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Outstanding read from world renowned Stanford Epidemiologist

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In an analysis published Tuesday, Stanford’s John P.A. Ioannidis — co-director of the university’s Meta-Research Innovation Center and professor of medicine, biomedical data science, statistics, and epidemiology and population health — suggests that the response to the coronavirus pandemic may be “a fiasco in the making” because we are making seismic decisions based on “utterly unreliable” data. The data we do have, Ioannidis explains, indicates that we are likely severely overreacting.

https://www.statnews.com/2020/03/17...e-are-making-decisions-without-reliable-data/
 
With all I have read the #'s just don't add up to the degree of the response to it.
This is where I’m at. We’ve put ourselves into a recession that could get even worse bc of this. I’m not saying “rabble rabble it’s just the flu” but I do think history may look back at this and think we overreacted. God forbid a virus with a 5% mortality rate comes down the line. The world could come crashing down.
 
What I want to know is what the decisions makers know that we don't that they are responding in such a way after many weeks of "oh this is nothing" remember it will go away like a miracle or we have 15 patients and soon 2 and then none.

Now it's trillion dollar bail outs, recession, depression, etc. Imagine once the virus hits the homeless population in large metro areas.

I am not saying run to the store and buy TP. I am saying, something fundamentally changed in the messaging and it was sudden.
 
What I want to know is what the decisions makers know that we don't that they are responding in such a way after many weeks of "oh this is nothing" remember it will go away like a miracle or we have 15 patients and soon 2 and then none.

Now it's trillion dollar bail outs, recession, depression, etc. Imagine once the virus hits the homeless population in large metro areas.

I am not saying run to the store and buy TP. I am saying, something fundamentally changed in the messaging and it was sudden.
It's like something out of a movie...are we being invaded by UFO's? Is a meteor headed towards earth? Just weird stuff
 
For one thing I believe that the numbers of infected people are much higher because the symptoms, or lack of, are across the spectrum and there are people walking around who are infected and have such a mild case they’ll never be tested or identified. So our numbers are likely a lot higher and officials know that even though they can only report official numbers.
Also, think about some of the people in these Federal agencies who have been in their jobs for years and have never ever (thankfully) had this sort of emergency arise...frankly some are ROTJ and as civil servants in a union don’t really have performance metrics like those of us in business. They refused or failed to recognize a real crisis early on and admittedly are limited in responding by laws that preserve our liberties but prevent draconian measures that are available in an authoritarian state like China.
The “it can’t happen here” insularity has proven itself to be very problematic.
 
The "over reaction" was created because three of the earliest locations of the virus - Wuhan, Seattle and northern Italy - all seemed to get out of control real fast. It is now appears - it may be possible - that although the coronavirus is highly contagious, it still requires some level of closer contact than previously known. Disney World has been closed for a week, but it was open to millions of guests from the start of this pandemic discussion (mid to late January) to March 13. As far as I can tell, no guest of Disney World has been reported to have the virus. I can be incorrect on that, but as of noon today, Orange County has 15 positive cases and Osceola County has 9 - the two counties where the park is located and where the bulk of the employees live. It was reported today that the there are only ten counties in the country that have a very high number of cases.

What does all this mean? I am not sure, but no one is going to say "get back to work" without the data to support it, even though the author correctly points out that the world wide quarantine lacked the data to actually initiate it. Wuhan is supposedly free of new infections.

And from a visceral level, clearly our Governor is reacting to the millennial outrage of the cancellation of spring break. How ironic that the generation drunk on social media is now exposed as selfish spoiled brats. Sure...these media clips of them partying on the beach may only be anecdotal. But this generation lives on creating global comments based on anecdotal BS you see on Facebook or instagram. And now they are burned by it. Us too.

Botton line...we have to get the data to a point where we can get back to normal. It will take a lot of political bravery to do that....leaders are real good at telling us what we can't do. They don't want to be responsible for making an early positive decision that goes bad.
 
