Bogleheads community discussion - Coronavirus

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ram
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Re: Bogleheads community discussion - Coronavirus

Post by ram » Tue Apr 21, 2020 12:11 pm

folkher0 wrote:
Tue Apr 21, 2020 11:51 am

On testing:

Every diagnostic test will have inevitable inaccuracy.
I had written this about the utility of testing a few days ago.

viewtopic.php?t=305217&start=3000
Ram

folkher0
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Re: Bogleheads community discussion - Coronavirus

Post by folkher0 » Tue Apr 21, 2020 12:12 pm

ram wrote:
Tue Apr 21, 2020 12:11 pm
folkher0 wrote:
Tue Apr 21, 2020 11:51 am

On testing:

Every diagnostic test will have inevitable inaccuracy.
I had written this about the utility of testing a few days ago.

viewtopic.php?t=305217&start=3000
:sharebeer

rkhusky
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Re: Bogleheads community discussion - Coronavirus

Post by rkhusky » Tue Apr 21, 2020 12:13 pm

veggivet wrote:
Tue Apr 21, 2020 12:03 pm
If the US population was more immunocompromised than other countries', one would expect overall death rates from infectious diseases like the flu to be statistically significantly higher, which they are not. You can tiptoe blindfolded around the edge of the room all you like, but the elephant will still be standing in the middle of it when you open your eyes.
The main factor is the general level of health of the population. A secondary factor is the authoritarian extent of the government.

edit: Forgot to add that S. Korea learned from their experience with MERS. US got complacent after dodging bullets from SARS, MERS, H1N1, Zika, and Ebola, although there was some effort to shore up supplies after SARS. "Past Performance Is Not Indicative Of Future Results"
Last edited by rkhusky on Tue Apr 21, 2020 1:13 pm, edited 2 times in total.

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iceport
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Re: Bogleheads community discussion - Coronavirus

Post by iceport » Tue Apr 21, 2020 12:14 pm

veggivet wrote:
Tue Apr 21, 2020 12:03 pm
iceport wrote:
Tue Apr 21, 2020 10:37 am
What percentage of the general US population is on pharmaceuticals that compromise the immune system, raising the probability of death?

Judging by the number of ads pushing them on TV, it's not a trivial percentage.

Is this being tracked along with other comorbidity factors?
If the US population was more immunocompromised than other countries', one would expect overall death rates from infectious diseases like the flu to be statistically significantly higher, which they are not. You can tiptoe blindfolded around the edge of the room all you like, but the elephant will still be standing in the middle of it when you open your eyes.
That makes sense I guess. But what are you considering the proverbial elephant in the room?
"Discipline matters more than allocation.” ─William Bernstein

folkher0
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Re: Bogleheads community discussion - Coronavirus

Post by folkher0 » Tue Apr 21, 2020 12:15 pm

KlangFool wrote:
Tue Apr 21, 2020 11:53 am
Ari wrote:
Tue Apr 21, 2020 11:44 am
Seeing as some people expressed interest in the Swedish situation, I thought I'd report the news from today's press conference.
  • It seems clear that the rate of infection has plateaued. Yesterday there were 462 new cases, about the same as March 31. You can see the data here: https://fohm.maps.arcgis.com/apps/opsda ... 7f152f1392 . It's in Swedish, but the graph in the middle is new cases per day. Current day is not complete, but the others should be. If you click the little arrows one step to the left, you get deaths per day. There's more of an issue with backlog there, but it seems quite evident that the peak has passed (April 8).
  • The random sampling I mentioned earlier was done between March 27 and April 3, and showed 2.5% of people in Stockholm who have not sought medical attention were currently carrying the virus. So we're not talking about antibodies, but a current infection.
  • Based on this and other data, Folkhälsomyndigheten* has done a model to predict the spread in Sweden. They estimate that the peak in new cases is indeed behind us, estimated at April 15.
  • They estimate that on May 1, one third of inhabitants in Stockholm will have been infected.
  • They also said that for each confirmed case, 1000 cases go unreported. I'm not sure how to interpret this bit, since current reporting shows over 15,000 cases, which would put the total number of cases at 15 million, more than Sweden's population. I must be missing something here.
  • They're currently making a sampling on the entire population to estimate the spread. Stockholm has about half of the cases in Sweden, but 1/10 of the population, so the spread would be less in the rest of the country.
  • Apparently some preliminary study on antibodies in Stockholm showed a prevalence of 10-11% of the population having antibodies, but it seemed like those numbers were not super reliable.
* I've been saying "Folkhälsoinstitutet", which is wrong. Should be "Folhälsomyndigheten".
Ari,

I am more interested in the daily death counts. Do you have the numbers for the last few days?

Thanks.

KlangFool
Its strange how the worldometer numbers site the Swedish source, but the numbers are totally different. Worldometer reports a record high number of deaths from covid today (185). The swedish source seems to have very different curves. I can't explain the discrepancy.

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Re: Bogleheads community discussion - Coronavirus

Post by Ari » Tue Apr 21, 2020 12:33 pm

KlangFool wrote:
Tue Apr 21, 2020 11:53 am
Ari,

I am more interested in the daily death counts. Do you have the numbers for the last few days?

Thanks.

KlangFool
Like I said above, you can get those at this link: https://fohm.maps.arcgis.com/apps/opsda ... 7f152f1392

Look at the graph in the middle. Below it are some arrows. Click one step to the left to get the daily deaths. But I'll get the data from the Excel link I posted earlier, too.

3/11/20 1
3/12/20 0
3/13/20 1
3/14/20 1
3/15/20 2
3/16/20 2
3/17/20 1
3/18/20 6
3/19/20 7
3/20/20 10
3/21/20 7
3/22/20 12
3/23/20 11
3/24/20 20
3/25/20 25
3/26/20 29
3/27/20 32
3/28/20 35
3/29/20 39
3/30/20 44
3/31/20 45
4/1/20 52
4/2/20 67
4/3/20 81
4/4/20 69
4/5/20 82
4/6/20 90
4/7/20 81
4/8/20 106
4/9/20 79
4/10/20 78
4/11/20 84
4/12/20 86
4/13/20 72
4/14/20 67
4/15/20 77
4/16/20 78
4/17/20 49
4/18/20 51
4/19/20 43
4/20/20 21
4/21/20 3

It's important to note, however, that deaths have a significant lag in reporting. Each day, new deaths are reported and the data is added to the date of death. Since there is often a delay in determining the cause of death, new deaths can be added as far back as a week sometimes. So the clear decline these numbers show in the last week is probably not real, but the peak on April 8 probably is.
All in, all the time.

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Re: Bogleheads community discussion - Coronavirus

Post by Ari » Tue Apr 21, 2020 12:40 pm

KyleAAA wrote:
Tue Apr 21, 2020 11:58 am
rkhusky wrote:
Tue Apr 21, 2020 11:57 am
Aren't schools still open there? People eating in restaurants? Haven't seen that in the US for awhile.
Yes, but sources in Stockholm reports traffic everywhere has reduced 80-90%. So while people may be "eating in restaurants," they aren't exactly packed. That's about the same as I've noticed in Seattle, which has also managed to flatten the curve nicely even though schools were late to shut down. Sweden has a much better healthcare system and favorable demographics compared to the US, so they are in a pretty good place to ride this out.
A lot of restaurants I've seen have closed down every other table. So you can only get half as many people in there as usual. There's a lot of other stuff, too: Gatherings of over 50 people are not allowed (though spontaneous gatherings can't be broken up by police). Anybody who can work from home is encouraged to do so. Kindergartens and elementary schools are open, but senior high schools and universities do distance education. Supermarkets have barriers in front of the cashiers, stickers on the ground to indicate where to line up to keep the distance, and other things. My local supermarket reserves the first hour of opening to risk groups. The message to wash your hands regularly and to stay at home even if you're just a little bit sick (and 48 hours after getting better) is everywhere. So yeah, it's not that "nothing" is done, it's just a complete lockdown. And it's almost all voluntary.
All in, all the time.

