Bogleheads community discussion - Coronavirus

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ImUrHuckleberry
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Re: Bogleheads community discussion - Coronavirus

Post by ImUrHuckleberry » Thu Mar 26, 2020 9:37 pm

tadamsmar wrote:
Thu Mar 26, 2020 8:15 pm
ebrasmus21 wrote:
Thu Mar 26, 2020 7:06 pm
Cash is King wrote:
Thu Mar 26, 2020 6:41 pm
KyleAAA wrote:
Thu Mar 26, 2020 6:30 pm
Cash is King wrote:
Thu Mar 26, 2020 6:28 pm


You can draw your own conclusion. I tend to believe what Dr. Birx said today about the math behind the modeling.
What did she say?
To paraphrase, Dr. Birx said that the UK had reduced their prediction of deaths from 500,000 to under 20,000. She said the math behind the originally models were flawed to have such a drastic change. Again, I'm paraphrasing. I think it's worth listening to your comments today.
Do these estimates really having any practical meaning at all? The experts we are all relying on, in the span of about 1 week, changed their numbers from 500,000 to less than 20,000. How are we supposed to rely on any of this information?
The 20,000 comes from this Oxford study:

https://nypost.com/2020/03/24/coronavir ... tudy-says/

The idea is that there are many more UK infections than we think. This means that the proportion of fatalities is lower than we think, and that UK is close to herd immunity.

It should be easy to determine if about half the Brits have antibodies. You just have to sample 100 Brits to get an pretty good estimate. An antibody test was developed and used a month ago in Singapore and put on the market. But Brix seemed to be waiting for an easier test or something.
The 500,000 versus 20,000 deaths studies we have been talking about recently in the thread both come from Imperial College studies conducted by Neil Ferguson. The 500,000 was based on "do nothing" while the 20,000 was based on intensive social distancing. The Oxford study was a completely different study with a different reasoning for 20,000 deaths (i.e. - the reason you mentioned).

https://www.nationalreview.com/corner/c ... edictions/

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Ramjet
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Re: Bogleheads community discussion - Coronavirus

Post by Ramjet » Thu Mar 26, 2020 9:39 pm

7eight9 wrote:
Thu Mar 26, 2020 6:47 pm
SteadyOne wrote:
Thu Mar 26, 2020 6:43 pm
surfstar wrote:
Thu Mar 26, 2020 4:33 pm
knpstr wrote:
Thu Mar 26, 2020 4:30 pm
surfstar wrote:
Thu Mar 26, 2020 4:12 pm


That was fast.
#1 with a bullet.
but not #1 in deaths
Be patient.
If we can believe numbers from China. Who knows how many people died from this virus there.
I think we have to believe the numbers from China.

If we start doubting them then we go down a slippery slope where everyone's numbers are suspect.
I know people that live near Wuhan

I don't believe China's numbers

folkher0
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Re: Bogleheads community discussion - Coronavirus

Post by folkher0 » Thu Mar 26, 2020 10:21 pm

Unladen_Swallow wrote:
Thu Mar 26, 2020 4:01 pm
folkher0 wrote:
Thu Mar 26, 2020 3:24 pm
And (in my opinion) Dr. Oz is not a reliable source for medical information. He is maybe one notch above Gwenyth Paltrow.
This is a nonsensical statement. Oz is interviewing other physicians actually treating patients. His own qualification is irrelevant. Doctor Oz could be Gwyneth Paltrow for all I care, nothing changes about the testimony from the folks he is talking to.

If one is honest, they can review the testimony of 100s of physicians and Infectious Disease specialists from all over the world that are sharing their experiences. Directors of hospitals, research centers etc are being very candid. Or one could listen to sources that validate their personal biases.

People have beliefs they hold on to...in spite of everything. Because opening their mind could comprise some other politucal or other sacred cow.
Dr. Oz chooses who he interviews in order to present a narrative of his choosing. The narrative he presents is designed to generate views, which generates revenue for Dr. Oz. His narrative is meant to reassure you. You find his show comforting so you click. You watch the ads. He gets revenue. Oz interviews physicians treating patients. He didn't interview me or anyone in my hospital. He picked the interviews to tell a story he wanted to tell.

It so-called infotainment. Many on this site deride so called "financial porn." Shows like Mad Money or whatever is on CNBC these days. Dr. Oz is the medical equivalent.

Its not about a "belief that I hold on to...in spite of everything." I think I have a pretty open mind when it comes to medicine. And this is not a political discussion.

I would hope that your doctor uses established guidelines, peer reviewed literature, and the recommendation of board certified specialists with whom they work with every day and trust to guide decision making. Not cherry picked anecdotes on a youtube video that was produced in order to generate clicks.

Like I said. Our ID docs advise to give hydroxychloroquine and azithromycin, largely because the risk/benefit when someone has COVID favors giving it a shot, not because we have any great expectation that it will work. Its not some secret formula. It has not worked for any of my cases.

Let me ask you:do you think any doctor would withhold a cheap, (relatively) plentiful generic medication if it could save someones life?

I'll ask you another question. Looking at the numbers around the world and in the US. Do you think its working?

This is not about being open minded. This is about false hopes and snake oil.

nigel_ht
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Re: Bogleheads community discussion - Coronavirus

Post by nigel_ht » Thu Mar 26, 2020 10:44 pm

folkher0 wrote:
Thu Mar 26, 2020 10:21 pm
This is not about being open minded. This is about false hopes and snake oil.
The grapevine has it that California has the Chinese strain but NYC/east coast has the Italian one and Seattle got both maybe even some from Iran.

How much is true and how much is docs speculating I dunno. Should be easy to verify but nobody I know has that info.

Could mean you get regional differences in efficacy but yes that’s just being hopeful as there are no conclusive studies at present that show it works.

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JAZZISCOOL
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Re: Bogleheads community discussion - Coronavirus

Post by JAZZISCOOL » Thu Mar 26, 2020 10:56 pm

ThankYouJack wrote:
Thu Mar 26, 2020 8:36 pm
Here's an interview with Bill Gates:

https://youtu.be/Xe8fIjxicoo

Definitely thinks there needs to be a strong push for testing.

Jotted a couple notes if you don't want to listen to the full thing:
2:30 (did people listen to your pandemic warning 5 years ago?) Basically no.

7:12 (when was it clear this could be a deadly pandemic) In January, human to human transmission - made his alarm bells ring. On Jan. 23 China did its version of the shutdown. Let's get our act together with testing, therapeutics and vaccines. We've got to get organized.

8:45 (what was going on behind the scenes during that period) Well you'd like to have government money show up for the key activities. We put up $100M, created the therapeutic accelerator. I think the most important thing today is we're still not creating the testing capacity and giving it to the people who are most in need. The testing has got to be organized and is super super urgent. The second thing is the isolation. The sooner you do it in a tough way, the sooner you can undo it.

11:00 (what happened with testing) We certainly didn't take advantage of the month of February. Sent info to the FDA that the accuracy of an individual test selfing is about the same as a HCP doing it.

13:11 (how well testing work) It's pretty chaotic today because the government hasn't stepped in to make sure the testing capacity both increased and is used in the right cases. There will be a website where you can get kits. The testing is everything because that's where you know if you need to do more shutdown or you're getting to the point where you can relieve it.

14:30 (testing absolutely essential) The 2 that go together are testing and isolation piece. Testing is what indicates to you, do you need to into isolation and not spread. So that is paired with the isolation piece. If you don't do these things that where you get to the huge overload of the medical system.

17:00 (thoughts on isolation strategy and crashing the economy) Very tough to say to people keep going to restaurants, go buy houses, ignore that pile of bodies in the corner because we want you to keep spending because maybe some politician cares that GDP growth is what really counts...I don't know of any rich countries that have chosen to use that approach. Herd immunity is meaningless until you infect over half the population. It's very irresponsible for someone to suggest we could have the best of both worlds.

18:00 S. Korea did not have to do the extreme shutdown because they did such a good job on testing. That's why it's so maddening to me that the government is not allocating the testing to where it's needed. And maybe that will have to happen at the state level because that's not happening on the federal level.

21:30 We did not act fast enough to avoid an ability to not have a shutdown.

22:30 Results of imperial are not matching what we're seeing in China. Seasonality may help us in the northern hemisphere. We don't know how seasonal this one is. And it's your testing that is always telling you do I have to shut down more or open up. I'm on the more optimistic side that it will be possible to do what China is doing.


