What do I need to know about coronavirus?

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Well, for those of us who have tried to educate themselves even a little bit, 3-18 months depending on many factors.

How do you not get that the main issue with this pandemic is that hospitals, including your hospital, are going to be utterly, utterly overwhelmed. Like at the minimum, 200% over capacity.

www.covidactnow.org

For most areas, the peak may still be a month away. Just because you don't see it now doesn't mean it isn't coming.

I admire the docs in your group who are at least trying to prepare.

Well, so far our volume is way down. The only thing overwhelming our ED currently are N95/surgical mask and TP thieves. Sure, I'm seeing plenty of pt's that probably have COVID and unfortunately don't qualify for testing (at the moment). I've only had to admit one of them so far and that was due to social issues as he couldn't self quarantine. The vast majority of them I'm sending home with self quarantine instructions and viral precautions.
 
Well, so far our volume is way down. The only thing overwhelming our ED currently are N95/surgical mask and TP thieves. Sure, I'm seeing plenty of pt's that probably have COVID and unfortunately don't qualify for testing (at the moment). I've only had to admit one of them so far and that was due to social issues as he couldn't self quarantine. The vast majority of them I'm sending home with self quarantine instructions and viral precautions.
Most locales in the US are only at the beginning. Why do you think your community is immune to exponential growth?
 
Not for long. Like I said very early in this thread people are going to swing from panic to apathy, like they always do. I give it another 2 weeks until good old fashion American apathy sets in. The speed at which COVID apathy sets in will = boredom x brokeness.
Well, so far our volume is way down. The only thing overwhelming our ED currently are N95/surgical mask and TP thieves. Sure, I'm seeing plenty of pt's that probably have COVID and unfortunately don't qualify for testing (at the moment). I've only had to admit one of them so far and that was due to social issues as he couldn't self quarantine. The vast majority of them I'm sending home with self quarantine instructions and viral precautions.
Most locales in the US are only at the beginning. Why do you think your community is immune to exponential growth?

The Surgeon General and, more importantly, the data suggest that things are going to get worse. Now is the time to buckle down, not loosen up.
 
For some perspective, we're 2 months in and 99.99% of Americans have not died from this thing (471 deaths out of 331 million). If the problem gets 100 times worse (47,100 out of 331,000,000), 99.98% of Americans will not have died from this.
In your educated mind, how long will it take to get to 100x worse, given a 30% daily increase? 🙂

Answer: 19 days to 112x, 30 days to 2000x.
 
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So fine, let's keep doing what we're doing. But here's a proposal to put to everyone. If another two weeks goes by and April 6 rolls around, and we're still not at even 0.1% of the deaths predicted, can we agree that maybe, just maybe, it's time to ease up a bit...

www.covidactnow.org

Click your state. Let us know results.
 
Like everything else in our society, the answer to when the quarantine will end is not dependent on data. It’s dependent on the emotional experience of the American public.

if enough people die to frighten people, or if nyc turns into a post-apocalyptic hellscape where the elderly are left to die, the quarantine will probably continue. The emotional oxygen will continue to stoke the fire.

If that doesn’t happen soon, apathy will set in and many of the dire predictions will probably take place. Our supreme leader will declare victory either way.


So it goes.
 
Most locales in the US are only at the beginning. Why do you think your community is immune to exponential growth?
All viruses follow exponential growth for only a short time, then convert to logistic growth.
 
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In your educated mind, how long will it take to get to 100x worse, given a 30% daily increase? 🙂

Answer: 19 days to 112x, 30 days to 2000x.
Viruses don't grow exponentially, forever in a vacuum.
 
The peak is 2-3 months away, best case scenario.
Two weeks ago: "We're Italy in two weeks."

Look at China.
Why didn't China's cased increase exponentially forever? Perhaps, because there was a societal response, which worked? Perhaps because the more people got the virus, the more got immune, reducing the rate of transmission and slowing "exponential thread" from "going to infinity" and killing everyone, like always happens with viruses?
 
