The ultimate COVID thread

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anbuitachi said:
no country in the world has surpassed 1k dead per day in the official count. not sure why USA will. perhaps we will but most likely not
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We're bigger than Italy. We've got the population of every country in Western Europe put together.

A reasonable comparison might be every European death west of what used to be the iron curtain, added up.

Of course we're going to top 1K/day. That can't possibly be in question at this point. :(
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pgg said:
We're bigger than Italy. We've got the population of every country in Western Europe put together.

A reasonable comparison might be every European death west of what used to be the iron curtain, added up.

Of course we're going to top 1K/day. That can't possibly be in question at this point. :(
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Our density is lacking .
 
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Coronavirus job losses could total 47 million, unemployment rate may hit 32%, Fed estimates
PUBLISHED MON, MAR 30 202011:40 AM EDTUPDATED MON, MAR 30 20208:16 PM EDT


POINTS
  • The coronavirus economic freeze could cost 47 million jobs and send the unemployment rate past 32%, according to St. Louis Fed projections.
  • There are nearly 67 million Americans working in jobs that are at a high risk of layoffs, according to the analysis.
  • St. Louis Fed President James Bullard said last week that the initial estimates are grim but the plunge should be short-lived.
 
1585681402219.png
 
Mman said:
He is not making N95 masks...
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This is correct. Thank you for pointing out that they will not be N95; articles I'd read presenting claims counter to this were incorrect.
 
Trump calls for $2T infrastructure bill as 'Phase 4' of coronavirus response


President Trump on Tuesday called for a $2 trillion infrastructure bill to serve as “Phase 4” of the federal government’s coronavirus response efforts, just days after Congress approved a massive stimulus package worth even more than that.

“With interest rates for the United States being at ZERO, this is the time to do our decades long awaited Infrastructure Bill,” Trump tweeted Tuesday. “It should be VERY BIG & BOLD, Two Trillion Dollars, and be focused solely on jobs and rebuilding the once great infrastructure of our Country! Phase 4.”
 
So, Vector 2 will likely want Medicare 4 all next. I guess with 5 Trillion in spending (Covid 19) Vector2 and his friends will think an extra 3 trillion per year every year for Medicare 4 all is a good deal.

The spending is out of control and the U.S. currency will be debased at some point. I was never a fan of Bitcoin but worthless virtual currency with limited circulation may indeed be better than U.S. Fiat currency with Unlimited circulation.

I am certainly going to re-evaluate the % of Gold in my portfolio as well. I am hoping that Gold settles back down to $1400 as the stocks recover over the next 12 months. U.S. debt is getting out of control (it was already too high in my opinion).
 
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  • The average amount employers contribute to their workers’ 401(k) accounts is 4.3% of a participant’s salary.
  • 95% of plans offer either a company match or other type of contribution, according to Vanguard.
  • Some experts say the share of companies that temporarily stop contributions may exceed those that did so during the financial crisis of 2008-2009.
www.cnbc.com

Employers may drop 401(k) matches as companies look to cut expenses

Companies both large and small are seeking legal advice about their options for reducing or pausing their contributions to their workers' 401(k) plans — a move that some employers made during the last U.S. economic downturn.
www.cnbc.com www.cnbc.com
 
In recent weeks, they’ve seen a dramatic impact to their businesses as COVID-19 spreads across the country. Policymakers and medical associations have advised provider groups like theirs to halt nonessential procedures in order to preserve vital supplies for fighting COVID-19.

These elective procedures are the lifeblood for thousands of primary care groups, specialty clinics and surgical centers, and many of the doctors who own them are now struggling to make payroll.

“Overnight we scaled back to having almost no patients,” Boyle said, noting that his practice is still taking emergency cases.