26:00 (if you were President for a month, what would you do?) Prepare ourselves that we have no choice but to maintain this isolation, probably for about 6 weeks and do it very well. We need a clear message that this is not going to be easy. It is very tragic that the economy took a hit but that is easier to bring back to life.
Thanks for posting the notes. I also watched this; very worthwhile. The B & M Gates Foundation has been working with vaccines for many years from what I understand.

bayview
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Re: Bogleheads community discussion - Coronavirus

Post by bayview » Thu Mar 26, 2020 11:13 pm

folkher0 wrote:
Thu Mar 26, 2020 4:10 pm
VictoriaF wrote:
Thu Mar 26, 2020 3:50 pm
Is there a simple way to related epidemiological statistics to individual statistics? So far, we've discussed percentages of:
- exposed people
- symptomatic people
- those needing ICU
- those needing ventilators
- those dying --
depending on the locality's place on the curve and the measures such as business closing and shelter in place.

But let's consider several individuals:
- Alan is a physician at a major hospital. He sees dozens of patients many of whom test positive. His PEP is inadequate.
- Bob is a janitor in major hospital.
- Cynthia takes a densely packed subway every day.
- David visits shops every day and occasionally bumps into other people.
- Eva visits shops once a week and maintains 6ft distance.
- Frank never leaves home, has everything delivered, and thoroughly disinfects it.

Clearly, A, B, C, D, E, and F have different probabilities of being exposed to a virus. Probabilities are decreasing from the highest for A to the lowest for F.

When they do catch a virus, they catch different quantities of viruses:
For the same level of the hospital contamination, A is catching 100 viruses, but B is catching only 30 viruses.
When they encounter the same carrier in a store, D is catching 10 viruses, but E is catching only 4 viruses.

In other words, some people are in a high-risk group where both the probability of exposure and the quantity of viruses are high. Other people are in intermediate and low risk groups.

For those of us who are not in medical profession and follow the guidance of shelter in place, is there much difference in risk between behaving like David vs. Eva?
Is Frank much safer than Eva?
If Eva occasionally catches 4 units of viruses, is her immune system more likely to fight it--and develop immunity--than if she were working in a hospital with a frequent exposure to 100 units?

Victoria
These are great questions and difficult to answer. In short, in face of so many unknowns, I am striving, to the best of my ability, to be an Eva or a Frank which I am doing well this week. Last week I was Alan. So how do you tally up my risk?

As to the number of viral particles you need to be exposed to to develop the disease, I just don’t know.

What I can say is that you are unlikely to develop any immunity if you are exposed at such a low level that the virus has not infected you on some level. That level may be a point which you are asymptomatic, but can still spread the virus. To be sure, your test may still be negative because the test is not perfect and has a considerable amount of false negatives.

Further, it is very difficult for me to say with any authority what immunity to this virus means. Are you immune for life (like the measles)? Are you immune to a current strain which will likely be different at some point in the future (like the flu?). Is immunity essentially meaningless and the virus comes around again and again in a different form with varying amounts of virulence (the common cold)?

All unknowns.

That’s the best answer I can give. Maybe someone else can do better.
First of all, please let me thank you for posting here. My older daughter is a PCP at a rural clinic up in the mountains of southern Appalachia. Many of her patients have NEVER had medical care before. Her healthcare system was bought out last year by a for-profit system, and they are now tragically underprepared and undersupplied for COVID-19. She is now living in the basement apartment of her home in an attempt to protect her family, only visiting them with mask and gloves.

I would like to know your opinion on the risk of infection by healthcare providers, especially what I would call (I’m sure there’s a better term) the concentration risk of exposure.

If a person is exposed to the virus, and one particle “gets in” (gets through the mucous membranes into the body), is there a difference in actually developing disease between that person with one virus particle “succeeding” vs. another person with ten or a hundred or a thousand particles succeeding?

Meaning, at what point do the defense systems break down? Is it when the one virus particle breaks through (now having a naive and defenseless immune system in which to replicate), or is it when there are waves and waves of additional virus particles getting into the body?

If there is a difference, it would seem that a provider’s risk of infection and developing disease would be directly correlated to the number of patients seen.

And thanks for not only posting here, but much more for being on the frontlines.
The continuous execution of a sound strategy gives you the benefit of the strategy. That's what it's all about. --Rick Ferri

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eye.surgeon
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Re: Bogleheads community discussion - Coronavirus

Post by eye.surgeon » Thu Mar 26, 2020 11:36 pm

For those who might feel like the world is ending, I'm just going to post this right here...

Image

You might also read an article published today in The New England Journal of Medicine titled: “Covid-19 — Navigating the Uncharted.”

The article considers the impact of the Covid-19 pandemic, concluding:

“This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.”
"I would rather be certain of a good return than hopeful of a great one" | Warren Buffett

ImUrHuckleberry
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Re: Bogleheads community discussion - Coronavirus

Post by ImUrHuckleberry » Thu Mar 26, 2020 11:48 pm

eye.surgeon wrote:
Thu Mar 26, 2020 11:36 pm
For those who might feel like the world is ending, I'm just going to post this right here...

Image

You might also read an article published today in The New England Journal of Medicine titled: “Covid-19 — Navigating the Uncharted.”

The article considers the impact of the Covid-19 pandemic, concluding:

“This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.”
And what would the fatalities look like if most of world wasn't taking drastic measures to slow the spread? Hint: look at Northern Italy and now pretend that they hadn't taken progressively more sever action to try and stem the tide over the past 6 weeks. Now extrapolate that to the world. And remember in most places it's just getting started.

webbie90
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Re: Bogleheads community discussion - Coronavirus

Post by webbie90 » Thu Mar 26, 2020 11:52 pm

eye.surgeon wrote:
Thu Mar 26, 2020 11:36 pm
You might also read an article published today in The New England Journal of Medicine titled: “Covid-19 — Navigating the Uncharted.”

The article considers the impact of the Covid-19 pandemic, concluding:

“This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.”
I just wanted to point out that the NEJM article you cited was first published on February 28, nearly one month ago, which makes it dated in this fast-moving pandemic. The U.S. had 63 confirmed cases then. Now it has more than 85,000.

"This editorial was published on February 28, 2020, at NEJM.org."

typical.investor
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Re: Bogleheads community discussion - Coronavirus

Post by typical.investor » Fri Mar 27, 2020 12:13 am

webbie90 wrote:
Thu Mar 26, 2020 11:52 pm
eye.surgeon wrote:
Thu Mar 26, 2020 11:36 pm
You might also read an article published today in The New England Journal of Medicine titled: “Covid-19 — Navigating the Uncharted.”

The article considers the impact of the Covid-19 pandemic, concluding:

“This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.”
I just wanted to point out that the NEJM article you cited was first published on February 28, nearly one month ago, which makes it dated in this fast-moving pandemic. The U.S. had 63 confirmed cases then. Now it has more than 85,000.

"This editorial was published on February 28, 2020, at NEJM.org."
Recent data from the Diamond Princess where everyone was tested shows for that population, the case fatality rate for those infected was calculated to be 0.63%. Of course it's higher for the elderly and I don't know how old the average Diamond Princess passenger/crew were. So if the average age were higher than the general population, the fatality rate could be lower than that.

Other estimates from March 5: Lower estimates might be closest to the true value, but a broad range of 0.25%–3.0% probably should be considered. https://wwwnc.cdc.gov/eid/article/26/6/20-0320_article

I highly doubt Covid-19 is similar to SARS or MERS at least based on data available today.
Last edited by typical.investor on Fri Mar 27, 2020 12:28 am, edited 1 time in total.

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eye.surgeon
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Re: Bogleheads community discussion - Coronavirus

Post by eye.surgeon » Fri Mar 27, 2020 12:20 am

webbie90 wrote:
Thu Mar 26, 2020 11:52 pm
eye.surgeon wrote:
Thu Mar 26, 2020 11:36 pm
You might also read an article published today in The New England Journal of Medicine titled: “Covid-19 — Navigating the Uncharted.”

The article considers the impact of the Covid-19 pandemic, concluding:

“This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.”
I just wanted to point out that the NEJM article you cited was first published on February 28, nearly one month ago, which makes it dated in this fast-moving pandemic. The U.S. had 63 confirmed cases then. Now it has more than 85,000.

"This editorial was published on February 28, 2020, at NEJM.org."
So your position is that a paper published in perhaps the most esteemed peer reviewed medical journal on the planet, co-authored by Anthony Fauci, M.D, the director of the National Institute of Allergy and Infectious Diseases since 1984 and point person in the Unites States to manage the outbreak, is out of date and no longer relevant because it was published less than 4 weeks ago ?

