OT: Article on why testing for COVID19 in the US has been a debacle (and other notes)
https://thedispatch.com/p/timeline-the-regulationsand-regulatorsthat
Here's a good article that explains why the US has tested so few (although that seems to be getting up to speed finally).
The FDA made it near impossible for labs to make testing kits BECAUSE of their emergency declaration. Then, they put all their eggs into one basket with a CDC test, which had a bunch of problems and was essentially unusable. And there's no good reason why they didn't just use the WHO tests.
Here's an update on the COVID19 mortality rate in Korea, which is likely the country closest to the true mortality rate because they've done the most testing.
https://twitter.com/iampaulkerry/status/1240811385660903431?s=20
After jumping up and down a bit in the beginning, it settled low but has been rising consistently and hasn't tapered off yet. It's at 1.1% as of now. The initial infected in Korea were largely young, so this is likely due to more elderly people getting infected and/or the disease running its course more fully. Reminder that the seasonal flu's mortality rate is about 0.1%.
And I'll just make a couple other remarks since I have the OP mic and you can't stop me, which you can TL;DR. It's still really early to tell how bad it can be and which countries have had the best response, besides obvious comparisons like Korea did a much better job than Italy (tracking is at least as important as testing). Italy probably got hammered with a mix of indifference until it was too late, the oldest median age population in the world, a lot of smokers, and pretty bad air pollution in northern Italy. Having said that, Japan is the 2nd oldest population and also has lots of smokers (you can still smoke in bars there! even some spots in restaurants), and also doesn't have the cleanest air in the world. While cases ramped up in Korea, testing languished in Japan and many Japanese were worried there was a coming disaster, but it hasn't materialized. Things are certainly going to get worse in the US, but urban sprawl, car ownership, and low smoking rates may help. I wonder how much is just plain luck as well. It's not entirely accurate to say China had a ton of cases. Wuhan and the surrounding provinces had a lot, but there are many provinces in China with tens of millions of people each that barely had any cases. As of a couple days ago, about 75% of all cases in Korea were in Daegu. This is largely because of a cult that had some super spreaders who had just come back from meetings in Wuhan and were very much uncooperative with authorities (avoiding testing, not telling about their contacts). New cases have dropped off dramatically since about a week ago.
Also, if you want to see some of the info Korea gets and publishes for tracking, here's a link to one district of Seoul's page.
Google translate works fairly well. It shows the neighborhood they live in, age, gender, nationality, and a timeline of their symptoms and where they've been recently.
The first surge of infected people needing treatment and overwhelming our available health care is happening right now in NYC. This is going to be the case, IMO, in all our major urban cities with dense populations.
I have saying this is going to be bad, real bad, for about a month here and it's now happening. Gonna be interesting to see if the "deniers" still want to claim it's no big deal and just a cold, especially if the 1.1% morbidity rate holds here. There are going to be a staggering high number of dead.
BTW, anyone thinking there will be a football season this year better be prepared to find something else to do on Saturday's this fall. No way is it going to happen.
I am not at all a doomsday "prepper" person.
That being said, I am solidly on your side of the ledger on this one. I think this is going to be a calamity for our country and our world...one which will have long-lasting implications for everyone.
I'm already mentally preparing myself for my kids not being able to return to school in the fall.
And, even if the number of cases levels off or decreases and we get an "all clear," people will stlil be reluctant to gather in restaurants, movie theaters, arenas, etc. And, who's going to be quick to get on a plane and travel? Plus, I think we are going to see a permanent shift to working from home, which will devastate the real estate market.
Why would working from home devastate the real estate market do you think?
Mostly because people won't need to move cities for work?
Commercial real estate. One of my attorney friends does a lot of business and real estate transactions. He has clients who own millions of sq. ft. of office space. They are very concerned about their businesses.
March 21st, 2020 at 11:08 AM ^
Rather simple. More people work from home. Fewer people work in an office. Less demand for office space. Fixed supply with lower demand equals lower prices. Fixed mortgage payments with lower prices equals disaster for landlords. Which spells disaster for taxpayers who will have to bail out the lenders. After all, we can't let the banks fail, can we?