KlangFool
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Re: Bogleheads community discussion - Coronavirus

Post by KlangFool » Tue Apr 21, 2020 12:41 pm

Ari wrote:
Tue Apr 21, 2020 12:33 pm
KlangFool wrote:
Tue Apr 21, 2020 11:53 am
Ari,

I am more interested in the daily death counts. Do you have the numbers for the last few days?

Thanks.

KlangFool
Like I said above, you can get those at this link: https://fohm.maps.arcgis.com/apps/opsda ... 7f152f1392

Look at the graph in the middle. Below it are some arrows. Click one step to the left to get the daily deaths. But I'll get the data from the Excel link I posted earlier, too.

3/11/20 1
3/12/20 0
3/13/20 1
3/14/20 1
3/15/20 2
3/16/20 2
3/17/20 1
3/18/20 6
3/19/20 7
3/20/20 10
3/21/20 7
3/22/20 12
3/23/20 11
3/24/20 20
3/25/20 25
3/26/20 29
3/27/20 32
3/28/20 35
3/29/20 39
3/30/20 44
3/31/20 45
4/1/20 52
4/2/20 67
4/3/20 81
4/4/20 69
4/5/20 82
4/6/20 90
4/7/20 81
4/8/20 106
4/9/20 79
4/10/20 78
4/11/20 84
4/12/20 86
4/13/20 72
4/14/20 67
4/15/20 77
4/16/20 78
4/17/20 49
4/18/20 51
4/19/20 43
4/20/20 21
4/21/20 3

It's important to note, however, that deaths have a significant lag in reporting. Each day, new deaths are reported and the data is added to the date of death. Since there is often a delay in determining the cause of death, new deaths can be added as far back as a week sometimes. So the clear decline these numbers show in the last week is probably not real, but the peak on April 8 probably is.
Thanks.

KlangFool

btenny
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Re: Bogleheads community discussion - Coronavirus

Post by btenny » Tue Apr 21, 2020 12:42 pm

Only the grade schools in Sweden are open. High schools and colleges are closed and have been for a while. The argument for not closing the grade schools was too many health care and front line workers would have to stay at home and take care of small kids. Plus very few small kids seem to be getting COVID. So they are keeping the grade schools open. I did not find any discussion of how they are tracking suspect kids or how they are watching those small kids.

And as far as bars and restaurants staying open that is right. BUT they have lots of new rules to follow. No bar service so no shoulder to shoulder people. Only table service and only half seating at those tables. No big groups of people. The article I read said nothing about masks and no pictures showed masks. So no masks. They also told older people and the vulnerable to stay home and self isolate. And being good Swedes most are following that suggestion.

So they are doing some things and it is sort of working. TBD long term what will happen.

veggivet
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Re: Bogleheads community discussion - Coronavirus

Post by veggivet » Tue Apr 21, 2020 12:42 pm

iceport wrote:
Tue Apr 21, 2020 12:14 pm
veggivet wrote:
Tue Apr 21, 2020 12:03 pm
iceport wrote:
Tue Apr 21, 2020 10:37 am
What percentage of the general US population is on pharmaceuticals that compromise the immune system, raising the probability of death?

Judging by the number of ads pushing them on TV, it's not a trivial percentage.

Is this being tracked along with other comorbidity factors?
If the US population was more immunocompromised than other countries', one would expect overall death rates from infectious diseases like the flu to be statistically significantly higher, which they are not. You can tiptoe blindfolded around the edge of the room all you like, but the elephant will still be standing in the middle of it when you open your eyes.
That makes sense I guess. But what are you considering the proverbial elephant in the room?
Forum rules prohibit me going any further [OT comment removed by admin LadyGeek]
If you watch your pennies, your dollars will take care of themselves.

Ari
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Re: Bogleheads community discussion - Coronavirus

Post by Ari » Tue Apr 21, 2020 12:49 pm

folkher0 wrote:
Tue Apr 21, 2020 12:15 pm
Its strange how the worldometer numbers site the Swedish source, but the numbers are totally different. Worldometer reports a record high number of deaths from covid today (185). The swedish source seems to have very different curves. I can't explain the discrepancy.
Yeah, that's pretty odd. I can only guess, but this might have something to do with it: Every day the Swedish data gets updated with new reported deaths. However, the data is added on the date of death, so you get data points added to previous dates. If Worldometer is counting the deaths on the day they were reported, rather than on the date of death, that might explain some of the discrepancy. Not sure if that should be record high for today, either, though.
All in, all the time.

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iceport
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Re: Bogleheads community discussion - Coronavirus

Post by iceport » Tue Apr 21, 2020 1:10 pm

veggivet wrote:
Tue Apr 21, 2020 12:42 pm
iceport wrote:
Tue Apr 21, 2020 12:14 pm
veggivet wrote:
Tue Apr 21, 2020 12:03 pm
iceport wrote:
Tue Apr 21, 2020 10:37 am
What percentage of the general US population is on pharmaceuticals that compromise the immune system, raising the probability of death?

Judging by the number of ads pushing them on TV, it's not a trivial percentage.

Is this being tracked along with other comorbidity factors?
If the US population was more immunocompromised than other countries', one would expect overall death rates from infectious diseases like the flu to be statistically significantly higher, which they are not. You can tiptoe blindfolded around the edge of the room all you like, but the elephant will still be standing in the middle of it when you open your eyes.
That makes sense I guess. But what are you considering the proverbial elephant in the room?
Forum rules prohibit me going any further...
Respectfully, I think the reasons are far more complex and varied than that alone, probably starting first and foremost with the real-life fire drill the 2015 MERS outbreak provided South Korea. Though I'll grant you, a leadership void at the top works against just about every one of them...
"Discipline matters more than allocation.” ─William Bernstein

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Re: Bogleheads community discussion - Coronavirus

Post by tadamsmar » Tue Apr 21, 2020 1:34 pm

veggivet wrote:
Tue Apr 21, 2020 9:09 am
Here's another interesting comparison, but between countries, not states:

Total # of confirmed cases:

US: 788,110
S. Korea: 10,683

Total # of confirmed deaths:

US: 42,374
S. Korea: 237

US population around 6X that of S. Korea. Both countries experienced their first case on the same date. Data from Johns Hopkins site accessed @ 10 AM.
My theory is that S. Korea is actually containing the virus with testing-tracing-quarantine. They developed a good testing-tracing-quarantine system with legal support for cell phone tracing in reaction to the SARS or MERS epidemic (I forget which). And they had a test that was approved by the S. Korean CDC in early February. It was developed by a biotech firm that quickly ramped up production. There testing research, development, and production went quickly and smoothly,

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Re: Bogleheads community discussion - Coronavirus

Post by veggivet » Tue Apr 21, 2020 1:38 pm

tadamsmar wrote:
Tue Apr 21, 2020 1:34 pm
veggivet wrote:
Tue Apr 21, 2020 9:09 am
Here's another interesting comparison, but between countries, not states:

Total # of confirmed cases:

US: 788,110
S. Korea: 10,683

Total # of confirmed deaths:

US: 42,374
S. Korea: 237

US population around 6X that of S. Korea. Both countries experienced their first case on the same date. Data from Johns Hopkins site accessed @ 10 AM.
My theory is that S. Korea is actually containing the virus with testing-tracing-quarantine. They developed a good testing-tracing-quarantine system with legal support for cell phone tracing in reaction to the SARS or MERS epidemic (I forget which). And they had a test that was approved by the S. Korean CDC in early February. It was developed by a biotech firm that quickly ramped up production. There testing research, development, and production went quickly and smoothly,
Exactly! They had a plan and executed it nearly perfectly. The results are plain for all to see. (By the way, it was SARS.)
If you watch your pennies, your dollars will take care of themselves.

