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  • Covid-19 moment of truth for our healthcare systems

    Posted by TM Lutas on April 5th, 2020 (All posts by )

    The University of Washington’s Institute for Health Metrics and Evaluation (IHME) has crucial data on Covid-19 for planning and it comes with a moment of truth for all Americans. The tide of good times has run out and those states that have built up a Potemkin health care system are now exposed in an undeniable way, in insufficient total hospital beds per million, insufficient total ICU beds per million, and insufficient ventilators available.

    The IHME data is available for download here. You can get to the pretty data projection visualizations here. The link takes you to the national visualization. Click on “United States of America” and you will see a state listing dropdown. They are doing the District of Columbia separately but the territories are missing.

    The state differences are sometimes stark and the worst state in the nation is not Alabama. More to come in further posts.

     

    57 Responses to “Covid-19 moment of truth for our healthcare systems”

    1. Gavin Longmuir Says:

      Excuse me — I don’t want to see projections from models with built-in assumptions that guarantee the forecast will be huge numbers of dead people.

      I want to see actual data — How many people died today or this week from All Causes? And how does that compare with the number who died in the same period in prior years?

      That data exists — somewhere! It gets my spidey sense tingling when available real data are hidden and uncertain projections are front & center.

    2. Gavin Longmuir Says:

      It is also worth noting that no place in the US is ready for a 1,000 year storm — although we know from the geological record that 1,000 year storms occur.

      No place on the planet is ready for a large meteor strike — although we know from the geological record that the Earth is sometimes hit by giant meteors causing planet-wide destruction.

      The US is totally unprepared for another Carrington Event — a solar storm which would wipe out electrical systems all over the planet, although we know such events happen.

      The US is totally unprepared for a massive volcanic eruption in Yellowstone, although the grumbling of the planet can already be noted.

      When we think of all the really serious events for which we are unprepared, the current virus perhaps filling hospitals to capacity is not high on the list.

    3. Grurray Says:

      I want to see actual data

      The data is incomplete, especially for places like Italy and Spain. Let’s not even mention China. But putting that aside, the problem with looking at current data is there also have to be some kind of assumptions for what you are going to do with that data. If you don’t trust assumptions in the models, what makes your assumptions about the data so valid?

      So you want to look at year over year deaths for March 2020 compared to March 2019. Say it shows no difference. Are you confident that will be a good indication about how April or May will go?

      I’m not. The real world is dynamic and highly sensitive to initial, often hidden, conditions. Past performance does not necessarily predict future results. Ridin’ high in April, shot down in May.

      I don’t trust the models either, but that makes me even more skeptical of any data I see. There were zero cases (that we knew of) in November. That doesn’t help us now.

      In the absence of quantitative certainty, we then must look at, (a) expert qualitative analysis on the one hand, and (b) trusted universal premises about how systems work on the other.

    4. PenGun Says:

      You have less than a million hospital beds. Your medical system should fail to cope, by the end of the month.

    5. MCS Says:

      Another bias is the PC one. Anyone that suggested that riding the subway during an air transmitted epidemic is unwise would probably be arrested in NYC. Any “model” that took mass transit into account as a liability would be professional suicide. Don’t hold your breath waiting for someone to bring it up once the data shows that many of the worst hit cities were heavy users either.

    6. Gavin Longmuir Says:

      Grurray: “In the absence of quantitative certainty, we then must look at, (a) expert qualitative analysis on the one hand, and (b) trusted universal premises about how systems work on the other.”

      Where do we find an expert — i.e., someone who has experience of this situation — to do an appropriate qualitative analysis?

      Frantic Faucci may know a lot about bureaucracy and quite a bit about epidemics, but he has absolutely zero prior experience with the course of action he recommends — shutting down an entire economy. That has not been tried for any previous outbreak within Faucci’s lifespan. The only “experts” who have tried something like that recently are the Chinese — and no-one trusts the Chinese.

      Similarly, the models which Faucci relies on assume exponentially increasing transmission, but they completely ignore the effects of his recommended total shut down. Those very real factors are simply not included in the models.

      Bureaucrats rush to print money to compensate for the lack of real production of goods & services during the economic shut-down — the only “experts” in the effects of that kind of money printing are in Venezuela and Zimbabwe, and no-one is asking for their advice.

      Since there are no real “experts”, we are forced back to Common Sense — or trusted universal premises about how systems work, if you prefer.

