Corona Virus #5
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rswyan
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Statistical modeling ... done in places like you know: John Hopkins University ... the place you might want to be ... if you were really broken bad and needed medical experts to fix you up.
Oh ... and it can be a whole lot worse than 2 mil ... and it would be ... if this virus were more lethal.
Thankfully, it's not.
Simulation of coronavirus pandemic months ago predicted millions dead - Business Insider
shooterdon
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It will have the opposite effect. More people now know they NEED guns. There will be no effort to confiscate guns unless some idiot fires on NG, LEO's doing their jobs to enforce curfews and ML: and it likely would be in a localized sweep of the local area to address the threat. Then I hope they kill the bastard.
The rules for engagement by citizens remain the same, with one important change. A week ago, I would not have killed someone for stealing from us. But let's say things get really bad, and there is a shortage of food/fuel/etc. Now things are different. He will be stealing things I need to survive...so I am protecting the lives of my loved ones. The looter is now endangering us...he will be killed in self defense. If he is not addressed, he will come back for more stuff and maybe bring his buddies.
One consideration, in the past, I would never have shot a threat that was running away (no longer a threat). Still feel that way, but stores are still open and relatively well stocked (in my area).
groundcover
Veteran Member
Written by physicians in Boston.
From a group of 50 Brookline, MA physicians:
驗*s there is so much confusion, misinformation and denial on social media about the coronavirus we hope to explain, in plain language, why the experts see this as such an emergency. Many people are reading the claim online that this virus is a lot like the viruses that cause colds, and that if you get it, it will probably just seem like a bad cold and you are very unlikely to die. Depending on who you are, this may be true, but there is more to this story that is key to our outcome as a community.
This is a coronavirus that is new to the human population. Although it is related to the viruses that cause colds, and acts a lot like them in many ways, nobody has ever been exposed to this before, which means nobody has any immunity to it.
The virus is now moving explosively through the human population, spreading through respiratory secretions and 10 times more contagious that the flu or cold. Although many people will recover, about 20% will wind up with a serious pneumonia that will require hospitalization. Some will be so ill from the pneumonia that they will die. We estimate this may be 2-3%, but it is higher in Italy逞ｴ experience, partially because the healthcare system was overwhelmed so rapidly. In those over age 70, the death rate is 8-20%.
So if a child catches it on a playdate, they can easily transmit it to their grandmother as easily as touching the same doorknob or countertop.
Scientists measure the spread of an epidemic by a number called R0, or 霑* naught. That number is calculated this way: for every person who develops the illness, how many other people do they give it to before they are cured (or dead) and no longer infectious? The R0 for coronavirus appears to be a number close to 3 an extremely frightening number for such a deadly disease.
Suppose you catch the virus. You will give it to 3 other people, and they will each give it to three others, and so forth. Here is how the math works, where you, the 螯ｬndex case, are the first line:
1
3
9
27
81
243
729
2,187
6,561
19,683
59,046
177,147
531,441
1,594,323
4,782,969
14,348,907
So, in just 15 steps of transmission, the virus has gone from just one index case to 14.3 million other people. Those 15 steps might take only a few weeks. With school out and lots of playdates, maybe less. The first person may be young and healthy Brookline child, but many of those 14 million people will be old and sick, and they will likely die because they got a virus that started in one person's throat.
R0 is not fixed it can be lowered by control measures. If we can get the number below 1, the epidemic will die out. This is the point of the quarantines and social distancing, but we are not doing it fast enough.
In the US, we have to slow down the virus. American hospitals, Boston hospitals, have limited resources. We have a fixed number of ventilators and an impending calamity on our hands. Our Italian critical care colleagues have shared with us that they simply do not have enough resources (ventilators, physicians and nurse, critical care beds), and are forced to choose who lives and dies based on old tenets of wartime triage.