Your standards for scientific merit are quite high.
"I would rather be certain of a good return than hopeful of a great one" | Warren Buffett

webbie90
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Re: Bogleheads community discussion - Coronavirus

Post by webbie90 » Fri Mar 27, 2020 12:31 am

[/quote]
Recent data from the Diamond Princess where everyone was tested shows for that population, the case fatality rate for those infected was calculated to be 0.63%.
[/quote]

Source for this?

This paper published March 9 estimated the case fatality ratio on the Diamond Princess to be 2.3%, or 1.2% if you include asymptomatic infections. My understanding is that there are still some passengers in serious or critical condition that may not be out of the woods yet.

https://www.medrxiv.org/content/10.1101 ... 20031773v2

This paper estimated that 79% of the passengers and crew would have been ultimately infected had isolation and quarantine measures not been implemented on the ship:

https://academic.oup.com/jtm/advance-ar ... 30/5766334

Novine
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Re: Bogleheads community discussion - Coronavirus

Post by Novine » Fri Mar 27, 2020 12:32 am

typical.investor wrote:
Fri Mar 27, 2020 12:13 am

Recent data from the Diamond Princess where everyone was tested shows for that population, the case fatality rate for those infected was calculated to be 0.63%. Of course it's higher for the elderly and I don't know how old the average Diamond Princess passenger/crew were. So if the average age were higher than the general population, the fatality rate could be lower than that.

Other estimates from March 5: Lower estimates might be closest to the true value, but a broad range of 0.25%–3.0% probably should be considered. https://wwwnc.cdc.gov/eid/article/26/6/20-0320_article

I highly doubt Covid-19 is similar to SARS or MERS at least based on data available today.
Your data is outdated. The number of deaths from the Diamond Princess has reached double digits and has pushed the fatality rate past 1.0%.

Novine
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Re: Bogleheads community discussion - Coronavirus

Post by Novine » Fri Mar 27, 2020 12:36 am

eye.surgeon wrote:
Thu Mar 26, 2020 11:36 pm
For those who might feel like the world is ending, I'm just going to post this right here...

Image

You might also read an article published today in The New England Journal of Medicine titled: “Covid-19 — Navigating the Uncharted.”

The article considers the impact of the Covid-19 pandemic, concluding:

“This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.”
That graph is garbage statistics. Comparing totals based on a 12 month total versus a disease that only emerged in most of the world in the past 3 months is completely useless. The same with the US totals. Show us the flu totals from the first 3 months of the 2017- 2018 flu season and you may have something useful.
Last edited by Novine on Fri Mar 27, 2020 12:37 am, edited 1 time in total.

webbie90
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Re: Bogleheads community discussion - Coronavirus

Post by webbie90 » Fri Mar 27, 2020 12:37 am

eye.surgeon wrote:
Fri Mar 27, 2020 12:20 am
webbie90 wrote:
Thu Mar 26, 2020 11:52 pm
eye.surgeon wrote:
Thu Mar 26, 2020 11:36 pm
You might also read an article published today in The New England Journal of Medicine titled: “Covid-19 — Navigating the Uncharted.”

The article considers the impact of the Covid-19 pandemic, concluding:

“This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.”
I just wanted to point out that the NEJM article you cited was first published on February 28, nearly one month ago, which makes it dated in this fast-moving pandemic. The U.S. had 63 confirmed cases then. Now it has more than 85,000.

"This editorial was published on February 28, 2020, at NEJM.org."
So your position is that a paper published in perhaps the most esteemed peer reviewed medical journal on the planet, co-authored by Anthony Fauci, M.D, the director of the National Institute of Allergy and Infectious Diseases since 1984 and point person in the Unites States to manage the outbreak, is out of date and no longer relevant because it was published less than 4 weeks ago ?

Your standards for scientific merit are quite high.
I never said it wasn't relevant. But a lot has transpired in the 4 weeks since Fauci wrote it. We know a lot more about the overall clinical consequences now. Italy's hospital system has been overwhelmed in parts of that country, and case fatality has skyrocketed there. Something similar could happen soon in New York City if they run out of ventilators and ICU beds.

MSO4PRN
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Re: Bogleheads community discussion - Coronavirus

Post by MSO4PRN » Fri Mar 27, 2020 12:53 am

didnt read thread, only this last page. ICU has been filling up. my hospital census is down, but nearly everyone that comes in to the ER is for cough, SOB, fevers, weakness, fatigue. nearly all are c19 +. if your not hypoxic, you are getting sent home. that study with plaquenil isnt the best imo. what the general public doesnt realize is how thin a hospital ran before this happened. theres only so many critical care docs, anesthesiologists, CRNAs, ICU nurses, resp techs, etc. that are comfortable (key word) and experienced and trained to manage ARDS (acute resp distress syndrome).

what we are seeing, is with that the majority that test positive are fine. the 10-15 that are hospitalized are fine, doing well with nasal cannula oxygen, Tylenol and what we call in the biz "supportive care"

the issue arises is when they decompensate, it happens FAST. they have an oxygen increase requirement and boom, they need intubation and ICU level care. the worst is yet to come. the infectious disease docs at my shop, predict on their models that midwest gonna get slammed april 5th - april 20th.

now keep in mind all the masks and PPE are in very short supply. equivalent would be every day you would be told you can make 3 phone calls, send 2 emails and use 3 sheets a paper PER DAY in your regular business job. gonna throw a hex in your daily workflow.

theres a reason most of the medical community is not feeling great right now.

there are people in their 30s intubated in full blown ARDS at my hospital right now. no medical comorbities.

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eye.surgeon
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Re: Bogleheads community discussion - Coronavirus

Post by eye.surgeon » Fri Mar 27, 2020 12:54 am

Novine wrote:
Fri Mar 27, 2020 12:36 am
eye.surgeon wrote:
Thu Mar 26, 2020 11:36 pm
For those who might feel like the world is ending, I'm just going to post this right here...

Image

You might also read an article published today in The New England Journal of Medicine titled: “Covid-19 — Navigating the Uncharted.”

The article considers the impact of the Covid-19 pandemic, concluding:

“This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.”
That graph is garbage statistics. Comparing totals based on a 12 month total versus a disease that only emerged in most of the world in the past 3 months is completely useless. The same with the US totals. Show us the flu totals from the first 3 months of the 2017- 2018 flu season and you may have something useful.
Since most flu deaths occur from October-May, it wouldn't be difficult. Take perhaps 1/3 of the total flu deaths to be very conservative. The graph is still quite striking don't you think? Death totals that last year didn't merit a news article are now causing mass panic. And that graph comes from the WHO, so if you feel it's garbage statistics you could take it up with them I suppose.
"I would rather be certain of a good return than hopeful of a great one" | Warren Buffett

Novine
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Re: Bogleheads community discussion - Coronavirus

Post by Novine » Fri Mar 27, 2020 1:04 am

eye.surgeon wrote:
Fri Mar 27, 2020 12:54 am
Novine wrote:
Fri Mar 27, 2020 12:36 am
That graph is garbage statistics. Comparing totals based on a 12 month total versus a disease that only emerged in most of the world in the past 3 months is completely useless. The same with the US totals. Show us the flu totals from the first 3 months of the 2017- 2018 flu season and you may have something useful.
Since most flu deaths occur from October-May, it wouldn't be difficult. Take perhaps 1/3 of the total flu deaths to be very conservative. The graph is still quite striking don't you think? Death totals that last year didn't merit a news article are now causing mass panic. And that graph comes from the WHO, so if you feel it's garbage statistics you could take it up with them I suppose.
The graph doesn't come from the WHO. It comes from a blog where someone thinks it's valid to use data from the WHO and present 12 months of activity in one column, 3 months in another and use that for comparison. When is that ever a valid comparison?

hilink73
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Re: Bogleheads community discussion - Coronavirus

Post by hilink73 » Fri Mar 27, 2020 1:32 am

Novine wrote:
Fri Mar 27, 2020 1:04 am
eye.surgeon wrote:
Fri Mar 27, 2020 12:54 am
Novine wrote:
Fri Mar 27, 2020 12:36 am
That graph is garbage statistics. Comparing totals based on a 12 month total versus a disease that only emerged in most of the world in the past 3 months is completely useless. The same with the US totals. Show us the flu totals from the first 3 months of the 2017- 2018 flu season and you may have something useful.
Since most flu deaths occur from October-May, it wouldn't be difficult. Take perhaps 1/3 of the total flu deaths to be very conservative. The graph is still quite striking don't you think? Death totals that last year didn't merit a news article are now causing mass panic. And that graph comes from the WHO, so if you feel it's garbage statistics you could take it up with them I suppose.
The graph doesn't come from the WHO. It comes from a blog where someone thinks it's valid to use data from the WHO and present 12 months of activity in one column, 3 months in another and use that for comparison. When is that ever a valid comparison?
Also, as said many times before, if even these numbers were comparable, they don't matter and a comparison to the flu is absolutely useless.