      Common Sense says there is a virus which can accelerate the deaths of those who are old & sick, but is otherwise broadly comparable to the common cold — as demonstrated on the Diamond Princess and in Italy and in Spain. Common Sense says we deal with that kind of situation by helping the At Risk part of the population to self-isolate while working age people keep on working & producing. But our Betters ignored Common Sense.

    7. TM Lutas Says:

      Gavin Longmuir – When I give the link for the data first and then I give the link for the visualization, I’m confused when I get a complaint about the need for the data. What data are you missing?
      As for your second objection about preparation, looking through the various state projections, some states are going to do fine. Others are not. This isn’t a 1000 year storm. It’s a mild pandemic compared to what is possible (see black death for comparison). When some states are likely to chug along just fine without going to heroic measures and others might not make it even with heroic measures, you have a failure to reasonably plan.

      It looks like I’m going to have to present comparisons in more detail. But that’ll be a different post.

      PenGun – The point of the projection is largely in the state level graphs. There are states where they are undergoing heroic level measures to overcome poor planning that has spanned decades. Other places are not going to exceed the level of preparation they already put into their normal budgets. This will make the Covid-19 experience in the United States very uneven. In some places it will not be as bad as you say. In others it will be much worse than you say. To grasp the tragedy of what is going on you are going to have to dive into the weeds on this one.

      MCS – Too late as I have already done so and plan on doing so some more as time goes on. I’ve also gone and raised questions about the larger movement of new urbanism. But I’m reckless that way.

    8. Grurray Says:

      The qualitative analysis I’m interested in is from doctors and nurses in clinical situations. What they’re saying about acute respiratory distress, for example, which does not have a cure and can cause permanent damage. There are reports of younger healthy people, including medical staff, on ventilators in New Orleans and New York City where age and comorbidities weren’t complicating factors.

      Maybe that’s still just a matter of rolling the dice and betting that this out-of-the-ordinary isn’t going to get so out of the ordinary that it ravages the otherwise healthy bulk of the population. However, if there is a genetic factor or if viral load is a factor, then social distancing is the only option. The economy can some day come back from workers on a furlough, but not if those workers are permanently gone.

    9. Brian Says:

      TM: Have you not been paying attention the last 2 months? Gavin is solid as a rock in his complete and total unseriousness. You can show him as many numbers as you like, until you get exhausted of it and give up, and he’ll never concede that the coronavirus is more than a slight flesh wound.

    10. MCS Says:

      If I was trying to find early evidence of transmission, I would look at subway conductors and bus drivers. Also cab and livery drivers. Subway conductors especially must get exposed to everything.

      Keeping something like this from spreading on subways, trains and buses is not going to be easy, if they even try. It’s not like New York can become L.A. but this might slow down the idea that L.A. should become like New York. Not that they’ve made much progress.

    11. Jay Guevara Says:

      I’m honked, too. I paid for fire insurance, but I didn’t have a fire, so I didn’t need it, right?

      I mean, I’ve seen projections of how many fires there would be, but they were wrong in my case. The whole fire insurance thing is just a big scam.

    12. Sconnie Says:

      Was there a maximum price you would have paid for that fire insurance?

    13. Jay Guevara Says:

      Was there a maximum price you would have paid for that fire insurance?

      Depends on whether I knew for sure whether or not I was going to have a fire. If yes, then I’d pay the value of my house. If no, then the maximum price would be zero.

      All I need now is certainty as to what will happen in the future.

      Kind of like deciding on a policy (sorry) for dealing with corona virus.

    14. Anonymous Says:

      I get your attempted analogy.
      But you are avoiding the crux of the cost/benefit consideration.
      You never know the certainty in insurance.
      Perhaps in the covid case you are in position to avoid/socialize economic cost.

    15. Gavin Longmuir Says:

      TMLutas: “When I give the link for the data first and then I give the link for the visualization, I’m confused when I get a complaint about the need for the data. What data are you missing?”

      The data I would like to see is the actual data referred to in my comment:
      “I want to see actual data — How many people died today or this week from All Causes? And how does that compare with the number who died in the same period in prior years?”

      Something I see quite often in my other life is people referring to “projections” or “forecasts” as “data”. Data are numbers that are measured in the real world. Projections or forecasts are numbers that come out of computer models — they have not been measured, they are not real. Both projections and data appear on spreadsheets as numbers, but they are not the same thing. Projections, such as in the IHME link, are not data.

      I hope we understand each other now.

    16. Jay Guevara Says:

      With respect, I think you kind of missed the point of my comment, which was to some extent sardonic.