Older patients do not even get a ventilator and die of their pneumonia. These are decisions nobody should have to face, and we are only 11 days behind Italy逞ｴ fate. Their hospitals are quite advanced, and we are no better in Boston. As doctors, we are desperately trying to prepare for the onslaught of patients in the coming weeks. It is already beginning. This is an opportunity for you as the district leadership the time to be aggressive and help us fight this by 謫｢lattening the Curve?
We implore you, as a group of Boston逞ｴ doctors preparing to fight this, to help us. Please send a new email to ALL the Brookline school district families. Social distancing is painful. We know that kids have cabin fever, they are pleading to see their friends, they may have birthday parties coming up or special events they have been looking forward to. All of us need to work and childcare is a big worry. But we need to overcome these issues and boredom for the coming weeks so that we can survive this with as few deaths as possible. What does that mean?
1) No playdates, not even 1:1.
2) No small gatherings, no meetings between a couple families, even for birthday parties.
3) Avoid trampoline parks, climbing gyms, restaurants, movie theaters, anything in an enclosed area. Many of these places are advertising increased cleaning and hygiene. This is not sufficient! Do not go.
4) Cancel planned vacations for the next month. Avoid airline travel that is not an emergency. Many airlines and rental agencies are offering penalty free cancellations.
5) Stay at home as much as possible. Work from home if you possibly can. You may have to go buy groceries and medicine, of course, but make the trips quick and purposeful.
6) Wash your hands thoroughly after you have been in public places, for a full 20 seconds, soaping up thoroughly and being sure to get between the fingers.
7) Please avoid disseminating social media claims that the situation is not serious or is being exaggerated. This is a national crisis and conveying misinformation to your friends and family may put their lives in danger.
Thank you for taking the time to read this and stay safe and healthy in the coming weeks.
Respectfully,
Signed by: Erika Rangel, MD, Director of Surgical Critical Care, Brigham and Women逞ｴ Faulkner Hospital
Shawn Rangel, MD, Pediatric Surgery, Children逞ｴ Hospital Boston
Asaf Bitton, MD, Executive Director Ariadne Labs and Internal Medicine, BWH
Daniel O蝗｣onnor, MD, Pediatrics, Longwood Pediatrics and Children逞ｴ Hospital Boston
Beth O蝗｣onnor, MD, Pediatrics, Roslindale Pediatrics
Vandana Madhavan, MD, Clinical Director of Pediatric Infectious Disease, MGH
Parag Amin, MD, Pediatrics, Centre Pediatrics
Christy Cummings, MD, Neonatology, Children逞ｴ Hospital Boston
Eric Bluman, MD, Orthopedic Surgery, BWH
Trimble Augur, MD, Internal Medicine, Hebrew Rehabilitation Center
Dasha Weir, MD, Pediatric gastroenterology
Amy Evenson Warren, Transplant Surgery, BIDMC
William Oldham, MD, PhD, Pulmonary and Critical Care Medicine, BWH
James Kryzanski, MD, Neurosurgery, Tufts Medical Center
Ben Zendejas-Mummert, MD, Pediatric Surgery, Children逞ｴ Hospital Boston
Johanna Iturrino Moreda, MD, Gastroenterology, BIDMC
David Berg, MD, Cardiology and Cardiac Critical Care, BWH
Jennifer Crombie, MD, Hematology Oncology, BWH
Jenifer Lightdale, MD, Chief of Pediatric Gastroenterology, U Mass Memorial Hospital
Wayne Tworetzky, MD, Pediatric Cardiology, Children逞ｴ Hospital Boston
Elaine Yu, MD, Endocrinology
Jonathan Li, Infectious Disease
Nancy Cho, MD, Surgical Oncology, BWH
Eric Sheu, MD, Minimally Invasive Surgery, BWH
Reza Askari, MD, Director, Surgical Critical Care, BWH
Cindy Lien, MD, Internal Medicine and Palliative Care, BIDMC
Hannah Parker, MD, OB/GYN
Alysa E. Doyle, PhD, Center for Genomic Medicine, MGH
Christopher Smith, MD, Internal Medicine, Charles River Medical Associates, Wellesley, MA
Maya Greer, NP, Children逞ｴ Hospital Boston
Rusty Jennings, MD, Pediatric Surgery, Children逞ｴ Hospital Boston