It's not forever, it's just until they mutate or use up the available population (either by death or immunity). Either of those takes much longer than a few months. Heck, H1N1 flu took like 2 years a century ago.
H1N1 is the most common strain going around right now. How come you not telling me that's going to grow exponentially, and given enough time kill everyone not vaccinated?
 
H1N1 is the most common strain going around right now. How come you not telling me that's going to grow exponentially, and given enough time kill everyone not vaccinated?
Because I have a basic understanding of immunity/infectious diseases/epidemiology and I am not dumb?

But, yes, it could always mutate and kill everybody. The fact that is has never happened before doesn't mean it couldn't (black swan).
 
You're onto something.
Yes. There's always "a response." There's always "some response" whether its a population developing individual and herd immunity, whether it's a single person, single family, feeling sick and staying home, a population social isolating or a military style lock down. Viruses never spread unimpeded like a one-line second-grade story problem.
 
Nothing predicts the future like telling someone to click on a website that says, "This model does not predict the future." So sciencey.
Actually, that's VERY "sciencey".

Scientists expect NOTHING to be true forever. It's true only until proven wrong. Everything is a best guess, even the fact that you and I exist.

Sooner or later, most things end up being proven wrong (or much more complex than we used to think). That's the beauty of science.
 
The anti-science denialism in this thread is crazy.

This. is. not. the. flu.
Taking things seriously is NOT the same as panicking.

We are emergency doctors. Get your heads out of the sand.
We all know this is not the flu. We are all taking this seriously. Being skeptical and question assumptions is exactly the definition of science. Blindly accepting assumptions, like "2.2 million Americans will die" without demanding proof, is the opposite of science. Putting a bunch of periods after every word, also isn't science.
 
We all know this is not the flu. We are all taking this seriously. Being skeptical and question assumptions is exactly the definition of science. Blindly accepting assumptions, like "2.2 million Americans will die" without demanding proof, is the opposite of science. Putting a bunch of periods after every word, also isn't science.
There is a difference between blind acceptance and understanding probabilities. Science is not faith, it's not binary. And it's fluid.

Our current epidemiologic models and data suggest that there is a high probability that at least 1% of infected Americans will die, should we do nothing and let the disease take its natural course. They may be wrong, too (e.g. the virus could mutate into a milder strain), but it's less likely FOR NOW.
 
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There is a high probability that at least 1% of Americans will die
Fmr. Obama CDC director Tom Frieden's prediction of 1.6 million Americans dying wasn't enough for you. Then the Royal Academy in U.K. predicted 2.2 million Americans dying wasn't enough for you. And since you're "not stupid" as you say and you don't question experts with a skeptical like me, you've decided to question them and predict 3.3 millions will die from COVID-19.

should we do nothing and let the disease take its natural course.
Ok, now I'm just wasting my time because you're not even reading the thread and you haven't even take the time to read about all the things I'vs said we should do and agreed that we are doing.
 
Ok, now I'm just wasting my time because you're not even reading the thread and you haven't even take the time to read about all the things I'vs said we should do and agreed that we are doing.
We are both wasting our time. 🙂

I will also "prophesize" something else: this will all end better than the worst case scenarios, for one reason or another, and much fewer people will die than we are afraid of. Then all the ignorants will use it as "proof" that the scientists were wrong, instead of proof that the former don't understand probabilities, or how fluid an epidemic can be (viruses can mutate).

It's like when I tell the surgeon that there is a chance the patient may be harmed if we proceed with surgery, and then he tells me "you were wrong" when the patient survives the surgery intact (due to his luck and my "genius"). Of course surgeons are never cocky when my 10% probability occasionally wins the Russian roulette (i.e the patient loses because of us, which should be a never event).

The definition of a simpleton in my book is a person who does not understand probabilistic thinking, not that it applies to you.
 
