Hoth

Got a few flakes falling now. It's good for the soul.

Yeah, that's probably a decent representation of a mild case, or about 60-70% of cases. On the flipside, there's stuff like this: https://www.yahoo.com/entertainment/virus-kills-chinese-film-director-100442476.html

Five days on average and up to 9 on some surfaces in a cool, humid environment.

I'm curious where you saw it doesn't spread as fast as the flu. From what I've read, typical flu has an R nought of around 1.25-1.5, with a severe pandemic like 1918 closer to 2. I've seen estimates for COVID19 ranging from 2 to 6. Case tracking and diligent isolation help lower that transmission rate, but once community spread takes hold even measures like China took can only reduce the infection rate so much. It does buy time though, which is important in preventing healthcare systems from breaking down. The trade off is, to prevent unchecked growth, you have to basically shut down your economy, which has its own knock on risks.

lol, and since social distancing is useful in preventing transmission, mission accomplished.

You've heard of bitcoin. TP becomes the new shitcoin.

For sure. We're talking about risk mitigation, not elimination.

So why do doctors in hospitals bother with them?

I don't mean to stoke fear at all, but I think preparedness and precautions are important. We're probably conditioned to be complacent because we haven't seen a threat like this in a long time. Here's an interview with Richard Hatchett, which I found to be pretty even-keeled and on the ball.

Saudis and Kuwait doing the same. I haven't seen any signs of people taking precautions here yet. It's classic normalcy bias at work. We've had some business continuity discussions at work, figuring out what operations we can cut, what can be done from home, and I know Yale is gearing up for an expected shutdown/quarantine scenario, but everyone seems to be taking a reactive vs proactive approach. Nobody wearing masks or gloves at supermarkets, people going out bars and restaurants and churches as usual. I expect we're going to see the exponential nature of COVID spread in the next couple weeks, not so much in test results, which will probably follow a linear model owing to the limits of availability, but in the rise of anecdotal talk of families falling ill, schools closing, hospitals suddenly swamped etc. etc. My boss has a friend who works for Bridgewater, Ray Dalio's giant hedge fund, which seems to be taking the proactive approach. They were dismissed to work from home indefinitely last week (which is interesting since they are in Westport and there were no reported cases in CT yet). You figure a place like that probably has one of the best risk management departments extant, with high level contacts across the spectrum of policy makers, virologists etc., so they know what's happening. Probably no coincidence that banks, Amazon, Google etc. are all banning corporate travel and increasingly moving towards telecommuting too. It will eventually sink in with the general public, but the damage will be done by then.

It's just a fantasy. It's not the real thing. Sometimes a fantasy is all you need.

Now first case in VT.

My understanding is that it's one of the defining symptoms of COVID19. That's how it was initially discovered in China, as an abnormal pneumonia that didn't fit any known disease profile. Along with fever, dry cough and muscular weakness, pneumonia appears to be pretty common, especially as the disease progresses into the second or third week. It's probably the primary reason a high percentage of people require hospitalization. The infection gets deep in the lungs and produces abnormally dense sputum that can't be cleared by coughing. That drives hypoxia and organ failure without intensive care in more serious cases. There have been cases requiring intensive manual ventilation for upwards of a month to keep them alive. There was even a lung transplant in China because a patient developed severe fibrosis. Anyway, here's an early study of patients in Wuhan from the Lancet: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext

If a young person gets pneumonia from this and the hospital capacity has been taxed to the point of breaking, mortality will increase in that group too. Just not enough doctors/ventilators etc. to treat everyone. We may not even be in the early innings here; the players are only now taking the field.

Agreed. We're inflecting into the exponential growth phase. I feel bad for any small business owner/retailer over the next few months. Once cases become common, foot traffic is going to fall off a cliff.

This is a superb point. A lot of people will worry that they might be hit with a hefty pricetag for a test that is not necessarily accurate. I saw Mass lawmakers mandated that anyone can get tested without expense (kudos to them), but there are only four states doing this. And as you say, a lot of people presenting mild symptoms probably just assume they have a bad cold and just soldier on as usual. Here's what I'll say about this, it ain't the flu. The Chinese Communist Party values social stability above everything else, and their model for keeping stability has been economic growth at any cost, including blowing an unprecedented debt bubble over the last decade. The fact that they've virtually locked their country down and destroyed their economy suggests that what they're seeing and what they're reporting are two very different things.

Sorry Steve, don't mean to be a downer. But normalcy bias can be a major problem in a situation like this. Better to take this seriously than be complacent.

Fingers crossed it has seasonality like the flu, but we can't assume. Our government seems to be intentionally downplaying the risk, which is only going to make this more likely to explode out of control in the coming month or two.

Bear in mind that the case fatality rate may actually rise going forward if draconian containment measures are not taken. This virus is very transmittable, and viral shedding is nearly as high in asymptomatic infected people as in those who are visibly sick. People can be walking around infecting others for weeks without knowing they are sick themselves. Based on the data we have, somewhere between 13-20% of infected people will require hospitalization, usually in the second or third week, which will very quickly will overwhelm hospital capacity, especially considering hospitals are already near capacity from the flu. Worse, coronavirus cases that progress to the pneumonia stage often require weeks of oxygen, assisted ventilation and other intensive care. Some patients appear to develop fibrosis, so basically permanent lung damage. There simply isn't enough capacity for the number of people who will likely need this therapy in the coming months. This will lead to deaths in people of all ages; obviously the rate will be higher in the elderly (which is somewhere around 15% for those above 80) and people with existing health complications, diabetes, smokers, cancer etc. etc. (of which there are millions), but there have been plenty of cases of young, healthy people dying from multiple organ failure from cytokine storms. Basically overly aggressive immune response causes massive inflammation and floods the lungs with fluid. Same thing happened in the young in 1918. The other thing to consider regarding the case fatality rate is that dividing deaths by confirmed cases may not be the best metric. Deaths/recoveries may be a better method, as it captures cases where the disease has completely run its course. Based on data so far, that would put SARS-COVID19 around 6-8%, not too far out of line with SARS' 10%. Don't expect this to disappear from the headlines anytime soon. We likely have not seen an infectious disease threat of this magnitude in a century.

Bump.

Amazing how spring is asserting itself down here already. My yard is full of crocuses and snowdrops; my daffodils are already up and budding; I've noticed some forsythia blooming and several maples around Yale with red buds. If we get a warm month, it'll be an early leaf-out for sure. Bring it, say I.

My brother's in-laws live up in Tupper Lake. They had a two foot pack before this storm and got another two feet from the LE. Talk about utopia.

You're killing it dude. I'm still trying to get to double digits.

Reversion to the mean working in our favor when the bar is so low.

This year has been rough, but I think I've passed through the stages of grief. Acceptance feels good. Time to move on and get ready for spring. Get those mowers ready.