking style hall with a sub-terrain gun range. Competition for this place tho could be stiff from tech bros so Im unsure if I will get it.

Currently I sit atop the highest ground in my neighborhood with a 4th story "crow's nest" type sign out room my contractor added for me some years back. Only 180 degree visibility but I have cameras for the opposite south facing side. Good but not great, my son dressed me down last night at dinner for not owning a 338 Lapua sniper rifle capable of max engagement distances beyond my long barrel 308 and 50cal. rifles. We had company for dinner and my son telling them we had insufficient ballistics to properly counter battery sniper fire was quite the social embarrassment in my house.

To put in context for the soy SDN crowd, it was the embarrassment that is probably felt telling your gay liberal friends at a SF cocktail party you thought about not voting for Biden briefly because he constantly having strokes all the time i.e. very, very embarrassing....

 

[ScubaV]

Im going on Sunday to look at a place with 70+ acres, massive water supply with water rights, 4 houses on site and a massive viking style hall with a sub-terrain gun range. Competition for this place tho could be stiff from tech bros so Im unsure if I will get it.

Currently I sit atop the highest ground in my neighborhood with a 4th story "crow's nest" type sign out room my contractor added for me some years back. Only 180 degree visibility but I have cameras for the opposite south facing side. Good but not great, my son dressed me down last night at dinner for not owning a 338 Lapua sniper rifle capable of max engagement distances beyond my long barrel 308 and 50cal. rifles. We had company for dinner and my son telling them we had insufficient ballistics to properly counter battery sniper fire was quite the social embarrassment in my house.

To put in context for the soy SDN crowd, it was the embarrassment that is probably felt telling your gay liberal friends at a SF cocktail party you thought about not voting for Biden briefly because he constantly having strokes all the time i.e. very, very embarrassing....

Not bad, but needs that little something extra. I know of a crazy survivalist bunker type who claimed he was the last living Neanderthal or something and therefore had super strength, super intelligence and was overall superior to ordinary humans.

 

[gbwillner]

Enough of the "both sides are bad" nonsense. This has been a failure of epic proportions by this government- one that installs sycophants rather than experts to head leadership positions at key enforcement and regulatory departments.
Here is the latest "liberal hit job" by the NEJM:
https://www.nejm.org/doi/full/10.1056/NEJMe2029812?query=TOC

 

[WEBB PINKERTON]

Pathologist left her job to go to New Zealand because of all this

Here’s what made a Bay Area medical examiner move her family from SF to New Zealand

Dr. Judy Melinek took over Alameda County’s morgue in March and sounded alarms about...

www.sfchronicle.com

 

[coroner]

Pathologist left her job to go to New Zealand because of all this

So, there's a job opening in the Bay Area...?!?

 

[WEBB PINKERTON]

Too dangerous there! Hell, don't you have put your mask over your mouth while you are chewing in the restaurant?

You need to flee to island nations that can get rid of covid and keep people from coming in for like the next two years or more.

This game is still very early, 2nd or 3rd inning at best.

 

[Thr0mbus]

Enough of the "both sides are bad" nonsense. This has been a failure of epic proportions by this government- one that installs sycophants rather than experts to head leadership positions at key enforcement and regulatory departments.
Here is the latest "liberal hit job" by the NEJM:
https://www.nejm.org/doi/full/10.1056/NEJMe2029812?query=TOC

Quoting the Chinese numbers as if they are some kind of truth says all you need to know.

Senile Joe wants us all in lockdown. Screw that!

We should all be able to choose quality of life vs quantity of life. Just like we give it to patients. Forcing us to choose quantity (at least in their minds) is UNETHICAL and TYRANNY!!

 

[Med Director New England]

Enough of the "both sides are bad" nonsense. This has been a failure of epic proportions by this government- one that installs sycophants rather than experts to head leadership positions at key enforcement and regulatory departments.
Here is the latest "liberal hit job" by the NEJM:
https://www.nejm.org/doi/full/10.1056/NEJMe2029812?query=TOC

imo the NEJM publication was irresponsible. They praise the Chinese policy of “strict quarantine“ which literally translates marching people testing positive into positive camps at gun point, separating family members to either recover or die. We can’t do that in the US we aren’t a communist country. Maybe we could have done better, but if you exclude NYC (b/c of nursing homes forced to take Covid + patients) and surrounding areas we did better than almost all of Western Europe. NEJM should be non- partisan.

 

[gbwillner]

imo the NEJM publication was irresponsible. They praise the Chinese policy of “strict quarantine“ which literally translates marching people testing positive into positive camps at gun point, separating family members to either recover or die. We can’t do that in the US we aren’t a communist country. Maybe we could have done better, but if you exclude NYC (b/c of nursing homes forced to take Covid + patients) and surrounding areas we did better than almost all of Western Europe. NEJM should be non- partisan.

I would argue that this was not partisan. What was the federal plan? What was the federal response? That's right- no plan, no response. Obscuring reality to fit a political goal hoping reality would not set in was the only plan I saw.
The buck was passed to the states, without means or expertise, and no coordination.
Not sure where you see we did better than western Europe excluding NYC... we had our worst day in terms of infections... yesterday. Most states are currently still heading in the wrong direction.

 

[path24]

TDS is real.