The difference to the flu is that hospitals are now getting overwhelmed and there are not enough ICUs.
It's not only that patients are dying because of Covid-19, but also other patients in need of ICUs (accident victims, etec.) cannot be treated.

You don't have that with "the flu".

[Comment removed by moderator oldcomputerguy]

phantom0308
Posts: 196
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Re: Bogleheads community discussion - Coronavirus

Post by phantom0308 » Fri Mar 27, 2020 2:13 am

eye.surgeon wrote:
Thu Mar 26, 2020 11:36 pm
For those who might feel like the world is ending, I'm just going to post this right here...

Image

You might also read an article published today in The New England Journal of Medicine titled: “Covid-19 — Navigating the Uncharted.”

The article considers the impact of the Covid-19 pandemic, concluding:

“This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.”
This is just a painfully bad comparison. One graph is global over the course of a year and the other is a highly infectious disease that hasn’t even reached its inflection point or hit most of the world yet. It hasn’t hit Africa or the rest of the developing world where death from infectious disease is so problematic. Most countries are taking significant steps to reduce transmissivity and those that didn’t do so soon enough are seeing their hospitals overwhelmed.

If this disease were no worse than the a bad flu then hospitals would cope like they do every year. It so obviously isn’t and it’s hard to understand how anyone could honestly believe that a disease crippling hospitals around Europe and the US is in any way comparable to a yearly phenomena. If you have videos from any of the last few years of flu showing people laying in the hallways of hospitals due to lack of beds or military trucks carting away corpses because the cremation facilities can’t cope, please feel free to share.

madbrain
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Re: Bogleheads community discussion - Coronavirus

Post by madbrain » Fri Mar 27, 2020 2:24 am

Barkingsparrow wrote:
Thu Mar 26, 2020 5:41 pm
A friend her works in a hospital said her hospital was pulling antibodies from the plasma of recovered patients and injecting those antibodies into the more critical patients. Anyone have information about this?
This sounds like a clinical trial.

madbrain
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Re: Bogleheads community discussion - Coronavirus

Post by madbrain » Fri Mar 27, 2020 2:41 am

folkher0 wrote:
Thu Mar 26, 2020 10:21 pm
Like I said. Our ID docs advise to give hydroxychloroquine and azithromycin, largely because the risk/benefit when someone has COVID favors giving it a shot, not because we have any great expectation that it will work. Its not some secret formula. It has not worked for any of my cases.

Let me ask you:do you think any doctor would withhold a cheap, (relatively) plentiful generic medication if it could save someones life?
I have read that patients previous taking hydroxychloroquine for chronic conditions, for which it is proven to be effective, are no longer able to refill their meds. Apparently, hospitals have been stockpiling this drug due to unproven hope that it will be effective against COVID-19. And the rightful recipients of these drugs are suffering, and may die.

I know I was reading recently about HIV meds being tried against COVID-19 also. The clinical trial failed quickly as the drugs showed no effect. It wasn't the combo I take daily, but I would be more than a little upset if my lifesaving HIV meds were withheld because someone wants to do what amounts to a mass clinical trial. I would likely have other treatment options and would not die, though, but I'm not sure existing users of hydroxychloroquine are in that same position.

folkher0
Posts: 156
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Re: Bogleheads community discussion - Coronavirus

Post by folkher0 » Fri Mar 27, 2020 3:08 am

MSO4PRN wrote:
Fri Mar 27, 2020 12:53 am
didnt read thread, only this last page. ICU has been filling up. my hospital census is down, but nearly everyone that comes in to the ER is for cough, SOB, fevers, weakness, fatigue. nearly all are c19 +. if your not hypoxic, you are getting sent home. that study with plaquenil isnt the best imo. what the general public doesnt realize is how thin a hospital ran before this happened. theres only so many critical care docs, anesthesiologists, CRNAs, ICU nurses, resp techs, etc. that are comfortable (key word) and experienced and trained to manage ARDS (acute resp distress syndrome).

what we are seeing, is with that the majority that test positive are fine. the 10-15 that are hospitalized are fine, doing well with nasal cannula oxygen, Tylenol and what we call in the biz "supportive care"

the issue arises is when they decompensate, it happens FAST. they have an oxygen increase requirement and boom, they need intubation and ICU level care. the worst is yet to come. the infectious disease docs at my shop, predict on their models that midwest gonna get slammed april 5th - april 20th.

now keep in mind all the masks and PPE are in very short supply. equivalent would be every day you would be told you can make 3 phone calls, send 2 emails and use 3 sheets a paper PER DAY in your regular business job. gonna throw a hex in your daily workflow.

theres a reason most of the medical community is not feeling great right now.

there are people in their 30s intubated in full blown ARDS at my hospital right now. no medical comorbities.
This account is similar to what I’ve seen.

folkher0
Posts: 156
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Re: Bogleheads community discussion - Coronavirus

Post by folkher0 » Fri Mar 27, 2020 3:11 am

madbrain wrote:
Fri Mar 27, 2020 2:41 am
folkher0 wrote:
Thu Mar 26, 2020 10:21 pm
Like I said. Our ID docs advise to give hydroxychloroquine and azithromycin, largely because the risk/benefit when someone has COVID favors giving it a shot, not because we have any great expectation that it will work. Its not some secret formula. It has not worked for any of my cases.

Let me ask you:do you think any doctor would withhold a cheap, (relatively) plentiful generic medication if it could save someones life?
I have read that patients previous taking hydroxychloroquine for chronic conditions, for which it is proven to be effective, are no longer able to refill their meds. Apparently, hospitals have been stockpiling this drug due to unproven hope that it will be effective against COVID-19. And the rightful recipients of these drugs are suffering, and may die.

I know I was reading recently about HIV meds being tried against COVID-19 also. The clinical trial failed quickly as the drugs showed no effect. It wasn't the combo I take daily, but I would be more than a little upset if my lifesaving HIV meds were withheld because someone wants to do what amounts to a mass clinical trial. I would likely have other treatment options and would not die, though, but I'm not sure existing users of hydroxychloroquine are in that same position.
This is a concern. Some patients need these meds which are being consumed (as are all other resources) by COVID, with likely minimal benefit.

folkher0
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Re: Bogleheads community discussion - Coronavirus

Post by folkher0 » Fri Mar 27, 2020 3:23 am

eye.surgeon wrote:
Fri Mar 27, 2020 12:54 am
Novine wrote:
Fri Mar 27, 2020 12:36 am
eye.surgeon wrote:
Thu Mar 26, 2020 11:36 pm
For those who might feel like the world is ending, I'm just going to post this right here...

Image

You might also read an article published today in The New England Journal of Medicine titled: “Covid-19 — Navigating the Uncharted.”

The article considers the impact of the Covid-19 pandemic, concluding:

“This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.”
That graph is garbage statistics. Comparing totals based on a 12 month total versus a disease that only emerged in most of the world in the past 3 months is completely useless. The same with the US totals. Show us the flu totals from the first 3 months of the 2017- 2018 flu season and you may have something useful.
Since most flu deaths occur from October-May, it wouldn't be difficult. Take perhaps 1/3 of the total flu deaths to be very conservative. The graph is still quite striking don't you think? Death totals that last year didn't merit a news article are now causing mass panic. And that graph comes from the WHO, so if you feel it's garbage statistics you could take it up with them I suppose.
Again, I encourage folks not to concentrate on the death rate, which is clearly lower than SARS, MERS, Ebola or other scary viruses.

The pandemic nature of this phenomenon means its spreading at an unprecedented pace, and a relatively large percent of these patients require inpatient and ultimately ICU care, overwhelming all hospital resources. Unlike the flu. It is happening all at once.

You are presumably an ophthalmologist. Are you in a metro area of any size? What has happened to your practice? I am a surgeon. We are shut down for all but emergent cases. We don’t have enough masks, nurses anesthesiologists or critical care beds for me to do my regular job. Everything is for COVID.

If you haven’t witnessed it I am happy for you, and hope your locale is spared.

But please stop comparing this to the flu. Pandemic COVID-19 is nothing at all like seasonal influenza.

I don’t care of the article was written by Fauci, Osler, or St. Peter. The data you site does not account for the speed of the pandemic.

ADDENDUM:

I will add that comparing this pandemic to any of the past does not taken into account how a virus spreads in 2020.

