Covid-19 Response - or Over Reaction?
Credible experts have posed this question. But what I don't see them proffer is the alternative, at least not explicitly. What is the alternative? To let the fire burn uncontrolled and have an Italy situation for weeks or months? Even with the relatively small numbers to date, hospitals in hot spots (like in NJ) are feeling overwhelmed. ERs could collapse. Covid is not the only thing that needs to be treated. The realistic goal is not to prevent any deaths. It's to prevent the collapse of the hospital system. The economy matters but a two or three week full lock down seems preferable to a slow economic death over months with half measures.
The side of the argument that I think we are missing is how much long term health damage an economic collapse like this does to the poor. By stopping everything to try to help the sick and elderly are we shaving years off of the lives of a huge but not easily measured segment of our population? I'm not arguing to let thisxrun free, I'm just wondering about the collateral damage of our choices.
tomcat said:
Today, in a conservative DK morning paper, a retired MD (in his 70's and with underlying health issues) has written an OpEd. In it, he questions whether the attempt at stopping this virus is a valid investment by society.
Society should certainly care for those who fall ill, and try to cure them. But, is it reasonable to attempt to prevent any deaths?
Unbelievable that an MD wrote this. We can't stop it but we can mitigate it. Have you read any of the posts on flatten the curve? Has he read about that? Is he really an MD or some old quack masquerading?
If we don't flatten the curve we will see a critical overload on hospital bed and ventilator needs. Over 95% of those needing hospital care and ventilators will not get it. They will be told, sorry, we can't give you the treatment you need. This will also be told to the young. Resulting in the mortality rate for all age groups being even higher. The young are not immune.
Also, try 5 to 15% for the elderly, depending on age.
FilmCarp said:
The side of the argument that I think we are missing is how much long term health damage an economic collapse like this does to the poor. By stopping everything to try to help the sick and elderly are we shaving years off of the lives of a huge but not easily measured segment of our population? I'm not arguing to let thisxrun free, I'm just wondering about the collateral damage of our choices.
Let me tell you a secret. The poor can also die from this disease. Also, more likely due to their higher rate of underlying health issues. The poor can also be out of their jobs for weeks when they get sick. Or would you prefer the poor to continue interacting with the public while contagious or to just die?
So stick your heads in the sand and don't be surprised when we end like Italy or Iran. Or we can be very active and be like Hong Kong.
I'm starting to think many don't take the disease aspect seriously, instead just worrying about the economy.
Also, don't count on a vaccine to save us. This virus mutates. Vaccines for viruses are very difficult. Every year we need a new flu vaccine which is not even that effective for the elderly. After many years we don't have a vaccine for HIV. We don't have a vaccine for the common cold.
Stop lecturing me for pointing out a different aspect. What's more, you are the one who proudly posted about buying 12 bottles of hand sanitizer, hoarding away at the expense of others. For the record, I'm not ignoring this at all, and our family has lost all of our income. I don't foresee a vaccine, or an end to the quarantine for some time.
I don't fault you for advancing the position. I just think the full court press, bite the bullet now approach is best medically and economically. If we acted sooner and more forcefully, we might be in the position of have countries that have turned the corner on this.
FilmCarp said:
Stop lecturing me for pointing out a different aspect. What's more, you are the one who proudly posted about buying 12 bottles of hand sanitizer, hoarding away at the expense of others. For the record, I'm not ignoring this at all, and our family has lost all of our income. I don't foresee a vaccine, or an end to the quarantine for some time.
I was not lecturing you. But I will. I seems me you're over loss of income more than the health risk. Sad.
You lecture on hand sanitizer. The hand sanitizer was there to be bought. I'm not putting my family and relations at risk by us running out of sanitizer.
Plan ahead. Planning ahead also means saving, if you're not poor, so when crap happens you need not worry. I lost 35% of my liquid wealth but I'm not crying. Even if I had no income, I would still be OK for several years. I planned ahead, saved aggressively while paying off my mortgage.
The ones I feel sorry for are the poor. The ones who live month by month and don't have the resources to bulk stock up. Should I feel sorry for you? Are you economically disadvantaged or did you not plan for your rainy day? And if you're not in need but others in your family are then the kind thing to do is to help them. Which is what I do.