Another interesting article: https://www.dailywire.com/news/repo...utm_content=non_insiders&utm_source=housefile

1918 Spanish Flu - H1N1, 50 million deaths worldwide, 675,000 U.S. deaths
1957 Asian Flu pandemic, H2N2, China - 1 million to 2 million deaths, 116,000 U.S. deaths
1968 Hong Kong Flu, H3N2, China, - 1 million deaths, 100,000 U.S. deaths
1986 Taiwan Flu, China - 500,000 deaths, 12,469 U.S. deaths (vaccine developed before 2nd wave)
2003 SARS Flu, China - 9.6% fatality rate! 774 deaths, 17 countries
2009 Taiwan Flu #2, "Swine Flu," H1N1, China

Not hard to see why China tried to cover this up. But still unforgivable.
 
The reality of viruses is most are not super dangerous to us overall because they are rarely both easily transmitted AND dangerous. Ebola sucks and is a real killer, but it is not as easy to transmit and it kills so fast that you don't have people running around transmitting it long. Similarly, we have tended to develop some immunity to most over time.

This virus hits the sweet spot. It is not super dangerous to any one individual (though we are seeing reports of more lung damage even from people who don't need much/any care), but it is not nearly as bland as the flu or cold viri. It is not super transmittable, but it is 2-3 times more infectious than the flu and people are not immediately put down by it so they are out passing it on more/longer.

I think Trump took this seriously because he shut down travel from China 1/31. But I do think he thought it would be less of an issue here if/when it got here. Then starting a few weeks ago he was being given info from folks he trusts showing how what may appear innocuous up front can become a major issue based on pure numbers. That was when you saw the change in tone. I am fine with that. I want presidents to be willing to adapt to info they get. I was not an Obama guy, but I respected that his "I will close Gitmo on day one" claims never came to be once he saw the info the president gets that others don't ever see.
 
Another interesting article: https://www.dailywire.com/news/repo...utm_content=non_insiders&utm_source=housefile

1918 Spanish Flu - H1N1, 50 million deaths worldwide, 675,000 U.S. deaths
1957 Asian Flu pandemic, H2N2, China - 1 million to 2 million deaths, 116,000 U.S. deaths
1968 Hong Kong Flu, H3N2, China, - 1 million deaths, 100,000 U.S. deaths
1986 Taiwan Flu, China - 500,000 deaths, 12,469 U.S. deaths (vaccine developed before 2nd wave)
2003 SARS Flu, China - 9.6% fatality rate! 774 deaths, 17 countries
2009 Taiwan Flu #2, "Swine Flu," H1N1, China

Not hard to see why China tried to cover this up. But still unforgivable.
Omigosh look at all those racist names. Alert the media!
 
I thinks it’s way too early and incredibly naive for anyone to assert how insignificant or dangerous this thing is. Not enough data. That said the mortality rate in Italy based on 40k sample size is close to 9%. That is not exactly good news for a country adding 5k new cases today.
 
I thinks it’s way too early and incredibly naive for anyone to assert how insignificant or dangerous this thing is. Not enough data. That said the mortality rate in Italy based on 40k sample size is close to 9%. That is not exactly good news for a country adding 5k new cases today.
Latest mortality rate is 1.4% here in the US and is only lower in South Korea. That's today.
 
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I thinks it’s way too early and incredibly naive for anyone to assert how insignificant or dangerous this thing is. Not enough data. That said the mortality rate in Italy based on 40k sample size is close to 9%. That is not exactly good news for a country adding 5k new cases today.

Quite obvious you failed to read the article I posted from the Epidemiologist.
 
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I suspect the author was not involved or asked to be a part of any of the teams of scientists who have been working around the clock to mitigate this situation.
 
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I suspect the author was not involved or asked to be a part of any of the teams of scientists who have been working around the clock to mitigate this situation.

And another one who has obviously failed to read the article from the Epidemiologist.
 
