An investing physician's view of the pandemic

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ilan1h
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An investing physician's view of the pandemic

Post by ilan1h »

As a professional physician (and amateur investor) I am trying to reconcile fact vs fiction with this pandemic. China, with a population of 1.4 billion, has lost under 5000 lives and is already seeing improving numbers. It is hard to say if the U.S experience is going to be similar but we have had more forewarning than the Chinese and we have taken steps to containment. It is not unreasonable to expect a similar trajectory. We have taken the approach of sacrificing GDP (shutting down the economy) rather than overstretching our healthcare capabilities. If we did not do this, the virus would run its course more rapidly but also more destructively. Herd immunity would ultimately occur but the healthcare system would be overtaxed and probably result in greater mortality and morbidity rates. We are trying now a new approach, containment, which is understandably generating much anxiety. It has disrupted business and financial markets in the hope of saving lives. Perhaps in the future, if we have to do this again, people will be less spooked. Ultimately, I don't think that we are facing any type of armageddon but simply a better approach to dealing with epidemics/pandemics. As is happening in China, this too will blow over and we will return to normalcy. We may look back and think that we have overreacted but it's hard to fault excess caution. Furthermore, this will be an invaluable experience with a process that we may have to repeat in the future for something far deadlier than coronavirus. I think that if we look at the big picture we should realize that a market drop is justified due to the inevitable contraction of the economy secondary to our efforts at containment. The question is how much of the market drop is due to that as opposed to naked fear and panic? In 2009 and 2018 we had horrible flu epidemics with tens of thousands of deaths but minimal effects on either the economy or the markets. After the first blush of panic we are seeing that this virus is probably about 7-10X more lethal than typical flu strains...but it's not a zombie apocalypse by any stretch.
sambb
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Re: An investing physician's view of the pandemic

Post by sambb »

you cant stop an epidemic that cant be tested.
soputh korea and china TESTED their people. There is virtually no testing in the USA. This has an effect of more people getting it and hence economic despair and market decreasing. we are not china or south korea. people coughing everywhere. no masks, no tests.
J295
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Re: An investing physician's view of the pandemic

Post by J295 »

ilan1h

Thank you very much for sharing. it would help me filter your information if you would kindly provide your medical credentials, other than generally being a physician. I don’t think chapter and verse is necessary, but something to give us a little flavor as we digest your analysis. Thanks again
peskypesky
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Re: An investing physician's view of the pandemic

Post by peskypesky »

As a physician, you should understant that the mortality rate is not what's so threatening about this virus. :oops:

The threats are three-fold
1. It is very contagious
2. It has a long incubation period when the infected are asymptomatic
3. It looks like 10-15% of the infected require hospitalization
Unladen_Swallow
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Re: An investing physician's view of the pandemic

Post by Unladen_Swallow »

sambb wrote: Sat Mar 14, 2020 7:25 pm you cant stop an epidemic that cant be tested.
soputh korea and china TESTED their people. There is virtually no testing in the USA. This has an effect of more people getting it and hence economic despair and market decreasing. we are not china or south korea. people coughing everywhere. no masks, no tests.
Sambb,

I seem in terrible distress. You might frighten yourself to poor health.

And if you get tested, I don't know what you would achieve. The treatment protocol is still - stay home. Unless you are seriously ill, then you would be admitted.

But there is no cure. Tests feed data. They are not a treatment.
"I think it's much more interesting to live not knowing than to have answers which might be wrong." - Richard Feynman
ThankYouJack
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Re: An investing physician's view of the pandemic

Post by ThankYouJack »

Unladen_Swallow wrote: Sat Mar 14, 2020 7:40 pm
sambb wrote: Sat Mar 14, 2020 7:25 pm you cant stop an epidemic that cant be tested.
soputh korea and china TESTED their people. There is virtually no testing in the USA. This has an effect of more people getting it and hence economic despair and market decreasing. we are not china or south korea. people coughing everywhere. no masks, no tests.
Sambb,

I seem in terrible distress. You might frighten yourself to poor health.

And if you get tested, I don't know what you would achieve. The treatment protocol is still - stay home. Unless you are seriously ill, then you would be admitted.