I’m in commercial real estate. Agility of space has been implement several years ago. Meaning- employers are focusing on their employees health and productivity. Not all have, but those that have should be bettered prepared. It’s too soon to determine the impact.
I don't think people will be all that reluctant. I think people will be anxious to return to some semblance of normalcy. Bars and restaurants are certainly less-populated in Korea these days, but they're still open and they still get some customers. Public schools in Korea were delayed but scheduled to start April 6th, so we'll see what happens then. Could get pushed back further though.
March 21st, 2020 at 12:51 PM ^
You may be right and if you are then that's when the second wave will begin and in the 1918 flu pandemic it was the second wave that was the worst wave.
1918 vs 2020. No comparison. Fear mongering helps no one.
not as down on this as some, but i do see how it will spill into the summer. no football season would be tough for literally hundreds of thousands (millions?) of kids from grade school on up. could happen, too.
another fall out is the small colleges which are on the edge financially - what are they going to do with tuition refunds, getting an entering class next year, etc? and the 4/13/20 SAT was of course cancelled, so our 2021 son doesn't have that most critical test to take as he is getting more recruiting attention. many waves of problems.
and just because they are in fact robbing the food king, i think this is appropriate:
Think it through my virtual good friend. We are a long ways from this peaking (most official estimates say 2 months or longer) and that peak just means we're having LESS daily new infections, not zero new infections. Which means people are still getting sick, still going to hospitals still infecting others.
You know I work in medical, every clinician, physician and hospital administrator I talk to thinks this will be our new normal for about 12-18 months unless a breakthrough vaccine is found. The changes to our way of life in everything will be profound when it's over.
I'm definitely not an alarmist or doomsday prepper but I do trust intelligent people's opinion much more than I do elected officials or the media. And they, the highly educated medical professionals, are of one voice on this matter.
One thing that's hard to predict is how all this is going to work in a health care environment like the US where tons of people are uninsured or underinsured. That really hasn't been the case for any of the countries hit hard yet. There have already been horror stories of huge bills, even just to get tested. You're likely to have lots of people who should see a doctor not going.
This makes no sense. The government is paying for costs for people affected by this virus. Also, the hospitals are being bombarded by people who think they "have it" so I think we are seeing many more people going to the doctor than SHOULD see the doctor.
Do you have a source for that statement the government is going to pay the costs for people affected? That’s news to me. Are you referencing the president’s news conference that was immediately walked back when the insurance companies were like, “yo, we said we’d just pay for testing, not everything!”
March 21st, 2020 at 10:49 AM ^
Please tell me you forgot the /s
March 21st, 2020 at 11:18 AM ^
Also, the hospitals are being bombarded by people who think they "have it"
Just to clarify - the problem is not that there are people with mild symptoms going to the hospital. They get sent back home and told to rest up. The problem is the number of seriously ill people who do need hospitalization - that number is growing fast.
March 21st, 2020 at 11:46 AM ^
PeterKlima your statement is a complete untruth. The US government is absolutely NOT paying for the costs of treatment. That might change down the road, but the Republicans in the US Senate have blocked any consideration of this from legislation currently being passed.
Ok. I am sorry. I heard they had. Anyway, I am sure there will be coverage for it down the road. Thanks.
I'm not even sure that's feasible. Let's consider 3 hypothetical uninsured people. Person A is hospitalized from a heart attack. Person B is hospitalized from the flu. Person C is hospitalized from COVID-19. The government is going to pay all costs for the health care of Person C but not A and B? How is that fair? Plus, I don't think you've even begun to think of what it would cost for the federal government, already running huge deficits, to pay for the full costs of everyone's cost of dealing with COVID-19 if millions are hospitalized with it.
Already seeing that people aren't seeing doctors. With the existing xenophobia in our government, immigrants (legal and illegal) are refusing to be tested or treated. I'm not making a case about immigration either way - but if they're not tested and/or treated, it only hurts the rest of us. Its a tough thing to answer...