Emily Oken, MD, Professor of Population Medicine, BWH
Chinwe Ukomadu, MD, Head of Clinical Hepatology, Novartis
Jennifer Kaufman, MD, Internal Medicine, BWH
Ann Poduri, MD, MPH, Pediatric Neurology
Susan Yehle Ritter, MD, Rheumatology
Diego Martinucci, MD Psychiatry, Atrius Health
Shih-Ning Liaw, MD, Pediatric Palliative Care, Dana-Farber Cancer Institute/Boston Children逞ｴ Hospital
Wolfram Goessling, MD, Gastroenterology and Oncology, MGH
Paola Daza, Pediatrics, MGH
Juan Matute, Neonatology, MGH
John Ross, MD, Internal Medicine, BWH
Megan Sandel, MD, Pediatrics, Boston Medical Center
Kathy Calvillo, MD, Surgery, BWH
Christine Greco, MD, Anesthesia, Children逞ｴ Hospital Boston
Niteesh Choudhry, MD, PhD, Internal Medicine, BWH and Harvard T.H. Chand School of Public Health
Chandru Krishnan, MD, Ophthalmology, Tufts Medical Center
Amy Ship, MD, Internal Medicine, Associate Director of Medical Education, Atrius Health
Yen-Lin Evelyn Chen, MD, Radiation Oncology, MGH
Daihung Do, MD, Dermatology, BIDMC
Chloe Zera, MD, MPH, Maternal Fetal Medicine, BIDMC
Alejandra Barrero-Castillero, MD, MPH, Neonatology, Children逞ｴ Hospital Boston
Jesse Esch, MD, Pediatric Cardiology, Children逞ｴ Hospital Boston
Alison Packard, MD, OB/GYN, MGH
Vik Khurana, MD PhD, Chief Division of Movement Disorders, BWH
Tu-Mai Tran, MD, MSc, Family Medicine, BMC
Yu Liu, MD PhD, Internal Medicine, Bristol Myers Squibb
Yih-Chieh Chen, MD
Lily Li, MD, Allergy and Immunology, BWH
From a group of 50 Brookline, MA physicians:
驗*s there is so much confusion, misinformation and denial on social media about the coronavirus we hope to explain, in plain language, why the experts see this as such an emergency. Many people are reading the claim online that this virus is a lot like the viruses that cause colds, and that if you get it, it will probably just seem like a bad cold and you are very unlikely to die. Depending on who you are, this may be true, but there is more to this story that is key to our outcome as a community.
This is a coronavirus that is new to the human population. Although it is related to the viruses that cause colds, and acts a lot like them in many ways, nobody has ever been exposed to this before, which means nobody has any immunity to it.
The virus is now moving explosively through the human population, spreading through respiratory secretions and 10 times more contagious that the flu or cold. Although many people will recover, about 20% will wind up with a serious pneumonia that will require hospitalization. Some will be so ill from the pneumonia that they will die. We estimate this may be 2-3%, but it is higher in Italy逞ｴ experience, partially because the healthcare system was overwhelmed so rapidly. In those over age 70, the death rate is 8-20%.
So if a child catches it on a playdate, they can easily transmit it to their grandmother as easily as touching the same doorknob or countertop.
Scientists measure the spread of an epidemic by a number called R0, or 霑* naught. That number is calculated this way: for every person who develops the illness, how many other people do they give it to before they are cured (or dead) and no longer infectious? The R0 for coronavirus appears to be a number close to 3 an extremely frightening number for such a deadly disease.
Suppose you catch the virus. You will give it to 3 other people, and they will each give it to three others, and so forth. Here is how the math works, where you, the 螯ｬndex case, are the first line:
1
3
9
27
81
243
729
2,187
6,561
19,683
59,046
177,147
531,441
1,594,323
4,782,969
14,348,907
So, in just 15 steps of transmission, the virus has gone from just one index case to 14.3 million other people. Those 15 steps might take only a few weeks. With school out and lots of playdates, maybe less. The first person may be young and healthy Brookline child, but many of those 14 million people will be old and sick, and they will likely die because they got a virus that started in one person's throat.