But there is no cure. Tests feed data. They are not a treatment.
More testing would definitely help people out. Take for instance my daughter - she has had a mild fever on and off with a cough. Seems just like her typical cough that lasts a couple weeks. But without a test, do we just isolate at home for weeks? Do we still have her birthday party not knowing if she's a carrier?
Last edited by ThankYouJack on Sat Mar 14, 2020 7:49 pm, edited 1 time in total.
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BolderBoy
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Re: An investing physician's view of the pandemic

Post by BolderBoy »

sambb wrote: Sat Mar 14, 2020 7:25 pmThere is virtually no testing in the USA. This has an effect of more people getting it...
The testing you suggest won't prevent infection.
"Never underestimate one's capacity to overestimate one's abilities" - The Dunning-Kruger Effect
J295
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Re: An investing physician's view of the pandemic

Post by J295 »

ThankYouJack wrote: Sat Mar 14, 2020 7:48 pm
Unladen_Swallow wrote: Sat Mar 14, 2020 7:40 pm
sambb wrote: Sat Mar 14, 2020 7:25 pm you cant stop an epidemic that cant be tested.
soputh korea and china TESTED their people. There is virtually no testing in the USA. This has an effect of more people getting it and hence economic despair and market decreasing. we are not china or south korea. people coughing everywhere. no masks, no tests.
Sambb,

I seem in terrible distress. You might frighten yourself to poor health.

And if you get tested, I don't know what you would achieve. The treatment protocol is still - stay home. Unless you are seriously ill, then you would be admitted.

But there is no cure. Tests feed data. They are not a treatment.
More testing would definitely help people out. Take for instance my daughter - she has had a mild fever on and off with a cough. Seems just like her typical cough that lasts a couple weeks. But without a test, do we just isolate at home for weeks? Do we still have her birthday party not knowing if she's a carrier?
All medical tests, of course, are not 100% accurate. In this environment, as sad as it might be, not having the birthday party now but postponing may the prudent course of action for her friends and their families, and the broader community.
Kennedy
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Re: An investing physician's view of the pandemic

Post by Kennedy »

As the OP alluded, one of the primary goals of the global shutdown is to prevent healthcare systems from becoming over-burdened. Look what's happening in Italy. Providers there in some cases are having to ration resources and decide which patient is more likely to survive with treatment and, hence, takes priority over someone with less likelihood of survival.

Along that line, if our ICUs generally have an 85% "occupancy" rate without coronavirus, where will all the non-coronavirus patients go when the ICU is filled with pandemic cases?
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JonnyDVM
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Re: An investing physician's view of the pandemic

Post by JonnyDVM »

Kennedy wrote: Sat Mar 14, 2020 7:55 pm As the OP alluded, one of the primary goals of the global shutdown is to prevent healthcare systems from becoming over-burdened. Look what's happening in Italy. Providers there in some cases are having to ration resources and decide which patient is more likely to survive with treatment and, hence, takes priority over someone with less likelihood of survival.

Along that line, if our ICUs generally have an 85% "occupancy" rate without coronavirus, where will all the non-coronavirus patients go when the ICU is filled with pandemic cases?
Italy has had nearly 3000 new cases and 175 deaths in the last 24 hours. They are 11 days ahead of us and took the same nonchalant approach initially that we did.

The time for downplaying this is over. If you are still doing that you need to stop.

I would be apprehensive about going to a children’s birthday party right now and quite frankly upset if the host was coughing all over my kid.
I’d trade it all for a little more | -C Montgomery Burns
Explorer
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Re: An investing physician's view of the pandemic

Post by Explorer »

Our local church has canceled the congregation.. it is a prudent idea to take preventive actions.
motorcyclesarecool
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Re: An investing physician's view of the pandemic

Post by motorcyclesarecool »

In before the lock. I think the time to panic was 3 weeks ago.
Understand that choosing an HDHP is very much a "red pill" approach. Most would rather pay higher premiums for a $20 copay per visit. They will think you weird for choosing an HSA.
Caduceus
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Re: An investing physician's view of the pandemic

Post by Caduceus »

ThankYouJack wrote: Sat Mar 14, 2020 7:48 pm
More testing would definitely help people out. Take for instance my daughter - she has had a mild fever on and off with a cough. Seems just like her typical cough that lasts a couple weeks. But without a test, do we just isolate at home for weeks? Do we still have her birthday party not knowing if she's a carrier?
Testing would be quite pointless in your daughter's case because your behavioral response should have been the same anyway. Either the test comes back negative or positive.