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Re: Bogleheads community discussion - Coronavirus

Post by grayfox » Tue Apr 21, 2020 1:48 pm

folkher0 wrote:
Tue Apr 21, 2020 12:15 pm

Its strange how the worldometer numbers site the Swedish source, but the numbers are totally different. Worldometer reports a record high number of deaths from covid today (185). The swedish source seems to have very different curves. I can't explain the discrepancy.
Both show the same total deaths 1,765. Just on which days are different. I am going to guess that Sweden is backfilling the days as deaths are reported, and worldometer is counting all on the current day, even if the person died three days ago.

I am just guessing. But that would mean that worldometer reports deaths on the wrong day and their curves are off. This is a problem because people using are the graphs to see when deaths peaked. IMO, there will always be errors in the reported data and the counting.
Sic transit gloria mundi. [STGM]

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Re: Bogleheads community discussion - Coronavirus

Post by folkher0 » Tue Apr 21, 2020 2:01 pm

grayfox wrote:
Tue Apr 21, 2020 1:48 pm
folkher0 wrote:
Tue Apr 21, 2020 12:15 pm

Its strange how the worldometer numbers site the Swedish source, but the numbers are totally different. Worldometer reports a record high number of deaths from covid today (185). The swedish source seems to have very different curves. I can't explain the discrepancy.
Both show the same total deaths 1,765. Just on which days are different. I am going to guess that Sweden is backfilling the days as deaths are reported, and worldometer is counting all on the current day, even of the person died three days ago.

I am just guessing. But that would mean that worldometer reports deaths on the wrong day and their curves are off.
I was thinking the same. Gotta go to the primary source.

But I wonder why worldometer is doing it that way. It should be pretty easy to just take the excel file Ari posted and make the chart.

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Re: Bogleheads community discussion - Coronavirus

Post by tadamsmar » Tue Apr 21, 2020 2:10 pm

KyleAAA wrote:
Tue Apr 21, 2020 11:55 am
It's important to note that many people are saying Sweden has done "nothing." That is not true. They've probably socially distanced more than most areas of the US, they've just been able to do it without needing a government lockdown. It is not an example of "did nothing" that many people are saying it is.
50% of Swedish households are single-person, highest in the EU. It's 30% in the US.

rkhusky
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Re: Bogleheads community discussion - Coronavirus

Post by rkhusky » Tue Apr 21, 2020 2:23 pm

veggivet wrote:
Tue Apr 21, 2020 1:38 pm
(By the way, it was SARS.)
SARS was 2002-2004. MERS in S. Korea was 2015.

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Re: Bogleheads community discussion - Coronavirus

Post by KlangFool » Tue Apr 21, 2020 2:33 pm

Folks,

Sweden population -> 10.23 million
Norway population -> 5.368 million

https://wuflu.live/

Sweden total death -> 1765
Norway Total death -> 182

Total death per 1 million population

Sweden -> 172.5
Norway -> 33.9

The USA number is 128.

KlangFool

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Re: Bogleheads community discussion - Coronavirus

Post by veggivet » Tue Apr 21, 2020 2:50 pm

rkhusky wrote:
Tue Apr 21, 2020 2:23 pm
veggivet wrote:
Tue Apr 21, 2020 1:38 pm
(By the way, it was SARS.)
SARS was 2002-2004. MERS in S. Korea was 2015.
Thank you for the correction.
If you watch your pennies, your dollars will take care of themselves.

FoolStreet
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Re: Bogleheads community discussion - Coronavirus

Post by FoolStreet » Tue Apr 21, 2020 2:51 pm

ram wrote:
Tue Apr 21, 2020 12:11 pm
folkher0 wrote:
Tue Apr 21, 2020 11:51 am

On testing:

Every diagnostic test will have inevitable inaccuracy.
I had written this about the utility of testing a few days ago.

viewtopic.php?t=305217&start=3000
Thanks for sharing the math. Its really hard to understand infection rate and societal impacts without an appreciation for it.

Jozxyqk
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Re: Bogleheads community discussion - Coronavirus

Post by Jozxyqk » Tue Apr 21, 2020 2:53 pm

I want to thank everyone for the productive and informative discussion here. I found this article reporting the spikes in all deaths around the world to be extraordinary. What a tragedy this continues to be.

https://www.nytimes.com/interactive/202 ... eaths.html

New York's monthly deaths normally fluctuate between 4,000-5,000. The highest total in the past 20 years was September 2001, with 7,010 deaths -- spike due to the 9/11 attacks.

The most recent 31-day total is staggering: 9,780.

https://www.nytimes.com/interactive/202 ... -city.html

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Re: Bogleheads community discussion - Coronavirus

Post by JAZZISCOOL » Tue Apr 21, 2020 3:05 pm

tadamsmar wrote:
Tue Apr 21, 2020 2:10 pm
KyleAAA wrote:
Tue Apr 21, 2020 11:55 am
It's important to note that many people are saying Sweden has done "nothing." That is not true. They've probably socially distanced more than most areas of the US, they've just been able to do it without needing a government lockdown. It is not an example of "did nothing" that many people are saying it is.
50% of Swedish households are single-person, highest in the EU. It's 30% in the US.
That's very interesting. I wonder what the driving force is behind this vs. the US.

EnjoyIt
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Re: Bogleheads community discussion - Coronavirus

Post by EnjoyIt » Tue Apr 21, 2020 3:19 pm

KlangFool wrote:
Tue Apr 21, 2020 11:19 am
EnjoyIt wrote:
Tue Apr 21, 2020 10:52 am
KlangFool wrote:
Tue Apr 21, 2020 9:50 am
JonnyB wrote:
Tue Apr 21, 2020 9:34 am
EnjoyIt wrote:
Tue Apr 21, 2020 12:22 am

The way I see it, this virus is not going anywhere. Because of the high false negative rate on testing, all that testing will do is keep the lid on some spread and hopefully not overwhelm the healthcare system. Other than that, 30% give or take will be missed and keep spreading the disease until 70%-80% of the world population have been infected and we will have herd immunity if immunity can actually exist. The fact remains that 30% is a huge false negative rate which will give a false sense of security to those who are positive. They will then go out and infect many other people because they will not practice social distancing. The question is, what will R0 be if we open up the economy but miss 30% of the positive cases? If it is <1 then we may be in decent shape. If it is >1 then we will be right back where were 5-10 days ago.
The fact is, you keep citing a 30% false negative rate that is mostly anecdotal. It is extremely hard to establish a false negative rate in the field -- because it is negative.
JonnyB,

That is irrelevant anyhow. Other countries had solved the problem by testing multiple times. And, they can do this because they had greater testing capacities. And, we do not have the testing capacities because we do not have the reagents.

There is no point arguing about this. The answer is clear that we need more reagents. Who is going to do something about this? As per the NY Governor, only the Federal government can solve this problem.

The problem and the solution = reagents.

KlangFool
KlangFool,

As I said before, testing will help, but it is not the end all be all that you keep claiming it to be.

BTW, using the worldometer link you can clearly see that the US has already done more testing than any other country. Almost twice as much as the next country which is Russia. Testing per 1 million people we are way further on the list but then again, the places that benefit the most from mass testing is in the areas where we have hot spots. Other areas can be more focuses.

BTW, have you been tested? If so please share your experience.
EnjoyIt,

<<As I said before, testing will help, but it is not the end all be all that you keep claiming it to be.
>>

That is not the point. The point is we cannot move forward without more testing capacity.

<<BTW, have you been tested? If so please share your experience.>>

No. We cannot get tested in Virginia. We do not have the testing capacity.

KlangFool
I know you don’t agree with me, but once you can rationalize exactly what information a nasopharyngeal swab provides and more importantly what it does not provide, I’m sure you too would understand why mass testing is not required to move forward.