“For practices like ours, it’s been devastating,” added Alul. “But we know it’s the right thing as we take seriously that we shouldn’t bring in our patients, many of whom are older. We don’t know the extent of how prevalent COVID-19 is.”

www.cnbc.com

Rural hospitals and private medical practices struggle to stay open during the COVID-19 pandemic

Dr. Ed Boyle is trying to keep a brave face for his staff in Bend, Oregon, but revenue has taken a huge hit now that his medical practice can no longer perform elective procedures during the coronavirus shutdown. His wife, Dr. Ida Azul, is in the same boat.
www.cnbc.com www.cnbc.com
 
BLADEMDA said:
So, Vector 2 will likely want Medicare 4 all next. I guess with 5 Trillion in spending (Covid 19) Vector2 and his friends will think an extra 3 trillion per year every year for Medicare 4 all is a good deal.
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I like how you think jabs like this aren't nonsensical at all considering how much debt has been racked up in the last 3.2 years of a Republican administration even before COVID. 10 years ago you guys were HOWLING about how much of a waste stimulus was and how corporate bailouts were unjust and unAmerican. And now without an ounce of shame you all act like of course Keynesian stimulus, massive QE, straight socialist cash to the people, and a gift to Trump and Mnuchin's corporate friends is what's needed to stabilize the economy, when literally all I've heard squawked at me for years is FRIEDMAN FRIEDMAN HAYEK FRIEDMAN.

Gimme a break.
 
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anbuitachi said:
Our density is lacking .
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One of the models Birx and Fauci may be talking about on the WH presser tonight is the UW one found here IHME | COVID-19 Projections

That one calls for ~84,000 total deaths by end of summer. But I think it was made was assumptions that we will essentially continue doing the same if not more social distancing behavior that we are doing now until that time.


The question for the economy and the stock market is whether we will be able to avoid a bimodal distrubtion. What if we peak in April, get it kind of under control, people relax too much, and then we get a big, panic-inducing spike in cases in May or June? Uncertainty is one of the biggest if not the biggest killer of corporate profits and the market. If corporations don't know that a true peak has actually been hit and that the curve will remain under healthcare capacity, then I suspect they will be very loath to rehire to full capacity and move full steam ahead.
 
vector2 said:
One of the models Birx and Fauci may be talking about on the WH presser tonight is the UW one found here IHME | COVID-19 Projections

That one calls for ~84,000 total deaths by end of summer. But I think it was made was assumptions that we will essentially continue doing the same if not more social distancing behavior that we are doing now until that time.


The question for the economy and the stock market is whether we will be able to avoid a bimodal distrubtion. What if we peak in April, get it kind of under control, people relax too much, and then we get a big, panic-inducing spike in cases in May or June? Uncertainty is one of the biggest if not the biggest killer of corporate profits and the market. If corporations don't know that a true peak has actually been hit and that the curve will remain under healthcare capacity, then I suspect they will be very loath to rehire to full capacity and move full steam ahead.
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That's why there will be a U shaped recovery. We will bounce up to 2800 but then the market will question whether it is full stream ahead. I expect a back and fill from 2700-2900 throughout the summer but by Fall we are over 3,000 most likely.
 
vector2 said:
I like how you think jabs like this aren't nonsensical at all considering how much debt has been racked up in the last 3.2 years of a Republican administration even before COVID. 10 years ago you guys were HOWLING about how much of a waste stimulus was and how corporate bailouts were unjust and unAmerican. And now without an ounce of shame you all act like of course Keynesian stimulus, massive QE, straight socialist cash to the people, and a gift to Trump and Mnuchin's corporate friends is what's needed to stabilize the economy, when literally all I've heard squawked at me for years is FRIEDMAN FRIEDMAN HAYEK FRIEDMAN.

Gimme a break.
Click to expand...

The debt is killing us. Each trillion is like 5-10 lbs. of fat around our waist. Each Trillion makes it that much harder to get lean and fit as a nation. I awalys thought Trump was more of a populist than a true fiscal conservative. Nothing in his past ever convinced me he would care about debt. In fact, he loves cheap money as that is how he got rich in real estate.

While I applaud the goal of Medicare 4 all, the reckless spending by this President doesn't mean the next drunken sailor should spend even more. I would support a tax increase if I thought the next administration would actually use the money to pay down debt rather than incur even more. Instead, taxes are going to go way up, GDP goes down while the debt keeps piling up.
 
