Coronavirus (COVID-19)

[ET80]

30 minutes ago, mission27 said:

Realistically this has already done more damage than any natural disaster or war or terrorist attack in 75 years when you look at the social and economic consequences, worried might not even be the right word anymore, we're living through a disaster

Agree. Agree 100%. As LGB said, this might be a defining moment for all of us with the backdrops all cascading upon one another.

29 minutes ago, LETSGOBROWNIES said:

Getting off the web and shooting some hoops, playing some video games or whatever is a necessity rn.

We actually got a puppy a few days before this really ramped up, and playing with her has really de-stressed the entire family. Sasha has no idea, but she's saved us all emotionally. My kids aren't scared with this sudden change in routine because they have their puppy to play with. It's de-stressed me a whole lot, too.

[ramssuperbowl99]

6 minutes ago, ET80 said:

We actually got a puppy a few days before this really ramped up, and playing with her has really de-stressed the entire family. Sasha has no idea, but she's saved us all emotionally. My kids aren't scared with this sudden change in routine because they have their puppy to play with. It's de-stressed me a whole lot, too.

Puppy pictures. Now.

[Dome]

32 minutes ago, LETSGOBROWNIES said:

I also think we need to take time to unplug from the news for a while.  This stuff can consume you if you let it.  Getting off the web and shooting some hoops, playing some video games or whatever is a necessity rn.

My wife, our roommate and I have already adopted this rule at our house. First thing in the AM, and dinner time. This is when we talk about everything that’s going on.
 

Other than that we get blasted and watch garbage on TV and keep the covid talk out of it. 
 

 

 

getting a roommate just before all this kicked off worked out well. Having a 3rd person in the house made our lives feel a little “off” already as we adjusted. So when this happened we just kept adjusting to this new world. Felt like one big adjustment that just never ended. It’s been surreal for everyone I’m sure, but in a way we were already in the “this is a new thing in our lives” mindset anyways and I think it made a pretty big difference.

 

[ET80]

7 minutes ago, ramssuperbowl99 said:

Puppy pictures. Now.

That's Sasha on her 4th favorite pillow.

[ET80]

15 minutes ago, ramssuperbowl99 said:

Puppy pictures. Now.

Excuse the mess in the backyard...

[Nex_Gen]

I was told by my employer I'd get set up to work from home a week ago. And here I am still typing this from my desk at the office; along with more news along the way on how this seems to be getting closer and closer to where I am in Central California. One of the reported cases locally is a former football player at Fresno State. I'm an introvert by nature so I know I'd quarantine well, and this is all making me super anxious cause I'm ready to shut myself off from outside contact as necessary.

[mission27]

10 minutes ago, mistakey said:

i get its a model, but it certainly is real exponential growth right now.  thats how viruses with high R0s work.  and yes, that IS the potential situation that real experts in this field have determined is a distinct possibility without intervention.  we're doing the intervention right now but we may not be for long if a certain person gets his way

Again there’s a big difference between straight exponential growth and exponential growth with diminishing returns due to community links.  The virus spreads more slowly between communities than within communities.  The issue is models saying we are going to have simultaneous exponential growth on a nation wide or global basis... which is leading to some doomsday predictions... this is extremely unlikely to happen when you actually look at how this is spreading which is incredibly important because it would in theory allow us to move resources like ventilators around to lessen (tho not eliminate by any means) healthcare system failure.  

[mistakey]

Just now, mission27 said:

Again there’s a big difference between straight exponential growth and exponential growth with diminishing returns due to community links.  The virus spreads more slowly between communities than within communities.  The issue is models saying we are going to have simultaneous exponential growth on a nation wide or global basis... which is leading to some doomsday predictions... this is extremely unlikely to happen when you actually look at how this is spreading which is incredibly important because it would in theory allow us to move resources like ventilators around to lessen (tho not eliminate by any means) healthcare system failure.  

lol i get math bro 

[mission27]

50 minutes ago, ramssuperbowl99 said:

The models have been extraordinarily helpful, at least in this specific instance, because they let us act earlier in the exponential phase.

You don't have to like what the models say, you don't have to agree with their predictions, but saying they aren't helpful is just 100% wrong, even in the present day.

If you want to argue misinformation and fear mongering is useful because people are stupid and don’t respond to anything else I can agree with you 100%

Im sure that is part of what is driving these simplistic “worst case” models and another part of it is pure incompetence 

My fear is political leaders in all countries and across the political spectrum may fall into the category of “stupid people” and not be in on the joke so to speak, which will lead to suboptimal responses that, while aggressive, are unsustainable in the long run and don’t get the resources to the places they are needed 
 

For example on ventilators the correct response (nationally at least) would be to produce as much as we can on a national level and aggressively push to communities that need them the most.  But when you tell people in communities without an active outbreak that the spread is exponential and they will be just like Wuhan and Milan in 2 weeks, they aren’t going to let you take their share of the ventilators and give them to NYC.  And rightly so.  That’s literally what’s happening right now.  States outbidding each other.  And the reality is many places are not experiencing a large scale outbreak yet and if they do it might be in 3 or 6 months not 2 week... we just don’t know where the clusters are going to pop up.