"But it may also be a once-in-a-century evidence fiasco."

This is the key phrase "may". I work with epidemiologists all the time. The tobacco industry denied smoking and lung cancer because there was no "reliable" epidemiology. Epi is important, but its not a way to make quick decisions and you can't wait on it to make a decision. Because if you do, then the horse is well out of the barn.

It may be a fiasco. But if it isn't and we don't take it seriously the consequences are difficult to overstate.
 
Why are you so defensive? The guy writes his opinion as did I. Was he part of one of the teams or not?
Not being defensive, I just knew along with everyone else who read his article and then read your response that you absolutely didn't read it at all or else you wouldn't have responded as you did.
 
Not being defensive, I just knew along with everyone else who read his article and then read your response that you absolutely didn't read it at all or else you wouldn't have responded as you did.

Well you were wrong and still not sure how you are coming to that conclusion. Maybe you were expecting a certain reply and sorry I could not oblige you.
 
I’m thinking most of the ones saying it’s not a big deal are also the ones who’ve lost a 1/3 of their retirement accounts.
You may be confusing whether or not the virus or the response to it is the “big deal”.
 
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Is Our Fight Against Coronavirus Worse Than the Disease?
There may be more targeted ways to beat the pandemic.

By Dr. David L. Katz is the founding director of Yale University’s Yale-Griffin Prevention Research Center.

We routinely differentiate between two kinds of military action: the inevitable carnage and collateral damage of diffuse hostilities, and the precision of a “surgical strike,” methodically targeted to the sources of our particular peril. The latter, when executed well, minimizes resources and unintended consequences alike.

As we battle the coronavirus pandemic, and heads of state declare that we are “at war” with this contagion, the same dichotomy applies. This can be open war, with all the fallout that portends, or it could be something more surgical. The United States and much of the world so far have gone in for the former. I write now with a sense of urgency to make sure we consider the surgical approach, while there is still time.

https://www.nytimes.com/2020/03/20/opinion/coronavirus-pandemic-social-distancing.html
 
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T
Is Our Fight Against Coronavirus Worse Than the Disease?
There may be more targeted ways to beat the pandemic.

By Dr. David L. Katz is the founding director of Yale University’s Yale-Griffin Prevention Research Center.

We routinely differentiate between two kinds of military action: the inevitable carnage and collateral damage of diffuse hostilities, and the precision of a “surgical strike,” methodically targeted to the sources of our particular peril. The latter, when executed well, minimizes resources and unintended consequences alike.

As we battle the coronavirus pandemic, and heads of state declare that we are “at war” with this contagion, the same dichotomy applies. This can be open war, with all the fallout that portends, or it could be something more surgical. The United States and much of the world so far have gone in for the former. I write now with a sense of urgency to make sure we consider the surgical approach, while there is still time.

https://www.nytimes.com/2020/03/20/opinion/coronavirus-pandemic-social-distancing.html
Thanks for sharing. It's nice to read something that makes sense, that acknowledges the current measures are potentially worse than the virus
 
For those who like data here is something to chew on.

For some reason the URL won't attach

Search for Tomas Pueyo
Coronavirus: The Hammer and the Dance
What the Next 18 Months Can Look Like, if Leaders Buy Us Time

 
COVID-19 - Evidence Over Hysteria

While we should be concerned and diligent, the situation has dramatically elevated to a mob-like fear spreading faster than COVID-19 itself. When 13% of Americans believe they are currently infected with COVID-19 (mathematically impossible), full-on panic is blocking our ability to think clearly and determine how to deploy our resources to stop this virus. Over three-fourths of Americans are scared of what we are doing to our society through law and hysteria, not of infection or spreading COVID-19 to those most vulnerable.
The following article is a systematic overview of COVID-19 driven by data from medical professionals and academic articles that will help you understand what is going on (sources include CDC, WHO, NIH, NHS, University of Oxford, Stanford, Harvard, NEJM, JAMA, and several others).