      One buys insurance to hedge the possibility of a huge uncertain loss by accepting a certain, smaller loss.

      That’s exactly what we’re doing now. We’re accepting a certain but hopefully smaller loss (economically) as against the possibility of a huge uncertain loss in human life (and the inevitably attendant loss economically).

    17. Grurray Says:

      Jay, good point. I might add that we used to have all kinds of different forms of insurance against this kind of thing, such as cohesive communities, domestic industry, strategic travel restrictions due to the Cold War, faith. Now that all those things are either gone or threatened we have to shut everything down instead. In the future we need a better insurance plan.

      To other fellow readers open to such ideas, check out this thread and accompanying study speculating that the Chinese Communist Virus is not a lung condition but an affliction of the blood

      https://threadreaderapp.com/thread/1244717172871409666.html

      In this case, diabetes would be the most dangerous underlying condition. That might include pre-diabetes. That could potentially ensure up to 100 million Amwricans.

      And intubation may make things worse. The best treatment would be full blood transfusion.

    18. Sconnie Says:

      Certainty of the economic loss is uncertain given the need for “hopefully”.
      A lot of that depends on duration.
      You know..Pence holding up the 15, then 30 day signs.
      I heard an interview with Fauci where he noted the US is so widespread we arelike a bunch of countries. Yet, one size fits all.

      Grurray,
      I have seen elsewhere the notion that diabetes/obesity is a big factor, maybe more so in younger patients.

    19. Gavin Longmuir Says:

      Here is an interesting report about some scientific research relevant to the treatment of patients with Covid-19:
      https://threadreaderapp.com/thread/1244717172871409666.html

      The referenced paper is about modeling of molecular interactions — which will (should) automatically have us all reaching for a few grains of salt. It is also written by a researcher in China — and no-one trusts the Chinese. With those provisos …

      What the modeling suggests is that we have not fully understood the mechanism by which Covid-19 leads to death. The researcher postulates that the virus works to eject iron from hemoglobin in Red Blood Cells, rendering them unable to transport oxygen to the body’s organs or to remove resulting CO2.

      Implicit in this is that intubation mostly will not be successful — which seems to agree with the observation that about 2/3 of Covid-19 patients put on ventilators end up dying. The problem is not getting oxygen into the lungs (where a ventilator can help), it is getting oxygen from the lungs into the bloodstream (where a ventilator is irrelevant). Instead of Governors demanding thousands of ventilators to prolong unpleasant deaths, they should be pushing for greatly increased blood transfusions which could help patients recover.

    20. raymondshaw Says:

      Gavin,

      When the author says: “Using computational analysis (modeling the behavior of a molecule in a computer)”, my guess is that he misunderstands what it means. Back in the days before we had powerful computing, people in the laboratory would construct actual physical models of (presumed) active drug molecules, and scaled to a size where they could see how that physical structure might attach to some biological physical structure and interact with it (i.e the virus active site). So they would actually start by constructing that active site structure. Laboratory Science supply vendors sold these model structure kits that would have various elements usually differentiated by color (say black for carbon, yellow for sulfur, red for hydrogen, etc.) with stick like bonds attached at the known bond angle and length for different inter-element bonds. Then you merely attach the elements together, one by one until the structure is completed. Having such a structure for the active site, one then sees how the two structures interact. Today they use computer programs to do the same, but much faster with greater precision.

      When I worked as a synthetic organic chemist at E.R. Squibb & Sons (now Bristol-Meyers Squibb) in the mid 70s there was a fellow working there named Miquel Ondetti who I believe was (one of??) the first researcher/s to use such an approach that led to the development of a successful pharmaceutical, Captopril. In our chemistry department, we routinely built models of chemical structures we wanted to screen as potential new drug candidates. I have a vague recollection that Mr. Ondetti’s initial exploration involved some snake venom peptide that he was exploring and I remember a derived nona-peptide, a model of which floated around the building. When I worked at the Squibb Institute for Medical Research (Princeton, N.J.), I wasn’t involved with the Captopril project, but when I transferred to the Pilot Plant in New Brunswick, I did work on the project to optimize and scale up Captopril production for commercial sale.

      https://en.wikipedia.org/wiki/Miguel_Ondetti

      An interesting anecdote- I recall at that time, management made a big fuss that the cost of developing and getting FDA approval for Captopril was the outrageous amount of $50 million. What does it cost today? $1 billion, $2 billion? Thank the FDA.