POINTS
  • DoubleLine Capital CEO Jeffrey Gundlach said the market low reached last week will get taken out before a more “enduring” bottom.
  • “The market has really made it back to a resistance zone and the market continues to act somewhat dysfunctionally in my opinion,” Gundlach said. “Take out the low of March and then we’ll get a more enduring low.”
  • The S&P 500 tumbled into a bear market at the fastest pace ever as the coronavirus pandemic caused unprecedented economic uncertainty.
  • The equity benchmark hit a three-year closing low of 2,237.40 on March 23, more than 30% from its record high reached in February.
 
BLADEMDA said:
The debt is killing us. Each trillion is like 5-10 lbs. of fat around our waist. Each Trillion makes it that much harder to get lean and fit as a nation. I awalys thought Trump was more of a populist than a true fiscal conservative. Nothing in his past ever convinced me he would care about debt. In fact, he loves cheap money as that is how he got rich in real estate.

While I applaud the goal of Medicare 4 all, the reckless spending by this President doesn't mean the next drunken sailor should spend even more. I would support a tax increase if I thought the next administration would actually use the money to pay down debt rather than incur even more. Instead, taxes are going to go way up, GDP goes down while the debt keeps piling up.
Click to expand...


The realpolitik of the situation is that there is no party that meets your definition of fiscal responsibility. Trump did not spend all that money on hisbown- he had an enabling congress and Senate that was also filled with Republicans. Debt is just a reality going forward, and if that's the case then I would rather have debt going toward services for the middle class and people who need them instead of tax cuts for the wealthy and corporations.
 
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BLADEMDA said:
Trump calls for $2T infrastructure bill as 'Phase 4' of coronavirus response


President Trump on Tuesday called for a $2 trillion infrastructure bill to serve as “Phase 4” of the federal government’s coronavirus response efforts, just days after Congress approved a massive stimulus package worth even more than that.

“With interest rates for the United States being at ZERO, this is the time to do our decades long awaited Infrastructure Bill,” Trump tweeted Tuesday. “It should be VERY BIG & BOLD, Two Trillion Dollars, and be focused solely on jobs and rebuilding the once great infrastructure of our Country! Phase 4.”
Click to expand...
Isn't it beautiful (sarcasm) to see both parties coming together as one with Republicans out-progressiving the Progressives. Everybody everywhere is a Feel the Bern Socialist now.
 
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GravelRider said:
Healthcare capacity. Once we know healthcare system can cope with surge then things will open up. That’s the number that matters in responding to this. Not deaths, not number of people infected.
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My post was not referring to when are we open for business.
 
BLADEMDA said:
Goldman sees the main propulsion coming from fiscal and monetary support greater than expected. Congress has recently passed a $2 trillion rescue package aimed at a variety of targets, and Goldman expects another measure on the way specifically aimed at supporting state governments. The Federal Reserve also has taken its benchmark interest rate to near zero and has rolled out a number of other programs aimed at supporting the economy.

In addition, measures taken to contain the coronavirus spread, specifically through social distancing and increased testing, will “result in sharply lower new infections over the next month, and our baseline is that slower virus spread and adaptation by businesses and individuals should set the stage for a gradual recovery in output starting in May/June,” Goldman wrote.

However, that won’t happen without sharp contractions in manufacturing, particularly autos as well as consumer spending, that will be offset by food and beverage production and medical equipment.

“We expect manufacturing to recover somewhat more rapidly than services, as factories are likely to reopen more quickly than non-essential services firms,” Goldman wrote.

The firm’s estimates come amid a plethora of downbeat forecasts of how bad things could get in the near term and the uncertainty of how sharp the recovery will be.
Click to expand...
It isn't Market Support as much as Market Being Propped Up. I don't think anyone can really guess what wins out here regarding the market, a huge economic recession/depression/collapse vs ungodly amounts of government borrowing/spending and money printing.

Similar to what Blade has said earlier about seeing this game before, I am absolutely convinced that our market obsession with its nominal value will lead to infinite about of intervention (printing, etc) to keep it propped up as much as possible.
 
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BLADEMDA said:
So, Vector 2 will likely want Medicare 4 all next. I guess with 5 Trillion in spending (Covid 19) Vector2 and his friends will think an extra 3 trillion per year every year for Medicare 4 all is a good deal.