In 1919 the flu crossed the Atlantic on a boat and probably spread through the US on trucks and horses. People did not travel like to day.

‘57 and ‘68 did not have nearly the degree of international travel that we have today. China, i believer, was closed to international visitors until the 70s.

Just a different time.
Last edited by folkher0 on Fri Mar 27, 2020 3:52 am, edited 1 time in total.

folkher0
Posts: 156
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Re: Bogleheads community discussion - Coronavirus

Post by folkher0 » Fri Mar 27, 2020 3:41 am

bayview wrote:
Thu Mar 26, 2020 11:13 pm
folkher0 wrote:
Thu Mar 26, 2020 4:10 pm
VictoriaF wrote:
Thu Mar 26, 2020 3:50 pm
Is there a simple way to related epidemiological statistics to individual statistics? So far, we've discussed percentages of:
- exposed people
- symptomatic people
- those needing ICU
- those needing ventilators
- those dying --
depending on the locality's place on the curve and the measures such as business closing and shelter in place.

But let's consider several individuals:
- Alan is a physician at a major hospital. He sees dozens of patients many of whom test positive. His PEP is inadequate.
- Bob is a janitor in major hospital.
- Cynthia takes a densely packed subway every day.
- David visits shops every day and occasionally bumps into other people.
- Eva visits shops once a week and maintains 6ft distance.
- Frank never leaves home, has everything delivered, and thoroughly disinfects it.

Clearly, A, B, C, D, E, and F have different probabilities of being exposed to a virus. Probabilities are decreasing from the highest for A to the lowest for F.

When they do catch a virus, they catch different quantities of viruses:
For the same level of the hospital contamination, A is catching 100 viruses, but B is catching only 30 viruses.
When they encounter the same carrier in a store, D is catching 10 viruses, but E is catching only 4 viruses.

In other words, some people are in a high-risk group where both the probability of exposure and the quantity of viruses are high. Other people are in intermediate and low risk groups.

For those of us who are not in medical profession and follow the guidance of shelter in place, is there much difference in risk between behaving like David vs. Eva?
Is Frank much safer than Eva?
If Eva occasionally catches 4 units of viruses, is her immune system more likely to fight it--and develop immunity--than if she were working in a hospital with a frequent exposure to 100 units?

Victoria
These are great questions and difficult to answer. In short, in face of so many unknowns, I am striving, to the best of my ability, to be an Eva or a Frank which I am doing well this week. Last week I was Alan. So how do you tally up my risk?

As to the number of viral particles you need to be exposed to to develop the disease, I just don’t know.

What I can say is that you are unlikely to develop any immunity if you are exposed at such a low level that the virus has not infected you on some level. That level may be a point which you are asymptomatic, but can still spread the virus. To be sure, your test may still be negative because the test is not perfect and has a considerable amount of false negatives.

Further, it is very difficult for me to say with any authority what immunity to this virus means. Are you immune for life (like the measles)? Are you immune to a current strain which will likely be different at some point in the future (like the flu?). Is immunity essentially meaningless and the virus comes around again and again in a different form with varying amounts of virulence (the common cold)?

All unknowns.

That’s the best answer I can give. Maybe someone else can do better.
First of all, please let me thank you for posting here. My older daughter is a PCP at a rural clinic up in the mountains of southern Appalachia. Many of her patients have NEVER had medical care before. Her healthcare system was bought out last year by a for-profit system, and they are now tragically underprepared and undersupplied for COVID-19. She is now living in the basement apartment of her home in an attempt to protect her family, only visiting them with mask and gloves.

I would like to know your opinion on the risk of infection by healthcare providers, especially what I would call (I’m sure there’s a better term) the concentration risk of exposure.

If a person is exposed to the virus, and one particle “gets in” (gets through the mucous membranes into the body), is there a difference in actually developing disease between that person with one virus particle “succeeding” vs. another person with ten or a hundred or a thousand particles succeeding?

Meaning, at what point do the defense systems break down? Is it when the one virus particle breaks through (now having a naive and defenseless immune system in which to replicate), or is it when there are waves and waves of additional virus particles getting into the body?

If there is a difference, it would seem that a provider’s risk of infection and developing disease would be directly correlated to the number of patients seen.

And thanks for not only posting here, but much more for being on the frontlines.
I appreciate the situation your daughter is in. I too worry about bringing the virus home. I have no symptoms but I shower and change in the basement. No longer sleep in our bedroom. I avoid kissing my kids on the face.

I am not even a front line ER, ICU, or hospitalist. But I have diagnosed and treated several cases, been exposed to these patients who have subsequently ruled in for COVID, and join several institutional meetings every day to discuss the status of the disease at our hospital.

I can’t really answer your question though. I really have no idea how much contact will expose you to enough virus particles to transmit.

All I can really say is it sounds like she is trying to use protective equipment to the best of her ability, which ought to help. Also, when possible, we are trying to minimize our clinics to only very urgent cases. Telephone triage for symptoms and tele health, where possible.

I do know from talking to colleagues around the country that some areas of southern Appalachia have been relatively spared to this point. All things considered, I would rather be where she is than New York right now.

vested1
Posts: 1978
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Re: Bogleheads community discussion - Coronavirus

Post by vested1 » Fri Mar 27, 2020 4:35 am

mouses wrote:
Thu Mar 26, 2020 3:34 pm
Is this thread accomplishing anything? Just asking. Endless arguments about currently unknowable things, with giant included posts. I'd like to see some discussion about the structure of society, as what the effect is of giantly more jobless claims than ever, Washington disbursing giant amounts of money (where is that coming from, what effect does it have on inflation or other things of significance). That's something at least some of the people here ought to be able to discuss.

And Dr. Oz as an expert, really, how low have we sunk.
Not if those who wish to downplay the current crisis we are facing have anything to say about it.

One member wrote:
"Or one could listen to sources that validate their personal biases."
Which is the definition of irony considering the obtuse links that were previously posted by that member to "prove" the unknowable. Doubt is then cast upon those who are accused of elevating Dr. Fauci to god-like stature, then he is cited as a the paragon of veracity in the next breath.

When innovative methods of testing (antibody) are proposed and the implications of doing so, they are ignored in favor of two opposing sides who's differences couldn't be more stark. That we surpassed the confirmed number of infections of China last night merits only a passing reference.

To paraphrase the commanding general of the Corps of Engineers who has been contacted by the governors of all 50 States, pleading for his help in constructing additional facilities, "It's a waste of time to argue, this is not a debate, it is reality".

The Boston Globe reported yesterday that over 160 healthcare professionals have now tested positive for COVID-19. Some of those infections could have come from simple community spread. I wonder how that number may have increased by this morning, and wonder how that relates to thousands of other medical facilities in the U.S., and what that means to their families and our ability to treat those who need it.

https://www.bostonglobe.com/2020/03/26/ ... ronavirus/

Maybe it's time to stop arguing about things that don't matter and to put personal bias and pre-existing ideology aside. The virus doesn't recognize borders or political parties. It isn't the flu, it isn't the common cold, it isn't vehicle fatalities or cancer. It is a threat in addition to all of those, only far more universal in its effects.

columbia
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Re: Bogleheads community discussion - Coronavirus

Post by columbia » Fri Mar 27, 2020 6:28 am

Boris Johnson has tested positive.
If you leave your head in the sand for too long, you might get run over by a Jeep.

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tadamsmar
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Re: Bogleheads community discussion - Coronavirus

Post by tadamsmar » Fri Mar 27, 2020 6:32 am

ImUrHuckleberry wrote:
Thu Mar 26, 2020 9:37 pm
tadamsmar wrote:
Thu Mar 26, 2020 8:15 pm
ebrasmus21 wrote:
Thu Mar 26, 2020 7:06 pm
Cash is King wrote:
Thu Mar 26, 2020 6:41 pm
KyleAAA wrote:
Thu Mar 26, 2020 6:30 pm


What did she say?
To paraphrase, Dr. Birx said that the UK had reduced their prediction of deaths from 500,000 to under 20,000. She said the math behind the originally models were flawed to have such a drastic change. Again, I'm paraphrasing. I think it's worth listening to your comments today.
Do these estimates really having any practical meaning at all? The experts we are all relying on, in the span of about 1 week, changed their numbers from 500,000 to less than 20,000. How are we supposed to rely on any of this information?
The 20,000 comes from this Oxford study:

https://nypost.com/2020/03/24/coronavir ... tudy-says/

The idea is that there are many more UK infections than we think. This means that the proportion of fatalities is lower than we think, and that UK is close to herd immunity.