So you see, I can lecture.
BG9 said:
You lecture on hand sanitizer. The hand sanitizer was there to be bought. I'm not putting my family and relations at risk by us running out of sanitizer.
You do understand the concept of public health, don't you? You can have all of the hand sanitizer you can hoard but if everyone else in society is ill, the sanitizer you hoarded will be worthless.
Steve said:
BG9 said:
You lecture on hand sanitizer. The hand sanitizer was there to be bought. I'm not putting my family and relations at risk by us running out of sanitizer.
You do understand the concept of public health, don't you? You can have all of the hand sanitizer you can hoard but if everyone else in society is ill, the sanitizer you hoarded will be worthless.
More than you do. I know public health exceedingly well.
Even though I went into computer software, an industry that happily gave me my 55 retirement, my degree is from the College of Pharmaceutical Sciences, Columbia University. A rigorous five year 168 credit course of study with many microbiology credits. I did get very sick once and the suspicion was I was not careful with a petri culture.
Also, my acquaintance a Dr and my very good friend a Dentist have similarly protected themselves, with masks for their families no less. Or do they also not know public health?
Strange. They American public supposedly questions authority while prizing individuality but when the Surgeon General tells them to not bother wearing masks, almost all fall in line.
BG9 said:
FilmCarp said:
Stop lecturing me for pointing out a different aspect. What's more, you are the one who proudly posted about buying 12 bottles of hand sanitizer, hoarding away at the expense of others. For the record, I'm not ignoring this at all, and our family has lost all of our income. I don't foresee a vaccine, or an end to the quarantine for some time.
I was not lecturing you. But I will. I seems me you're over loss of income more than the health risk. Sad.
You lecture on hand sanitizer. The hand sanitizer was there to be bought. I'm not putting my family and relations at risk by us running out of sanitizer.
Plan ahead. Planning ahead also means saving, if you're not poor, so when crap happens you need not worry. I lost 35% of my liquid wealth but I'm not crying. Even if I had no income, I would still be OK for several years. I planned ahead, saved aggressively while paying off my mortgage.
The ones I feel sorry for are the poor. The ones who live month by month and don't have the resources to bulk stock up. Should I feel sorry for you? Are you economically disadvantaged or did you not plan for your rainy day? And if you're not in need but others in your family are then the kind thing to do is to help them. Which is what I do.
So you see, I can lecture.
When it's on paper, you haven't "lost" yet. You only lose if you sell at a lower number than you bought. If you've been saving for a long time, I'm guessing that your cost basis is still lower than the value that's currently on paper.
Yes, many of our account balances are lower than they were two weeks ago but I'm far more worried about monthly cash flow right now. Fortunately, I have not lost any income.... yet.
I'm not crying about my income. I'll survive. but poor folks who can only afford one can of hand sanitizer are SOL because you had the money to buy a lot of it, and your attitude is that you feel bad for the poor, but not bad enough to limit yourself.
FilmCarp said:
The side of the argument that I think we are missing is how much long term health damage an economic collapse like this does to the poor. By stopping everything to try to help the sick and elderly are we shaving years off of the lives of a huge but not easily measured segment of our population? I'm not arguing to let thisxrun free, I'm just wondering about the collateral damage of our choices.
The side of the argument that I think this misses is how much long term damage to our most basic values and concepts of civilization would be done by not caring for those stricken by the virus, regardless of their age or prior condition.
I think this is the collateral damage that the choices made in decades past (our healthcare system) has already done to us as people.
The idea that that an all out effort to mitigate the impact of this virus by flattening the curve is a charitable gesture to the sick and elderly is not supported by the available evidence. If you look at the case fatality rates by age demographic from china, what you see is a disease that hits the elderly hardest but most emphatically does NOT spare the young. Only the very youngest seemed to have been less stricken.
You can see the impact in the New York Times interactive here: https://www.nytimes.com/interactive/2020/03/16/upshot/coronavirus-best-worst-death-toll-scenario.html
If we assume that just 40% of Americans are infected and the fatality rate is 2.0%, we can expect to see 4,200 deaths in those aged 10-19, 12,000 deaths in those aged 20-29, 15,000 deaths in those aged 30-39 and 38,000 deaths in those aged 40-49.