https://www.zerohedge.com/health/covid-19-evidence-over-hysteria
 
Last edited:
COVID-19 - Evidence Over Hysteria

While we should be concerned and diligent, the situation has dramatically elevated to a mob-like fear spreading faster than COVID-19 itself. When 13% of Americans believe they are currently infected with COVID-19 (mathematically impossible), full-on panic is blocking our ability to think clearly and determine how to deploy our resources to stop this virus. Over three-fourths of Americans are scared of what we are doing to our society through law and hysteria, not of infection or spreading COVID-19 to those most vulnerable.
The following article is a systematic overview of COVID-19 driven by data from medical professionals and academic articles that will help you understand what is going on (sources include CDC, WHO, NIH, NHS, University of Oxford, Stanford, Harvard, NEJM, JAMA, and several others).

https://www.zerohedge.com/health/covid-19-evidence-over-hysteria
And here’s an expert rebuttal:
 
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Is the Coronavirus as Deadly as They Say?
Current estimates about the Covid-19 fatality rate may be too high by orders of magnitude.

By
Eran Bendavid and
Jay Bhattacharya
March 24, 2020 6:21 pm ET
The Wall Street Journal

If it’s true that the novel coronavirus would kill millions without shelter-in-place orders and quarantines, then the extraordinary measures being carried out in cities and states around the country are surely justified. But there’s little evidence to confirm that premise—and projections of the death toll could plausibly be orders of magnitude too high.

Fear of Covid-19 is based on its high estimated case fatality rate—2% to 4% of people with confirmed Covid-19 have died, according to the World Health Organization and others. So if 100 million Americans ultimately get the disease, two million to four million could die. We believe that estimate is deeply flawed. The true fatality rate is the portion of those infected who die, not the deaths from identified positive cases.

The latter rate is misleading because of selection bias in testing. The degree of bias is uncertain because available data are limited. But it could make the difference between an epidemic that kills 20,000 and one that kills two million. If the number of actual infections is much larger than the number of cases—orders of magnitude larger—then the true fatality rate is much lower as well. That’s not only plausible but likely based on what we know so far.

Population samples from China, Italy, Iceland and the U.S. provide relevant evidence. On or around Jan. 31, countries sent planes to evacuate citizens from Wuhan, China. When those planes landed, the passengers were tested for Covid-19 and quarantined. After 14 days, the percentage who tested positive was 0.9%. If this was the prevalence in the greater Wuhan area on Jan. 31, then, with a population of about 20 million, greater Wuhan had 178,000 infections, about 30-fold more than the number of reported cases. The fatality rate, then, would be at least 10-fold lower than estimates based on reported cases.

Next, the northeastern Italian town of Vò, near the provincial capital of Padua. On March 6, all 3,300 people of Vò were tested, and 90 were positive, a prevalence of 2.7%. Applying that prevalence to the whole province (population 955,000), which had 198 reported cases, suggests there were actually 26,000 infections at that time. That’s more than 130-fold the number of actual reported cases. Since Italy’s case fatality rate of 8% is estimated using the confirmed cases, the real fatality rate could in fact be closer to 0.06%.

In Iceland, deCode Genetics is working with the government to perform widespread testing. In a sample of nearly 2,000 entirely asymptomatic people, researchers estimated disease prevalence of just over 1%. Iceland’s first case was reported on Feb. 28, weeks behind the U.S. It’s plausible that the proportion of the U.S. population that has been infected is double, triple or even 10 times as high as the estimates from Iceland. That also implies a dramatically lower fatality rate.

The best (albeit very weak) evidence in the U.S. comes from the National Basketball Association. Between March 11 and 19, a substantial number of NBA players and teams received testing. By March 19, 10 out of 450 rostered players were positive. Since not everyone was tested, that represents a lower bound on the prevalence of 2.2%. The NBA isn’t a representative population, and contact among players might have facilitated transmission. But if we extend that lower-bound assumption to cities with NBA teams (population 45 million), we get at least 990,000 infections in the U.S. The number of cases reported on March 19 in the U.S. was 13,677, more than 72-fold lower. These numbers imply a fatality rate from Covid-19 orders of magnitude smaller than it appears.