It should be easy to determine if about half the Brits have antibodies. You just have to sample 100 Brits to get an pretty good estimate. An antibody test was developed and used a month ago in Singapore and put on the market. But Brix seemed to be waiting for an easier test or something.
The 500,000 versus 20,000 deaths studies we have been talking about recently in the thread both come from Imperial College studies conducted by Neil Ferguson. The 500,000 was based on "do nothing" while the 20,000 was based on intensive social distancing. The Oxford study was a completely different study with a different reasoning for 20,000 deaths (i.e. - the reason you mentioned).

https://www.nationalreview.com/corner/c ... edictions/
You are right that Imperial study contained a range of scenarios ranging from 500,000 to below 20,000.

But I think the 20,000 number got into the conversation yesterday was due to the Oxford study that proposed a scenario that was not in the Imperial study. That is why Birx was discussing the unknown number of asymptotic cases in the context of the 20,000 projection.

I am personally skeptical of the Oxford study.

rkhusky
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Re: Bogleheads community discussion - Coronavirus

Post by rkhusky » Fri Mar 27, 2020 7:13 am

Novine wrote:
Fri Mar 27, 2020 12:36 am
eye.surgeon wrote:
Thu Mar 26, 2020 11:36 pm
For those who might feel like the world is ending, I'm just going to post this right here...

Image

You might also read an article published today in The New England Journal of Medicine titled: “Covid-19 — Navigating the Uncharted.”

The article considers the impact of the Covid-19 pandemic, concluding:

“This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.”
That graph is garbage statistics. Comparing totals based on a 12 month total versus a disease that only emerged in most of the world in the past 3 months is completely useless. The same with the US totals. Show us the flu totals from the first 3 months of the 2017- 2018 flu season and you may have something useful.
At viewtopic.php?f=9&t=305217&p=5123672#p5123543 is a plot of the hospitalizations from the flu over the past 10 years.

With the coronavirus we have went from about 2,000 hospitalizations on 3/21 to 10,000 hospitalization on 3/26, 5 days. If you look at the plot for 2017-18, the worst year for flu, that took from about week 47 to week 51, almost a month.

If the coronavirus hospitalizations continue to increase at their current pace, we will hit 100,000 hospitalizations by next Friday. Something it took the 2017-18 flu to accomplish in 18 weeks. Can our hospitals accommodate 90,000 new patients over the next week?

Note that the data is from https://docs.google.com/spreadsheets/u/ ... j5/pubhtml# and the hospitalization projections are based on only 6 data points. However, yesterday's hospitalization number was higher than that projected from the previous 5 data points. (Using the fit from the first 5 data points projects 100K hospitalizations by next Saturday)

Here is a plot of the fit:
Image
Last edited by rkhusky on Fri Mar 27, 2020 7:31 am, edited 2 times in total.

sevenseas
Posts: 191
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Re: Bogleheads community discussion - Coronavirus

Post by sevenseas » Fri Mar 27, 2020 7:20 am

folkher0 wrote:
Fri Mar 27, 2020 3:08 am
MSO4PRN wrote:
Fri Mar 27, 2020 12:53 am
didnt read thread, only this last page. ICU has been filling up. my hospital census is down, but nearly everyone that comes in to the ER is for cough, SOB, fevers, weakness, fatigue. nearly all are c19 +. if your not hypoxic, you are getting sent home. that study with plaquenil isnt the best imo. what the general public doesnt realize is how thin a hospital ran before this happened. theres only so many critical care docs, anesthesiologists, CRNAs, ICU nurses, resp techs, etc. that are comfortable (key word) and experienced and trained to manage ARDS (acute resp distress syndrome).

what we are seeing, is with that the majority that test positive are fine. the 10-15 that are hospitalized are fine, doing well with nasal cannula oxygen, Tylenol and what we call in the biz "supportive care"

the issue arises is when they decompensate, it happens FAST. they have an oxygen increase requirement and boom, they need intubation and ICU level care. the worst is yet to come. the infectious disease docs at my shop, predict on their models that midwest gonna get slammed april 5th - april 20th.

now keep in mind all the masks and PPE are in very short supply. equivalent would be every day you would be told you can make 3 phone calls, send 2 emails and use 3 sheets a paper PER DAY in your regular business job. gonna throw a hex in your daily workflow.

theres a reason most of the medical community is not feeling great right now.

there are people in their 30s intubated in full blown ARDS at my hospital right now. no medical comorbities.
This account is similar to what I’ve seen.
I want to thank those of you on the front lines for posting your experiences. People need to know. I am in NY and we are just starting to see the first of these accounts, from our local hospitals, show up in the news. It is what we've feared all along, now just in its infancy. I am in dread of what the next 2-4 weeks will bring. To hear others dismissing these accounts, or still imagining that this is "no worse than the flu", boggles my mind. To know that some people, including at the highest levels of government, will not believe until they see it with their own eyes, or it spreads across the country, fills me with despair (and anger).

technovelist
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Re: Bogleheads community discussion - Coronavirus

Post by technovelist » Fri Mar 27, 2020 7:24 am

Governor Abbott of Texas has issued an executive order that anyone flying into Texas from the New York metro area or New Orleans must self-quarantine for 14 days: https://www.msn.com/en-us/news/us/gov-g ... r-BB11L4qO.
In theory, theory and practice are identical. In practice, they often differ.

folkher0
Posts: 156
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Re: Bogleheads community discussion - Coronavirus

Post by folkher0 » Fri Mar 27, 2020 7:34 am

technovelist wrote:
Fri Mar 27, 2020 7:24 am
Governor Abbott of Texas has issued an executive order that anyone flying into Texas from the New York metro area or New Orleans must self-quarantine for 14 days: https://www.msn.com/en-us/news/us/gov-g ... r-BB11L4qO.
Sighs:

Too little. Too late.

webbie90
Posts: 32
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Re: Bogleheads community discussion - Coronavirus

Post by webbie90 » Fri Mar 27, 2020 7:40 am

folkher0 wrote:
Fri Mar 27, 2020 7:34 am
technovelist wrote:
Fri Mar 27, 2020 7:24 am
Governor Abbott of Texas has issued an executive order that anyone flying into Texas from the New York metro area or New Orleans must self-quarantine for 14 days: https://www.msn.com/en-us/news/us/gov-g ... r-BB11L4qO.
Sighs:

Too little. Too late.
Not many people are flying these days. People don't drive into Texas from New Orleans?

"Gov. Abbott said people flying in from the designated areas will have to fill out a form provided by DPS to identify where they will quarantine. DPS troopers will then conduct unannounced visits to the designated quarantine locations to verify compliance with the executive order.

Gov. Abbott said it is a criminal offense to defy the order, punishable by a fine of up to $1,000, up to 180 days in jail or both."

mouses
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Re: Bogleheads community discussion - Coronavirus

Post by mouses » Fri Mar 27, 2020 7:41 am

Cash is King wrote:
Thu Mar 26, 2020 6:48 pm
KyleAAA wrote:
Thu Mar 26, 2020 6:42 pm
Cash is King wrote:
Thu Mar 26, 2020 6:41 pm
KyleAAA wrote:
Thu Mar 26, 2020 6:30 pm
Cash is King wrote:
Thu Mar 26, 2020 6:28 pm


You can draw your own conclusion. I tend to believe what Dr. Birx said today about the math behind the modeling.
What did she say?
To paraphrase, Dr. Birx said that the UK had reduced their prediction of deaths from 500,000 to under 20,000. She said the math behind the originally models were flawed to have such a drastic change. Again, I'm paraphrasing. I think it's worth listening to your comments today.
And Dr Ferguson himself says that they have done no such thing:
https://twitter.com/neil_ferguson/statu ... 5200124928

She also doesn't say the math was flawed. She said we now have predictions we can test.

Dr Birx starts talking around 1:17
https://www.youtube.com/watch?v=BtTc8zc09iE
Please start listening at 1:22.
https://www.youtube.com/watch?v=Z3i1qyZOumc
Dr. Birx is insisting there is no equipment shortage. She's gone over to the dark side. To me, this makes anything she says questionable.

folkher0
Posts: 156
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Re: Bogleheads community discussion - Coronavirus

Post by folkher0 » Fri Mar 27, 2020 8:00 am

webbie90 wrote:
Fri Mar 27, 2020 7:40 am
folkher0 wrote:
Fri Mar 27, 2020 7:34 am
technovelist wrote:
Fri Mar 27, 2020 7:24 am
Governor Abbott of Texas has issued an executive order that anyone flying into Texas from the New York metro area or New Orleans must self-quarantine for 14 days: https://www.msn.com/en-us/news/us/gov-g ... r-BB11L4qO.
Sighs:

Too little. Too late.
Not many people are flying these days. People don't drive into Texas from New Orleans?