The spending is out of control and the U.S. currency will be debased at some point. I was never a fan of Bitcoin but worthless virtual currency with limited circulation may indeed be better than U.S. Fiat currency with Unlimited circulation.

I am certainly going to re-evaluate the % of Gold in my portfolio as well. I am hoping that Gold settles back down to $1400 as the stocks recover over the next 12 months. U.S. debt is getting out of control (it was already too high in my opinion).
Click to expand...
Absolutely. Some kind of store of value is much better than holding a fiat currency that is being inflated at an insane level. I wish gold had more functionality. A huge warehouse with new stored guns and ammo is probably as good a store of value as anything, but then you still have security concerns and nutjobs getting their wish of government gun confiscation. But point being "stuff" that can be a store of value (land, other hard assets) is far better than fiat currency in this environment.
 
BLADEMDA said:
The debt is killing us. Each trillion is like 5-10 lbs. of fat around our waist. Each Trillion makes it that much harder to get lean and fit as a nation. I awalys thought Trump was more of a populist than a true fiscal conservative. Nothing in his past ever convinced me he would care about debt. In fact, he loves cheap money as that is how he got rich in real estate.

While I applaud the goal of Medicare 4 all, the reckless spending by this President doesn't mean the next drunken sailor should spend even more. I would support a tax increase if I thought the next administration would actually use the money to pay down debt rather than incur even more. Instead, taxes are going to go way up, GDP goes down while the debt keeps piling up.
Click to expand...
Agree with all of that except that I've never seen a fiscal conservative in power in my lifetime. They all talk it and never walk it. The great fiscal conservative Paul Ryan (sarcasm) came up with a budget plan that if everything worked perfectly, which it never does with budgets, we would balance the budget in THIRTY FIVE YEARS!! Give me a break; 34 more years of deficits before a balanced budget under the best of conditions. They are all frauds.
 
vector2 said:
The realpolitik of the situation is that there is no party that meets your definition of fiscal responsibility. Trump did not spend all that money on hisbown- he had an enabling congress and Senate that was also filled with Republicans. Debt is just a reality going forward, and if that's the case then I would rather have debt going toward services for the middle class and people who need them instead of tax cuts for the wealthy and corporations.
Click to expand...

It's not about the taxes or the services it is about the children. What kind of country will you be leaving for the youngest among us? 50 trillion in debt? 100 trillion? You do realize that these newborn children aren't going to get services when they need them if the U.S. dollar isn't worth anything.

Debt doesn't have to be a reality going forward. We have a choice but each administration makes the wrong one every time. Politics over country. FYI, those corporations are why most of us get to retire wealthier than we started our jobs. Taxing them to death won't really get the budget in line or help the economy. If anything it hurts the middle class' ability to retire with any real wealth. Teachers, Fireman, Police, Nurses, etc all rely on those "corporations" in our S and P 500 or Russel 1000 to make retirement possible.

Please don't misconstrue my statement to mean I am in favor of ultra-low corporate taxes. I just want our taxes to be in line with those of Ireland and other nations. We must remain competitive and not allow "socialism" to destroy the goose that lays the golden egg.
 
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BLADEMDA said:
It's not about the taxes or the services it is about the children. What kind of country will you be leaving for the youngest among us? 50 trillion in debt? 100 trillion? You do realize that these newborn children aren't going to get services when they need them if the U.S. dollar isn't worth anything.
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The future generation debt slavery thing is a myth, as well as any classic analogies trying to compare the strongest free floating currency /most powerful economy/most powerful military in the world with a family of 4 sitting down at the dinner table to balance a checkbook. I will start worrying when the inflationary environment everyone's been scaremongering about for 30 yrs actually arrives. Same goes for when other countries stop buying up our debt by the handful. Or when our credit rating actually goes down.

Debt doesn't have to be a reality going forward. We have a choice but each administration makes the wrong one every time. Politics over country. FYI, those corporations are why most of us get to retire wealthier than we started our jobs. Taxing them to death won't really get the budget in line or help the economy. If anything it hurts the middle class' ability to retire with any real wealth. Teachers, Fireman, Police, Nurses, etc all rely on those "corporations" in our S and P 500 or Russel 1000 to make retirement possible.