 

[mistakey]

33 minutes ago, mission27 said:

If you want to argue misinformation and fear mongering is useful because people are stupid and don’t respond to anything else I can agree with you 100%

Im sure that is part of what is driving these simplistic “worst case” models and another part of it is pure incompetence 

My fear is political leaders in all countries and across the political spectrum may fall into the category of “stupid people” and not be in on the joke so to speak, which will lead to suboptimal responses that, while aggressive, are unsustainable in the long run and don’t get the resources to the places they are needed 
 

For example on ventilators the correct response (nationally at least) would be to produce as much as we can on a national level and aggressively push to communities that need them the most.  But when you tell people in communities without an active outbreak that the spread is exponential and they will be just like Wuhan and Milan in 2 weeks, they aren’t going to let you take their share of the ventilators and give them to NYC.  And rightly so.  That’s literally what’s happening right now.  States outbidding each other.  And the reality is many places are not experiencing a large scale outbreak yet and if they do it might be in 3 or 6 months not 2 week... we just don’t know where the clusters are going to pop up.

 

all of india locked down

i just find it funny that you think you know more than the experts in this field and can call out their so called incompetence

[theJ]

2 minutes ago, mistakey said:

all of india locked down

i just find it funny that you think you know more than the experts in this field and can call out their so called incompetence

Is he wrong?

For example: NYC has ~13k cases, from my google search just now.

As of last night, Toledo, OH had 10.

It's not spreading at the same rate everywhere.

[Shanedorf]

Jon Cohen wrote an article about the clinical trials being launched right now, for several re-purposed drugs
They each have their challenges. For example, Remdesivir shows anti-viral activity, but it needs to be dosed Intravenously (IV).
For an overloaded healthcare system, that's less than ideal as compared to a pill.

https://www.sciencemag.org/news/2020/03/who-launches-global-megatrial-four-most-promising-coronavirus-treatments

One of the biggest challenges is getting the dose right. Just having a potential drug isn't enough. The right dose for the right patient at the right time.
Too soon and its hard to see an effect. Too late and the drug may be ineffective (that was seen in China)
Too much drug and that means less for others, too little and it may lead to resistance

There are other considerations here as well.
Do we dose patients until they are better ? OR  Do we dose patients until they stop shedding virus and aren't a transmission risk ?
Those are 2 different dosing regimens and you can see how the needs of the individual patient vs the needs of society diverge at some point - 
especially when we have scarce supply.

Who decides the winning strategy ?

Each patient is different; some are young / old, some are smokers, others are not, some are taking blood pressure meds, some have impaired kidneys, some are Asian, some are Caucasian, some are diabetic, some have heart issues. Some have impaired lung function
Each variable impacts the success/failure of the drug to make a difference

The list of variability goes on and on and that’s why they are trying to enroll so many different types of patients in so many countries.
One size does not fit all and some of the interactions and side effects are significant, so again - getting the dose right is critical and that’s even harder with a combination drug or cocktail such as 2 of the treatments currently being considered. And don't forget, these people are already compromised

This is where Modeling & Simulation can play a critical role, allowing PK scientists to ask " What if ? " questions without needing to test each hypothesis in a patient population over time. 

Similar issues exist for vaccine development. Its an immense hurdle to overcome before we can start rolling these out en masse
And that's why suppression is the current policy until more progress is made on the drug / vaccine side.

 

Also noted: Puppies rule and should be a part of every post in this thread going forward

[mistakey]

1 minute ago, theJ said:

Is he wrong?

For example: NYC has ~13k cases, from my google search just now.

As of last night, Toledo, OH had 10.

It's not spreading at the same rate everywhere.

yeah it is.  whats 10% of 100?
whats 10% of 1000?

same rate increase.

its what happens when you funnel all flights from other countries into JFK
its also what happens when NYC tests more than any other state and actually more per capita than S. Korea.  They're just finding their cases.

[mistakey]

also, per his argument @theJ dewine is shutting down the economy to keep cases low, but thats what he's calling out for being dumb

[theJ]

Just now, mistakey said:

also, per his argument @theJ dewine is shutting down the economy to keep cases low, but thats what he's calling out for being dumb

Time will tell on that one.  

On one side, it's protecting people from getting sick.

On the other side, it's hurting people who live paycheck to paycheck and won't be able to pay bills next week.

Best case scenario on the latter is that it only hurts us economically.

Worst case scenario is that this drags on for months or a year, and there are literally riots that also kill people.

None of this is good, and we can't act like there aren't major downsides to shutting down the economy.

 

The fact is that we'll never know the right answer, because we'll never be able to trace cause/effect well enough.  Everyone is just doing the best they can.