    21. Mike K Says:

      What the modeling suggests is that we have not fully understood the mechanism by which Covid-19 leads to death. The researcher postulates that the virus works to eject iron from hemoglobin in Red Blood Cells, rendering them unable to transport oxygen to the body’s organs or to remove resulting CO2.

      I saw that too, elsewhere. The same paper has a few errors in biology, such as malaria is caused by a bacterium.

      My knowledge of the mechanisms in hemoglobin-oxyhemoglobin is 50 years old but I am doubtful.

    22. raymondshaw Says:

      The David Friedberg tweet mentions “causes “crushed glass” lung imagery”. I believe the expression is “ground glass”. Ground glass refers to the joints in laboratory glassware that can be (near)vacuum proof when properly greased. Looks kinda frosted, semi-opaque. Grind, crush not the same.

    23. David Foster Says:

      Raymondshaw…”Laboratory Science supply vendors sold these model structure kits that would have various elements usually differentiated by color (say black for carbon, yellow for sulfur, red for hydrogen, etc.) with stick like bonds attached at the known bond angle and length for different inter-element bonds. Then you merely attach the elements together, one by one until the structure is completed. Having such a structure for the active site, one then sees how the two structures interact. Today they use computer programs to do the same, but much faster with greater precision.”

      So does that mean the the computer program is merely a visualization tool…presumably with 3-D rotation capabilities, etc…rather than something that itself predicts the molecule performance?

    24. MCS Says:

      Without parading my ignorance, anybody that’s interested in computational chemistry might check out the folding@home project.
      https://foldingathome.org/

      The fact that it has to be carried out on the most powerful super computers seems to indicate that it isn’t just visualization of static molecules.

    25. Gavin Longmuir Says:

      David F: “So does that mean the the computer program is merely a visualization tool …”

      It seems likely to be much more than a visualization tool — although 3D structure is itself important in how molecules can interact.

      Way back in the Jurassic when I was an undergraduate, I got a summer job in the University’s Chemistry Department as a peon helping with modeling of possible Phosphorus-Nitrogen ring compounds, trying to predict their stability. Even back then, it involved mathematical modeling of interactions between electron shells of atoms in different spatial arrangements. Given the computing advances since then, it is not surprising that they are studying atomic-level interactions between complex molecules.

    26. JAL Says:

      As an expat who’s lived in southern Germany for almost 30 years, I think the situation is hopeless. We were concerned at first about people getting the Chinese Virus in our area because we’re so close to Italy. But since about 3 weeks we’ve been more concerned and damned angry about the Chicken Little “the sky is falling” panic makers. They’ve worried about the health infrastructure here being taxed to its limits too, the clinics are completely over staffed. The media here plays the chicken little game too and the majority of people are very afraid – sehr ängstlich. But the people in our area have never been more healthy. A friend of the family had a son who was in Thailand for 3 weeks and returned last week. He wasn’t afraid of getting the virus until he returned to Germany – scheiss Media! An expats 2 Euro Cents – still worth something at the moment.

    27. raymondshaw Says:

      The phrase was: “modeling the behavior of a molecule in a computer” It’s not one, but 2 molecules (structures) behavior that is modeled. For a reaction to occur between 2 molecules (structures), they have to get close enough to each other that the attractive forces can overcome the repulsive forces in a biologically useful way. When this ‘interaction’ occurs, bond angles and lengths changes, energies, really everything. It is not hard to envision modeling such interactions can be very computationally intensive. Now do it with 1,000,000 potential drug candidates.

    28. Brian Says:

      thread from the Chair of New York City Council health committee:
      https://twitter.com/MarkLevineNYC/status/1247155576221716480
      It’s not just deaths in hospitals which are up. On an average day before this crisis there were 20-25 deaths at home in NYC. Now in the midst of this pandemic the number is 200-215. *Every day*. 5/

      FYI, this guy, a leftist nutjob, and the entire NYC government, needs to be face serious consequences for encouraging people to keep acting as if nothing was going on long after other places were warning about crowded events, etc. I’m not putting him up as an exemplar of anything. Just sharing a quote that things are indeed very bad in NYC in ways that aren’t necessarily going to be captured in many immediate stats.

    29. raven Says:

      The initial reports out of China were of a horror movie style Apocalyptic Plague on Mankind nature.- bio hazard suits everywhere, massive chemical foggers choreographed on the streets, people collapsing on the streets, doors blocked shut with steel tube braces, dozens of portable incinerators brought in, …..now we have reports of a huge under-reporting of deaths, thousands of funeral urns being shipped to Wuhan, etc. Just like a movie. JUST LIKE A MOVIE.