That's 69,200 dead people under 50.
That's 23 9/11s or 11,000 more dead young people than were lost by the US in the Vietnam War.
Many more young people would be very ill for a long period and suffer lasting effects.
That this horror would be accompanied by millions of deaths among older adults should not blind people to the real danger this virus poses to the young and healthy.
You can choose to imagine that the infection rate will only be 10% and the fatality rate less than 1% but there is no evidence to support such a rosy conjecture at this time.
Getting back to the basic values and civilization thing:
I grew up with the golden rule and the understanding that no man is an island. Though not raised in any religious tradition, I received from the culture the idea that "as you did it to the least of these, you did it to me."
If we are seriously thinking about giving up those values, perhaps the people who are panic buying guns and ammunition have the right idea.
The virus may force our medical professionals into nightmare triage situations, but we owe it to our selves, our children and our civilization to do everything we can to mitigate that.
Ask not for whom the bell tolls.
yahooyahoo said:
When it's on paper, you haven't "lost" yet. You only lose if you sell at a lower number than you bought. If you've been saving for a long time, I'm guessing that your cost basis is still lower than the value that's currently on paper.
Yes, many of our account balances are lower than they were two weeks ago but I'm far more worried about monthly cash flow right now. Fortunately, I have not lost any income.... yet.
You're right. Nothing in my portfolios has been sold. I may regret that. My cost basis is lower. I should have looked at it that way instead of comparing from a couple of months ago. Which makes me feel better.
It wasn't easy. During one span of six years I worked a consistent 65 - 75 hour week.
BG9 said:
More than you do. I know public health exceedingly well.
Even though I went into computer software, an industry that happily gave me my 55 retirement, my degree is from the College of Pharmaceutical Sciences, Columbia University. A rigorous five year 168 credit course of study with many microbiology credits. I did get very sick once and the suspicion was I was not careful with a petri culture.
Also, my acquaintance a Dr and my very good friend a Dentist have similarly protected themselves, with masks for their families no less. Or do they also not know public health?
Strange. They American public supposedly questions authority while prizing individuality but when the Surgeon General tells them to not bother wearing masks, almost all fall in line.
Guess that means that you don't really care about public health and the impact of your actions on it. (P.S. You have no idea what my knowledge/experience/access to experts is so you'd be better off not trying to compare yourself to others - this is true in general not just in this particular instance).
tomcat said:
Full disclosure: I am over 65, and have a minor underlying condition. I can't be sure, but I might have had the Corona virus already.
Today, in a conservative DK morning paper, a retired MD (in his 70's and with underlying health issues) has written an OpEd. In it, he questions whether the attempt at stopping this virus is a valid investment by society.
With medical advances, our population has a much higher percentage of vulnerable individuals, than was the case 2 or 3 generations ago. Thus, the current mortality rate (whether it is 3% or 5%). In other words, if this had happened 100 years ago, the mortality rate would probably only have been around 1%
Some of the reports I see predict that the peak will not occur till May or June. Other reports predict that this will be an ongoing 18 month event (with multiple waves of infections). This begs a very big question: Can our society/economy bear a prolonged partial (let alone full) shut-down?
YES
Society should certainly care for those who fall ill, and try to cure them. But, is it reasonable to attempt to prevent any deaths?YES
Seems to me that BG9 needs to admit that hoarding hand sanitizer was an ethical lapse and that everyone else needs to lay off of him/her because we are all new to this ####show and we are all going to make mistakes.
Doing a double take on Tomcat's original post: What makes you think you had it, and how was it?
My FIL is in his late 70’s, has cardiac issues, and chronic bronchitis. He’s posting on FB about this being a hoax by the media in an attempt to control society. My SIL lived near him and is doing his shopping so he doesn’t have to risk going to a store, and he HATES it. He thinks she has been brainwashed by the media. She purchases groceries, calls him and has him open his garage door, and places them inside his garage for him to collect after she leaves. He’s pissed that she won’t even come inside for a cup of coffee
At least my MIL (divorces from my FIL) and my mother are more realistic about the situation. I have extra eggs so I drove out there and placed a dozen at each of their doors, then texted them that they had eggs. No one got pissy about me not stopping to say hello
tomcat said:
Society should certainly care for those who fall ill, and try to cure them. But, is it reasonable to attempt to prevent any deaths?
