The ultimate COVID thread

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the same strategies to flatten the curve, if implemented early and aggressively also introduce the possibility of eliminating the virus from the population. It's too early to tell if that is possible long term but it's promising. The best example of that so far is NZ (well done Kiwis), parts of Australia are getting there too

yes that would have been nice. Unfortunately would not have been politically feasible at the time we would have needed to do it. The "problem" for the US is the staggering amount of distant travel both within the country and arriving from overseas that we see on a daily basis. We would have had to lock down the entire country including international travel in late January.
 
yes that would have been nice. Unfortunately would not have been politically feasible at the time we would have needed to do it. The "problem" for the US is the staggering amount of distant travel both within the country and arriving from overseas that we see on a daily basis. We would have had to lock down the entire country including international travel in late January.

yes - that's what NZ did, and shortly after that's what Australia did - but it was late Feb I think.

International and interstate arrivals - initially we had mandatory 14 day self isolation at home, that got upgraded to isolation at a hotel of the government's choosing. Airlines cancelled flights anyway after a while as they became uneconomic.

we have given up some liberties (temporarily) for sure, I've been stunned actually how accomodating the public has been.
There have been a few people complaining in the media, but it gets VERY little traction.
 
Exactly. I don't recall hearing that Swedish hospitals were overwhelmed.

The problem with waiting for vaccine/treatment is that it takes a huge amount of time. We can't stay shutdown for another 12-18 months.

The point I was making is that flattening the curve doesn't change the mortality from the disease unless the hospitals are overwhelmed.
He’ll yeah. Let’s reopen. Job security for me! Hahah
But on a serious note, we can’t stay shut down for that long. People are going nuts at home. Including me. And I am going to Covid hospitals cuz I am going crazy at home.
 
From this logic each governor should be well within their right to decide for their state what their policy will be. Not Trump, and not the NYC media.

That is the actual situation. It’s up to the governors. They deserve the credit or blame for their actions. We have zero federal leadership.
 
yes that would have been nice. Unfortunately would not have been politically feasible at the time we would have needed to do it. The "problem" for the US is the staggering amount of distant travel both within the country and arriving from overseas that we see on a daily basis. We would have had to lock down the entire country including international travel in late January.

Maybe sooner. The new patient zero died of COVID on February 6, and she acquired the disease by community spread.
 
He’ll yeah. Let’s reopen. Job security for me! Hahah
But on a serious note, we can’t stay shut down for that long. People are going nuts at home. Including me. And I am going to Covid hospitals cuz I am going crazy at home.


This is the first extended break I’ve had in many years. And I’m enjoying not doing much and putzing around the house most days. It feels reminiscent if summer vacation while I was still in school.
 
This is the first extended break I’ve had in many years. And I’m enjoying not doing much and putzing around the house most days. It feels reminiscent if summer vacation while I was still in school.
I am soo bored. I do full time locums and am off about one week every four to five weeks. This right here is too much!
 
yes - that's what NZ did, and shortly after that's what Australia did - but it was late Feb I think.

International and interstate arrivals - initially we had mandatory 14 day self isolation at home, that got upgraded to isolation at a hotel of the government's choosing. Airlines cancelled flights anyway after a while as they became uneconomic.

we have given up some liberties (temporarily) for sure, I've been stunned actually how accomodating the public has been.
There have been a few people complaining in the media, but it gets VERY little traction.



Ardern took the threat seriously and made a point of hitting it hard and fast. She probably saved her economy by doing so. Our leaders could have done the same instead of telling us it would miraculously disappear.
 
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Exactly. I don't recall hearing that Swedish hospitals were overwhelmed.

The problem with waiting for vaccine/treatment is that it takes a huge amount of time. We can't stay shutdown for another 12-18 months.

The point I was making is that flattening the curve doesn't change the mortality from the disease unless the hospitals are overwhelmed.

NYC hospitals did get overwhelmed, very overwhelmed. Without lockdown it wouldve been much much worse. Even now they are estimating 20% of population in nyc infected.

He’ll yeah. Let’s reopen. Job security for me! Hahah
But on a serious note, we can’t stay shut down for that long. People are going nuts at home. Including me. And I am going to Covid hospitals cuz I am going crazy at home.

I know everyone is different but i think its pretty crazy how so many people are going insane at home... its not stone ages anymore. there are so many things to do at home... ( and i live in a pretty crappy place)
 
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NYC hospitals did get overwhelmed, very overwhelmed. Without lockdown it wouldve been much much worse. Even now they are estimating 20% of population in nyc infected.