Please don't misconstrue my statement to mean I am in favor of ultra-low corporate taxes. I just want our taxes to be in line with those of Ireland and other nations. We must remain competitive and not allow "socialism" to destroy the goose that lays the golden egg.
Click to expand...

We have a large difference of opinion as to what constitutes a fair personal and corporate tax rate vs "taxing them to death." But I would say that we can still leave the corporate rate low and make up for it on the back end with higher cap gains and an expanded number of brackets on higher incomes.
 
GravelRider said:
No. Not sure of the role but they were looking for intensivists, hospitalists, internists, emergency docs, and anesthesia. Basically anyone.
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PM me if you don’t mind. Thanks
 
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vector2 said:
The future generation debt slavery thing is a myth, as well as any classic analogies trying to compare the strongest free floating currency /most powerful economy/most powerful military in the world with a family of 4 sitting down at the dinner table to balance a checkbook. I will start worrying when the inflationary environment everyone's been scaremongering about for 30 yrs actually arrives. Same goes for when other countries stop buying up our debt by the handful. Or when our credit rating actually goes down.



We have a large difference of opinion as to what constitutes a fair personal and corporate tax rate vs "taxing them to death." But I would say that we can still leave the corporate rate low and make up for it on the back end with higher cap gains and an expanded number of brackets on higher incomes.
Click to expand...
Dude, you sound like a guy invested in Madoff blowing off a warning because you've been killing it year after year with 15-25% returns. It's very very basic arithmetic. Your benchmarks of when to worry are way past the time to do something about it, like trying to get your money out of Madoff after he is arrested. It does blow me away this complete denial so many otherwise intelligent people have of the debt and inflated money.
 
anbuitachi said:
where to find these offers? im in ny at the moment and that sounds like a great deal..
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What's the update at your hospital? You intubated 7 in one shift not long ago. Getting worse at your hospital? Number of deaths per day increasing? Intubated ICU prognosis grim as I've been reading and hearing from colleagues? Plaquenil anecdotes? Thanks
 
We'llBeDoneIn15Minutes said:
What's the update at your hospital? You intubated 7 in one shift not long ago. Getting worse at your hospital? Number of deaths per day increasing? Intubated ICU prognosis grim as I've been reading and hearing from colleagues? Plaquenil anecdotes? Thanks
Click to expand...

not really, it has stabilized. i think because my hospital is now full, and other hospitals around me are getting caught up. they dont tell us the number of deaths in the hospital =\, and vented patients are slowly rolling into pacu. but now a lot of things are set up and in place, it feels less hectic than the beginning.

we dont have a overall mortality rate for intubated patients (at least no one told me), but i try to keep a log of patients i intubated if i remember/have time. only have a list of 16 and only TWO are alive (still tubed). so i would guess our mortality rate is in line with some of the numbers ive been hearing for intubated patients at other places. i dont think plaquenil changed anything but then again i only see the worst cases
 
anbuitachi said:
not really, it has stabilized. i think because my hospital is now full, and other hospitals around me are getting caught up. they dont tell us the number of deaths in the hospital =\, and vented patients are slowly rolling into pacu. but now a lot of things are set up and in place, it feels less hectic than the beginning.

we dont have a overall mortality rate for intubated patients (at least no one told me), but i try to keep a log of patients i intubated if i remember/have time. only have a list of 16 and only TWO are alive (still tubed). so i would guess our mortality rate is in line with some of the numbers ive been hearing for intubated patients at other places. i dont think plaquenil changed anything but then again i only see the worst cases
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Wow, only 2 alive out of 16. That's very very significant and in line with everything else I've heard and read. More ventilators will have very little effect on overall mortality. I've been talking with family and non medical friends to strongly consider DNI/DNR for elderly relatives with medical issues should they get to that point. Those are just grim numbers, and it's not like the 2 are out of the woods either. Do you know their ages? I would guess if they have any chance of doing well they aren't elderly with other medical issues.
 