It seems the question is more like: Is it reasonable in such a wealthy society to decide to leave people over a certain age to die? In Italy, performing triage will cause trauma to the healthcare workforce: No one over the age of 70 gets intubated (on a ventilator). And even that is not enough.
See, for example this WSJ article:
It's behind a paywall, but it's very informative, so pasted below with just a few paragraphs removed:
Lessons From Italy’s Hospital Meltdown. ‘Every Day You Lose, the Contagion Gets Worse.’
The coronavirus is pushing a wealthy region with high-tech health care toward a humanitarian disaster
By Marcus Walker and Mark Maremont
March 17, 2020 10:31 am ET
BERGAMO, Italy—Ambulances here have stopped using sirens. The frequent blaring only adds to local fears. Besides, there are few other vehicles on the road in Italy’s national lockdown.
...
Some U.S. doctors are trying to understand how the coronavirus defeated all efforts so far to contain it in Lombardy, the Italian region that includes Bergamo and Milan. They seek lessons but don’t have much time, as the pandemic, now coming under control in China, takes off throughout the West.
Maurizio Cereda, an intensive-care doctor and anesthesiologist in Philadelphia, recently circulated a list of lessons from Italy to colleagues. Dr. Cereda, now at the Hospital of the University of Pennsylvania, trained in Milan and has been in close touch with Italian colleagues in Bergamo and elsewhere.
Many of the lessons relate to public health, to avoid overwhelming hospitals. “Mild-to-moderate cases should be managed at home, not in the hospital, and with massive deployment of outreach services and telemedicine,” he wrote. Some therapies could be delivered at home, he said, via mobile clinics.
Another lesson: Italian emergency-medical technicians have experienced a high rate of infection, Dr. Cereda said, spreading the disease as they travel around the community.
He also warned that smaller hospitals “are unprepared to face the inflow of patients” and are likely to collapse. He suggested admitting the sickest patients to bigger facilities and using dedicated ambulances for suspected coronavirus patients to avoid infecting the entire fleet.
Italy’s death toll from the coronavirus hit 2,158 on Monday, up 349 since Sunday. The country is on course to overtake China’s 3,099 deaths within days. Its large elderly population is especially vulnerable to Covid-19, the respiratory disease caused by the coronavirus.
About two-thirds of Italy’s dead, 1,420 people, are in Lombardy, the ground zero of Europe’s epidemic. It is where the virus is all the more deadly because hospitals in the worst-hit towns have reached their limits. Bergamo, in particular, has become Italy’s symbol of an epidemic spinning out of control.
Studying the dire turn of events in Italy has helped U.S. doctors better prepare, said Brendan Carr, chair of emergency medicine for The Mount Sinai Health System, a New York City hospital network.
Dr. Carr said he and other U.S. physicians have had informal calls with Italian doctors in recent weeks. “It’s terrible to hear them talk, but it benefits us to learn from it,” he said. One lesson, he said, is to build capacity for the expected influx of Covid-19 patients before it’s needed. Mount Sinai is clearing out space and creating new ICU beds, he said.
Bergamo shows what happens when things go wrong.
In normal times, the ambulance service at the Papa Giovanni hospital runs like a Swiss clock. Calls to 112, Europe’s equivalent of 911, are answered within 15 to 20 seconds. Ambulances from the hospital’s fleet of more than 200 are dispatched within 60 to 90 seconds. Two helicopters stand by at all times. Patients usually reach an operating room within 30 minutes, said Angelo Giupponi, who runs the emergency response operation: “We are fast, in peacetime.”
Now, people wait an hour on the phone to report heart attacks, Dr. Giupponi said, because all the lines are busy. Each day, his team fields 2,500 calls and brings 1,500 people to the hospital. “That’s not counting those the first responders visit but tell to stay home and call again if their condition worsens,” he said.
Ambulance staff weren’t trained for such a contagious virus. Many have become infected and their ambulances contaminated. A dispatcher died of the disease Saturday. Diego Bianco was in his mid-40s and had no prior illnesses.
