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Covid 19 virus

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nctnico:

--- Quote from: DrG on March 17, 2020, 11:08:13 pm ---
--- Quote from: Cerebus on March 17, 2020, 10:14:01 pm ---You mean horizontal line. But, no, you haven't read it wrong. Critical Care facilities are not sized to cope with this. In the UK Critical Care beds (at 8 per 100,000 population) get overflowed in anything other than a mild flu season. I doubt the US is in any better situation despite having 14 critical care beds per 100,000.

--- End quote ---
Yes, I meant vertical horizontal lin and made that correction twice. I'm not asking for an explanation of hospital bed number or surge capability. That information is available from many other sources and has been for a very long time. Nor is it particularly helpful to simply state "not sized to cope with this", because, in my opinion, it simply sounds too smug. It is the details of the *this* that are up for reasonable discussion, otherwise a simple - "we're fuxored" is sufficient and need not be embellished upon.

What is under intensive scrutiny here is the accuracy of the calculations. Take a step back. What the Brits have done here is characterized the disease with particular respect to required care by the Health Institutions. Further, the course of that load requirement has been projected under different non-pharmacological interventions (NPI).

--- End quote ---
Well, even if the numbers are off by a factor of 4 then "we're fuxored" still applies. Over here they are already moving patients to different hospitals in order to distribute the load across the country and they are building triage tents in front of some hospitals. We ain't seen nothing yet!

Also the NPIs can only last for so long otherwise the economy will collapse and probably cause more deaths due to lack of electricity, water, sanitation, etc. Imagine getting a Cholera epidemic on top.

If there is some view on having a working vaccine I'm sure it will be fast-tracked and likely administered as part of a trial. AFAIK this is often the case in cancer treatments so people get the latest & greatest medicines.

DrG:

--- Quote from: Cerebus on March 17, 2020, 11:52:28 pm ---
--- Quote from: DrG on March 17, 2020, 11:08:13 pm ---So, the prediction of the NOV surge, as described, is a very big issue. If you (i.e., anybody) has read the report, knows a good deal about modelling, and can comment on the confidence of that prediction, I would sure like to hear about it.

--- End quote ---

Too complex to do anything other than guess at really. Many of the figures used as assumptions in the Imperial study are provisional (moreso than in science in general, which is always to some extent provisional). I see no reason to treat the Imperial study as anything less than "the best predictions we can make at the moment". We've no better working hypothesis, and I fully expect Imperial to revise their model (or someone else to build a similar but revised model) as more data becomes available and assumptions can be refined in the light of new data.

My concerns would be elsewhere. If the Imperial study is accurate (and for argument's sake lets take it as such) I fear it is short-sighted. I say this because if we achieved the effective level of control interventions to make things start to follow the Imperial graphs (on either the green or brown traces), as the general population sees a levelling off of infection rates they will become less compliant with the control measures. So we won't be waiting around for the putative September cut off of control measures to generate those peaks in Nov-Dec, they will happen sooner as folks take a more laissez-faire attitude to the controls.

Look at the difficulties we have here, among a group mostly made up of educated scientists and engineers, at getting some people to take this seriously enough. Imagine then, the difficulty getting "Bert the builder" or "Karen the data entry clerk" to continue taking preventative measures for five months that have financial and social costs to them when in three months time "I haven't seen people dropping like flies. I reckon it's all exaggerated, I'm going back to work/down the bar/whatever".

To maintain Imperial's controls for the next five months as they envisage, is going to require a level of coercion that the west is unaccustomed to and is likely to be increasing resistant to if the apparent disease spread is temporarily halted. The public will accept restrictions if they see "the enemy at the gate", they won't be so happy to do so if the "enemy" appears to them not to be materialising even though that is part of the plan and they've been told that. It will require a massive education drive to convince the public that this is just "holding back the flood" and continued isolation and other measure are still required; and this happens at a time when public confidence in government in the West is probably at the lowest I've seen it in my lifetime.

--- End quote ---

Good, now you are seeing what I am writing about in my response to @flyte

One conclusion is that the stringent NPI has to be in effect longer than the end of Sep. In the US, we have a rather important election planned for early Nov (and starting a few weeks before with mail in ballets). IF that projection is credible, we either have to attempt a general election under strict NPI conditions (how the ef do you do that) or we have to relax/remove the strict NPI and incur the catastrophic failure of the health care system.

