COVID-19 Megathread 4: Grandma Got Run Over by the Dow Jones

[100% pro-life no matter what]

You know, GOP posters.

You belong to one of the only political parties in the western world that denies the existence of climate change as a real and man-made threat. Your party has overruled doctors, nurses and healthcare experts to impose bizarre restrictions on abortion. Your party has demeaned and belittled the scientific community as shills and liars for decades, in an astonishing display of projection.

Now, we're seeing, in frustrating detail what happens when a party indoctrinates its voters to ignore the experts on a range of scientific issues and instead trust the Trumps and DeSantis types of the world.

It doesn't surprise me that Extreme Republican and Fuzzy Bear believe they know more about epidemiology than Dr Fauci, or a suite of European doctors.

I just wish there was a way to prove them wrong that didn't involve the loss of further life.

I've never said to blow the "experts" off.  But "experts" often disagree, and the "expert" that is currently front and center was pretty much wrong 2 months ago.

Do we just leave the military to the "experts" (the Generals)?  Do we just leave Law Enforcement to the "experts" (the Police)?  We don't do that any more than we just leave everything to business "experts".  Experts see life through THEIR area of expertise, but their expertise is only one area of life.  Our civilian government's job is to balance these competing worldviews as much as possible.

I'm not anti-science, by the way.  I do live in the real world, however, and that real world is a world where there are alternatives for fossil fuels, but no substitute for fossil fuels.  Without fossil fuels, our way of life would be drastically impacted if we stopped using them all now.  That's another issue, but it illustrates the fact that this problem, as well as the climate problem, involves choices that have negative impacts that are significant, whichever way we choose.

I never claimed to know more about this than Fauci (although, I do think I have a decent understanding of epidemics for a lay man with no formal training).  Obviously, he knows a lot more about viruses than I do.  But, the epidemic itself is just one portion of the issue here.  We need to also listen to economists and mental health experts to come up with the best solution for as many people as possible.  We need to be more holistic than just saying that the only goal is to completely stop a virus.  By that logic, we should live in lockdown forever.  We would almost never get sick if we did that, but it would also be no life to lead.

[💥💥 brandon bro (he/him/his)]

I never claimed to know more about this than Fauci (although, I do think I have a decent understanding of epidemics for a lay man with no formal training).  Obviously, he knows a lot more about viruses than I do.  But, the epidemic itself is just one portion of the issue here.  We need to also listen to economists and mental health experts to come up with the best solution for as many people as possible.  We need to be more holistic than just saying that the only goal is to completely stop a virus.  By that logic, we should live in lockdown forever.  We would almost never get sick if we did that, but it would also be no life to lead.

emphasis added by me

Survey shows that economists think that loosening lockdowns before the virus is contained will lead to more economic damage than the lockdowns themselves.

Question B: Abandoning severe lockdowns at a time when the likelihood of a resurgence in infections remains high will lead to greater total economic damage than sustaining the lockdowns to eliminate the resurgence risk.

Strongly agree: 41%
Agree: 39%
Uncertain: 14%
Disagree: 0%
Strongly disagree: 0%
No opinion: 0%

The general consensus among actual economists is that the best way to resume economic activity is to contain the virus. Reopening public economic activity will simply lead to another high-transmission period for the virus.

If you really want to watch sports, go to YouTube. You can find entire broadcasts (sans commercials) of old football, hockey, basketball, etc. games. I think MLB even put the entirety of the last two seasons online.

[Skill and Chance]

You know, GOP posters.

You belong to one of the only political parties in the western world that denies the existence of climate change as a real and man-made threat. Your party has overruled doctors, nurses and healthcare experts to impose bizarre restrictions on abortion. Your party has demeaned and belittled the scientific community as shills and liars for decades, in an astonishing display of projection.

Now, we're seeing, in frustrating detail what happens when a party indoctrinates its voters to ignore the experts on a range of scientific issues and instead trust the Trumps and DeSantis types of the world.

It doesn't surprise me that Extreme Republican and Fuzzy Bear believe they know more about epidemiology than Dr Fauci, or a suite of European doctors.