      To start with , I was very alarmed- the chi-coms apparently let a bio weapon get loose. Cue the The Stand, we are doomed. And I stayed that way for weeks. Thought our favorite “poly-anna ” Gavin was nuts. Now, I think he is right- the evidence does not support our reaction.

      Problem is, none of the data coming in from anywhere else shows this level of lethality. Yes, it is killing people. Now this is going to sound cruel, and I don’t mean it to be- but what this virus is doing, by and large, is pulling forward the deaths of old and sick people, who were unlikely to live more than a year or two anyway- the data out of Italy shows this, the data out of NYC shows it, the overwhelming number of deaths are the old, and very sick. Yes , there are a FEW outliers- like in any data set. But very few. And most of the outliers for age, were sick. Very sick. Cancers, etc. We cannot extrapolate an accurate death rate for the general population, from this. Isolate the vulnerable,use reasonable hygiene care , and get back to work.

      IMO, this virus escaped from the lab in Wuhan, the Chinese shit a brick, then they saw, 1, they could not contain it, and ,2, how the west was panicking, and decided they would leverage it for effect as the best remaining option- and what a success! They and their allies in the western press got the most powerful country in the world to stick a gun in it’s mouth and commit economic suicide!
      Sun Tze had good pupils!

      The western press has jumped in on this hard, it reminds most of the “climate change” scam, with the total unquestioning enthusiastic support. Of course, the underlying reason is the same, the hope for change (ha ha) and the imposition of a socialist political system. Just look at what the Dem. state governors are doing for a taste of the national socialist wet dream. And the box of goodies the congress is handing out. “Why work, dude? You a sucker?” The political threat from this dwarfs the viral aspects. What better way to break apart the already fragile bonds than “social distancing” Bring the TSA/stasi effect into everyday life with chicken shit laws about going out in public , and encourage informers.
      Training for the New Man.
      The sort of crap we are putting up with, with the excuse of the Dreaded Virus, makes me sick.

      Never let a crisis go to waste.

    30. miguel cervantes Says:

      that Levine character, went to Chinatown, caught the covid, save us from these jackalope

    31. Brian Says:

      Raven: No, no, no. We *reacted* after Wuhan and Lombardy got hit hard (Iran got little attention, but by all accounts they were/are also absolutely pummeled) and *that* is why our cities aren’t like them. *We* got R0 down, *we* suppressed the spread, because of collective action, and we’re going to get through it together and be stronger. I’ll bring up the seatbelt analogy–the fact that you survived the crash doesn’t mean you didn’t need it, it means you did!
      You’re wrong about the death statistics, but at this point it’s futile to argue about that.
      The media is terrible, ignore them. When Trump “stopped” flights from China, they attacked him for overreacting. Then they decided to attack him for underreacting. They’re vipers and morons. Don’t let them distort the truth of what has happened. They’re a sideshow. A destructive sideshow, but do not let them be the focus.

    32. BobtheRegisterredFool Says:

      A default skepticism towards computational chemistry is probably wise.

      Would you trust a hypersonic missile design where the fluids work was CFD done by a grad student? CFD may well be a good tool, but it is still in the category of tool where user skill and type of problem matter. If you can’t evaluate user skill and the type of problem, caution is the smart position.

      Another point, insurance is probably the wrong way to think about this.

      Strictly speaking, I understand that insurance uses a relatively stable asset, money, and a pool of estimated similar risks.

      We are trading off between two uncertainties.

      We have the disease costs between, simplifying, policy set A and policy set B.

      We have the economic costs between policy set A and policy set B.

      If we try to simplify the uncertainty by discarding as bullshit the Chinese, Italian, and NY numbers, then the disease deaths become more certainly low, and we insure against economic harm by accepting them.

      If we try to simplify the uncertainty by accepting the socialist model of economics, then the economic deaths become more certainly low, and we assume we insure against disease harm by accepting them. Of course, the socialist model of economics thought that the great leap forward was a good idea, and the Nazis did not sell socialized medicine to the Germans on the basis of the T4 program.

      Insure is not quite the correct word, because even if we are simplifying one, the other is still understood as a single risk, not a collection of smaller risks.

      The risks of economic harm probably can not be captured by any simple model. Which leaves us with analysis of the disease risk. If my epidemic model shows tens of billions of dead, that is a very large risk, if you take my probabilities as modeled. A large risk, means avoiding the risk might be worth a great deal of economic harm, perhaps on the level of millions starving to death. If you are instead ruthless about discarding models and data that have been screwed around with, and go, ‘given the safely proven disease impacts, aggregated across individuals, how likely is it that aggregate individual disease risks will be substantially worse’, you may well go ‘is any level of economic harm worth it?’.