March 21st, 2020 at 11:26 AM ^
Note that people who suspect themselves to be positive should not see their doctor, in person. They could cause him/her to be infected.
They should call their doctor and go to one of the drive-up testing spots.
March 21st, 2020 at 11:39 AM ^
Oh, I completely agree with you! Also, we need FAR more drive up testing locations and significantly more relaxed rules about who can get tested. Just repeating what I read elsewhere...
I agree that this has the potential to be very bad in the US. I respectfully disagree on your timeline. The infection in Wuhan started in December and by March, life is starting to normalize, by report.
I think over the next month, we’ll see how successful (or unsuccessful) our public health efforts have been. In my opinion, if we are unsuccessful, our problems will be worse but the timeline might actually be shorter (similar to Wuhan) because people will be getting sick and dying quickly because of the lack of resources. If we are successful, we may actually see a slower timeline because infected patients will be able to receive care and thus live longer.
Except those efforts basically just started. And some of those efforts are still largely missing (e.g., testing). I just read another good piece on how the Veneto region of Italy is actually doing much better than Lombardy, in large part because of widespread testing so they know who needs to be quarantined.
March 21st, 2020 at 11:44 AM ^
But at this point we are all largely quarantined....and have been for the most part for about a week. At this point, the virus will go through our systems and work its way out. Personally I think this has been in the US far longer than people realize and has been largely asymptomatic for 80% of the population.
It's the 20% we have to worry about and hopefully we can figure out a way to keep THEM quarantined while the rest of the country goes back to work....otherwise....disaster.
March 21st, 2020 at 11:48 AM ^
The 20% with severe symptoms don't need quarantine. They need a hospital - they're too sick to stay at home. That's the crux of the problem.
March 21st, 2020 at 11:52 AM ^
The 20% in my statement were the "at risk" not the severely symptomatic. We need to keep the 20% at risk who aren't sick yet at home as long as possible and find services to help them day to day. Keeping them out of the hospitals should be the plan.
I think it's great they are preparing for the influx....I still think they are working with flawed data but it's better to have and not need than to need and not have.
March 21st, 2020 at 12:30 PM ^
MileHighWolverine, the British government initially wanted to follow your advice - build herd immunity among the majority and isolate those most at risk.
The problem was that they discovered that a lot of younger adults also were getting hospitalized, they just weren't dying as much as the elderly. And the strain from this wave of hospitalizations would cripple their health system. They've now adopted the same approach as everyone else.
The economic consequences are going to be severe, there's really no way around that.
March 21st, 2020 at 12:50 PM ^
I just think it's not realistic to think we can survive a national quarantine of more than 14-30 days unless everyone agrees that no bills, no debt, no anything, will come due during that period. A national "pause" if you will on expenses so people don't go bankrupt en masse.
And to the hospital point, sounds like we need to be building more hospitals given the aging of society. I'm going to look more closely at the British youth epidemic....I'm surprised they require hospitalization. Does that mean ventilator, or does that mean they are taking up a bed while they recover? If the former, that's a problem, if it's the latter - send their asses home like my aunt and uncle in their 70s had happen to them.
I disagree that the British government only found out that young people could be hospitalized too after their decision was made. They knew that. I believe the reports were that the Imperial College of London projections (based on worse case scenarios) showed the strain on the health care system would be too great. No politician when faced with those projections case take them lightly. It doesn't mean the worst case is the most likely though.
If the beaches in Florida that were filled with spring break and other folks is your example of quarantine, I'd suggest that we are in trouble. China rules with a heavy hand and I suspect their quarantine actually meant something. Here, while many of us are taking this seriously, many others are not. You need a high level of cooperation to do what the Chinese claim to have done.
March 21st, 2020 at 10:08 AM ^
Everyone’s opinion here has valid, well reasoned thoughts.
However to think that America won’t have a response to hospitals being overwhelmed, high number of cases etc is counting out all the ingenious people out there, ready to act.