I just wish there was a way to prove them wrong that didn't involve the loss of further life.

I've never said to blow the "experts" off.  But "experts" often disagree, and the "expert" that is currently front and center was pretty much wrong 2 months ago.

Do we just leave the military to the "experts" (the Generals)?  Do we just leave Law Enforcement to the "experts" (the Police)?  We don't do that any more than we just leave everything to business "experts".  Experts see life through THEIR area of expertise, but their expertise is only one area of life.  Our civilian government's job is to balance these competing worldviews as much as possible.

I'm not anti-science, by the way.  I do live in the real world, however, and that real world is a world where there are alternatives for fossil fuels, but no substitute for fossil fuels.  Without fossil fuels, our way of life would be drastically impacted if we stopped using them all now.  That's another issue, but it illustrates the fact that this problem, as well as the climate problem, involves choices that have negative impacts that are significant, whichever way we choose.

I never claimed to know more about this than Fauci (although, I do think I have a decent understanding of epidemics for a lay man with no formal training).  Obviously, he knows a lot more about viruses than I do.  But, the epidemic itself is just one portion of the issue here.  We need to also listen to economists and mental health experts to come up with the best solution for as many people as possible.  We need to be more holistic than just saying that the only goal is to completely stop a virus.  By that logic, we should live in lockdown forever.  We would almost never get sick if we did that, but it would also be no life to lead.

A majority of the population is afraid to leave their homes right now and a majority of employers don't want them in the office anyway.  This legally voluntary behavior is driving most of the economic changes and it will not recede until people are convinced the virus is under control and/or easily treatable.  Formal government restrictions are not the cause of the downturn.  They are just icing on the cake.  

[Bandit3 the Worker]

Do we know when things will be back to normal? (meaning: large gatherings, multiple people shopping, non-essential businessis open, no National Gaurd at state boarders, not having to wear masks, etc)?

When the FDA approves remdesivir for broad use, which they won't do.

[T'Chenka]

We need to be more holistic than just saying that the only goal is to completely stop a virus.  By that logic, we should live in lockdown forever.  We would almost never get sick if we did that, but it would also be no life to lead.

Downplaying the seriousness of this pandemic by comparing it to typical viruses is inappropriate IMO and a textbook example of a bad faith argument. Minimizing lives lost is our #1 priority right now other than preventing anarchy and total collapse of economy/ government. That in no way compares to seasonal influenza, and you know that.

[T'Chenka]

Do we know when things will be back to normal? (meaning: large gatherings, multiple people shopping, non-essential businessis open, no National Gaurd at state boarders, not having to wear masks, etc)?

When the FDA approves remdesivir for broad use, which they won't do.

The FDA is part of Hillary's deep state.

[🐒Gods of Prosperity🔱🐲💸]

De Blasio (like Kemp) thinks we only learned within the last 48 hours that asymptomatic people could spread the virus:

https://www.mediaite.com/news/bill-de-blasio-rejects-claim-u-s-knew-asymptomatic-people-could-spread-the-virus-only-learned-that-in-the-last-48-hours/

“The city’s position used to be that healthy people don’t need masks because they’re not very effective at preventing the virus from coming in, they’re mostly from keeping you from spreading it, so explain this new recommendation,” Lehrer said.

“Exactly, it’s still the fundamental truth, so we have, you know, a renowned health department here in New York City… only in the last really 48 hours or so do they feel they’ve seen evidence around the world, particularly a new study coming out of Singapore, that shows more evidence that this disease can be spread by asymptomatic people,” de Blasio responded.
.
.
.
When Lehrer asked, “Didn’t we know weeks and months ago that asymptomatic people can spread this disease?” The mayor insisted we did not.

“No, the fact is I’ve been at so many press conferences where our top doctors for New York City addressed this and they said ‘we just didn’t have evidence from all the global medical community that was studying this issue,” de Blasio told Lehrer. “There was suspicion, but there was not evidence.”