How can we reconcile these estimates with the epidemiological models? First, the test used to identify cases doesn’t catch people who were infected and recovered. Second, testing rates were woefully low for a long time and typically reserved for the severely ill. Together, these facts imply that the confirmed cases are likely orders of magnitude less than the true number of infections. Epidemiological modelers haven’t adequately adapted their estimates to account for these factors.

The epidemic started in China sometime in November or December. The first confirmed U.S. cases included a person who traveled from Wuhan on Jan. 15, and it is likely that the virus entered before that: Tens of thousands of people traveled from Wuhan to the U.S. in December. Existing evidence suggests that the virus is highly transmissible and that the number of infections doubles roughly every three days. An epidemic seed on Jan. 1 implies that by March 9 about six million people in the U.S. would have been infected. As of March 23, according to the Centers for Disease Control and Prevention, there were 499 Covid-19 deaths in the U.S. If our surmise of six million cases is accurate, that’s a mortality rate of 0.01%, assuming a two week lag between infection and death. This is one-tenth of the flu mortality rate of 0.1%. Such a low death rate would be cause for optimism.

This does not make Covid-19 a nonissue. The daily reports from Italy and across the U.S. show real struggles and overwhelmed health systems. But a 20,000- or 40,000-death epidemic is a far less severe problem than one that kills two million. Given the enormous consequences of decisions around Covid-19 response, getting clear data to guide decisions now is critical. We don’t know the true infection rate in the U.S. Antibody testing of representative samples to measure disease prevalence (including the recovered) is crucial. Nearly every day a new lab gets approval for antibody testing, so population testing using this technology is now feasible.

If we’re right about the limited scale of the epidemic, then measures focused on older populations and hospitals are sensible. Elective procedures will need to be rescheduled. Hospital resources will need to be reallocated to care for critically ill patients. Triage will need to improve. And policy makers will need to focus on reducing risks for older adults and people with underlying medical conditions.

A universal quarantine may not be worth the costs it imposes on the economy, community and individual mental and physical health. We should undertake immediate steps to evaluate the empirical basis of the current lockdowns.

Dr. Bendavid and Dr. Bhattacharya are professors of medicine at Stanford. Neeraj Sood contributed to this article.

https://www.wsj.com/articles/is-the...as-they-say-11585088464?mod=opinion_lead_pos5
 
Why is everyone so focused on the Mortality rate??? It is of definite significance and will dictate policies for sure, but the steps that are being taken now are not related to how deadly this disease is, but to protect our healthcare system.

Current data shows that up to 18-20% of infections require some sort of hospitalization. 5% need ICU, and then a lower percentage become deceased. The issue is the amount of people that will need hospitalization. Hospitals operate at 70-80% capacity already. With a major influx of patients with Covid-19, which for most hospitals could represent just 40 new patients, they reach full capacity.

At that point, where do victims of other circumstances go, such as heart attacks, strokes, car accidents and other trauma. We will not have enough staff or beds to take care of them and then you have medical professionals deciding who gets treatment or not.

This is the reason for the measures being taken and why things changed. It was simple math for our healthcare and the good of the country. NOT how deadly the disease is.

Until we can reduce the number of Covid-19 patients, this is the best case because we lost the opportunity to test and have containment which could have avoided the stay at home policy.
 
Why is everyone so focused on the Mortality rate??? It is of definite significance and will dictate policies for sure, but the steps that are being taken now are not related to how deadly this disease is, but to protect our healthcare system.

Current data shows that up to 18-20% of infections require some sort of hospitalization. 5% need ICU, and then a lower percentage become deceased. The issue is the amount of people that will need hospitalization. Hospitals operate at 70-80% capacity already. With a major influx of patients with Covid-19, which for most hospitals could represent just 40 new patients, they reach full capacity.