Yes, more testing will be beneficial especially if we can pair it with antibody screening if immunity is actually possible.
A time to EVALUATE your jitters. | https://www.bogleheads.org/forum/viewtopic.php?f=10&t=79939&start=400#p5275418

EnjoyIt
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Re: Bogleheads community discussion - Coronavirus

Post by EnjoyIt » Tue Apr 21, 2020 3:25 pm

folkher0 wrote:
Tue Apr 21, 2020 11:51 am
JonnyB wrote:
Tue Apr 21, 2020 10:50 am
Some say ... Now there's a useful piece of data.
On testing:

Every diagnostic test will have inevitable inaccuracy. If I do a test on you, I will get a result: positive or negative. If you test positive and have the disease, its called a TRUE POSITIVE. If you test negative and you don't have the disease its a TRUE NEGATIVE. If you test positive but DON'T have the disease, its a FALSE POSITIVE. If you test negative but DO have the disease its a FALSE NEGATIVE. Whether the test result correlates with the true presence or absence of a condition is how we gauge the accuracy and usefulness of the test. We think about the accuracy of diagnostic tests in terms of a few characteristics based on the results of the test: Sensitiviy, Specificy, Positive predictive value and negative predictive value. I

Sensitivity of a test is the ratio of True positives results to ALL positives. In other words True positive/(True positive+false negative). Tests that have high sensitivity are good at identifying people who have the disease. However, this metric suggests nothing about false positives. So you may be flagging a test as positive, even if there is no disease. Screening mammograms are an example. They are reasonably sensitive, but there are alot of false positives, and many women go on to get more testing and find out they have no cancer.

Specificity is the ratio of True Negatives to All negative. In other word true negative/(true negative+false positive). Tests with high specificity are good at ruling out a disease. For instance: when looking for a pulmonary embolism, we might send a test called a D-Dimer. It has high specificity but low senistiivity. If D-Dimer is negative, you likely don't have a PE. But D-Dimer can be elevated in a number of conditions (COVID for instance). A high D dimer is not rule you in for PE. It has a lot of false positives. You can do another, more invasive test like a spiral CT scan to diagnose PE with fewer false positives, but that is expensive, time consuming, and involves some risk, so many just start with D-Dimer and go from there.

Positive Predictive Value (PPV). The likelihood that a positive test actually correlates with disease. Its the ratio True postive/(True Pos+False Pos). Testing positive for a test with high PPV means you can take it to the bank that you have the condition. Many biopsies have high PPV. For instance, if I send a liver biopsy to a pathologist and it shows cancer, you got cancer. Now that doesn't mean a negative test rules out cancer. The biopsy could be of the wrong tissue or it could have weird other stuff that confounds the read, but if the pathologist says cancer you got cancer. It also may not be sensitive because a high number of patients who have the condition still may get a negative biopsy.

Negative Predictive Value (NPV). The likelihood that a negative test actually means you don't have the disease. Its the ratio True negative/(true negative+false negative). If you NPV is high, it implies that you are accurately identifying most patients who don't have the disease. But it may not be specific, meaning the people who test negative, while likely not having the disease, are not the only people who don't have the disease. You might be missing people if there are alot of false positives.

How do you know who a false positive and false negative are? Its not like there's an answer sheet at the back of the book. The answer is we compare any test against a "gold standard." The gold standard may not be perfect, but it has the best characteristics of any known test. In the case of pulmonary embolism, the gold standard is pulmonary angiography. Why don't we just skip to the gold standard every time? Well in the case of PE, pulmonary angiography involves heavy sedation, threading a catheter through the heart and into the lungs, and injecting IV contrast into the pulmonary artery. IV contrast may cause allergy or kidney failure. You can have complications from the cather insertion, etc. No one really ever does it anymore, but it is the gold standard.

In the case of COVID, its hard to know what the gold standard is. Probably pathology of lungs. Some studies report CT scans as a gold standard but I have seen a few patients misdiagnosed on CT.

PPV and NPV are useful, but depend on the prevalence of the disease. In the case of a very rare disease, the likelihood that you test positive, but are truly negative goes up, because the actual incidence of the disease is low. In low prevalence diseases, the PPV tends to be low. In a situation where the prevalence of disease is so dynamic (like pandemic covid) these numbers are fluid. I expect that in NY 2 weeks ago the PPV of the covid test was higher than it will be in two weeks because the prevalence of active PCR positive disease (hopefully) will be much lower.

In any case, I have been told by our ID teams that nasopharyngeal swab PCR for COVID has an NPV of about 60% meaning that about 40% of patients with negative swabs actually do have the disease. This is roughly equivalent to the number EnjoyIt sites, and I believe is the consensus among most medical professionals in the US. The NPV can be improved with repeat swabbing or perhaps better swabbing technique, but who knows. Nasopharyngeal PCR will miss cases, no doubt.

The PPV of the COVID swab is probably high, at least at the prevalence we are at now, fwiw. If you have a positive swab, you got COVID buddy.

I'm sorry I don't have the literature handy to back up the numbers, but I trust my ID doc friends know what they are talking about. That's what I am transmitting to you.
Thanks for explaining it way better than me :)
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EnjoyIt
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Re: Bogleheads community discussion - Coronavirus

Post by EnjoyIt » Tue Apr 21, 2020 3:31 pm

veggivet wrote:
Tue Apr 21, 2020 12:03 pm
iceport wrote:
Tue Apr 21, 2020 10:37 am
veggivet wrote:
Tue Apr 21, 2020 10:16 am
rkhusky wrote:
Tue Apr 21, 2020 9:53 am
KlangFool wrote:
Tue Apr 21, 2020 9:16 am


veggivet,

A more interesting comparison would be total death per 1 M population.

South Korea's population is about 52 million.

South Korea's total death per 1 M population = 4.6

The USA number is about 128.

KlangFool
What is the rate of obesity in S. Korea vs the US? Rate of respiratory illness? Rate of heart disease? Rate of high blood pressure?

Edit: S. Korea has 4% obesity. US has 42%. Perhaps there is a link. Although correlation is not the same as causation.

http://www.oecd.org/els/health-systems/ ... yfacts.htm
https://www.cdc.gov/obesity/data/adult.html
Rates of obesity and hypertension are lower in South Korea, but not low enough to explain the dramatic difference noted above. South Korea excels in its low rate of heart disease, but again, not low enough to explain the differential. Here are the numbers for you:

US: Age adjusted death rate for heart disease is 87/100,000
S. Korea's rate is 30

US: Age adjusted death rate for hypertension is 7.4/100,000
S. Korea's rate is 4.3

With respect to obesity rates, if you delve a little deeper than the first google search result, you will find consensus figures are around 40% for males, and 25% for females. (www.statista.com)

None of these potential confounding factors can account for a death rate that is 30 times higher here than there. I 100% agree with you that correlation is not the same as causation, but the difference in these numbers is pretty staggering, nonetheless.
What percentage of the general US population is on pharmaceuticals that compromise the immune system, raising the probability of death?

Judging by the number of ads pushing them on TV, it's not a trivial percentage.

Is this being tracked along with other comorbidity factors?
If the US population was more immunocompromised than other countries', one would expect overall death rates from infectious diseases like the flu to be statistically significantly higher, which they are not. You can tiptoe blindfolded around the edge of the room all you like, but the elephant will still be standing in the middle of it when you open your eyes.
Different diseases affect different demographics of people.

For example, infuenza H1N1 happened to kill a good amount of healthy young people, while COVID seems to be worse on the older population and those with high blood pressure, obesity, hypertension. Americans are fatter than South Koreans. Fatter People tend to have high blood pressure and diabetes.
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Re: Bogleheads community discussion - Coronavirus

Post by EnjoyIt » Tue Apr 21, 2020 3:33 pm

ram wrote:
Tue Apr 21, 2020 12:11 pm
folkher0 wrote:
Tue Apr 21, 2020 11:51 am

On testing:

Every diagnostic test will have inevitable inaccuracy.
I had written this about the utility of testing a few days ago.

viewtopic.php?t=305217&start=3000
Nice write up.
People really think testing is somehow going to fix everything. It is a delusion.