I know everyone is different but i think its pretty crazy how so many people are going insane at home... its not stone ages anymore. there are so many things to do at home... ( and i live in a pretty crappy place)
Like what? You can only play on the computer and watch TV for so long.
 
I am soo bored. I do full time locums and am off about one week every four to five weeks. This right here is too much!
I am enjoying time home. Before I spent little time with my son and he was not even close to me. Now I am his
favorite. 🙂

In addition, I am trying to be a budding chef.

Make me think to get a day job post-covid.
 
Exactly. I don't recall hearing that Swedish hospitals were overwhelmed.

The problem with waiting for vaccine/treatment is that it takes a huge amount of time. We can't stay shutdown for another 12-18 months.

The point I was making is that flattening the curve doesn't change the mortality from the disease unless the hospitals are overwhelmed.
Doesn’t the AUC represent the number of infected, not number of deaths?

Flattening the curve does lower mortality. Otherwise there’s no point of preventing overwhelming the healthcare system.
 
I thought the whole point of shutting everything down was to make sure the hospitals didn't get overwhelmed. Flattening the curve doesn't change the area under the curve.
If we didn't flatten the curve, there would be patients dying from simple stuff, such as not enough oxygen, or CPAP, or not even making it to the hospital, people who could otherwise survive. The system would be completely overwhelmed, to the level that healthcare workers would get sick and/or quit in droves, which would make things even more complicated, and we would run out of basic things and medications, not just PPE.

Let's not mention the non-Covid patients who would die unnecessarily because of the overrun hospitals.

It's the difference between riding river rapids and riding a tsunami.

Not to mention that anything that buys time can save a lot of Covid patient-lives. Every week we learn something new about this virus. So flattening the curve decreases the AUC.
 
Let's not mention the non-Covid patients who would die unnecessarily because of the overrun hospitals.

Sadly this is happening now in my (lightly impacted) community because patients are afraid to come to the hospital and being exposed to COVID. Multiple reports of people dying at home with STEMI’s and strokes😢


Every week we learn something new about this virus.

Yes, like how none of the prospective therapies actually work.
 
Yes, like how none of the prospective therapies actually work.
We used to intubate everybody who needed NIV and they would basically just die. Think about all the people we don't intubate anymore, and put on CPAP instead, so many more survive.

Little things like this can make a lot of difference in ICU mortality.
 
Nope, Bought in like 40% of my portfolio on march 28-april 2nd and sold on april 13th. Still sitting in all cash 🙂

the S&P went from 2626 on March 30 to 2761 on April 13th. And you probably pay what, 37% tax on any of that amount you made as profit? Seems like a mostly pointless exercise for such a small gain.
 
Doesn’t the AUC represent the number of infected, not number of deaths?

Flattening the curve does lower mortality. Otherwise there’s no point of preventing overwhelming the healthcare system.
Depends which curve you use, although the infected curve can mimic the death curve.
 
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If we didn't flatten the curve, there would be patients dying from simple stuff, such as not enough oxygen, or CPAP, or not even making it to the hospital, people who could otherwise survive. The system would be completely overwhelmed, to the level that healthcare workers would get sick and/or quit in droves, which would make things even more complicated, and we would run out of basic things and medications, not just PPE.

Let's not mention the non-Covid patients who would die unnecessarily because of the overrun hospitals.

It's the difference between riding river rapids and riding a tsunami.

Not to mention that anything that buys time can save a lot of Covid patient-lives. Every week we learn something new about this virus. So flattening the curve decreases the AUC.
To the part about not overwhelming the system: duh. I've said that part multiple times.

As to the learning new stuff, I wonder if that's actually changed the mortality significantly. That's an honest question since I'm not on the front lines of this and am genuinely curious.
 
Think about all the people we don't intubate anymore, and put on CPAP instead, so many more survive.

Can you actually convince me of that?
Even if it’s just your own anecdotes.

Have you been taking care of a lot of COVIDs in your unit? (honest question - no snark intended).
 
I am enjoying time home. Before I spent little time with my son and he was not even close to me. Now I am his
favorite. 🙂

In addition, I am trying to be a budding chef.

Make me think to get a day job post-covid.
That’s awesome for you. Being a good available parent can be overlooked sometimes.
Guess I can get out of quarantine now that my third test is negative but I don’t trust those things.
And I have no kids who will bug me and take my time.
 