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You're being disingenuous. The site was created by population health experts and is being endorsed by numerous state and local governments around the country.
Quoting directly from the website you referred me to is disingenuous? It says right on the front page, it does "not predict the future."

CaptureCovid.PNG
 
If you go through and read this thread, I've linked countless peer reviewed scientific articles on this subject, to support my statements. Yet not one person has clicked on a single link and reference those scientific articles in their attempts to counter my arguments. That would be scientific. But it's so much easier to just say, "You're anti-science," or "I'm right because 'I'm not dumb'" because that makes one feel right and brings social approval, with zero effort.
 
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If you go through and read this thread, I've link countless peer reviewed scientific articles on this subject, to support my statements. Yet not one person has clicked on a single link and reference those scientific articles in their attempts to counter my arguments. That would be scientific. But it's so much easier to just say, "You're anti-science," or "I'm right because 'I'm not dumb'" because that gets you social approval, with no effort.
Don't forget that the holy books are also "peer-reviewed". Just sayin'...

P.S.
I am not trying to teach you :=|:-): , but these threads are read by MANY more (lay)people than those who post in them.

And you were right about my mistake: I should have said 1% of infected Americans may die, which is estimated to end up being 40-70% of the population.

Tons of respect for the best in your specialty, by the way (I have been educated by some great EM blogs and intensivists). Now I am going to run back to my usual sections, before I overstay my welcome. 🙂
 
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The anti-science denialism in this thread is crazy.

This. is. not. the. flu.
Taking things seriously is NOT the same as panicking.

We are emergency doctors. Get your heads out of the sand.

It's not even science denialism, it's ignorance of grade school level math! I'm legitimately astounded that people who made it all the way through medical school seem to have zero appreciation of exponential growth. How is this even possible...smh
 
It's not even science denialism, it's ignorance of grade school level math! I'm legitimately astounded that people who made it all the way through medical school seem to have zero appreciation of exponential growth. How is this even possible...smh
Y'all are over here, typin' away like a caffeinated Jonas Salk in huff, exasperated at our lack of "exponential growth" knowledge, and you have't even looked at the second half of the curve.
 
It's not even science denialism, it's ignorance of grade school level math! I'm legitimately astounded that people who made it all the way through medical school seem to have zero appreciation of exponential growth. How is this even possible...smh
Viruses Follow Logistic Growth, Not Exponential Growth, And That Difference Is Everything

Viral growth is a population is not "exponential" no matter how many periods someone types after each word, how "pro-science" they proudly say they are or how many self proclaimed "experts" say it on CNN. Viral growth in a population follows logistic growth, not exponential growth. The two are completely different and the difference is everything. Exponential growth accelerates forever. Logistic growth accelerates, then levels off. There's a carrying capacity of a virus in a population. This is why viruses with higher fatality rates than COVID-19 that are more contagious than COVID-19, haven't accelerated "exponentially" and killed us all. Because no matter how many times you say everyone else is dumb, "anti-science," and failed grade school math with "zero appreciation for exponential growth," viruses will still not follow a pattern of exponential growth. Because they don't and never did. Not COVID-19, not Ebola and not the flu. They follow logistic growth, and eventually level off. This why the grade school level predictions of the future, where you plug and play with viral stats, and predict 1.6, 2.2 or 3 million Americans will die, don't work. And this is why your "predict the future of the virus" websites say right on the front page, they "don't predict the future."