And thanks for sharing the NEJM link earlier.
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Re: Bogleheads community discussion - Coronavirus

Post by KlangFool » Tue Apr 21, 2020 4:12 pm

EnjoyIt wrote:
Tue Apr 21, 2020 3:19 pm


I know you don’t agree with me, but once you can rationalize exactly what information a nasopharyngeal swab provides and more importantly what it does not provide, I’m sure you too would understand why mass testing is not required to move forward.

Yes, more testing will be beneficial especially if we can pair it with antibody screening if immunity is actually possible.
EnjoyIt,

For a normal non-medical person, antibody screening is part of the testing too.

Testing = diagnostic testing + antibody screening.

Testing = a method and procedure to detect whether someone is or was infected with Coronavirus. To move forward, we need to scale up our testing capacity and velocity. We do not have enough at this moment. For both diagnostic and antibody screening, we need more reagents.

KlangFool

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ResearchMed
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Re: Bogleheads community discussion - Coronavirus

Post by ResearchMed » Tue Apr 21, 2020 5:13 pm

btenny wrote:
Tue Apr 21, 2020 12:42 pm
Only the grade schools in Sweden are open. High schools and colleges are closed and have been for a while. The argument for not closing the grade schools was too many health care and front line workers would have to stay at home and take care of small kids. Plus very few small kids seem to be getting COVID. So they are keeping the grade schools open. I did not find any discussion of how they are tracking suspect kids or how they are watching those small kids.

And as far as bars and restaurants staying open that is right. BUT they have lots of new rules to follow. No bar service so no shoulder to shoulder people. Only table service and only half seating at those tables. No big groups of people. The article I read said nothing about masks and no pictures showed masks. So no masks. They also told older people and the vulnerable to stay home and self isolate. And being good Swedes most are following that suggestion.

So they are doing some things and it is sort of working. TBD long term what will happen.
Are there any data about whether young children don't seem to be getting COVID, or if they can indeed get infected and usually/often remain asymptomatic, and if the latter, can they spread the disease just like adults?

RM
This signature is a placebo. You are in the control group.

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Re: Bogleheads community discussion - Coronavirus

Post by smitcat » Tue Apr 21, 2020 5:18 pm

KlangFool wrote:
Tue Apr 21, 2020 2:33 pm
Folks,

Sweden population -> 10.23 million
Norway population -> 5.368 million

https://wuflu.live/

Sweden total death -> 1765
Norway Total death -> 182

Total death per 1 million population

Sweden -> 172.5
Norway -> 33.9

The USA number is 128.

KlangFool
In our area of the US it is very clear that both African Americans and Latino Americans are being adversely affected by this virus by a huge margin.
It is becoming pretty clear that preexisting conditions, age and ethnic background play a role in the severity of this virus.
I am not sure how many folks of African and Latino heritage are in Sweden and Norway.
Here is one link describing the differences based on ethnicity...
https://www.vox.com/coronavirus-covid19 ... -infection

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Re: Bogleheads community discussion - Coronavirus

Post by KlangFool » Tue Apr 21, 2020 5:39 pm

smitcat wrote:
Tue Apr 21, 2020 5:18 pm
KlangFool wrote:
Tue Apr 21, 2020 2:33 pm
Folks,

Sweden population -> 10.23 million
Norway population -> 5.368 million

https://wuflu.live/

Sweden total death -> 1765
Norway Total death -> 182

Total death per 1 million population

Sweden -> 172.5
Norway -> 33.9

The USA number is 128.

KlangFool
In our area of the US it is very clear that both African Americans and Latino Americans are being adversely affected by this virus by a huge margin.
It is becoming pretty clear that preexisting conditions, age and ethnic background play a role in the severity of this virus.
I am not sure how many folks of African and Latino heritage are in Sweden and Norway.
Here is one link describing the differences based on ethnicity...
https://www.vox.com/coronavirus-covid19 ... -infection
smitcat,

<<In our area of the US it is very clear that both African Americans and Latino Americans are being adversely affected by this virus by a huge margin.>>

And, your point is?

It is obvious that if you are poor, you will be adversely affected.

KlangFool

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Re: Bogleheads community discussion - Coronavirus

Post by AlphaLess » Tue Apr 21, 2020 5:47 pm

About a 6 weeks ago, I purchased two Pulse Oximeters from Target. I think these are incredibly useful. In my household, we measure our oxygen level a few times a day.

Here is an article emphasizing the importance of doing so:

https://www.nytimes.com/2020/04/20/opin ... monia.html
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Re: Bogleheads community discussion - Coronavirus

Post by tadamsmar » Tue Apr 21, 2020 5:48 pm

veggivet wrote:
Tue Apr 21, 2020 2:50 pm
rkhusky wrote:
Tue Apr 21, 2020 2:23 pm
veggivet wrote:
Tue Apr 21, 2020 1:38 pm
(By the way, it was SARS.)
SARS was 2002-2004. MERS in S. Korea was 2015.
Thank you for the correction.
MERS caused 38 deaths in S. Korea. It was found that their first case was not initially forthcoming to public health officials about his travels and he infected dozens of people. This and some other quarantine violators caused extreme public outrage leading to passage of very strict reporting and quarantine laws in 2015 that have facilitated a strong public health effort against covid-19:

https://www.nytimes.com/2015/06/27/worl ... flaws.html

But I have read that SARS played a role too. They had had it with coronavirus epidemics.
Last edited by tadamsmar on Tue Apr 21, 2020 5:51 pm, edited 2 times in total.

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Re: Bogleheads community discussion - Coronavirus

Post by smitcat » Tue Apr 21, 2020 5:48 pm

KlangFool wrote:
Tue Apr 21, 2020 5:39 pm
smitcat wrote:
Tue Apr 21, 2020 5:18 pm
KlangFool wrote:
Tue Apr 21, 2020 2:33 pm
Folks,

Sweden population -> 10.23 million
Norway population -> 5.368 million

https://wuflu.live/

Sweden total death -> 1765
Norway Total death -> 182

Total death per 1 million population

Sweden -> 172.5
Norway -> 33.9

The USA number is 128.

KlangFool
In our area of the US it is very clear that both African Americans and Latino Americans are being adversely affected by this virus by a huge margin.
It is becoming pretty clear that preexisting conditions, age and ethnic background play a role in the severity of this virus.
I am not sure how many folks of African and Latino heritage are in Sweden and Norway.
Here is one link describing the differences based on ethnicity...
https://www.vox.com/coronavirus-covid19 ... -infection
smitcat,

<<In our area of the US it is very clear that both African Americans and Latino Americans are being adversely affected by this virus by a huge margin.>>

And, your point is?

It is obvious that if you are poor, you will be adversely affected.

KlangFool
"It is obvious that if you are poor, you will be adversely affected."
The ones of color that I know are not poor - in any event I do not see the relationship between that and a mortality rate from a virus.

"And, your point is?"
Genetic background is likely one key parameter in the affects this specific virus has on the population. When comparing testing, treatment, severity, death rates, etc we will need to refine the results and what we learn by all of the background information about the persons affected.

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Re: Bogleheads community discussion - Coronavirus

Post by tadamsmar » Tue Apr 21, 2020 5:54 pm

JAZZISCOOL wrote:
Tue Apr 21, 2020 3:05 pm
tadamsmar wrote:
Tue Apr 21, 2020 2:10 pm
KyleAAA wrote:
Tue Apr 21, 2020 11:55 am
It's important to note that many people are saying Sweden has done "nothing." That is not true. They've probably socially distanced more than most areas of the US, they've just been able to do it without needing a government lockdown. It is not an example of "did nothing" that many people are saying it is.
50% of Swedish households are single-person, highest in the EU. It's 30% in the US.
That's very interesting. I wonder what the driving force is behind this vs. the US.
Not completely sure. I have read that part of it is that kids leave home relatively early to live alone in apartments.

folkher0
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Re: Bogleheads community discussion - Coronavirus

Post by folkher0 » Tue Apr 21, 2020 6:16 pm

smitcat wrote:
Tue Apr 21, 2020 5:18 pm
KlangFool wrote:
Tue Apr 21, 2020 2:33 pm
Folks,

Sweden population -> 10.23 million
Norway population -> 5.368 million

https://wuflu.live/

Sweden total death -> 1765
Norway Total death -> 182

Total death per 1 million population

Sweden -> 172.5
Norway -> 33.9

The USA number is 128.