Can you actually convince me of that?
Even if it’s just your own anecdotes.

Have you been taking care of a lot of COVIDs in your unit? (honest question - no snark intended).
I don't take care of Covid (and I've been out of ICU for a good while), but I know that there is already an American CPAP helmet trial going on in some places. I expect to see way more CPAP helmets as months pass.

And the fact that postponing intubation saves lives is beyond anecdote by now.

Here are some anecdotes:

When all is said as done we will talk about how we killed Covid patients with early mechanical ventilation.

I'm also curious what our Covid-experienced colleagues have to say.
 
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the S&P went from 2626 on March 30 to 2761 on April 13th. And you probably pay what, 37% tax on any of that amount you made as profit? Seems like a mostly pointless exercise for such a small gain.

Sorry i mis remembered the dates, I started buying in at around 2300ish. Then sold when everything went to 2800. All of it is in my Roth IRA so it's not taxed. Also I didn't sell to make a small profit, I sold because i don't believe the market should be going up. I am waiting for the downturn again before I buy in.
 
I don't take care of Covid (and I've been out of ICU for a good while), but I know that there is already an American CPAP helmet trial going on in some places. I expect to see way more CPAP helmets as months pass.

And the fact that postponing intubation saves lives is beyond anecdote by now.

Here are some anecdotes:

When all is said as done we will talk about how we killed Covid patients with early mechanical ventilation.

I'm also curious what our Covid-experienced colleagues have to say.

would you CPAP pts without having negative pressure rooms?

at what point would YOU intubate?
 
Sorry i mis remembered the dates, I started buying in at around 2300ish. Then sold when everything went to 2800. All of it is in my Roth IRA so it's not taxed. Also I didn't sell to make a small profit, I sold because i don't believe the market should be going up. I am waiting for the downturn again before I buy in.

u can retire now
 
u can retire now

Can't tell if you're being for real. If you scroll back and see that my investment horizon is very long and this money that i'm messing with is essentially meaningless.

I do'nt believe I can time the market. But this is the wrong time to buy.
 
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Can you actually convince me of that?
Even if it’s just your own anecdotes.

Have you been taking care of a lot of COVIDs in your unit? (honest question - no snark intended).
Some studies and meta-analyses here showing avoidance of intubation in respiratory failure patients using NIPPV leads to decreased mortality in the ICU, among other benefits.

This one from the SARS outbreak which showed NIPPV and intubation avoidance led to lower ICU morbidity and mortality.

A twitter thread here about helmet NIPPV from someone who's trialing it at their shop:
 
Sorry i mis remembered the dates, I started buying in at around 2300ish. Then sold when everything went to 2800. All of it is in my Roth IRA so it's not taxed. Also I didn't sell to make a small profit, I sold because i don't believe the market should be going up. I am waiting for the downturn again before I buy in.

Market Timing is almost impossible. So, you should start buying back in when the market pulls back to 2700. We may not see an S and P 500 of 2600 if things go well over the summer. Typically, you look "smart" right now but if you don't get back in then you will look stupid when the S and P hits 3100 in December and even dumber next year if it hits 3400.

I certainly agree with selling some equities at 2800 or 2950 to raise cash for pullbacks but I wouldn't sell everything because market timing is rarely successful 2 times over 3 months. I bought a lot of equities at 2500 which at the time seemed foolish but today looks pretty good.

I have a lot of cash to invest but not at these prices because earnings are uncertain or non existent for the second quarter. I'd rather miss the next run up than invest here at these prices. But, I'm prepared to miss the move entirely as my allocation to equities is already extended from my norm.
 
would you CPAP pts without having negative pressure rooms?

at what point would YOU intubate?
This was the problem I had when I was up north. No one wanted to CPAP. But they did high flow.
There were a few delayed intubations. Eventually they bought the tube.
 
would you CPAP pts without having negative pressure rooms?

at what point would YOU intubate?
With helmets, absolutely. Without, I think it's a matter of getting the proper seal.

I would intubate when the patient fails NIV, based on the patient's assessment, not on numbers. Even then, there are anecdotes about patients who were put on morphine for respiratory comfort, and still survived without intubation.

You have more experience with Covid than me, so you're asking the wrong person. 🙂

There is one thing about Covid that's definitely good for the future of critical care: it punishes disgusting knee-jerk medicine with a vengeance. This disease is about treating the patient's personal physiology like nothing else.