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@Angry Birds @FFP @Money-Moniker @bougiecric
 
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Viral growth is a population is not "exponential" no matter how many periods you type after each word, how "pro-science" you proudly say you are on the internet or how many self proclaimed "experts" say it on CNN. Viral growth in a population follows logistic growth. The two are completely different. Exponential growth accelerates forever. Logistic growth accelerates, then levels off. There's a carrying capacity of a virus in a population. This is why viruses with higher fatality rates than COVID-19 that are more contagious than COVID-19, haven't accelerated "exponentially" and killed us all. Because no matter how many times you say everyone else is dumb, "anti-science," and failed grade school math despite graduating medical school with "zero appreciation for exponential growth," viruses will still not follow a pattern of exponential growth. Because they don't and never did. Not COVID-19, not Ebola and not the flu. They follow logistic growth, and eventually level off. This why the grade school level predictions of the future, where you plug and play with viral stats, and predict 1.6, 2.2 or 3 million Americans will die, don't work. And this is why your "predict the future of the virus" websites say right on the front page, the "don't predict the future."


But you understand that the carrying capacity is different for each virus, and is based on how infectious each virus is? There are viruses that are sufficiently infectious that the carrying capacity is, basically, 100% of the population. That's why there are so many more measles outbreaks than mumps outbreaks when antivaxxers refuse the MMR vaccine. Measles is so infectious that herd immunity requires more than 90% of the population to be immune, while mumps is mostly prevented with a much lower uptake of the vaccine. Back before the vaccine getting measles was an almost universal experience while some people got through childhood without getting mumps.

Unfortunately everything we have heard up until now is that coronavirus is several times as infectious as flu, and flu sickens 10-40 million people each year in this country despite nearly 50% of the population being vaccinated with a somewhat effective quadrivalent vaccine. When the worlds various health authorities are saying that this virus really could infect the majority of us they're not unaware of the concept of carrying capacity, they've modeled the infection and determined what they think the carrying capacity likely to be.

You can hold out hope that this is less dangerous that it looks. Right now our data on asymptomatic disease prevalence is based on PCR nasal swabs, so maybe there is a significant percentage of the population catching this but who never shed? Maybe you think that this is much less infectious than the public health experts think for some reason? We can hope, but there is no great reason to think that this couldn't infect at least a majority of Americans before it is over
 
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Viruses Follow Logistic Growth, Not Exponential Growth, And That Difference Is Everything

Viral growth is a population is not "exponential" no matter how many periods someone types after each word, how "pro-science" they proudly say they are or how many self proclaimed "experts" say it on CNN. Viral growth in a population follows logistic growth, not exponential growth. The two are completely different and the difference is everything. Exponential growth accelerates forever. Logistic growth accelerates, then levels off. There's a carrying capacity of a virus in a population. This is why viruses with higher fatality rates than COVID-19 that are more contagious than COVID-19, haven't accelerated "exponentially" and killed us all. Because no matter how many times you say everyone else is dumb, "anti-science," and failed grade school math with "zero appreciation for exponential growth," viruses will still not follow a pattern of exponential growth. Because they don't and never did. Not COVID-19, not Ebola and not the flu. They follow logistic growth, and eventually level off. This why the grade school level predictions of the future, where you plug and play with viral stats, and predict 1.6, 2.2 or 3 million Americans will die, don't work. And this is why your "predict the future of the virus" websites say right on the front page, they "don't predict the future."


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@Angry Birds @FFP @Money-Moniker @bougiecric


What's the carrying capacity of this very infectious virus? Could it be 40-70% of americans?
 
But you understand that the carrying capacity is different for each virus, and is based on how infectious each virus is? There are viruses that are sufficiently infectious that the carrying capacity is, basically, 100% of the population.
Carrying capacity is how many people are infected at one time, not how many people get infected, ever.

When the worlds various health authorities are saying that this virus really could infect the majority of us they're not unaware of the concept of carrying capacity, they've modeled the infection and determined what they think the carrying capacity likely to be.
"1.6 million, 2.2 million, 6 million Americans predicted dead!"

Experts are wrong, often. This will be a good lesson, for some. How can someone who's not a declared "expert" in a field, spot nearly instantaneously, that a large number of the "experts" are wrong? When the majority of "experts" disagree with each other. "Expert" predictions on the "Americans dead" estimates have ranged from 6 million, all the way down to a few hundred. Some of that discrepancy, is between "experts." Some of the "experts" have that range within their own model (!) indicating an a precision essentially equivalent to "From zero to infinity." That is a radical variation, indicating essential zero predictive ability, and is akin to wild guessing. Why so few people have been unable to see that, I have no idea. But it's getting exhausting trying to point it out what has been so obvious to me from the beginning.