"Gov. Abbott said people flying in from the designated areas will have to fill out a form provided by DPS to identify where they will quarantine. DPS troopers will then conduct unannounced visits to the designated quarantine locations to verify compliance with the executive order.

Gov. Abbott said it is a criminal offense to defy the order, punishable by a fine of up to $1,000, up to 180 days in jail or both."
As if anyone is flying. Or that a flight from cincinatti did not originate or at some point go through NY.

This is only a PR measure. The governor clearly wants to generate the appearance of action without creating inconvenience. I actually don’t disagree with the quarantine measures themselves, but it is comically naive to think this act alone at this time will meaningfully alter transmission in Texas.

folkher0
Posts: 156
Joined: Fri Dec 09, 2016 2:48 pm

Re: Bogleheads community discussion - Coronavirus

Post by folkher0 » Fri Mar 27, 2020 8:02 am

mouses wrote:
Fri Mar 27, 2020 7:41 am
Cash is King wrote:
Thu Mar 26, 2020 6:48 pm
KyleAAA wrote:
Thu Mar 26, 2020 6:42 pm
Cash is King wrote:
Thu Mar 26, 2020 6:41 pm
KyleAAA wrote:
Thu Mar 26, 2020 6:30 pm


What did she say?
To paraphrase, Dr. Birx said that the UK had reduced their prediction of deaths from 500,000 to under 20,000. She said the math behind the originally models were flawed to have such a drastic change. Again, I'm paraphrasing. I think it's worth listening to your comments today.
And Dr Ferguson himself says that they have done no such thing:
https://twitter.com/neil_ferguson/statu ... 5200124928

She also doesn't say the math was flawed. She said we now have predictions we can test.

Dr Birx starts talking around 1:17
https://www.youtube.com/watch?v=BtTc8zc09iE
Please start listening at 1:22.
https://www.youtube.com/watch?v=Z3i1qyZOumc
Dr. Birx is insisting there is no equipment shortage. She's gone over to the dark side. To me, this makes anything she says questionable.
I cordially invite Dr. Birx and any other public health official to visit New York. Maybe she would like to tour our facilities?

technovelist
Posts: 3160
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Contact:

Re: Bogleheads community discussion - Coronavirus

Post by technovelist » Fri Mar 27, 2020 8:12 am

folkher0 wrote:
Fri Mar 27, 2020 7:34 am
technovelist wrote:
Fri Mar 27, 2020 7:24 am
Governor Abbott of Texas has issued an executive order that anyone flying into Texas from the New York metro area or New Orleans must self-quarantine for 14 days: https://www.msn.com/en-us/news/us/gov-g ... r-BB11L4qO.
Sighs:

Too little. Too late.
My wife and I live in a place that until a few days ago had no confirmed cases within 100 miles. Now there is one that the map says is within 5 miles.

It doesn't really matter because I'm not going anywhere that I might encounter other people at least until one of these situations obtains:

1. There is an antibody test so I can figure out if we've been infected and have recovered. I have no discernible symptoms except that my lymph nodes have been indicating that I'm fighting something off for the last week. Obviously if we have had asymptomatic infections and are recovered, we can go out.

2. There is a workable treatment with a good track record of preventing severe outcomes and that has general availability, and the hospitals are functioning normally.

I'm expecting to spend at least the next month locked down, and am prepared to do that, other than of course if my wife or I have a medical emergency.

I'm doing everything possible to avoid such a situation and we are both in very good general health, so I feel reasonably confident of success.

As for food, we have plenty of beans and rice and canned vegetables, as well as dried fruits and dehydrated vegetables, but my wife wants to go to Walmart to get some fresh produce. I'm holding her at bay for the moment. If I need to pay $7 a pound to buy fresh apples on ebay, so be it.
In theory, theory and practice are identical. In practice, they often differ.

M.Lee
Posts: 89
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Re: Bogleheads community discussion - Coronavirus

Post by M.Lee » Fri Mar 27, 2020 8:14 am

mouses wrote:
Fri Mar 27, 2020 7:41 am
Dr. Birx is insisting there is no equipment shortage. She's gone over to the dark side. To me, this makes anything she says questionable.
What is 'the dark side'? I just want to make sure this isn't a political statement which I don't believe is allowed here.

User avatar
tadamsmar
Posts: 8757
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Re: Bogleheads community discussion - Coronavirus

Post by tadamsmar » Fri Mar 27, 2020 8:16 am

folkher0 wrote:
Fri Mar 27, 2020 8:02 am
mouses wrote:
Fri Mar 27, 2020 7:41 am
Cash is King wrote:
Thu Mar 26, 2020 6:48 pm
KyleAAA wrote:
Thu Mar 26, 2020 6:42 pm
Cash is King wrote:
Thu Mar 26, 2020 6:41 pm


To paraphrase, Dr. Birx said that the UK had reduced their prediction of deaths from 500,000 to under 20,000. She said the math behind the originally models were flawed to have such a drastic change. Again, I'm paraphrasing. I think it's worth listening to your comments today.
And Dr Ferguson himself says that they have done no such thing:
https://twitter.com/neil_ferguson/statu ... 5200124928

She also doesn't say the math was flawed. She said we now have predictions we can test.

Dr Birx starts talking around 1:17
https://www.youtube.com/watch?v=BtTc8zc09iE
Please start listening at 1:22.
https://www.youtube.com/watch?v=Z3i1qyZOumc
Dr. Birx is insisting there is no equipment shortage. She's gone over to the dark side. To me, this makes anything she says questionable.
I cordially invite Dr. Birx and any other public health official to visit New York. Maybe she would like to tour our facilities?
She said that that there was no shortage of ventilators right now in the city as a whole. "Right now" would be 6 PM yesterday or earlier when she talked to officials.

folkher0
Posts: 156
Joined: Fri Dec 09, 2016 2:48 pm

Re: Bogleheads community discussion - Coronavirus

Post by folkher0 » Fri Mar 27, 2020 8:23 am

tadamsmar wrote:
Fri Mar 27, 2020 8:16 am
folkher0 wrote:
Fri Mar 27, 2020 8:02 am
mouses wrote:
Fri Mar 27, 2020 7:41 am
Cash is King wrote:
Thu Mar 26, 2020 6:48 pm
KyleAAA wrote:
Thu Mar 26, 2020 6:42 pm


And Dr Ferguson himself says that they have done no such thing:
https://twitter.com/neil_ferguson/statu ... 5200124928

She also doesn't say the math was flawed. She said we now have predictions we can test.

Dr Birx starts talking around 1:17
https://www.youtube.com/watch?v=BtTc8zc09iE
Please start listening at 1:22.
https://www.youtube.com/watch?v=Z3i1qyZOumc
Dr. Birx is insisting there is no equipment shortage. She's gone over to the dark side. To me, this makes anything she says questionable.
I cordially invite Dr. Birx and any other public health official to visit New York. Maybe she would like to tour our facilities?
She said that that there was no shortage of ventilators right now in the city as a whole. "Right now" would be 6 PM yesterday or earlier when she talked to officials.
Yesterday we heard that at least one hospital (not mine) was at least considering connecting multiple patients to one vent.

I do not watch the nightly briefings. I do not find them accurate or informative. Feels more like propaganda to me.

Edit: before anyone jumps down my throat, I don’t watch Cuomo either.

Edit 2: I hate posting the lay press but I think the New York Times is doing a pretty good job laying it out there.

https://www.nytimes.com/2020/03/26/heal ... ticleShare
Last edited by folkher0 on Fri Mar 27, 2020 8:43 am, edited 1 time in total.

webbie90
Posts: 32
Joined: Mon Mar 23, 2020 10:52 pm

Re: Bogleheads community discussion - Coronavirus

Post by webbie90 » Fri Mar 27, 2020 8:33 am

tadamsmar wrote:
Fri Mar 27, 2020 8:16 am
folkher0 wrote:
Fri Mar 27, 2020 8:02 am
mouses wrote:
Fri Mar 27, 2020 7:41 am
Cash is King wrote:
Thu Mar 26, 2020 6:48 pm
KyleAAA wrote:
Thu Mar 26, 2020 6:42 pm


And Dr Ferguson himself says that they have done no such thing:
https://twitter.com/neil_ferguson/statu ... 5200124928

She also doesn't say the math was flawed. She said we now have predictions we can test.