Regarding CPAP, some people are even considering whether the upper airway edema may be contributing to a special form of OSA in these patients, hence the success of CPAP.
 
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I don't take care of Covid (and I've been out of ICU for agood while
What?
You've been beating your own horn here about how great an Intensivist you are, but you don't do icu? Or take care of covids?


And why is an American CPAP helmet trial of any interest? We've been using them literally for over a decade in Europe and you got them what, 4 weeks ago? I would imagine the quality of research/care from the first few weeks of any new modality would be basically useless
 
From @Ezekiel2517's link, an easier to read version:

 
Senate Majority Leader Mitch McConnell (R-Ky.) warned Wednesday of a potential “second pandemic” — of lawsuits — if his idea of shielding businesses from liability is not included in the next round of legislation crafted by Congress in response to the coronavirus outbreak.

McConnell’s loaded description came during a radio interview as he and House Speaker Nancy Pelosi (D-Calif.) continued to jockey over the scope of the legislation. Democrats are insisting that it include hundreds of billions of dollars in additional aid to states and localities to make up for lost tax revenue during the pandemic.

“Well look, there’s no question at all governors regardless of party would like to have more money, and I’m open to discussing that,” McConnell said on Fox News Radio’s “The Brian Kilmeade Show.” “But what [Pelosi is] ignoring is the second pandemic, which is going to be lawsuits against doctors, nurses, hospitals and brave business people.”

McDonnell suggested this week that any legislation that provides state and local aid should also include some sort of “liability shield” that would prevent businesses from being sued by customers and perhaps employees who contract the coronavirus, an idea that has been under consideration at the White House.

“I mean this is the best way to protect the brave people who have been taking care of covid-19 patients, and it will take a good deal of bravery to open up their business,” McConnell said.

“If there’s a lawyer out on the sidewalk looking at every move you make as to whether you somehow have been irresponsible in this phase one and two that we move into as we reopen America, that’s not the way to get the country going again.”

Pelosi and Senate Minority Leader Charles E. Schumer (D-N.Y.) have both spoken out against liability changes, suggesting that employees of businesses that are reopening deserve more protections, not fewer.

On Tuesday, Schumer accused McConnell of “subterfuge” for pushing a measure that could derail assistance to cash-strapped states and localities.
 
“We’ll revisit the 2,200 S&P low, if not make a lower low — probably by late summer,” he said. “That’s going to come because we’re going to find out now is a critical time for the market.”

Bianco predicts there will be an overwhelming realization that life isn’t getting back to normal when then economy starts to reopen.




“What the market seems to be thinking is we’re going to restart, and we’re all going to pretend that it’s 2019,” said Bianco. “And, we’re all going to stand on the subway platform with 500 other people waiting for the next train.”

He contends a recovery will still be long and slow — despite the Federal Reserve’s aggressive policies to support the economy and financial system.

“We are moving to a lower growth environment, and I think the market is a little ahead of itself right now in what that means,” Bianco said. “There’s going to be more changes and more evolution that the economy is going to have to go through before we’re ready to start a full on bull market.”
 
“We’ll revisit the 2,200 S&P low, if not make a lower low — probably by late summer,” he said. “That’s going to come because we’re going to find out now is a critical time for the market.”

Bianco predicts there will be an overwhelming realization that life isn’t getting back to normal when then economy starts to reopen.




“What the market seems to be thinking is we’re going to restart, and we’re all going to pretend that it’s 2019,” said Bianco. “And, we’re all going to stand on the subway platform with 500 other people waiting for the next train.”

He contends a recovery will still be long and slow — despite the Federal Reserve’s aggressive policies to support the economy and financial system.

“We are moving to a lower growth environment, and I think the market is a little ahead of itself right now in what that means,” Bianco said. “There’s going to be more changes and more evolution that the economy is going to have to go through before we’re ready to start a full on bull market.”


I don't know about a massive retrace of the lows. I do think the stock market seems a bit heated right now. Valuations are stretched. We should pull back over the summer. I think news from Regeneron will keep the market stable and Moderna is making progress on a vaccine.

Pfizer could have its vaccine ready for use on a million people by late fall if an outbreak were to occur. There is so much uncertainty about Covid 19 and a second wave vs new drugs or a vaccine by January 2021.