Public health efforts are well under way, but if these measures don’t ‘flatten the curve’ or are ignored as some have chosen to do, than we will be tested and forced to act. We have seen plagues before, we have seen despair before. We will react, and projections will be reprojected. Don’t fall into this fear mongering people. The threat is real, no doubt. But the collective we are more than capable for a response.
American is a country that for better or worse sometimes runs despite its government. No politics here simple fact. We have driven people, who will shine through this global catastrophe.
A few examples of people in motion already;
On the medical side of things, in a few short months we’ve already figured out that this represents acute respiratory distress syndrome (ARDS) tho with a high compliance which is atypical. Some of these pts can be managed with NIPPV (think simple CPAP machine). Now if anyone wants to get into the nuts and bolts of this, it’s far more complex, and I’m happy to discuss. While not the magic potion or vaccine, this certainly represents one (amoung many other being employed in our ICU’s) successful treatment/support while the virus runs its course.
pop up hospitals are soon to be under way to combat the shear volume.
on the production side of things companies outside of the big 3 automotive companies are already transitioning into products that are needed now. Namely PPE, other hospital equipment, and hopefully soon ventilators.
while we can all sit here a predict the future, maybe we should do more pulling together, and decide the future.
lastly, do not underestimate the human desire to live. Hopefully we as a species learn a great deal from this, and move forward together. There are still great threats to our way of life at the end of this.
If you can please donate blood to Red Cross, this is how all the non medical professionals can contribute to this crisis (outside of listening to current red’s re social distancing etc)
my longest post to date, but I don’t social media much, and as someone who is quite literally on the front line of this I felt the desire to share my thoughts somewhere. While I’m scared for my mom, my premature infant, I’m not scared for the human race.
March 21st, 2020 at 10:33 AM ^
"while we can all sit here a predict the future, maybe we should do more pulling together, and decide the future." Really well said. Let's make the news instead of reporting it. Thank you!
March 21st, 2020 at 12:03 PM ^
Besides social distancing (which is the biggest thing we can do), if anyone knows of a supply of masks, they should contact their local hospital system. There are PSAs going around Michigan about this, and surely other states, too.
i'm not saying there is a zero-chance of the worst/very bad case scenario. what i'm saying is that at some point folks are just going to get on to a more normal life pattern as can be seen in the other countries that are further along then we are. the fact that infections will continue is a given. friend of mine got out of the hospital last night after 5 days with it. i anticipate most people thinking this is 'bad flu' after a certain point, and that folks that can't make their car/house/student loan/credit card/etc payment are only going to sit tight for so long. the world will restart and of course we all hope that is sooner rather than later.
good warnings from you, thank you for sharing. keep that family safe. how goes it with the 15 yr old? everyone is home here and in 3 weeks all 5 middle children will be teenagers.
Exactly this. There are really two camps of opinion on the outbreak: people whose income isn't at risk (retirees, students, government employees, housewives) who think we should all hide at home indefinitely no matter the economic cost to other people and the rest of us who need to work to live. I'll avoid gatherings and going to restaurants and bars. I'll wash my hands religiously and avoid touching my face. If the hospitals in my area fill up, I'll take further precautions. But these calculations are going to become a part of life for the next 18 months. I have to work, as do most people.
Yes to getting the opinion of intelligent, experienced professionals. I'm trying to maintain as much social contact as possible, so I've been talking and Facetiming with many of my friends, pretty much all of whom are 45-55 year old professionals. My two friends who are partners in large orthopedic surgery practices are worrying about having to lay off their staff and still cover very large monthly overhead. My attorney friends are seeing deals crater and business fall of of a cliff. A friend who is an executive in a very large media entity said advertisers are pulling out like crazy and the corporate folks are worried about covering the very large payments due to being over-leveraged. Another good friend is a partner in a very large REIT in NYC; he is very even-keeled but is worried that the entire financial system could fall apart. It goes on and on. I decided today to liquidate our entire stock portfolio. I'd rather lose out on any possible upside than risk losing the majority of our wealth...which I think is the more signifant risk at this point.