I guess they don't listen to Dr. Fauci:

https://twitter.com/OKnox/status/1246493897712418827

What the CDC and most of the public health establishment was saying up until yesterday was that there is no reason to wear a mask unless you are sick.  That would imply that if you aren't sick then you can't spread the virus.

[Green Line]

https://www.indystar.com/story/news/health/2020/04/03/coronavirus-indiana-how-get-help-mental-health-addiction/5104357002/

Sullivan said Indiana's 211 hotline went from receiving roughly 1,000 calls a day regarding mental health — including suicidal ideation — to 25,000 calls a day. And calls to Indiana's addiction hotlines went from an average of 20 a week to 20 a day.

Damn, we need to flatten this curve.  Spare a thought for the millions of lives that are in the process of being destroyed by the elite of this country.

[Penn_Quaker_Girl]

Do we know when things will be back to normal? (meaning: large gatherings, multiple people shopping, non-essential businessis open, no National Gaurd at state boarders, not having to wear masks, etc)?

When the FDA approves remdesivir for broad use, which they won't do.

Remdesivir has shown promise and I'm definitely interested to see its potential, but the FDA approval process is slow and deliberate.  By approving a drug or treatment, the FDA is basically saying "we have conclusively determined that this item's benefits outweigh its risks."  And with something novel like COVID-19, they need to do more thorough testing before upping its status from compassionate use designation. 

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

It's also very likely that deaths from COVID-19 are being significantly under-reported due to lack of confirmation of infection.  If this is the case, and numerous articles support that it is, then comparing the actual number of deaths to any estimated number of cases is inherently flawed, and will certainly underestimate the fatality rate.  For consistency, you need to either compare actual deaths to actual reported cases, or estimated deaths to estimated total cases.

It's likely that we won't be able to estimate the true death toll until after the fact, by calculating excess deaths over the number that would have been expected in a typical population during the same period.

Two things I would add to this and the other points that people have made.

1) First, along the lines of Georgia Moderate's point, one should keep in mind that from historical precedence, virus fatality rates estimated from early in an outbreak don't only get revised down, they also get revised up. For example, while it is true that the 2009 H1N1 swine flu outbreak appeared from initial data to be more deadly than it ultimately turned out to be, for SARS, the fatality rate initially seemed to be quite a bit lower than the 10% or so (possibly more given that the Chinese data is suspect and international data points to a higher fatality rate) that it ultimately ended up as. And while I certainly would not say that this implies that it is more likely to be revised up than to be revised down for COVID-19, we do know that in biological terms COVID-19 is similar to SARS (since that was caused by another Coronavirus).

2) In addition to seeming to be inconsistent with most other available data/information, the idea that COVID-19 may only be as deadly as the flu seems to be inconsistent with the data from the Diamond Princess Cruise ship. For the IFR to be in that range (with 11 deaths out of 712 confirmed cases, and that at a time early in the outbreak when hospitals were not overwhelmed and they could get good medical care), probably something like every single person on the ship (maybe more?) would have had to have been infected with COVID-19 at some point during the cruise, even accounting for demographics. But thousands of passengers tested negative. So either the tests of passengers would have to have been extremely inaccurate, or else thousands of passengers would all have had to have gotten the virus early enough (and without anyone on the ship realizing that there was an epidemic going around) that by the time they were tested all traces of the virus would have to have disappeared from their bodies.

[Bandit3 the Worker]

Remdesivir has shown promise and I'm definitely interested to see its potential, but the FDA approval process is slow and deliberate.  By approving a drug or treatment, the FDA is basically saying "we have conclusively determined that this item's benefits outweigh its risks."  And with something novel like COVID-19, they need to do more thorough testing before upping its status from compassionate use designation. 

There's no time left. People are dying RIGHT NOW.

[💥💥 brandon bro (he/him/his)]

De Blasio (like Kemp) thinks we only learned within the last 48 hours that asymptomatic people could spread the virus:

https://www.mediaite.com/news/bill-de-blasio-rejects-claim-u-s-knew-asymptomatic-people-could-spread-the-virus-only-learned-that-in-the-last-48-hours/

“The city’s position used to be that healthy people don’t need masks because they’re not very effective at preventing the virus from coming in, they’re mostly from keeping you from spreading it, so explain this new recommendation,” Lehrer said.