If the test comes back negative, then so what? Your daughter's just recovered from an immuno-compromising event. So now she's all good to go all out with riskier social activities? This is what Dr. Deborah Birx was afraid of - that people who get negative results back get lulled into a false sense of securuty and start becoming lax about their personal hygiene regiment. Testing only provides a snapshot at one point in time of your daughter's status. She can be negative one day, and positive the next, having picked it up from someone else 2 seconds after she's finished the test. The things she should have done while being afraid of testing positive are still the same things she should still do once the negative results come back, because we're not trying to just protect ourselves, but others as well.

If the test comes back positive, then, again, so what? If your daughter continues to just be having a mild fever, cough, etc., she's not going to be hospitalized. So how does the positive test result help? The test won't help you predict if this is going to be mild or turn into something serious. It doesn't have diagnostic value like that.

Since the virus can no longer be contained, testing and contact tracing is largely pointless. The people you'd want to test are the people who are not showing any symptoms (i.e. people who are not like your daughter), because they are more likely to be silent spreaders of the disease without realizing it.

I think people just want to be tested to be re-assured they don't have the coronavirus. This is irrational, because they can easily just pick it up one second, one hour, one day, one week after the test.
fortyofforty
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Re: An investing physician's view of the pandemic

Post by fortyofforty »

Thanks for posting that, ilan1h. Fear is feeding on fear, and panic is leading to overreaction. Unfortunately, the market reacts to fear. Always has. Always will. Eventually, sanity returns, and more logical valuations are applied. In the short run, the hair-on-fire crowd will rule the day. A vaccine will be developed. And if China's medical facilities are superior to those in the West, I'd be surprised. They have seen relatively few deaths. No way they have more respirators per capita than the United States, yet they've gotten a handle on this new virus, and the mortality. Hopefully we can, too.
Ferdinand2014
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Re: An investing physician's view of the pandemic

Post by Ferdinand2014 »

sambb wrote: Sat Mar 14, 2020 7:25 pm you cant stop an epidemic that cant be tested.
soputh korea and china TESTED their people. There is virtually no testing in the USA. This has an effect of more people getting it and hence economic despair and market decreasing. we are not china or south korea. people coughing everywhere. no masks, no tests.
As a physician, I know first hand this is simply inaccurate information. I am on the ground in the trenches dealing with it right now. I work in a hospital setting. We have weekly webinars with the state CDC and daily email updates as the situation. There are distinctions between who and why on testing as well as what to do with the information. It is way more nuanced than the media understands. I have where I live, been able to test anyone that I feel is appropriate. Every state in the union has the ability to test. Our turnaround time is 24 hours with our state lab. Most of that is transport as I live in a rural area and do not do point of contact patient testing. The throughput currently exceeds the demand. That is a fact.
“You only find out who is swimming naked when the tide goes out.“ — Warren Buffett
Ferdinand2014
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Re: An investing physician's view of the pandemic

Post by Ferdinand2014 »

Caduceus wrote: Sat Mar 14, 2020 8:08 pm
ThankYouJack wrote: Sat Mar 14, 2020 7:48 pm
More testing would definitely help people out. Take for instance my daughter - she has had a mild fever on and off with a cough. Seems just like her typical cough that lasts a couple weeks. But without a test, do we just isolate at home for weeks? Do we still have her birthday party not knowing if she's a carrier?
Testing would be quite pointless in your daughter's case because your behavioral response should have been the same anyway. Either the test comes back negative or positive.

If the test comes back negative, then so what? Your daughter's just recovered from an immuno-compromising event. So now she's all good to go all out with riskier social activities? This is what Dr. Deborah Birx was afraid of - that people who get negative results back get lulled into a false sense of securuty and start becoming lax about their personal hygiene regiment. Testing only provides a snapshot at one point in time of your daughter's status. She can be negative one day, and positive the next, having picked it up from someone else 2 seconds after she's finished the test. The things she should have done while being afraid of testing positive are still the same things she should still do once the negative results come back, because we're not trying to just protect ourselves, but others as well.

If the test comes back positive, then, again, so what? If your daughter continues to just be having a mild fever, cough, etc., she's not going to be hospitalized. So how does the positive test result help? The test won't help you predict if this is going to be mild or turn into something serious. It doesn't have diagnostic value like that.

Since the virus can no longer be contained, testing and contact tracing is largely pointless. The people you'd want to test are the people who are not showing any symptoms (i.e. people who are not like your daughter), because they are more likely to be silent spreaders of the disease without realizing it.