    33. Brian Says:

      more on the above:
      https://gothamist.com/news/surge-number-new-yorkers-dying-home-officials-suspect-undercount-covid-19-related-deaths
      Statistics from the Fire Department, which runs EMS, confirm a staggering rise in deaths occurring at the scene before first responders can transport a person to a hospital for care.
      The FDNY says it responded to 2,192 cases of deaths at home between March 20th and April 5th, or about 130 a day, an almost 400 percent increase from the same time period last year. (In 2019, there were just 453 cardiac arrest calls where a patient died, according to the FDNY.)
      That number has been steadily increasing since March 30th, with 241 New Yorkers dying at home Sunday — more than the number of confirmed COVID-19 deaths that occurred citywide that day. On Monday night, the city reported 266 new deaths, suggesting the possibility of a 40% undercount of coronavirus-related deaths.

      (Merely posting this because there are still inexplicably a lot of JTFers out there.)

    34. Gavin Longmuir Says:

      Brian — what is happening to total deaths from all causes in New York? Can you find those numbers, compared to prior years? If not, why not?

      There are videos circulating from “citizen reporters” who have gone to hospitals in New York and Los Angeles and shown them to be unusually quiet. Part of that is because hospitals have cancelled many planned surgeries, so they have capacity for this forecasted C-19 surge. Part of it may be changes in individual behavior — instead of going to hospital when feeling sick (heart problem, gastro-intestinal, whatever), people may be frightened into staying home to avoid the high risk of being exposed to C-19 in hospital — and thus end up dying (perhaps needlessly) at home. We don’t really know what is going on.

      The only facts that will show we are in a pandemic are substantial increases in total daily/weekly All Causes deaths — as was seen, for example, in the 1918 Spanish Flu epidemic. That kind of data is not forthcoming from our Betters. (Why not?) Where that data can be found, eg England, this year’s deaths are comparable to prior years.

      Be cautious in interpreting events when the Authorities are not giving you the whole picture.

    35. Brian Says:

      JTF Now!
      JTF Tomorrow!
      JTF Forever!
      https://twitter.com/ChrisGiles_/status/1247458186300456960
      We knew the daily coronavirus death counts were too low because of reporting delays
      We had little idea they were 80% too low….
      All in guts of todays
      @ONS statistics

    36. Anonymous Says:

      what is happening to total deaths from all causes in New York? Can you find those numbers, compared to prior years? If not, why not?

      I recall seeing those stat’s for Italy, and the total death numbers were very little different from 2017,18,19 and 20 for the first few months of the year.
      basically, the Chi-com Crud was lost in the noise.

      I don’t think our stay at home interventions are doing a thing.
      and if this thing is as nasty as everyone makes it out to be, as soon as the orders are lifted, it will come roaring back- how are you supposed to gain immunity by staying safely out of the way? Leave it long enough and it will come back coinciding with flu season…

      We have a couple of really good places to measure- one is the Kirkland nursing home where a bunch (20?)of presumably healthy firemen and cops got the virus. What was their outcome? Second is the Diamond Princess- it would be revealing to know how the presumably healthy crew made out.

      The fact that the at home deaths in NYC increased, if they did increase, is useless without knowing the age and underlying conditions. If this virus is pulling forward the deaths of the people otherwise likely to die in the next six months, it stands to reason some would die at home.

    37. raven Says:

      Sorry, that anon.was me, above. Raven

    38. Brian Says:

      This is from the SCMP which means it can’t be trusted, but we absolutely have to know if this is true or not:
      https://www.scmp.com/news/china/science/article/3078840/coronavirus-low-antibody-levels-raise-questions-about
      “Researchers in Shanghai hope to determine whether some recovered coronavirus patients have a higher risk of reinfection after finding surprisingly low levels of Covid-19 antibodies in a number of people discharged from hospital.
      A team from Fudan University analysed blood samples from 175 patients discharged from the Shanghai Public Health Clinical Centre and found that nearly a third had unexpectedly low levels of antibodies.
      In some cases, antibodies could not be detected at all.
      “Whether these patients were at high risk of rebound or reinfection should be explored in further studies,” the team wrote in preliminary research released on Monday on Medrxiv.org, an online platform for preprint papers.”