“Exactly, it’s still the fundamental truth, so we have, you know, a renowned health department here in New York City… only in the last really 48 hours or so do they feel they’ve seen evidence around the world, particularly a new study coming out of Singapore, that shows more evidence that this disease can be spread by asymptomatic people,” de Blasio responded.
.
.
.
When Lehrer asked, “Didn’t we know weeks and months ago that asymptomatic people can spread this disease?” The mayor insisted we did not.

“No, the fact is I’ve been at so many press conferences where our top doctors for New York City addressed this and they said ‘we just didn’t have evidence from all the global medical community that was studying this issue,” de Blasio told Lehrer. “There was suspicion, but there was not evidence.”

I guess they don't listen to Dr. Fauci:

https://twitter.com/OKnox/status/1246493897712418827

What the CDC and most of the public health establishment was saying up until yesterday was that there is no reason to wear a mask unless you are sick.  That would imply that if you aren't sick then you can't spread the virus.

You could interpret it that way, but the reason that directive exists is that masks are much better for stopping transmitting virus particles to others (as well as to other surfaces) than they are at stopping virus particles from reaching you.

One of the main ways the virus is transmitted is through spit particles. A lot of spit particles are large and will be caught by a mask, but these particles typically only travel short distances. There are a lot of smaller spit particles (or even airborne viral material) which can travel further distances and can pass through most masks (but not N95s).

So the idea is, if you are sick, wear a mask because it will stop your larger spit particles from traveling to people you come into close contact with, surfaces, or your hands/arms. But if you aren't sick and there are airborne particles, a mask will not help you.

One of the main advantages to an asymptomatic (or even non-infected) person wearing a mask is that you're much likely to touch your mouth or nose (with an infected hand) if you're wearing a mask. They probably thought it would be better to tell people not to touch their faces and that would be sufficient, but that was idiotic and unrealistic advice for people to follow.

[Penn_Quaker_Girl]

Remdesivir has shown promise and I'm definitely interested to see its potential, but the FDA approval process is slow and deliberate.  By approving a drug or treatment, the FDA is basically saying "we have conclusively determined that this item's benefits outweigh its risks."  And with something novel like COVID-19, they need to do more thorough testing before upping its status from compassionate use designation.  

There's no time left. People are dying RIGHT NOW.

I know, I know.  But ethically, medical providers can't just say "let's try it! If it works it works.  If it doesn't, it doesn't" -- especially with a novel drug such as remdesivir.  The "doesn't work" side of the coin isn't restricted to simply not having any effect at all.  It could mean adverse and dangerous side effects.  It could mean unexpected interactions with other drugs.  

The unknown is a major factor in the administration of novel medications.  Politics and money aside (though, hey, it's drug companies, so those are always considerations), that's why testing is so important and so deliberate.  

[Oswald Acted Alone, You Kook]

Have the various drugs that can be used as treatments shown any negative side effects so far?

[Penn_Quaker_Girl]

Have the various drugs that can be used as treatments shown any negative side effects so far?

With hydroxychloroquine (and I can attest to this as I remember being informed of this before being administered the drug for malaria) -- one of the more notable side effects is a disruption of the heart's rhythm (an elongation of the QT interval).  

It may take months to know the true outcomes from larger trials,[4,5] but what we do know is the safety profiles of these medications. Both hydroxychloroquine and chloroquine have been U.S. Food and Drug Administration (FDA) approved for lupus erythematosus, rheumatoid arthritis, and malaria.[6] Years of safety data show that these medications can cause cardiac ECG QT prolongation and subsequent arrhythmias, including torsade de pointes.[9] These medications can prolong the QT correction (QTc), even when taken as recommended.[9] With limited treatment options how can providers proceed with treatment options?