But don't let me stop you. Choose to see only those "experts" that predict in the millions of Americans dead. Choose to ignore the many that predict a small fraction of that. And choose to ignore the absurdly wide range of disagreement which demonstrates the fact that none of them really know much better than if they threw a dart at a dartboard.

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P.S. Follow precautions, social isolate, take precautions as directed.
 
What's the carrying capacity of this very infectious virus? Could it be 40-70% of americans?
Read the article. I can't type out all 72 pages. You're going to have to read it, if you want to get the point. I can't keep doing this, typing the same things, reading and posting scientific papers that no one even reads, because they think personal insults and group-think are science and logic.
 
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How many infected actually require hospitalization? No way of knowing without much more testing. I’m not even sure I buy the argument that we’d have to ration care if we just let this thing run wild with herd immunity factored in.

this would never get past an IRB, but if we could throw ethics out the window, it would be great if we could infect 5000 matching the demographics of the US and see what actually happens.
 
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Read the article. I can't type out all 72 pages. You're going to have to read it, if you want to get the point. I can't keep doing this, typing the same things, reading and posting scientific papers that no one even reads, because they think personal insults and group-think are science and logic.

While I guarantee that you have not read all 72 pages, I can guarantee you that the United States was not measured in the paper linked (didn't even see that you ahd linked a papert initially). So I don't know what the carrying capacity in the US is, which is why I asked you.

Look at Figure 1 (below) and tell me which graph looks more like a logistic regression in the graph you put, the one for total confirmed cases (top) or the one for daily increase (bottom).

The paper defined carrying capacity asymptote on total confirmed cases, so your statement about carrying capacity as currently active cases is false.

1584992719671.png



SO - I ask again - what do you think the potential carrying capacity (total confirmed cases) of the US is?
 
As I've repeatedly said, the answer is in front of us with the Princess Cruise's ship. 3700 people on the ship in close quarters for weeks at a time. 696 tested positive for the virus. So WORST case is 18% infectivity. Of those 8 died, or 1.14%.

To me this represents the absolute worst case because certainly without close quarters, less than 18% of people will get the virus nationwide, and far less than 1.14% will die given the horrendous age/health profile of the average cruiser passenger.

Applied to the US population, that's 72,000,0000 infected people with 1,008,000 deaths. That sounds like a lot, but in 2018 we had more than 2.8 million americans die from all causes NVSS - Mortality Data.

Definitely not numbers for which we should be shutting down our country.
 
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SO - I ask again - what do you think the potential carrying capacity (total confirmed cases) of the US is?
I don't know what the carrying capacity of the U.S. population for COVID-19 is and I don't have any confidence in anyone who claims to know. People love to "quote the experts" but cherry pick which one's to quote. Plenty of people have quoted those predicting sensational numbers, but I don't hear anyone quoting those, and there are many, predicting a fraction of that. It's the classic fear filter. They only quote the one guy (five posts above) predicting 6 million dead and ignore the many at the other end of the spectrum. Why?
 
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How many infected actually require hospitalization? No way of knowing without much more testing. I’m not even sure I buy the argument that we’d have to ration care if we just let this thing run wild with herd immunity factored in.

this would never get past an IRB, but if we could throw ethics out the window, it would be great if we could infect 5000 matching the demographics of the US and see what actually happens.

Or we can test 5000 random strangers without asking if they have symptoms and apply the data to a population of 330 million to see how many actual cases there.
 
Or we can test 5000 random strangers without asking if they have symptoms and apply the data to a population of 330 million to see how many actual cases there.

would likely need a much bigger sampling as to draw meaningful data about the outcomes of the infected. We don’t know **** about this, but I’m squarely in the camp that fear of covid is worse than the disease.
 