I think people just want to be tested to be re-assured they don't have the coronavirus. This is irrational, because they can easily just pick it up one second, one hour, one day, one week after the test.
+1
“You only find out who is swimming naked when the tide goes out.“ — Warren Buffett
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bluquark
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Re: An investing physician's view of the pandemic

Post by bluquark »

If I knew for sure the market's beliefs are similar to OP I would be selling everything, as I'm 95% convinced that containment is a mirage and that America's near-term future will resemble Italy's. I hold onto my stock because institutional investors don't seem to be reacting with the same complacency and greed we see in retail investors, but instead have rationally given a decent haircut to prices.
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sambb
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Re: An investing physician's view of the pandemic

Post by sambb »

it is interesting how many on BH have minimized the risk of the disease from an investing and public health perspective, and i hope they are right.
oken
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Re: An investing physician's view of the pandemic

Post by oken »

Caduceus wrote: Sat Mar 14, 2020 8:08 pm
Since the virus can no longer be contained, testing and contact tracing is largely pointless. The people you'd want to test are the people who are not showing any symptoms (i.e. people who are not like your daughter), because they are more likely to be silent spreaders of the disease without realizing it.

I think people just want to be tested to be re-assured they don't have the coronavirus. This is irrational, because they can easily just pick it up one second, one hour, one day, one week after the test.
I tend to agree with those who say that the time for testing is over. US and Europe have dropped the ball to test for containment.

So basically, anyone showing symptoms should act in the same socially responsible manner and quarantine themselves.

I also agree that it is those not showing symptoms that should be tested. But then, how do you decide who to test? Clearly it makes no sense to test anyone who doesn't have symptoms.

So we go back to testing to show whether or not those with symptoms actually have the virus, and seeing if clusters can be established. Then test those in that cluster who don't have symptoms.

So looks like testing is still necessary. Just perhaps not for the reasons we initially thought it would be for.
Ferdinand2014
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Re: An investing physician's view of the pandemic

Post by Ferdinand2014 »

ilan1h wrote: Sat Mar 14, 2020 7:21 pm As a professional physician (and amateur investor) I am trying to reconcile fact vs fiction with this pandemic. China, with a population of 1.4 billion, has lost under 5000 lives and is already seeing improving numbers. It is hard to say if the U.S experience is going to be similar but we have had more forewarning than the Chinese and we have taken steps to containment. It is not unreasonable to expect a similar trajectory. We have taken the approach of sacrificing GDP (shutting down the economy) rather than overstretching our healthcare capabilities. If we did not do this, the virus would run its course more rapidly but also more destructively. Herd immunity would ultimately occur but the healthcare system would be overtaxed and probably result in greater mortality and morbidity rates. We are trying now a new approach, containment, which is understandably generating much anxiety. It has disrupted business and financial markets in the hope of saving lives. Perhaps in the future, if we have to do this again, people will be less spooked. Ultimately, I don't think that we are facing any type of armageddon but simply a better approach to dealing with epidemics/pandemics. As is happening in China, this too will blow over and we will return to normalcy. We may look back and think that we have overreacted but it's hard to fault excess caution. Furthermore, this will be an invaluable experience with a process that we may have to repeat in the future for something far deadlier than coronavirus. I think that if we look at the big picture we should realize that a market drop is justified due to the inevitable contraction of the economy secondary to our efforts at containment. The question is how much of the market drop is due to that as opposed to naked fear and panic? In 2009 and 2018 we had horrible flu epidemics with tens of thousands of deaths but minimal effects on either the economy or the markets. After the first blush of panic we are seeing that this virus is probably about 7-10X more lethal than typical flu strains...but it's not a zombie apocalypse by any stretch.
Agree. I am becoming frustrated by the incredible misinformation being thrown around by the media which is getting repeated on this website. Especially the issue around testing. It is becoming highly politicized and unhelpful. People simply do not grasp the benefit or lack of benefit in testing. I am also a physician. Internal Medicine/Infectious Disease and currently hospital medicine as my main practice focus.
“You only find out who is swimming naked when the tide goes out.“ — Warren Buffett
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Re: An investing physician's view of the pandemic

Post by LadyGeek »

This thread has run it's course and is locked (medical advice - herd immunity).

In order to keep this forum focused on investing, please only post about the coronavirus in these threads:


- Market impacts: Coronavirus and the market

- Preparations: Coronavirus (Consumer Issues) How you are preparing?

- Everything else: Bogleheads community discussion - Coronavirus (stay within forum guidelines)
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