Now it's worth noting that these side effects occur primarily as a result of chronic intake or overdosing.  Those testing HCQ in the fight against COVID-19 have to determine (a) if it's truly effective against the virus, (b) what is the dosage necessary to be effective against the virus and (c) is that dosage safe enough to administer on a widespread scale? There is an array of other factors too (including the patient's medical history, the interactions when taken on a concomitant basis, etc), but I won't get into those. 

Source: https://www.dicardiology.com/article/covid-19-hydroxychloroquine-treatment-brings-prolonged-qt-arrhythmia-issues

[TJ in Oregon]

Remdesivir has shown promise and I'm definitely interested to see its potential, but the FDA approval process is slow and deliberate.  By approving a drug or treatment, the FDA is basically saying "we have conclusively determined that this item's benefits outweigh its risks."  And with something novel like COVID-19, they need to do more thorough testing before upping its status from compassionate use designation.  

There's no time left. People are dying RIGHT NOW.

I know, I know.  But ethically, medical providers can't just say "let's try it! If it works it works.  If it doesn't, it doesn't" -- especially with a novel drug such as remdesivir.  The "doesn't work" side of the coin isn't restricted to simply not having any effect at all.  It could mean adverse and dangerous side effects.  It could mean unexpected interactions with other drugs.  

The unknown is a major factor in the administration of novel medications.  Politics and money aside (though, hey, it's drug companies, so those are always considerations), that's why testing is so important and so deliberate.  

I though the safety trials had already been completed for Remdesivir from its Ebola testing days and they were primarily testing for efficacy now?

[Bandit3 the Worker]

I though the safety trials had already been completed for Remdesivir from its Ebola testing days and they were primarily testing for efficacy now?

That's what I thought too. I thought they also said the efficacy for this drug was fantastic.

[Absentee Voting Ghost of Ruin]

https://twitter.com/MarkLevineNYC/status/1246499789359001600

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

What the CDC and most of the public health establishment was saying up until yesterday was that there is no reason to wear a mask unless you are sick.  That would imply that if you aren't sick then you can't spread the virus.

They were only saying that because there was (is) a huge shortage of proper masks (both N95s and surgical masks) and they made a judgment that it was better (not good, but less bad) to lie and tell people that they didn't need masks and that masks don't do anything in the hopes that it would make it easier to get more masks into the hands of health care providers. And also, it was easier to communicate than it was to spell out the differences between different types of masks and the varying effectiveness of them in different settings, which doesn't fit so easily into a simple soundbite and which people would have a hard time understanding. Moreover, at the time they said that you didn't need to wear a mask or be particularly worried on the individual level, that *was* true. On an individual level, current risk *was* low (and in most parts of the country, current individual risk is quite low even now!

This was a bad judgment IMO, but it is not hard to see why they made it. It is not that they didn't know that asymptomatic or pre-symptomatic people could spread the virus.

[GeorgiaModerate]

I though the safety trials had already been completed for Remdesivir from its Ebola testing days and they were primarily testing for efficacy now?

That's what I thought too. I thought they also said the efficacy for this drug was fantastic.

From https://www.rxlist.com/consumer_remdesivir_rdv/drugs-condition.htm:

IS REMDESIVIR EFFECTIVE AGAINST COVID-19, BASED ON THE LIMITED EVIDENCE AVAILABLE?

There is only one randomized control trial for remdesivir (RDV) conducted during the last Ebola outbreak. That study was stopped before it was concluded because of a significant increase in mortality in patients taking RDV, meaning it didn’t help those Ebola patients.

The majority of clinical decisions are made based on the historical epidemics Ebola, SARS, and MERS. The outcomes of RDV use in those three disease outbreaks has not been as promising as hoped.

WHEN WILL WE KNOW IF REMDESIVIR IS SUCCESSFUL AGAINST COVID-19 CORONAVIRUS?

As of March 27, 2020:

There are four U.S. trials.

Two China trials are expected to complete at the beginning of April.

One Chinese trial is for severe COVID-19, one is for mild-to-moderate COVID-19.

The last day for data collection for the severe trial is April 3.

The last day for data collection for the mild-to-moderate one is April 10.

There are two or three European trials that have RDV as a comparator, meaning it’s one of
the drugs they are testing in a multi-drug trial.