I do know that market pullbacks to below 2600 should be bought not sold. If you need to raise some cash now is a good time to do so. By all means "stay the course" for most of your investments but 10-15% of you allocation in cash seems prudent right now. This way you can deploy that cash at lower prices in a few months.


 
This is a serious question, not trying to be snarky. Can anyone elaborate on what happened to the other Corona virus SARS? We did nothing to flatten the curve or clean out all of the TP from Costco when it emerged.. But seriously, is it gone? Is it an epidemic elsewhere or re emerge in the fall of 2009? We didnt seem to worry about it for 10 yrs. I'm not sure we will see a big re emergence this fall despite what the frequently wrong experts tell us. Remember, Fauci, is head of Allergy and Infectious Disease, sponsoring Remdisivir studies. A little help here please.
 
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This is a serious question, not trying to be snarky. Can anyone elaborate on what happened to the other Corona virus SARS? We did nothing to flatten the curve or clean out all of the TP from Costco when it emerged.. But seriously, is it gone? Is it an epidemic elsewhere or re emerge in the fall of 2009? We didnt seem to worry about it for 10 yrs. I'm not sure we will see a big re emergence this fall despite what the frequently wrong experts tell us. Remember, Fauci, is head of Allergy and Infectious Disease, sponsoring Remdisivir studies. A little help here please.



Just my guess but it had a much higher case fatality rate (around 10%) and caused severe illness in almost everyone who was infected. That probably made it easier to trace and isolate.
 
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Just my guess but it had a much higher case fatality rate (around 10%) and cause severe illness in almost everyone who was infected. That probably made it easier to trace and isolate.
I dont disagree, but I dont remember any super sleuthing in America, school closures, or available testing for SARS. It was here, then it was gone. Nothing like we see going on today. Thanks for your thoughts!
 
I dont disagree, but I dont remember any super sleuthing in America, school closures, or available testing for SARS. It was here, then it was gone. Nothing like we see going on today. Thanks for your thoughts!

I’m not sure it ever reached the USA. I remember Toronto had a bad outbreak. I was working with a surgeon who’s sister lived in Hong Kong at the time. I remember him saying how his sister did not go out and also asked her housekeeper not to come.
 
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Yes, only 8 documented cases in the US, but there must have been more. I dont remember a 2nd wave of infections worldwide. CDC initially closed some schools for a few days, then re opened them. No significant outbreaks since as far as I know. I'm thinking we might not see a 2nd outbreak of Covid this fall. But it's just my guess. We'll just have to wait.
 
I’m not sure it ever reached the USA. I remember Toronto had a bad outbreak. I was working with a surgeon who’s sister lived in Hong Kong at the time. I remember him saying how his sister did not go out and also asked her housekeeper not to come.
I think SARS-1 was not as contagious, or contagious only after symptoms (fever) had developed. Every airport screened passenger's temp and picked out the suspects.
 
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Sorry i mis remembered the dates, I started buying in at around 2300ish. Then sold when everything went to 2800. All of it is in my Roth IRA so it's not taxed. Also I didn't sell to make a small profit, I sold because i don't believe the market should be going up. I am waiting for the downturn again before I buy in.

market timing tends to work out well, especially when remembered after the timing took place.

But seriously, a Roth IRA should never be in all cash. Ever.
 
Yes, only 8 documented cases in the US, but there must have been more. I dont remember a 2nd wave of infections worldwide. CDC initially closed some schools for a few days, then re opened them. No significant outbreaks since as far as I know. I'm thinking we might not see a 2nd outbreak of Covid this fall. But it's just my guess. We'll just have to wait.

You said it yourself. SARS had a few cases in the USA then went away. SARS-2 at one point also had a few cases and then instead of going away, it climbed to over 1 million and is still going strong. It's pretty obvious that using SARS as a predictor of the future behavior of SARS-2 is rather illogical given their paths have diverged many tens of thousands of deaths ago.
 
I hope these are the header pictures in future US history textbook chapters about COVID-19. Sums up our federal response and attitude pretty well

UWhBQ5S.jpg



DA5WkKX.jpg
 
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I hope these are the header pictures in future US history textbooks about COVID-19. Sums up our federal response and attitude pretty well

UWhBQ5S.jpg


Oh come on, there’s a valid and completely understandable reason VP Pence didn’t mask. He stated he wanted to be able to look the workers in the eye and thank them.

I guess the vice presidential retinas are in his oral cavity.
 
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