Dr Birx starts talking around 1:17
https://www.youtube.com/watch?v=BtTc8zc09iE
Please start listening at 1:22.
https://www.youtube.com/watch?v=Z3i1qyZOumc
Dr. Birx is insisting there is no equipment shortage. She's gone over to the dark side. To me, this makes anything she says questionable.
I cordially invite Dr. Birx and any other public health official to visit New York. Maybe she would like to tour our facilities?
She said that that there was no shortage of ventilators right now in the city as a whole. "Right now" would be 6 PM yesterday or earlier when she talked to officials.
Dr. Birx's comments yesterday were ripped by Harvard infectious disease epidemiologist Mark Lipsitch. He used terms such as "naive" and "deceptive."

rkhusky
Posts: 8667
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Re: Bogleheads community discussion - Coronavirus

Post by rkhusky » Fri Mar 27, 2020 8:38 am

technovelist wrote:
Fri Mar 27, 2020 8:12 am
As for food, we have plenty of beans and rice and canned vegetables, as well as dried fruits and dehydrated vegetables, but my wife wants to go to Walmart to get some fresh produce. I'm holding her at bay for the moment. If I need to pay $7 a pound to buy fresh apples on ebay, so be it.
How would Ebay apples be less risky than those from the store? Where I go to the store, there is not a lot of people so easy to stay 5+ ft away and then I sanitize my hands afterwards.

webbie90
Posts: 32
Joined: Mon Mar 23, 2020 10:52 pm

Re: Bogleheads community discussion - Coronavirus

Post by webbie90 » Fri Mar 27, 2020 8:43 am

We owe our healthcare workers an immense debt of gratitude.

From CNN:

"Forty five doctors who tested positive for coronavirus have died in Italy, the Italian Association of Doctors said Friday.

The death toll comes after there was an urgent call for medical protective equipment from Filippo Anelli, the president of the association, on Thursday.

Since the beginning of the epidemic, more than 6,000 health workers have been infected by coronavirus as of Thursday, according to the Italian National Institute of Health."

Maybe the naysayers who think that too much has been made of the COVID-19 pandemic can point to the last time something like this happened with the seasonal flu.
Last edited by webbie90 on Fri Mar 27, 2020 9:05 am, edited 1 time in total.

technovelist
Posts: 3160
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Contact:

Re: Bogleheads community discussion - Coronavirus

Post by technovelist » Fri Mar 27, 2020 8:49 am

rkhusky wrote:
Fri Mar 27, 2020 8:38 am
technovelist wrote:
Fri Mar 27, 2020 8:12 am
As for food, we have plenty of beans and rice and canned vegetables, as well as dried fruits and dehydrated vegetables, but my wife wants to go to Walmart to get some fresh produce. I'm holding her at bay for the moment. If I need to pay $7 a pound to buy fresh apples on ebay, so be it.
How would Ebay apples be less risky than those from the store? Where I go to the store, there is not a lot of people so easy to stay 5+ ft away and then I sanitize my hands afterwards.
It's not that the apples would be less risky. It's that going out at all is risky.
I don't want to take a chance of getting in a traffic accident or having my car break down so I need a tow truck.
I don't want to encounter other people at all.
My wife and I are both over 70 so it's hard to be too cautious.
In theory, theory and practice are identical. In practice, they often differ.

User avatar
Tony-S
Posts: 140
Joined: Tue Sep 18, 2018 11:48 am

Re: Bogleheads community discussion - Coronavirus

Post by Tony-S » Fri Mar 27, 2020 8:51 am

nigel_ht wrote:
Thu Mar 26, 2020 10:44 pm
folkher0 wrote:
Thu Mar 26, 2020 10:21 pm
This is not about being open minded. This is about false hopes and snake oil.
The grapevine has it that California has the Chinese strain but NYC/east coast has the Italian one and Seattle got both maybe even some from Iran.

How much is true and how much is docs speculating I dunno. Should be easy to verify but nobody I know has that info.

Could mean you get regional differences in efficacy but yes that’s just being hopeful as there are no conclusive studies at present that show it works.
This information is readily available and has been for a couple of months.

https://nextstrain.org/ncov

ImUrHuckleberry
Posts: 370
Joined: Sat Apr 15, 2017 7:44 am

Re: Bogleheads community discussion - Coronavirus

Post by ImUrHuckleberry » Fri Mar 27, 2020 8:54 am

As bad as the official CV-19 death numbers look right now in Northern Italy, there are studies starting to come out which estimate CV-19 deaths have been under-counted in at least some towns by as much as 4x. (In one town average deaths in February is about 35 but this year they are over 125 with only a small number attributed to CV-19.)

I expect this is happening everywhere that is getting hit hard, and we will only truly understand this when we come out of this fog of war that we are currently in.

User avatar
tadamsmar
Posts: 8757
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Re: Bogleheads community discussion - Coronavirus

Post by tadamsmar » Fri Mar 27, 2020 8:56 am

webbie90 wrote:
Fri Mar 27, 2020 8:33 am
tadamsmar wrote:
Fri Mar 27, 2020 8:16 am
folkher0 wrote:
Fri Mar 27, 2020 8:02 am
mouses wrote:
Fri Mar 27, 2020 7:41 am
Cash is King wrote:
Thu Mar 26, 2020 6:48 pm

Please start listening at 1:22.
https://www.youtube.com/watch?v=Z3i1qyZOumc
Dr. Birx is insisting there is no equipment shortage. She's gone over to the dark side. To me, this makes anything she says questionable.
I cordially invite Dr. Birx and any other public health official to visit New York. Maybe she would like to tour our facilities?
She said that that there was no shortage of ventilators right now in the city as a whole. "Right now" would be 6 PM yesterday or earlier when she talked to officials.
Dr. Birx's comments yesterday were ripped by Harvard infectious disease epidemiologist Mark Lipsitch. He used terms such as "naive" and "deceptive."
I agree that her remarks are definitely deceptive. They were naive-sounding but I think she knows exactly what she is doing or intending to do. Happy talk.
Last edited by tadamsmar on Fri Mar 27, 2020 10:38 am, edited 2 times in total.

vested1
Posts: 1978
Joined: Wed Jan 04, 2012 4:20 pm

Re: Bogleheads community discussion - Coronavirus

Post by vested1 » Fri Mar 27, 2020 9:02 am

technovelist wrote:
Fri Mar 27, 2020 7:24 am
Governor Abbott of Texas has issued an executive order that anyone flying into Texas from the New York metro area or New Orleans must self-quarantine for 14 days: https://www.msn.com/en-us/news/us/gov-g ... r-BB11L4qO.
I had promised to take my wife to the big island this year and even though we're not planning on going right now she asked me yesterday to check prices just for fun. We try to fly Southwest because we usually get at least one free ticket with credit card points. I found this:

https://www.southwest.com/Coronavirus

Passengers are required to self-quarantine for 14 days upon arrival in Kona. The same applies for Florida and Rhode Island. The rest of the destinations listed in the link will not be on Southwest's flight schedule until May 4th, and probably longer than that.

I then went to a flight discount site and checked various destinations for all airlines and found that there's a fire sale going on. I smell desperation. No thanks.

KlangFool
Posts: 15454
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Re: Bogleheads community discussion - Coronavirus

Post by KlangFool » Fri Mar 27, 2020 9:02 am

Folks,

https://www.washingtonpost.com/health/s ... story.html

<<After 21 years in military medicine, there isn’t much that rattles Richard Barnett. He was part of the Marine force that invaded Baghdad in 2003, where he intermittently came under enemy fire.

But during a 12-hour overnight nursing shift at West Hills Hospital and Medical Center in Los Angeles, the working conditions became more than he could accept. Ill-fitting masks. Poor sterilization technique. Worst of all, two patients with covid-19 slipped through the screening procedures, exposing health-care workers who treated them without knowing they were infected, he said.

At the end of the shift, at 7 a.m. March 15, Barnett quit and turned in his badge.>>

<<Labor unions have noted that in China, where supplies were more plentiful, health-care workers were told to double up on gowns and other protective equipment. They have warned of a catastrophe if many health-care workers fall ill.

Dee Shine was sitting at her desk at MedStar Washington Hospital Center’s eye clinic last week when she took a surgical mask from a box behind her and began to greet patients. She said some doctors had been pleading with their bosses to close the office, but she accepted being there. She needs the $21.36 an hour she is paid.

Soon, she said, she was summoned to the human resources department and told to go home. She had been suspended indefinitely for wearing the mask.

“They said they were saving them for staff,” she said, “and the masks would scare the patients off.”>>

KlangFool
Last edited by KlangFool on Fri Mar 27, 2020 9:16 am, edited 1 time in total.

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