Once the trials are completed, there will be a short lag time as researchers crunch the data and put their paper through peer review.

WHAT ARE SIDE EFFECTS OF REMDESIVIR (RDV)?

In the Ebola trial, researchers noted side effects of remdesivir (RDV) that included:

Increased liver enzyme levels that may indicate possible liver damage

Researchers documented similar increases in liver enzymes in three U.S. COVID-19 patients

Typical antiviral drug side effects include:

Nausea
Vomiting

[Vaccinated Russian Bear]

Castiglione d'Adda was one of the earliest and hardest hit towns in Northern Italy.  There was a report that 70% of people who showed up to donate blood last week had antibodies, so that town may have herd immunity now if that is verified.  But, crucially, they have already lost about 2% of their total 2017 population to coronavirus.  Many other people there are still very sick and at risk of dying from it.  That's what any jurisdiction that goes for herd immunity is risking.

It there more data about Castiglione? In Kirkland's nursing home ~50% died. With other words, if a nursing homes with 100 people in Castiglione would get infected, it'd be enough to get 2% of whole population. 5k town can become anecdotal evidence. Italy has also 4-6 times less ventilators per capita then US I think.

The bad news is that recent news show that Western World keep failing protecting places like nursing homes, so we can, indeed, follow Castiglione...

[Skill and Chance]

Castiglione d'Adda was one of the earliest and hardest hit towns in Northern Italy.  There was a report that 70% of people who showed up to donate blood last week had antibodies, so that town may have herd immunity now if that is verified.  But, crucially, they have already lost about 2% of their total 2017 population to coronavirus.  Many other people there are still very sick and at risk of dying from it.  That's what any jurisdiction that goes for herd immunity is risking.

It there more data about Castiglione? In Kirkland's nursing home ~50% died. With other words, if a nursing homes with 100 people in Castiglione would get infected, it'd be enough to get 2% of whole population. 5k town can become anecdotal evidence. Italy has also 4-6 times less ventilators per capita then US I think.

The bad news is that recent news show that Western World keep failing protecting places like nursing homes, so we can, indeed, follow Castiglione...

That I don't know.

If it turns out to be Italy's version of The Villages, that would be somewhat reassuring.  If it's a college town, that would be terrifying. 

[rob in cal]

  Any theories why a lot of states aren't seeing a big jump in deaths like we are seeing in NYC/NJ? If you look daily deaths this week in Louisiana, Michigan, Massachusetts, California, Illinois, Georgia, Florida, deaths are certainly happening, but not exploding.  the calm before the storm, or some good news?

[Dr. Arch]

  Any theories why a lot of states aren't seeing a big jump in deaths like we are seeing in NYC/NJ? If you look daily deaths this week in Louisiana, Michigan, Massachusetts, California, Illinois, Georgia, Florida, deaths are certainly happening, but not exploding.  the calm before the storm, or some good news?

Those states are a week or two behind their timeline parallels in NYC/NJ. I doubt they've seen their peak, but neither has NYC/NJ, which are estimated to peak around mid April, if things remain under relative control.

[Omega21]

Remdesivir has shown promise and I'm definitely interested to see its potential, but the FDA approval process is slow and deliberate.  By approving a drug or treatment, the FDA is basically saying "we have conclusively determined that this item's benefits outweigh its risks."  And with something novel like COVID-19, they need to do more thorough testing before upping its status from compassionate use designation.  

There's no time left. People are dying RIGHT NOW.

I know, I know.  But ethically, medical providers can't just say "let's try it! If it works it works.  If it doesn't, it doesn't" -- especially with a novel drug such as remdesivir.  The "doesn't work" side of the coin isn't restricted to simply not having any effect at all.  It could mean adverse and dangerous side effects.  It could mean unexpected interactions with other drugs.  

The unknown is a major factor in the administration of novel medications.  Politics and money aside (though, hey, it's drug companies, so those are always considerations), that's why testing is so important and so deliberate.  

I never got the fact why it isn't possible for a patient to say let me try it, I accept every possible risk...