KlangFool
In our area of the US it is very clear that both African Americans and Latino Americans are being adversely affected by this virus by a huge margin.
It is becoming pretty clear that preexisting conditions, age and ethnic background play a role in the severity of this virus.
I am not sure how many folks of African and Latino heritage are in Sweden and Norway.
Here is one link describing the differences based on ethnicity...
https://www.vox.com/coronavirus-covid19 ... -infection
Many conditions more adversely affect African Americans and Latinos in the US. Health care disparities are common.

This is a worldwide affair with widespread fatalities on 3 continents (and counting). I could be wrong but I doubt there were many of African or Latino heritage in Wuhan.

One of the hardest hit communities in NYC has been Orthodox Jews.

A virus is a social disease. It spreads rapidly and overwhelms communities who are in close proximity. In New York these are often ethnic minorities. In the US, these groups often have lower socioeconomic status and concomitantly lower overall health.

I have also seen covid kill relatively young and healthy people without such risk factors.

In my opinion, (FWIW) the reason some parts of the world have seen overwhelming COVID and others is simple. In areas where disease prevalence becomes high, many will get sick and die. Health systems are overwhelmed. It’s a disaster. Most likely to die are the most vulnerable. Whether that means advanced age, comorbid conditions, or low SES.

Remember, for the first few years of the HIV/AIDS crisis many people thought incorrectly that the virus was only a problem in gay men. Well of course we know that’s not true, this was just an early group where the prevalence became very high.

Why are some places doing well? What about S. Korea? Simple. Low prevalence. Maybe that’s because of a good public health policy or favorable social structure. I don’t know. But at some point, people will get infected. Might be next week. Might be 6 months. I don’t know. But if your locale has a low prevalence of COVID, everything might look fine. If you are in an area of high prevalence, you get smoked.

So what’s the prevalence? We don’t know, even in NYC. We can’t know unless we truly know how many people are asymptomatic. Several studies have been published, most deeply, deeply flawed in my opinion.

I can tell you that even in NYC, I estimate the prevalence to be far lower than what is required for group or herd immunity. Why do I say that? Because we test everyone who comes in the ER with any symptoms that could be COVID. Even in those I think have covid only about 50% have it.

You may say well the NPV of a covid test is only 60%. Your missing people. Sure. But then I retest them and follow them clinically. Most of these folks turn out to have another etiology for their symptoms that is not covid. I could be wrong of course. But there’s just not much good data about the prevalence of disease in NYC yet.

So in my practice in NYC even people who I think HAVE COVID don’t have covid what do you think the prevalence is in your location? Probably way lower.

Anyway, we can’t keep everyplace low prevalence forever. Wherever you are, if you live in society, this virus will come to your town. It’s just a matter of how quick.

And that part is up to you. There are no shortcuts. Sorry It’s just the way it is.

EnjoyIt
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Re: Bogleheads community discussion - Coronavirus

Post by EnjoyIt » Tue Apr 21, 2020 6:44 pm

KlangFool wrote:
Tue Apr 21, 2020 4:12 pm
EnjoyIt wrote:
Tue Apr 21, 2020 3:19 pm


I know you don’t agree with me, but once you can rationalize exactly what information a nasopharyngeal swab provides and more importantly what it does not provide, I’m sure you too would understand why mass testing is not required to move forward.

Yes, more testing will be beneficial especially if we can pair it with antibody screening if immunity is actually possible.
EnjoyIt,

For a normal non-medical person, antibody screening is part of the testing too.

Testing = diagnostic testing + antibody screening.

Testing = a method and procedure to detect whether someone is or was infected with Coronavirus. To move forward, we need to scale up our testing capacity and velocity. We do not have enough at this moment. For both diagnostic and antibody screening, we need more reagents.

KlangFool
Can you please elaborate what you mean by "move forward?"
A time to EVALUATE your jitters. | https://www.bogleheads.org/forum/viewtopic.php?f=10&t=79939&start=400#p5275418

EnjoyIt
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Re: Bogleheads community discussion - Coronavirus

Post by EnjoyIt » Tue Apr 21, 2020 6:50 pm

KlangFool wrote:
Tue Apr 21, 2020 5:39 pm
smitcat wrote:
Tue Apr 21, 2020 5:18 pm
KlangFool wrote:
Tue Apr 21, 2020 2:33 pm
Folks,

Sweden population -> 10.23 million
Norway population -> 5.368 million

https://wuflu.live/

Sweden total death -> 1765
Norway Total death -> 182

Total death per 1 million population

Sweden -> 172.5
Norway -> 33.9

The USA number is 128.

KlangFool
In our area of the US it is very clear that both African Americans and Latino Americans are being adversely affected by this virus by a huge margin.
It is becoming pretty clear that preexisting conditions, age and ethnic background play a role in the severity of this virus.
I am not sure how many folks of African and Latino heritage are in Sweden and Norway.
Here is one link describing the differences based on ethnicity...
https://www.vox.com/coronavirus-covid19 ... -infection
smitcat,

<<In our area of the US it is very clear that both African Americans and Latino Americans are being adversely affected by this virus by a huge margin.>>

And, your point is?

It is obvious that if you are poor, you will be adversely affected.

KlangFool
I believe it is less to do with socioeconomic status and more to do with pre-existing conditions. In the US some races have a higher prevalence to having high blood pressure and diabetes as well as being overweight. The older Chineses data also shows worse outcomes for people with pre-existing conditions.

I'm sure you are aware that being poor or being middle class does not change the medical care one gets in US hospitals. The very rich have the option of paying for more care. It may not be better but definitely more.
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Re: Bogleheads community discussion - Coronavirus

Post by KlangFool » Tue Apr 21, 2020 7:12 pm

EnjoyIt wrote:
Tue Apr 21, 2020 6:44 pm
KlangFool wrote:
Tue Apr 21, 2020 4:12 pm
EnjoyIt wrote:
Tue Apr 21, 2020 3:19 pm


I know you don’t agree with me, but once you can rationalize exactly what information a nasopharyngeal swab provides and more importantly what it does not provide, I’m sure you too would understand why mass testing is not required to move forward.

Yes, more testing will be beneficial especially if we can pair it with antibody screening if immunity is actually possible.
EnjoyIt,

For a normal non-medical person, antibody screening is part of the testing too.

Testing = diagnostic testing + antibody screening.

Testing = a method and procedure to detect whether someone is or was infected with Coronavirus. To move forward, we need to scale up our testing capacity and velocity. We do not have enough at this moment. For both diagnostic and antibody screening, we need more reagents.

KlangFool
Can you please elaborate what you mean by "move forward?"
Re-opening of the economy. The total shutdown is not a sustainable solution.

KlangFool

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Re: Bogleheads community discussion - Coronavirus

Post by VictoriaF » Tue Apr 21, 2020 7:16 pm

AlphaLess wrote:
Tue Apr 21, 2020 5:47 pm
About a 6 weeks ago, I purchased two Pulse Oximeters from Target. I think these are incredibly useful. In my household, we measure our oxygen level a few times a day.

Here is an article emphasizing the importance of doing so:

https://www.nytimes.com/2020/04/20/opin ... monia.html
I was looking for an Oximeter for a while now. On Amazon, it occasionally shows up for $50-$60 from untrustworthy sellers. Target lists it for $37, but it's not available for hundreds of miles from where I live or as a mail order. Costco does not list Oximeters at all.

I refuse getting COVID-19 until I get an Oximeter.