“He never met patients. He only answered the phone. That shows you the contamination is everywhere,” a colleague said. Mr. Bianco’s co-workers sat Sunday at the operations center with masks on their faces and fear in their eyes.
The Papa Giovanni XXIII Hospital, a 950-bed complex that opened in 2012, is among the most advanced in Italy. It treats everything from trauma and heart surgery to organ transplants for children.
More than 400 of the beds are now occupied by confirmed or suspected coronavirus patients. The intensive-care unit has swelled to around 100 patients, most of whom have Covid-19. New cases keep arriving. Three of the hospital’s four top managers are home sick with the virus.
“Until three weeks ago, we did everything for every patient. Now we have to choose which patients to put in intensive care. This is catastrophic,” said anesthesiologist and intensive-care specialist Mirco Nacoti.
Dr. Nacoti worked for Doctors Without Borders in Haiti, Chad, Kurdistan and Ivory Coast, and he is one of the few medics in Bergamo who has seen epidemics. Yet, those were diseases with vaccines, such as measles and rubella.
He estimated that around 60% or more of the population of Bergamo has the coronavirus. “There is an enormous number of asymptomatic people, as well as unknown dead who die in their home and are not tested, not counted,” he said. “The ICU is the tip of an iceberg.”
Hospitals in the U.S. and across Europe must organize in advance, Dr. Nacoti said, and governments need community lockdowns early rather than late.
“An epidemic doesn’t let you proceed by trial and error,” he said. “Every day you lose, the contagion gets worse.”
Bergamo, a city of about 120,000 northeast of Milan, sits at the heart of one of Italy’s wealthiest regions. Companies nearby make San Pellegrino mineral water, luxury yachts, and brakes for Ferrari cars. The city’s hilltop core, a medieval citadel, is normally filled with tourists.
When Bergamo discovered a clutch of coronavirus cases in its outlying towns around Feb. 22, Dr. Giupponi of the Papa Giovanni hospital emailed Lombardy’s regional health authorities. He urged them to empty out some hospitals and use them exclusively for coronavirus cases.
Regional managers at the time were dealing with an outbreak south of Milan. “We haven’t slept for three days and we do not want to read your ********,” Dr. Giupponi recalled their reply.
Since then, Italy’s lockdown has turned Bergamo into a ghost town.
Death notices in the local newspaper, the Bergamo Echo, normally take up just over a page. On Monday, they filled nine pages. “And that’s just the ones that are in the paper,” Dr. Nacoti said.
Doctors taking a break at the Papa Giovanni swap stories of woe, including the call from an elderly care home reporting suspected virus sufferers who were over 80 years old. The hospital said the elderly residents had to stay put.
“None of us have ever seen such a thing,” trauma surgeon Michele Pisano said. “We’re trained for emergencies, but for earthquakes, not epidemics.” Dr. Pisano has little to do these days: Italy’s lockdown means there are virtually no car crashes, bicycle accidents or broken bones from skiing. He helps out in the coronavirus wards however he can.
In small towns around the province of Bergamo, the pressure on local hospitals is even greater.
Dr. Nacoti helps at a hospital in San Giovanni Bianco, located in the foothills of the Alps. On Sunday evening, the facility had around 70 coronavirus patients. The hospital, which specializes in outpatient surgery, normally has 20 beds.
Recently arrived patients lay on gurneys, filling the emergency room and a corridor while they wait for beds to become free.
Upstairs, more than 50 patients were administered oxygen through helmets or masks. Some were in critical condition, but the hospital has no intensive-care unit and no ventilators.
“We thought seven beds downstairs and seven upstairs would be enough,” senior nurse Fiorella Busi said.
The hospital had planned to send severe cases to Bergamo. “But we got indications that, if patients are over 65 or 70, they won’t get intubated,” said Davide Grataroli, one of the hospital doctors. “So, we’ve chosen to manage them here as best we can.”
That has been the situation for nearly three weeks. The patients know that the lack of intensive-care facilities dooms those not strong enough to survive the disease with limited help. “They accept it with resignation and no complaints,” said Ms. Busi, the nurse.
“The most devastating part is that they are dying alone,” she said. “Families see the patient for the last time at the emergency room. The next time is at the mortuary.”