      The rumors have said for months that there was no (or at least not absolute) acquired immunity to the virus. Every strategy on how to deal with it assumes there is, because “oh viruses don’t work that way”. If there is not, “herd immunity” strategies will mean it will spread so far we can basically never eliminate it.

    39. Mike K Says:

      Brian, the concern about that study is whether the CCP testing is valid. CCP tests sent to other countries have a high failure rate.

    40. Brian Says:

      Yes Mike read my first sentence.

    41. MCS Says:

      If it’s from China, it’s a lie. You can waste your time trying to what the lie is trying to cover up. In this case maybe alibiing continuing deaths but your guess is as good as mine.

      In this case it’s doubly meaningless since the lie is based on defective tests if they aren’t whole cloth. It’s a fools errand to waste the bandwidth to look at it when there are probably cat videos that you haven’t seen.

    42. Brian Says:

      be aware of this topic starting to percolate to the surface:
      https://www.statnews.com/2020/04/08/doctors-say-ventilators-overused-for-covid-19/
      “If the iconoclasts are right, putting coronavirus patients on ventilators could be of little benefit to many and even harmful to some.
      What’s driving this reassessment is a baffling observation about Covid-19: Many patients have blood oxygen levels so low they should be dead. But they’re not gasping for air, their hearts aren’t racing, and their brains show no signs of blinking off from lack of oxygen.”

      Covid-19 had us all fooled, but now we might have finally found its secret.
      https://archive.is/ONUmi
      “The past 48 hours or so have seen a huge revelation: COVID-19 causes prolonged and progressive hypoxia (starving your body of oxygen) by binding to the heme groups in hemoglobin in your red blood cells. People are simply desaturating (losing o2 in their blood), and that’s what eventually leads to organ failures that kill them, not any form of ARDS or pneumonia. All the damage to the lungs you see in CT scans are from the release of oxidative iron from the hemes, this overwhelms the natural defenses against pulmonary oxidative stress and causes that nice, always-bilateral ground glass opacity in the lungs. Patients returning for re-hospitalization days or weeks after recovery suffering from apparent delayed post-hypoxic leukoencephalopathy strengthen the notion COVID-19 patients are suffering from hypoxia despite no signs of respiratory ‘tire out’ or fatigue…
      All that hilariously misguided and counterproductive criticism the media piled on chloroquine (purely for political reasons) as a viable treatment will now go down as the biggest Fake News blunder to rule them all. The media actively engaged their activism to fight ‘bad orange man’ at the cost of thousands of lives. Shame on them.”
      Read more at the link.

      tweeps like:
      https://twitter.com/cameronks

    43. Mike K Says:

      I’ve seen that account about hemoglobin and my own education on hemoglobin and oxygen metabolism was 50 years ago but it does not sound right to me.

      There are serious concerns about ventilator over use but that is not the same topic.

    44. Brian Says:

      I’m not a doctor, and don’t even play one online, but I’m just saying it seems that there’s a lot of “COVID-19 isn’t actually a respiratory disease” stuff percolating around recently. I’m confident that the US healthcare system will figure things out. If they figure out a treatment before they really know why it works (a la the chloroquinine thing), that’s ok.

    45. TMLutas Says:

      Gavin – I think that this is what you are looking for:
      https://wonder.cdc.gov/mcd.html

    46. Mike K Says:

      Brian, I did PubMed searches using all the permutations of that theory I could think of and could find nothing remotely suggesting that Iron could dissociate from the Heme molecule. It’s a long time since I took organic chemistry. I just see nothing about it.

    47. Brian Says:

      I’m not a doctor, so I can’t speak to the details.
      The point isn’t to say that that one online post has the entire thing 100% correct. It was just something that is getting circulated in this discussion.
      You can also peruse twitter feeds like this, and associated ones w/ the one I posted above:
      https://twitter.com/yishan/status/1245066858597761024
      Virus is disrupting the hemoglobin’s oxygen capacity. It is attacking our BLOOD first, not the lungs. It is NOT a respiratory ailment (primarily), lung breakdown symptoms are a consequence of the attack on blood hemoglobins.
      Hypoxia is happening BEFORE lungs are affected.

      https://twitter.com/burrliner/status/1245026602771251201
      @cameronks it behaves like HAPE because hypoxia is FIRST. Hemoglobin is being deoxygenated by the virus FIRST and the lungs respond as if they are hypoxic (vasoc > pulm htn etc).

    48. raymondshaw Says:

      If you have 40 minutes of time to spare, you might listen to this fellow:

      https://www.youtube.com/watch?v=lGC5sGdz4kg&feature=youtu.be

      Warning, might be triggering!