As I've repeatedly said, the answer is in front of us with the Princess Cruise's ship. 3700 people on the ship in close quarters for weeks at a time. 696 tested positive for the virus. So WORST case is 18% infectivity. Of those 8 died, or 1.14%.

To me this represents the absolute worst case because certainly without close quarters, less than 18% of people will get the virus nationwide, and far less than 1.14% will die given the horrendous age/health profile of the average cruiser passenger.

Applied to the US population, that's 72,000,0000 infected people with 1,008,000 deaths. That sounds like a lot, but in 2018 we had more than 2.8 million americans die from all causes NVSS - Mortality Data.

Definitely not numbers for which we should be shutting down our country.

1 million deaths in just the US isn't a high number for you? Yes 2.8 million Americans die yearly from all causes, but you'd be OK with over 1 in 4 americans who died, to die because of the coronavirus this year?

I guess we'll just have to agree to disagree on that number being an acceptable amount dead.

Another thing to consider is that with numbers that low, evaluating how many people will die was likely with full equipment availability. When healthcare is rationed (if/when it comes to that, for the fraction of 71,000,000 americans who require hospitalization), death rates will spike. Again, this is the whole premise of flattening the curve. If health care systems get overwhelmed at a certain point in time mortality rate increases, as is happening in Italy currently.

If Italy had the same number of cases they do now but spread out over an additional month their mortality rates would likely do better. It is multifactorial, and I agree that an older population, more multi-generational families, more smoking, etc. likely aren't helping their mortality rate.
 
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1 million deaths in just the US isn't a high number for you? Yes 2.8 million Americans die yearly from all causes, but you'd be OK with over 1 in 4 americans who died, to die because of the coronavirus this year?

I guess we'll just have to agree to disagree on that number being an acceptable amount dead.

Another thing to consider is that with numbers that low, evaluating how many people will die was likely with full equipment availability. When healthcare is rationed (if/when it comes to that, for the fraction of 71,000,000 americans who require hospitalization), death rates will spike. Again, this is the whole premise of flattening the curve. If health care systems get overwhelmed at a certain point in time mortality rate increases, as is happening in Italy currently.

actual infected rates and by extension mortality will be lower than it would be on a cruise ship. I’d like to know the average age of those on that cruise as well.
 
1 million deaths in just the US isn't a high number for you? Yes 2.8 million Americans die yearly from all causes, but you'd be OK with over 1 in 4 americans who died, to die because of the coronavirus this year?

I guess we'll just have to agree to disagree on that number being an acceptable amount dead.

Another thing to consider is that with numbers that low, evaluating how many people will die was likely with full equipment availability. When healthcare is rationed (if/when it comes to that, for the fraction of 71,000,000 americans who require hospitalization), death rates will spike. Again, this is the whole premise of flattening the curve. If health care systems get overwhelmed at a certain point in time mortality rate increases, as is happening in Italy currently.

Well what numbers of dead are acceptable such that we can keep the country open? 500,000? 20,000? 1?

Bear in mind the 1,000,000 represents mostly extremely elderly people with comorbid conditions. Their annual mortality is high, and many likely would have succumbed to something else that year, or as Birdstrike has pointed out again and again they would possibly be DNR nursing home patients.

It will be interesting to see how much the suicide rate increases this year due to joblessness, social conflict, and depression.
 
Why are all those who are "quoting the experts" only quoting these, but not these? Why are only those "experts" making the extreme outlier predictions speaking unquestionable gospel and the low end ones, which happen to be the majority, speaking "anti-science" blasphemy?

We should clearly be aware of the high end predictions and make contingency plans to prepare for that as we are, but why no consideration, not even a possibility, that other experts, who have models saying something else? We shouldn't even look at that, or think about it, and question why the radical, wide disagreement among the experts?


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