If you want to know what being at risk is, it is my son who is a Michigan alum and an emergency medicine doc and doesn't have the personal protection equipment he needs. He is young and in good health but his mom and dad are wrecks.
What we are buying is time. Time to find drugs for treatment and perhaps sooner than later, a vaccine. We are also attempting to lower the infection rate so that medical facilities don't become so overburdened that we have to use triage to see who lives and dies as is the case in Italy.
The US and the world will come back and be fine. It may take some time and it may be tough sledding for a while, but there will be significant demands for goods and services when this mess ends. Our debt as a nation will skyrocket. I'd like to think that some of the money that is going into our defense budget might find its way into medical research to find a way to make broad spectrum vaccines.
March 21st, 2020 at 10:49 AM ^
Sorry man, but it is not possible for this to be our new normal for 12 months. Because after about six months of this, or maybe fewer, the normal will change again and we will be sunk into a global depression that will last the rest of our lives. All those medical people you work with have a perspective that is naturally going to skew towards the worst possible case - probably even far beyond worst possible and into worst conceivable.
The global economy cannot do this for a year without colossal permanent damage. I think you are being alarmist despite your claims not to be.
March 21st, 2020 at 11:27 AM ^
Wahoo, everything that has ever seemed impossible was impossible...until it happened.
March 21st, 2020 at 11:56 AM ^
Kind of a glib but logically fallacious statement, since many things that up to now have been considered impossible.....are still impossible and have never happened. Not something I'd use to justify expressing beyond-worst-case scenarios as plausible.
We will have to get back to work and living life like “normal” sooner than later. We can’t all just sit home for a year and expect to see anything but complete devastation. Humanity needs production and stagnation = death. As unbelievably complicated as this crisis is that part of it is not.
March 21st, 2020 at 12:46 PM ^
Maize and Blue Wahoo - that's why you don't put Dr's in charge, IMO. And I have 3 of them in the family! All brilliant people but 0 out of 3 can see 2nd order consequences....like Dr. Fauci calling for even MORE draconian actions to be taken without even considering the 2nd order economic effects which will be even more devastating long term than whatever death toll this thing takes on society.
I am prepared to get the hell negged outta me for this. But I'm glad you said that. Dr. Fauci's job is to slow the spread of the virus as much as possible and to that end he's doing exactly what he needs to. But his statement about how he wishes we would overreact highlights precisely what you said: he's not concerned about the consequences of what we do, because it's not his job to be. In fact, he's almost completely insulated from those consequences, having a nice high-paying government job and a pension that isn't reliant on the stock market. His definition of success excludes all economic effects, and unlike a waiter or personal trainer or restaurant owner, he doesn't have to deal with the consequences of what he says.
Responsible leadership (which we mostly lack) would be trying hard to do the insanely difficult job of balancing the exhortations of a Dr. Fauci against the consequences of those actions, and taking the path down the middle which, yes, would probably result in more COVID deaths, but also reduce human suffering overall. I don't know what the exact solution is, but that's why being in charge is hard and I don't have an army of doctors and economists I can go ask.
I'm partial to the idea of mandatory quarantines of 3 months or longer for those aged 70 or older and then the rest of us get a 15 day quarantine and then back to work.
I would also like to see every NBA/NHL player tested and lets see how many of them are walking around with literally no symptoms. I'll bet it's a high number of whomever tests positive. Which would mean this is deadly to the old and infirm, a really bad flu for 90% of the population and something requiring hospitalization for the 10% who are not in the other categories.
Couldn’t agree more, as a surgical oncologist, who did a critical care fellowship (which I thought at the time was a great idea, then dumb idea, now great again) we are not the people to lead us out of this, but are facilitators, to assist in the escape route.
I'm looking for some clarification/optimism concerning the 12 to 18 month timeframe. Just look at this curve:
If it continues on this path (it can't, can it?) the entire U.S. will be infected by early May - the nightmare scenario. If the curve is flattened enough that new cases are spread out over 18 months it seems like we would be able to get back to some sense of normal long before that.