R0 is not fixed it can be lowered by control measures. If we can get the number below 1, the epidemic will die out. This is the point of the quarantines and social distancing, but we are not doing it fast enough.
In the US, we have to slow down the virus. American hospitals, Boston hospitals, have limited resources. We have a fixed number of ventilators and an impending calamity on our hands. Our Italian critical care colleagues have shared with us that they simply do not have enough resources (ventilators, physicians and nurse, critical care beds), and are forced to choose who lives and dies based on old tenets of wartime triage.
Older patients do not even get a ventilator and die of their pneumonia. These are decisions nobody should have to face, and we are only 11 days behind Italy逞ｴ fate. Their hospitals are quite advanced, and we are no better in Boston. As doctors, we are desperately trying to prepare for the onslaught of patients in the coming weeks. It is already beginning. This is an opportunity for you as the district leadership the time to be aggressive and help us fight this by 謫｢lattening the Curve?
We implore you, as a group of Boston逞ｴ doctors preparing to fight this, to help us. Please send a new email to ALL the Brookline school district families. Social distancing is painful. We know that kids have cabin fever, they are pleading to see their friends, they may have birthday parties coming up or special events they have been looking forward to. All of us need to work and childcare is a big worry. But we need to overcome these issues and boredom for the coming weeks so that we can survive this with as few deaths as possible. What does that mean?
1) No playdates, not even 1:1.
2) No small gatherings, no meetings between a couple families, even for birthday parties.
3) Avoid trampoline parks, climbing gyms, restaurants, movie theaters, anything in an enclosed area. Many of these places are advertising increased cleaning and hygiene. This is not sufficient! Do not go.
4) Cancel planned vacations for the next month. Avoid airline travel that is not an emergency. Many airlines and rental agencies are offering penalty free cancellations.
5) Stay at home as much as possible. Work from home if you possibly can. You may have to go buy groceries and medicine, of course, but make the trips quick and purposeful.
6) Wash your hands thoroughly after you have been in public places, for a full 20 seconds, soaping up thoroughly and being sure to get between the fingers.
7) Please avoid disseminating social media claims that the situation is not serious or is being exaggerated. This is a national crisis and conveying misinformation to your friends and family may put their lives in danger.
Thank you for taking the time to read this and stay safe and healthy in the coming weeks.
Respectfully,
Signed by: Erika Rangel, MD, Director of Surgical Critical Care, Brigham and Women逞ｴ Faulkner Hospital
Shawn Rangel, MD, Pediatric Surgery, Children逞ｴ Hospital Boston
Asaf Bitton, MD, Executive Director Ariadne Labs and Internal Medicine, BWH
Daniel O蝗｣onnor, MD, Pediatrics, Longwood Pediatrics and Children逞ｴ Hospital Boston
Beth O蝗｣onnor, MD, Pediatrics, Roslindale Pediatrics
Vandana Madhavan, MD, Clinical Director of Pediatric Infectious Disease, MGH
Parag Amin, MD, Pediatrics, Centre Pediatrics
Christy Cummings, MD, Neonatology, Children逞ｴ Hospital Boston
Eric Bluman, MD, Orthopedic Surgery, BWH