Victoria
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Re: Bogleheads community discussion - Coronavirus

Post by KyleAAA » Tue Apr 21, 2020 7:17 pm

EnjoyIt wrote:
Tue Apr 21, 2020 6:50 pm
I believe it is less to do with socioeconomic status and more to do with pre-existing conditions. In the US some races have a higher prevalence to having high blood pressure and diabetes as well as being overweight. The older Chineses data also shows worse outcomes for people with pre-existing conditions.
Is it possible there's a connection?

folkher0
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Re: Bogleheads community discussion - Coronavirus

Post by folkher0 » Tue Apr 21, 2020 7:32 pm

VictoriaF wrote:
Tue Apr 21, 2020 7:16 pm
AlphaLess wrote:
Tue Apr 21, 2020 5:47 pm
About a 6 weeks ago, I purchased two Pulse Oximeters from Target. I think these are incredibly useful. In my household, we measure our oxygen level a few times a day.

Here is an article emphasizing the importance of doing so:

https://www.nytimes.com/2020/04/20/opin ... monia.html
I was looking for an Oximeter for a while now. On Amazon, it occasionally shows up for $50-$60 from untrustworthy sellers. Target lists it for $37, but it's not available for hundreds of miles from where I live or as a mail order. Costco does not list Oximeters at all.

I refuse getting COVID-19 until I get an Oximeter.

Victoria
A few years ago I was in Africa. One of the nurse practitioners brought one of the little thumb ones with her. It was so useful it was like a little portable icu.

Anyway. I remembered how useful it was a few weeks ago So bought one on amazon a few weeks ago. It was like 20-30 bucks. Arrived very quickly. Seems to work well, though I haven’t compared it to anything. Nice to have just in case.

I didn't overthink it just got a cheap one. But if it's just a difference of a few bucks it might be worth the piece of mind to get a better one

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Re: Bogleheads community discussion - Coronavirus

Post by VictoriaF » Tue Apr 21, 2020 8:02 pm

folkher0 wrote:
Tue Apr 21, 2020 7:32 pm
VictoriaF wrote:
Tue Apr 21, 2020 7:16 pm
AlphaLess wrote:
Tue Apr 21, 2020 5:47 pm
About a 6 weeks ago, I purchased two Pulse Oximeters from Target. I think these are incredibly useful. In my household, we measure our oxygen level a few times a day.

Here is an article emphasizing the importance of doing so:

https://www.nytimes.com/2020/04/20/opin ... monia.html
I was looking for an Oximeter for a while now. On Amazon, it occasionally shows up for $50-$60 from untrustworthy sellers. Target lists it for $37, but it's not available for hundreds of miles from where I live or as a mail order. Costco does not list Oximeters at all.

I refuse getting COVID-19 until I get an Oximeter.

Victoria
A few years ago I was in Africa. One of the nurse practitioners brought one of the little thumb ones with her. It was so useful it was like a little portable icu.

Anyway. I remembered how useful it was a few weeks ago So bought one on amazon a few weeks ago. It was like 20-30 bucks. Arrived very quickly. Seems to work well, though I haven’t compared it to anything. Nice to have just in case.

I didn't overthink it just got a cheap one. But if it's just a difference of a few bucks it might be worth the piece of mind to get a better one
I'll check Amazon again. I don't mind to spend a few dollars for the peace of mind, but it seems that Amazon has run out of all peace-of-mind oxymeters. The ones remaining are offered by speculators with little assurance of quality or even existence.

Victoria
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Re: Bogleheads community discussion - Coronavirus

Post by AlphaLess » Tue Apr 21, 2020 8:36 pm

VictoriaF wrote:
Tue Apr 21, 2020 7:16 pm
AlphaLess wrote:
Tue Apr 21, 2020 5:47 pm
About a 6 weeks ago, I purchased two Pulse Oximeters from Target. I think these are incredibly useful. In my household, we measure our oxygen level a few times a day.

Here is an article emphasizing the importance of doing so:

https://www.nytimes.com/2020/04/20/opin ... monia.html
I was looking for an Oximeter for a while now. On Amazon, it occasionally shows up for $50-$60 from untrustworthy sellers. Target lists it for $37, but it's not available for hundreds of miles from where I live or as a mail order. Costco does not list Oximeters at all.

I refuse getting COVID-19 until I get an Oximeter.

Victoria
Solid plan, Victoria. I agree.

Around 6 weeks ago, I got a few. Shipped one each to old relatives. Got 2 for us.

Oximeter should be an essential tool in every household, along with these:
- thermometer (preferably, ONE per household member, so that in case each get sick, you don't re-use; plus an extra),
- blood pressure monitor,
- oximeter,
- glucose monitor,
- a fairly robust medicine cabinet,
- UVC sanitizer box,
- a selection of disinfecting products (70% ethyl spray, clorox wipes, lysol spray, clorox spray, combination of different chemicals. chlorine works best, but benzalkonium chloride needed too as chlorine too hard and can discolor),
- masks,
- gloves.
"A Republic, if you can keep it". Benjamin Franklin. 1787. | Party affiliation: Vanguard. Religion: low-cost investing.

typical.investor
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Re: Bogleheads community discussion - Coronavirus

Post by typical.investor » Tue Apr 21, 2020 8:37 pm

rkhusky wrote:
Tue Apr 21, 2020 12:13 pm
veggivet wrote:
Tue Apr 21, 2020 12:03 pm
If the US population was more immunocompromised than other countries', one would expect overall death rates from infectious diseases like the flu to be statistically significantly higher, which they are not. You can tiptoe blindfolded around the edge of the room all you like, but the elephant will still be standing in the middle of it when you open your eyes.
The main factor is the general level of health of the population.
Perhaps, but I don't think the elderly in Japan are that healthy.
rkhusky wrote:
Tue Apr 21, 2020 12:13 pm
A secondary factor is the authoritarian extent of the government.
Legally, nobody in Japan really has the power to do the things being done in the States. Stay at home orders are voluntary. Closures are voluntary.

rkhusky wrote:
Tue Apr 21, 2020 12:13 pm
edit: Forgot to add that S. Korea learned from their experience with MERS. US got complacent after dodging bullets from SARS, MERS, H1N1, Zika, and Ebola, although there was some effort to shore up supplies after SARS. "Past Performance Is Not Indicative Of Future Results"
Perhaps the level of hygiene in some places is better than others.

Personally I find America very often filthy. The way the toilet is so often in the same room as the sink where you brush your teeth or shower. It's like there is no concept of the aerosols floating around from when you flush the toilet.

Perhaps the general level of health of the population explains things, but the level of hygiene is surely more significant that level of authority. In NY you can currently report people for violating social distancing measures and face a $1,000 fine. In Tokyo, if things get worse and they move to the next level, the Gov. will legally be able to disclose your name as a violator. Wow.

I'd say rather many Americans are failing in their personal responsibility because it isn't clear to them how a mask will benefit them. It's been a long fight getting people to understand it actually benefits others and their wearing a mask benefits you. Conceptually challenging to too many it seems.

Interestingly, a recent study found obesity put you more at risk for COVID-19 hospitalizations than even those with respiratory or heart conditions or diabetes. https://www.newsweek.com/obesity-covid- ... on-1497791

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wshang
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Re: Bogleheads community discussion - Coronavirus

Post by wshang » Tue Apr 21, 2020 9:03 pm

KyleAAA wrote:
Tue Apr 21, 2020 7:17 pm
EnjoyIt wrote:
Tue Apr 21, 2020 6:50 pm
I believe it is less to do with socioeconomic status and more to do with pre-existing conditions. In the US some races have a higher prevalence to having high blood pressure and diabetes as well as being overweight. The older Chineses data also shows worse outcomes for people with pre-existing conditions.
Is it possible there's a connection?
ACE2 connects all the dots. (metabolic syndrome, prediabetes, obesity, DM, hypertension, COPD, vaping, air pollution, inactivity, peripheral and cardiovascular disease) All these people have activated renin-angiotensin systems leading to ARDS, Covid-19 heart, renal and microthrombi related damage.
75% of African Americans have HTN by age 55. Wuhan has a 2.5PM of 80, (WHO lists 35 has the highest level of air pollution). Air pollution leads to lung damage and hypertension. Even children in China in these regions have elevated BP. The virus doesn't discriminate who it infects, but accelerates the underlying disease process.