At that point, where do victims of other circumstances go, such as heart attacks, strokes, car accidents and other trauma. We will not have enough staff or beds to take care of them and then you have medical professionals deciding who gets treatment or not.

This is the reason for the measures being taken and why things changed. It was simple math for our healthcare and the good of the country. NOT how deadly the disease is.

Until we can reduce the number of Covid-19 patients, this is the best case because we lost the opportunity to test and have containment which could have avoided the stay at home policy.

Quick question. Where are you getting your statistics?

Also, did this overwhelm the American Healthcare system when it happened? Because right now this absolutely pales in comparison to what happened then:

In the spring of 2009, a novel influenza A (H1N1) virus emerged. ... From April 12, 2009 to April 10, 2010, CDC estimated there were 60.8 million cases (range: 43.3-89.3 million), 274,304 hospitalizations (range: 195,086-402,719), and 12,469 deaths (range: 8868-18,306) in the United States due to the (H1N1)pdm09 virus.

https://www.cdc.gov/flu/pandemic-resources/2009-h1n1-pandemic.html
 
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Why is everyone so focused on the Mortality rate??? It is of definite significance and will dictate policies for sure, but the steps that are being taken now are not related to how deadly this disease is, but to protect our healthcare system.

Current data shows that up to 18-20% of infections require some sort of hospitalization. 5% need ICU, and then a lower percentage become deceased. The issue is the amount of people that will need hospitalization. Hospitals operate at 70-80% capacity already. With a major influx of patients with Covid-19, which for most hospitals could represent just 40 new patients, they reach full capacity.

At that point, where do victims of other circumstances go, such as heart attacks, strokes, car accidents and other trauma. We will not have enough staff or beds to take care of them and then you have medical professionals deciding who gets treatment or not.

This is the reason for the measures being taken and why things changed. It was simple math for our healthcare and the good of the country. NOT how deadly the disease is.

Until we can reduce the number of Covid-19 patients, this is the best case because we lost the opportunity to test and have containment which could have avoided the stay at home policy.
Have you seen accurate statistics of increases in hospitalizations, increases in ICU hospitalizations, and increases in ventilator needs? Bc merely saying 18-20% end up hospitalized is obviously not accurate when we know how many undiagnosed cases there are. I’m actually surprised this data isn’t readily available. However, death data is. The state of FL, with a ton of senior citizens, has 22 deaths and is going up in the 2-4 per day range. Hillsborough county with something like 2M people has 0 deaths so far. Social distancing has really only been a thing for like 10 days. If there aren’t a huge increase in serious cases over the next 4-5 days we should be in good shape.
 
I fully expect the death rate from new arrivals to Dade, Broward, and Palm Beach counties from the NYC area "evacuees" to skew our numbers over the next few weeks. SoFla will become a big CV19 hotspot.
That's unfortunate, but it's going to be the reality,I think.
It's estimated that at least 50% of us are practicing social isolation and if we can hold at that level or get it bumped a little it will help tremendously.
 
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Quick question. Where are you getting your statistics?

Also, did this overwhelm the American Healthcare system when it happened? Because right now this absolutely pales in comparison to what happened then:

In the spring of 2009, a novel influenza A (H1N1) virus emerged. ... From April 12, 2009 to April 10, 2010, CDC estimated there were 60.8 million cases (range: 43.3-89.3 million), 274,304 hospitalizations (range: 195,086-402,719), and 12,469 deaths (range: 8868-18,306) in the United States due to the (H1N1)pdm09 virus.

https://www.cdc.gov/flu/pandemic-resources/2009-h1n1-pandemic.html

You are quoting statistics for a twelve month period. Hopefully we lower the case load in the coming weeks, but the only comparison should be impacts during like timeframes to measure the impact on emergency rooms, hospitals, health providers, etc. JMHO
 
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