Trimble Augur, MD, Internal Medicine, Hebrew Rehabilitation Center
Dasha Weir, MD, Pediatric gastroenterology
Amy Evenson Warren, Transplant Surgery, BIDMC
William Oldham, MD, PhD, Pulmonary and Critical Care Medicine, BWH
James Kryzanski, MD, Neurosurgery, Tufts Medical Center
Ben Zendejas-Mummert, MD, Pediatric Surgery, Children逞ｴ Hospital Boston
Johanna Iturrino Moreda, MD, Gastroenterology, BIDMC
David Berg, MD, Cardiology and Cardiac Critical Care, BWH
Jennifer Crombie, MD, Hematology Oncology, BWH
Jenifer Lightdale, MD, Chief of Pediatric Gastroenterology, U Mass Memorial Hospital
Wayne Tworetzky, MD, Pediatric Cardiology, Children逞ｴ Hospital Boston
Elaine Yu, MD, Endocrinology
Jonathan Li, Infectious Disease
Nancy Cho, MD, Surgical Oncology, BWH
Eric Sheu, MD, Minimally Invasive Surgery, BWH
Reza Askari, MD, Director, Surgical Critical Care, BWH
Cindy Lien, MD, Internal Medicine and Palliative Care, BIDMC
Hannah Parker, MD, OB/GYN
Alysa E. Doyle, PhD, Center for Genomic Medicine, MGH
Christopher Smith, MD, Internal Medicine, Charles River Medical Associates, Wellesley, MA
Maya Greer, NP, Children逞ｴ Hospital Boston
Rusty Jennings, MD, Pediatric Surgery, Children逞ｴ Hospital Boston
Emily Oken, MD, Professor of Population Medicine, BWH
Chinwe Ukomadu, MD, Head of Clinical Hepatology, Novartis
Jennifer Kaufman, MD, Internal Medicine, BWH
Ann Poduri, MD, MPH, Pediatric Neurology
Susan Yehle Ritter, MD, Rheumatology
Diego Martinucci, MD Psychiatry, Atrius Health
Shih-Ning Liaw, MD, Pediatric Palliative Care, Dana-Farber Cancer Institute/Boston Children逞ｴ Hospital
Wolfram Goessling, MD, Gastroenterology and Oncology, MGH
Paola Daza, Pediatrics, MGH
Juan Matute, Neonatology, MGH
John Ross, MD, Internal Medicine, BWH
Megan Sandel, MD, Pediatrics, Boston Medical Center
Kathy Calvillo, MD, Surgery, BWH
Christine Greco, MD, Anesthesia, Children逞ｴ Hospital Boston
Niteesh Choudhry, MD, PhD, Internal Medicine, BWH and Harvard T.H. Chand School of Public Health
Chandru Krishnan, MD, Ophthalmology, Tufts Medical Center
Amy Ship, MD, Internal Medicine, Associate Director of Medical Education, Atrius Health
Yen-Lin Evelyn Chen, MD, Radiation Oncology, MGH
Daihung Do, MD, Dermatology, BIDMC
Chloe Zera, MD, MPH, Maternal Fetal Medicine, BIDMC
Alejandra Barrero-Castillero, MD, MPH, Neonatology, Children逞ｴ Hospital Boston
Jesse Esch, MD, Pediatric Cardiology, Children逞ｴ Hospital Boston
Alison Packard, MD, OB/GYN, MGH
Vik Khurana, MD PhD, Chief Division of Movement Disorders, BWH
Tu-Mai Tran, MD, MSc, Family Medicine, BMC
Yu Liu, MD PhD, Internal Medicine, Bristol Myers Squibb
Yih-Chieh Chen, MD
Lily Li, MD, Allergy and Immunology, BWH
shooterdon
Elite Member
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My friend, it is not difficult to find projections. They are a "best guess" at this point, and will always be....just like the number of deaths from flu every year varies and we "know" more about it.
It is why I was alarmed a few weeks ago. The projected range of deaths was significant and it raised a red flag. Lots of people here calling it "just the flu" had not done the research or were living by the great river DeNile. A couple of the resident morons here still reside by that river. (BTW, I am a member on a shooting site and they have an even larger number if morons and members of the tin foil hat crowd....the average tractor owner appears to be more sensible than guys shooting lead projectiles.)