    49. Gavin Longmuir Says:

      TMLutas: https://wonder.cdc.gov/mcd.html

      Thanks. That is the Multiple Causes of Death data — to the end of 2018.

      The media keeps telling us how many people died with C-19 today, in 2020. Why can’t they tell us how many people died in total from all causes today? Because if the total number of people dying today was higher than in previous years, this would be a real pandemic.

      Billions of $ being spent. Why can they not show us that number today (instead of for 2 years ago)?

      In England, where Government do show the total All Causes deaths with about 1 week’s delay, total deaths are lower than in previous years. Some pandemic!

    50. Brian Says:

      Shocker of the night–Lying Gavin is still lying, and ignoring evidence posted above.

    51. Brian Says:

      IANAD, but it’s never been just China claiming that patients can be reinfected, and/or those who have been apparently cured can have the virus come back, for some reason or other.
      https://www.bloomberg.com/news/articles/2020-04-09/coronavirus-may-reactivate-in-cured-patients-korean-cdc-says
      Perhaps due to bad tests, perhaps due to who knows, but this absolutely has to be nailed down, it seems to me.

    52. Gavin Longmuir Says:

      Boring Brian muttered: “Lying Gavin is still lying, and ignoring evidence posted above.”

      Sometimes, Brian, you post things which are quite interesting and which suggest you might be sensible. Sometimes you post things which are interesting but demonstrate that you don’t read what other people post. And sometimes you enter a parallel universe.

      It is fascinating how you keep saying you have posted evidence “above”, or maybe “before”, or maybe in your parallel universe. But you don’t post your evidence here and now. When you did once post “evidence” about Italy, it turned out to be an unsubstantiated blogger’s opinion which was unnecessarily doom & gloom because it failed to properly represent the actual evidence.

      This unnecessary lockdown is tough on all of us. I sympathize. But try to keep a grip, man!

    53. Brian Says:

      Lying Gavin doesn’t know how to follow links. Poor Lying Gavin. The internet must be very hard for him.

      Lying Gavin will find some utterly boring and predictable way to dismiss this (which is an updated post from the link I posted before, which Lying Gavin is too stupid and/or lazy to follow):
      https://twitter.com/ChrisGiles_/status/1248241247757664262
      #Coronavirus is not like a bad flu epidemic
      The latest “excess deaths” in the UK chart is pretty conclusive for week 14

      Lying Gavin, a “conservative” who thinks only an “official” government agency can be believed to do measurements or analysis, and that they get it perfectly right with zero time lag, is a lazy and boring troll.

    54. Gavin Longmuir Says:

      Time for some more lies, this time from Prof. Ioannidis at Stanford. Can’t trust those guys from Stanford, especially when they are publishing on an academic research site instead of on Twitter.
      https://www.medrxiv.org/content/10.1101/2020.04.05.20054361v1.full.pdf

      Just listen to these outrageous lies!
      “The COVID-19 death risk in people <65 years old during the period of fatalities from the epidemic was equivalent to the death risk from driving between 9 miles per day (Germany) and 415 miles per day (New York City). People <65 years old and not having any underlying predisposing conditions accounted for only 0.3%, 0.7%, and 1.8% of all COVID-19 deaths in Netherlands, Italy, and New York City."

      It is an interesting way of expressing the mortality risk — given how many miles many of us used to commute before the unnecessary lockdown with its unquantified future costs.

    55. Mike K Says:

      Raymondshaw, I watched a few minutes of that video and agree with what I saw.

      Chickenpox is an example, as is Polio, of a virus that is harmless to children and lethal to adults. The middle aged CV victims may be example of comorbidities or genetic weakness of some sort. The cytokine storm cases might be of that sort.

      It seems to happen with Influenza.

      Here are some ideas of how to treat it.

      So far, steroids seem to make CV worse but there will be time , once the worst is over, to study this subject.

      I have no way to research that theory of hemoglobin effects by CV.

    56. Brian Says:

      How cute. Lying Gavin has now decided that you have to be a tenured faculty posting an on-line preprint to be considered an authority. No more official government documents being good enough, now that they repeatedly show he’s lying. Or “unsubstantiated blogger’s opinion[s]”, which seems odd given the quality of material at this site from the likes of Trent, etc.

      Seems like a strange sort of “conservative” opinion, but things are pretty topsy turvy these days.

    57. Jonathan Says:

      Let’s keep it civil, please.