Such a lonely death is hard to take, the nurse said: “It’s not our culture. We’re very connected here.”
bub said:
Doing a double take on Tomcat's original post: What makes you think you had it, and how was it?
I was in an orchid show Jan 17-19. 3 bus loads of Chinese visitors/tourists came to the show.
At the next show, Jan 24-26, a colleague (who was next to my sales table at the previous show), came down with 'something' (fever, cough, etc.).
5 days later, I came down with it (1.1/2 days of fever & minor joint aches, 4-5 days of feeling terrible, occasional diarrhea, 2 weeks of coughing). I tried to work through it, but stayed in bed 1/2 day Friday and all day Sunday (Super Bowl Sunday).
5 days later my wife came down with it. It took her longer to get over it, which we at the time attributed to my having had a flu shot, while she did not.
Can't say for certain that I had it, but symptoms seem to match, including the 5 day incubation period.
Another case of over-reaction:
Tried to go to Home Depot. They only allow 50 customers to be in the store at any given time. The Springfield Avenue Home Depot has 50 aisles. That is 1 customer per aisle!!!!!
Klinker said:
Seems to me that BG9 needs to admit that hoarding hand sanitizer was an ethical lapse and that everyone else needs to lay off of him/her because we are all new to this ####show and we are all going to make mistakes.
You people seem to get so worked up, to so agonize over some bottles of sanitizer. Is there life, aside from MOL?
I do admit, thinking about it now, that I was unthinking when I grabbed the bottles considering that sanitizer is easily available to me. Maybe I should return for refund?
Steve said:
Guess that means that you don't really care about public health and the impact of your actions on it. (P.S. You have no idea what my knowledge/experience/access to experts is so you'd be better off not trying to compare yourself to others - this is true in general not just in this particular instance).
Actually, I do. That's why I posted factual stuff about the need for masks and other info. I was not comparing myself to you and others. I was attempting a rebuttal to your comment that I don't understand public health issues. Health issues is my thing. But, it seems I failed.
BG9 said:
Klinker said:
Seems to me that BG9 needs to admit that hoarding hand sanitizer was an ethical lapse and that everyone else needs to lay off of him/her because we are all new to this ####show and we are all going to make mistakes.
You people seem to get so worked up, to so agonize over some bottles of sanitizer. Is there life, aside from MOL?
I do admit, thinking about it now, that I was unthinking when I grabbed the bottles considering that sanitizer is easily available to me. Maybe I should return for refund?
I wouldn't sweat it. I almost bought four bags of flour the other day. We do a lot of baking but not that much.
Klinker said:
I wouldn't sweat it. I almost bought four bags of flour the other day. We do a lot of baking but not that much.
I know. I'm just giving you all hard time. Sometimes I wonder if I retired too early. I seem to spend too much time on MOL.
I have to start a new project.
Tomcat:
Sounds quite credible. I'm glad you made it. I have a project for you when this is all over (that's not the only reason I'm glad, of course). bub said:
Tomcat:
Sounds quite credible. I'm glad you made it. I have a project for you when this is all over (that's not the only reason I'm glad, of course).
I am still working through this. Send me a PM when you are ready.
tomcat said:
Another case of over-reaction:
Tried to go to Home Depot. They only allow 50 customers to be in the store at any given time. The Springfield Avenue Home Depot has 50 aisles. That is 1 customer per aisle!!!!!
Maybe this has something to do with protecting their workers and not their isles?
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Full disclosure: I am over 65, and have a minor underlying condition. I can't be sure, but I might have had the Corona virus already.
Today, in a conservative DK morning paper, a retired MD (in his 70's and with underlying health issues) has written an OpEd. In it, he questions whether the attempt at stopping this virus is a valid investment by society.
With medical advances, our population has a much higher percentage of vulnerable individuals, than was the case 2 or 3 generations ago. Thus, the current mortality rate (whether it is 3% or 5%). In other words, if this had happened 100 years ago, the mortality rate would probably only have been around 1%
Some of the reports I see predict that the peak will not occur till May or June. Other reports predict that this will be an ongoing 18 month event (with multiple waves of infections). This begs a very big question: Can our society/economy bear a prolonged partial (let alone full) shut-down?
Society should certainly care for those who fall ill, and try to cure them. But, is it reasonable to attempt to prevent any deaths?