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anbuitachi said:
not really, it has stabilized. i think because my hospital is now full, and other hospitals around me are getting caught up. they dont tell us the number of deaths in the hospital =\, and vented patients are slowly rolling into pacu. but now a lot of things are set up and in place, it feels less hectic than the beginning.
Click to expand...

Are you taking COVID patients in the PACU? Or just regular ICU players?
 
We'llBeDoneIn15Minutes said:
Wow, only 2 alive out of 16. That's very very significant and in line with everything else I've heard and read. More ventilators will have very little effect on overall mortality. I've been talking with family and non medical friends to strongly consider DNI/DNR. Those are just grim numbers, and it's not like the 2 are out of the woods either. Do you know their ages? I would guess if they have any chance of doing well they aren't elderly with other medical issues.
Click to expand...

yea definitely depressing. i think we are definitely trying to make more ppl dni/dnr. also things MAY be shifting from early intubation bc with a mortality that high.. thoughts are shifting to just place them on NIV.

im not sure if things can be improved since i do know some places are reporting better numbers, like 50% mortality. but i see pictures of these engineered 'vents' like with ambu , and vent splitting and stuff like that and my thought is if they cant even survive on a real vent with 1 patient, what are the chances with designed at home vents, and vent splitting? not going to help
 
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anbuitachi said:
yea definitely depressing. i think we are definitely trying to make more ppl dni/dnr. also things MAY be shifting from early intubation bc with a mortality that high.. thoughts are shifting to just place them on NIV.

im not sure if things can be improved since i do know some places are reporting better numbers, like 50% mortality. but i see pictures of these engineered 'vents' like with ambu , and vent splitting and stuff like that and my thought is if they cant even survive on a real vent with 1 patient, what are the chances with designed at home vents, and vent splitting? not going to help
Click to expand...

We're seeing about ~70%ish mortality once intubated. MICU here has discussed with ethics and pretty much anyone in multisystem organ failure is going to get full medical resuscitation and cardioversion/defib but no chest compressions.
 
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vector2 said:
We're seeing about ~70%ish mortality once intubated. MICU here has discussed with ethics and pretty much anyone in multisystem organ failure is going to get full medical resuscitation and cardioversion/defib but no chest compressions.
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Beyond multiple organ failure, we should all quietly realize that many of us suck at managing ARDS (beyond it being a hell of a disease), so many patients are doomed when intubated.

Early intubation kills patients. This reminds me of those who unnecessarily intubate DKA.
 
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FFP said:
Beyond multiple organ failure, we should all quietly realize that many of us suck at managing ARDS (beyond it being a hell of a disease), so many patients are doomed when intubated.

Early intubation kills patients. This reminds me of those who unnecessarily intubate DKA.
Click to expand...

Many of these intubated pts are on reasonable FIO2 (like 40-50%) but are requiring high PEEP 12-18. If negative pressure rooms, extreme PPE, and the machines were also unlimited, I think a large percentage could probably ride on Bipap/Cpap

emcrit.org

PulmCrit Wee- Could the best mode of noninvasive support for COVID-19 be… CPAP ??

The bleeding edge series examines the most controversial concepts - Caveat Emptor! COVID-19 patients seem to behave in a somewhat unique fashion, compared
emcrit.org emcrit.org
 
GravelRider said:
Yeah, that’s around what I’m hearing now. $3000 for 8 hour shift.
Click to expand...

How the hell does that even make sense. How are trhey offering that to people while in the same breath taking cutting salaries of docs currently working there, withholding 401K contributions, and suspending bonuses. What the hell?
 
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vector2 said:
Many of these intubated pts are on reasonable FIO2 (like 40-50%) but are requiring high PEEP 12-18. If negative pressure rooms, extreme PPE, and the machines were also unlimited, I think a large percentage could probably ride on Bipap/Cpap

emcrit.org

PulmCrit Wee- Could the best mode of noninvasive support for COVID-19 be… CPAP ??

The bleeding edge series examines the most controversial concepts - Caveat Emptor! COVID-19 patients seem to behave in a somewhat unique fashion, compared
emcrit.org emcrit.org
Click to expand...
I was referring more to the kind of intubation somebody described recently, where the patient was talking on the phone.
 
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