So, unless that modelling can be credibly criticized and replaced with more accurate modelling (that predicts something better and survives peer review scrutiny), we MUST bust ass and get a PI into the mix or figure out how to hold a general election under strict NPI.

It has a great deal to do with how the US goes forward.

DrG:

--- Quote from: nctnico on March 17, 2020, 11:53:21 pm ---
--- Quote from: DrG on March 17, 2020, 11:08:13 pm ---
--- Quote from: Cerebus on March 17, 2020, 10:14:01 pm ---You mean horizontal line. But, no, you haven't read it wrong. Critical Care facilities are not sized to cope with this. In the UK Critical Care beds (at 8 per 100,000 population) get overflowed in anything other than a mild flu season. I doubt the US is in any better situation despite having 14 critical care beds per 100,000.

--- End quote ---
Yes, I meant vertical horizontal lin and made that correction twice. I'm not asking for an explanation of hospital bed number or surge capability. That information is available from many other sources and has been for a very long time. Nor is it particularly helpful to simply state "not sized to cope with this", because, in my opinion, it simply sounds too smug. It is the details of the *this* that are up for reasonable discussion, otherwise a simple - "we're fuxored" is sufficient and need not be embellished upon.

What is under intensive scrutiny here is the accuracy of the calculations. Take a step back. What the Brits have done here is characterized the disease with particular respect to required care by the Health Institutions. Further, the course of that load requirement has been projected under different non-pharmacological interventions (NPI).

--- End quote ---
Well, even if the numbers are off by a factor of 4 then "we're fuxored" still applies. Over here they are already moving patients to different hospitals in order to distribute the load across the country and they are building triage tents in front of some hospitals. We ain't seen nothing yet!

Also the NPIs can only last for so long otherwise the economy will collapse and probably cause more deaths due to lack of electricity, water, sanitation, etc. Imagine getting a Cholera epidemic on top.

If there is some view on having a working vaccine I'm sure it will be fast-tracked and likely administered as part of a trial. AFAIK this is often the case in cancer treatments so people get the latest & greatest medicines.

--- End quote ---

The example of cancer treatment is, hopefully, not a good example here. In cases of the last stages of a terminal conditions, approval of unapproved medication is more likely because of compassionate use. I can't think of any compassionate use medicine that is not "self-medicating" that is approved in thousands of cases - but maybe I will not be able to say that next year.

nctnico:
Well, one of my relatives had the choice between going for the regular and experimental cancer treatment several decades ago. That person is still walking around.

Regarding elections: I'd say it is likely that these will be postponed. Not just in the US but everywhere in the world. You can't have a change of government in a crisis this large. Even if it is possible to organise a vote then whatever candidates say or promise will be lost in the noise from the Corona virus.

Cerebus:

--- Quote from: DrG on March 18, 2020, 12:06:24 am ---The example of cancer treatment is, hopefully, not a good example here. In cases of the last stages of a terminal conditions, approval of unapproved medication is more likely because of compassionate use. I can't think of any compassionate use medicine that is not "self-medicating" that is approved in thousands of cases - but maybe I will not be able to say that next year.

--- End quote ---

Slightly different circumstances, because the in-depth protocols for drug approval weren't existing then, but consider the rapid move to clinical use of penicillin in WWII. "Antibiotics" got that as a name because the prevailing wisdom was that they were "anti - living things", not anti-bacterials as they proved to be. With that as a background there was serious opposition in some scientific quarters to even trying them.  I think that the attitude will be much as it was in wartime  -  "Needs must when the devil drives" - and accelerated testing and safety trial protocols will get put in place to allow for clinical use of a vaccine in as short a time as is reasonably possible.

There's a closer parallel with cancer drug trials than might at first appear. With a 9.3% fatality rate for 80+ year olds infected with SARS-Covid-2 there's a much wider margin of appreciation for the trade off between risks of a foreshortened life from an experimental vaccine and risks of a foreshortened life from contracting SARS-Covid-2 in that age group. It's a rather different 'near end of life' situation than cancer, but it's kind of on the same spectrum. With fully informed consent, I'm sure that there are some brighter, braver people in this age group who would volunteer for a slightly riskier than normal drug trial with sightly more than normal rewards possibly associated with it.

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