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wshang
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Re: Bogleheads community discussion - Coronavirus

Post by wshang » Tue Apr 21, 2020 9:16 pm

EnjoyIt wrote:
Tue Apr 21, 2020 3:19 pm
KlangFool wrote:
Tue Apr 21, 2020 11:19 am
We cannot move forward without more testing
I know you don’t agree with me, but once you can rationalize exactly what information a nasopharyngeal swab provides and more importantly what it does not provide, I’m sure you too would understand why mass testing is not required to move forward.

Yes, more testing will be beneficial especially if we can pair it with antibody screening if immunity is actually possible.
For a lay person this sounds very straightforward. The FDA has granted unprecedented leeway in testing (quoted from their website):

https://www.fda.gov/news-events/press-a ... on-efforts
the FDA issued a policy explaining that FDA does not intend to object when developers of serological tests market or use their tests without prior FDA review where: 1) the tests are validated by the developer to determine that they are accurate and reliable, 2) notification of the developer’s validation is provided to FDA, and 3) the tests are labeled appropriately, including that they are not to be used as a sole basis for diagnosis.

we don’t yet know that just because someone has developed antibodies, that they are fully protected from reinfection, or how long any immunity lasts.
Nobody knows what antibody level cutoff to use because none has been scientifically established. In contrast to the CDC's overly strict policy which delayed testing, the FDA is going the other direction. Its going to be a Wild Wild West in serologic testing.

typical.investor
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Re: Bogleheads community discussion - Coronavirus

Post by typical.investor » Tue Apr 21, 2020 9:29 pm

folkher0 wrote:
Tue Apr 21, 2020 6:16 pm
In my opinion, (FWIW) the reason some parts of the world have seen overwhelming COVID and others is simple. In areas where disease prevalence becomes high, many will get sick and die. Health systems are overwhelmed. It’s a disaster. Most likely to die are the most vulnerable. Whether that means advanced age, comorbid conditions, or low SES.
I question that.

I would argue that even with same degree of disease prevalence, the number of hospitalizations and deaths can be very, very different.

We know that the amount of particles a person is exposed to can affect how likely they are to become infected and, once infected, how severe the symptoms become.

Thus, even with the same degree of prevalence, an area that takes measures to reduce the spread of infectious particles will have fewer and milder cases than one that doesn't.

And we know that if Covid-19 is like MERS, SARS and influenza, (it looks like it but data is preliminary) then disease severity is correlated with viral load and how many germs an infected person is spitting out which it turn will affect the number of people they infect and the severity of those infections.

So I contend that without measures to reduce the amount of particulates spread by each infected person, that the degree of disaster will be much higher than in places where such measures are used.

What we see in the world today is that those places which took measures or had the habit of reducing the spread of particulates, even by those who are not known to be infected, have not reached the level of crisis where such measures were taken late or are still not taken.

folkher0
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Re: Bogleheads community discussion - Coronavirus

Post by folkher0 » Tue Apr 21, 2020 10:09 pm

typical.investor wrote:
Tue Apr 21, 2020 9:29 pm

I question that.

I would argue that even with same degree of disease prevalence, the number of hospitalizations and deaths can be very, very different.

We know that the amount of particles a person is exposed to can affect how likely they are to become infected and, once infected, how severe the symptoms become.

Thus, even with the same degree of prevalence, an area that takes measures to reduce the spread of infectious particles will have fewer and milder cases than one that doesn't.

And we know that if Covid-19 is like MERS, SARS and influenza, (it looks like it but data is preliminary) then disease severity is correlated with viral load and how many germs an infected person is spitting out which it turn will affect the number of people they infect and the severity of those infections.

So I contend that without measures to reduce the amount of particulates spread by each infected person, that the degree of disaster will be much higher than in places where such measures are used.

What we see in the world today is that those places which took measures or had the habit of reducing the spread of particulates, even by those who are not known to be infected, have not reached the level of crisis where such measures were taken late or are still not taken.
Nope.

Not how Infection works.

SOME of what you just wrote is ok. ALOT of what you just wrote is false and the argument you make is just wrong.

Sure, the number of particles you are exposed to may affect the LIKELIHOOD that you will become infected. If you are exposed to only one viral particle you probably won't get infected. If you get exposed to 10 million particles, you are more likely to get infected. Various factors will make the likelihood a given individual will contract the infection change (imunocompromise, nurtritional status, chronic kidney failure, etc). But I'm not sure anyone knows how much SARS CoV2 the average person needs to be exposed to in order to develop COVID, but I could be wrong.

But you get off course when you talk about viral load. I think you misunderstand the concept.

Once you are infected the size of the initial innoculum is irrelevant. The virus replicates many million-fold larger than the initial exposure You may or may not shed more virus, I don’t know.In many cases, disease severity can be correlated to viral load in the infected person. But the phrase “viral load” does not refer to the number of viral particles you are exposed to. Viral load is the number of viral particles or "copies" circulating in a host. When doctors talk about viral load (HIV, HCV, HBV, many others) we usually talk about circulating viral particles isolated from the blood or other fluid of a patient, which can correlate to disease severity.

So when you say “We know that the amount of particles a person is exposed to can affect how likely they are to become infected and, once infected, how severe the symptoms become,” you are making a weird argument. The first clause in your sentence is ok. The second clause is speculation based on no infectious disease concept that I am aware of.

By your logic asymptomatic carriers would not transmit the infection to a significant degree because hocus pocus mumbo jumbo Gwenyth Paltrow they shed less virus because their disease is less severe and so they people they infect will have less severe disease and so on...

I also take some issue with your last sentence "What we see in the world today is that those places which took measures or had the habit of reducing the spread of particulates..." Some places in the world are absolutely doing better than others. For now. We don't know why for sure. I happen to think S. Korea, Germany, New Zealand have all taken different approaches that have gotten them through this first wave in pretty good shape. But by no means can we attribute that to reducing the spread of particles. That's just speculation. Its the same ecologic argument again. "I see people wearing masks, AND They have less disease (so far) THEREFORE masks prevent disease" Maybe true, may not, but I believe there's alot more going on than just masks. The masks are just so visible and obvious and easy...

I didn't want to get dragged into the masks again....

Anyway...Prevalence.

Prevalence is a simple concept. It’s the number of infected persons divided by the total population at a given time. In the case of covid we don’t know the numerator. The higher the prevalence the higher the proportion of a population is infected at a given time. The higher the prevalence, the higher the likelihood that you will stand next to someone on the subway who is shedding virus. That’s why exponential growth is a thing. The more people who have it the more people get it.

It’s that simple.

We can do things to decrease transmission. Social distancing, hand hygiene, and I’ll even give you your masks.

But you can’t escape the math. The more people are actively infected, the more people BECOME infected by interacting with them. The RATE that this happens at may be variable, and is VERY dependent on our behavior. And if you are really good at hygiene you might be one of the minority who make it all the way to herd immunity without becoming infected. If and when that glorious day happens, the Prevalence of COVID will have decreased to a very low level because so many are immune that the virus cannot find a host to infect. Even without a vaccine, the likelihood you, the king/queen of social distancing mask wearing hand hygiene, overall good social behavior will be protected by the herd, even without a vaccine.
Last edited by folkher0 on Tue Apr 21, 2020 10:52 pm, edited 5 times in total.

Teague
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Re: Bogleheads community discussion - Coronavirus

Post by Teague » Tue Apr 21, 2020 10:40 pm

Thank you folkher0 for your continuing invaluable contributions in this thread, especially these very much appreciated injections of facts.

And also for the hocus pocus Paltrow incantation, which I'm still laughing at. :D
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