This is real, it is serious, it will affect the economy, it will kill a lot of people, but we will survive if we are not stupid. Be safe!
k0ua
Epic Contributor
I wonder when the millions of bodies ARE going to start piling up? So far we have managed to wreck an economy and we don't have any bodies to show for it. I guess we are doing something right. In the time all of this has started regular flu has killed many times more people than this Chinese variety has. When do we get to see some real carnage? Millions are going to die huh? Ok. lets see that start to happen. When does it start? Where does it end? I am beginning to wonder. Will it really get worse? Lots of people think they have crystal balls and can predict future events. I see no evidence that statistical modeling can predict much of anything. It sure as he77 cannot predict the weather. Put me in the camp of wondering if the "cure" isn't a lot worse than the disease. The government says the economy will roar back just as soon as we whip this thing. Will it? How many businesses will be out of business permanently? I dunno. I could be totally FOS. But I tell yah, I run hot and cold on thinking this thing thru. At this point I am more worried about the nation's economy than I am a few thousand deaths. Remember we have 10's of thousands of flu deaths EVERY year. 50,000 to 60,000 is not uncommon. So far we have had a little over 200 deaths from Wuhan flu. Ok. flame suit on and zipped up tight. Go ahead and give it your best... 
Peter 315
Super Member
I shoot at a gun club but I'm home on TBN but should be outside doing yard work... LOL
groundcover
Veteran Member
We are 7-10 days behind Italy, be careful what you wish for !
Closer to the 1918 flu than the 2020 flu !
History of 1918 Flu Pandemic | Pandemic Influenza (Flu) | CDC
Closer to the 1918 flu than the 2020 flu !
History of 1918 Flu Pandemic | Pandemic Influenza (Flu) | CDC
shooterdon
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I wonder when the millions of bodies ARE going to start piling up? So far we have managed to wreck an economy and we don't have any bodies to show for it. I guess we are doing something right. In the time all of this has started regular flu has killed many times more people than this Chinese variety has. When do we get to see some real carnage? Millions are going to die huh? Ok. lets see that start to happen. When does it start? Where does it end? I am beginning to wonder. Will it really get worse? Lots of people think they have crystal balls and can predict future events. I see no evidence that statistical modeling can predict much of anything. It sure as he77 cannot predict the weather. Put me in the camp of wondering if the "cure" isn't a lot worse than the disease. The government says the economy will roar back just as soon as we whip this thing. Will it? How many businesses will be out of business permanently? I dunno. I could be totally FOS. But I tell yah, I run hot and cold on thinking this thing thru. At this point I am more worried about the nation's economy than I am a few thousand deaths. Remember we have 10's of thousands of flu deaths EVERY year. 50,000 to 60,000 is not uncommon. So far we have had a little over 200 deaths from Wuhan flu. Ok. flame suit on and zipped up tight. Go ahead and give it your best...
James,
I hear you. I have lost a lot of my retirement in a week or so. If I was selfish, I would say "let it spread and kill a couple million...not my problem...I am prepared." I am ashamed to say I have thought that a few times.
We cannot believe all the numbers, but it seems the Chinese have this contained with remarkably few deaths. They are a communist country and can do things western governments cannot do until it may be too late. Look at Italy. They still have not peaked and more will die, but already they have more deaths than we know of in China.
The lowest projection I have seen is about 300k dead in the US. But that is assuming we keep doing what we are doing now. So, one measure we can use is..."the day we get to 1000 deaths in the US, then this thing was as bad as they thought". By then it will too late to do much and we are riding it out unless a wonder drug is found, produced and distributed that mitigates the symptoms....note: no vaccine for about a year assuming it does not mutate.
Letting the old, compromised, stupid people die quickly might be the best course of action. I am old but not stupid so can rationalize that option. Heck they will die anyway soon enough!!! When the system gets overwhelmed the old will not get (or will be pulled from) ventilators, and the time/resources used to help the old winds up getting wasted anyway. That is happening in Italy and will happen here....letting the old die. One ventilator...a 35 YO with two kids...a 70 YO with asthma...who gets it? This is the choice they are trying to avoid by flattening the curve. And it cannot be flattened if we carry on business as usual.
- Status
