outbreak! (ebola, sars, coronavirus, etc)

here in oregon insurance companies are being mandated to pay everything.

so, any guesses as to how exactly health insurance companies are going to remain financially solvent? i give it three months before private insurers point out that every single one of them will go bankrupt if _somebody_ doesn't give them a very large amount of money.

I think the answer involves getting some combination of drugs approved that lessen the effects of the virus, and putting mass testing into place. Those are the biggest things we need ASAP if we are to have any hope of this not going on for a very long time.

― Mario Meatwagon (Moodles)

right now we don't have an eta on either of these things. do we need to start calculating an eta until enough of us lose our shit that everything descends into mass chaos?

this is literally a race against time and nobody is acknowledging that

It’s definitely getting acknowledged down here an Australia. These restrictions being put in place are being portrayed as something that will be in place for a minimum of 6 months.

Mass testing, even home testing is coming along at a clip but it’s no s fret that drugs and vaccines take a long time, a lot of work and a good sprinkling of luck.

I had hoped I’d be able to travel overseas again by October but I can’t see that happening. Countries that get convos (mostly) under control are going to want to keep it that way. I can’t see being let out of Australia unless immunity is a real thing, I can prove my antibody status either because I got it or I had the vaccine. It’s going to look a lot like the yellow fever regime.

If I'm looking at the worldometer graph correctly, worldwide deaths dropped today for the first time since March 16. I don't know how much hope I'd pin on that, but it's something.

"so, any guesses as to how exactly health insurance companies are going to remain financially solvent?"

Reserves. Laws mandate a bare minimum of reserves any insurance company must have at all times, and the bigger and/or smarter insurers have much more than that.

Difficulty with that is that in this case is that Coronavirus is so ridiculously transmissible with its 2-week period where you feel fine but are very infectious that it makes the isolate-and-track stuff incredibly difficult.

There's also reinsurance, and a pandemic would def trigger clauses in contracts between insurers and reinsurers that shift some of the burden onto the reinsurer.

Let's not forget the billions for corporations Congress just lined up.

cool, looking forward to seeing that get dragged through the courts

how are the reinsurers on reserves? hope they have lots! icus aren't terribly cheap, even if you cancel all "elective" procedures like, i don't know, gcs

Really feel that the US healthcare system, which has been predatory for who've had to interact with it for at least 40 years, is going to have the worst outcomes of all developed nations.

Everyone knows regularly interacting with the system is a swift path to bankruptcy. Many will choose to die without burdening relatives/estate with the bills. I'm on a high deductible ACA plan, and I've been scanning the the reports of those who've gone through the symptoms. I think I won't trouble my PCP until my fingertip O2 sat falls below 88%, right now. Terrible we live in a society where getting to know one's doctor is a worst case scenario.

It’s definitely getting acknowledged down here an Australia. These restrictions being put in place are being portrayed as something that will be in place for a minimum of 6 months.

― American Fear of Pranksterism (Ed)

oh sure it's no big deal for you your government completely collapses every two weeks on average

take it to the 77 despair thread, y'all

I have this one bookmarked for actual news

gladly

number of new cases decreased for the first time since 3/21...from 19,452 to 18,469. Marginal to where it's really not that impressive considering the inconsistent, insufficient testing.

Deaths, though, were interesting - went down almost by half. From 525 on the 28th to 264 on the 29th. Probably pure coincidence, considering the number of active cases.

still, i'm scouring for good news anywhere I can find it. I wouldn't say this is "good news", as it's a solitary piece of data and probably an outlier, but definitely going to be watching these numbers like a hawk the next few weeks to see if we're affecting the curve at all.

I read all the actual-scientist corrections in that Epstein interview in the voice of Ron Howard's Narrator.

(xpost) I noticed that too, that the deaths went down (above), although you're looking at the States and I was looking at world totals--first time in almost two weeks, globally.

I remember there being a dip last Sunday before a Monday surge so it might just be the reporting. Hopefully I'm mistaken.

entirely possible. was just surprised at the size of the dip, but it could just as easily shoot back up tomorrow.

please for all of your sanity don't read much into one days' data point on any of this stuff. Deaths per day in the US are going to continue to go up before they go down. The IHME projections (for USA and its several States) drive this point home. (They're premised on the continuation of strong distancing measures.)

it's almost as if I JUST FUCKING SAID THAT

the IHME projections at https://covid19.healthdata.org/projections are a curve-fitting exercise, i.e. they're the kind of thing a physicist would do. this doesn't necessarily make them bad, but ... well it kind of does. details below, but basically i wouldn't trust the totals implied by this model to any more than a factor of a few, and i wouldn't trust the details about when things will peak in each state *at all*.

there's no epidemiology in the model. they're literally taking the data for deaths/day by state, and fitting a curve with three parameters. AFAICT they choose the functional form of the curve because it's expedient rather than because it matches anything we know about epidemiology. and the fit involves extrapolating from very, very limited data. that's because we're early in the outbreak and the data is poor/incomplete. (look at the deaths per day plots. they're extrapolating from the solid line to the dashed line.) this situation (limited noisy data which you're forced to extrapolate into the far future) is exactly where some epidemiology would be useful to fill in the blanks or prevent obvious mistakes. a data-driven model is fine when you've got lots of data. we don't!

this is probably the reason there are some extremely dubious claims if you look at things in any kind of detail. e.g. they forecast the NY peak is 7 days away and they will be below 10 deaths/day by may 1 while the washington peak is still 20 days away and they'll be getting >10 deaths/day until almost june. this seems obviously nonsense. there are lots of these examples (NYS is a particular outlier relative to all the other states AFAICT).

https://i.imgur.com/5TEZuYB.png

e.g. this is the model for NYS. they're extrapolating from the solid line to get the dashed line. just by eye, it should be obvious that they're out on a limb here. you could draw lots of dashed lines with the same basic shape and they'd all be reasonable extrapolations from the tiny amount of data we have, with very different peaks and areas under the curve (i.e. total deaths).

Maybe we should just all agree that we can all look at whichever graph makes us feel the best

love this one

https://www.pmel.noaa.gov/co2/files/co2_data_mlo.jpg

The general idea, I think, is that lockdown levels of suppression stops community transmission enough so that when you slowly start easing restrictions you can isolate and quarantine the cases that do happen and stop outbreaks in their tracks.

Difficulty with that is that in this case is that Coronavirus is so ridiculously transmissible with its 2-week period where you feel fine but are very infectious that it makes the isolate-and-track stuff incredibly difficult.

So you need to get both hardcore on the tracking (see South Korea and phone tracking) and on the hygiene (masks for everyone and wash your hands).

And if it all fails you are back to lockdown again. Repeat until vaccination arrives.

(Or countries like Sweden prove that you can achieve a good enough reduction of transmission with less draconian lockdowns and everyone switches to that model. This is what the UK was initially going for, until it recognised the NHS couldn’t cope with the increased level of cases this route entails)

The general idea, I think, is that lockdown levels of suppression stops community transmission enough so that when you slowly start easing restrictions you can isolate and quarantine the cases that do happen and stop outbreaks in their tracks.

Difficulty with that is that in this case is that Coronavirus is so ridiculously transmissible with its 2-week period where you feel fine but are very infectious that it makes the isolate-and-track stuff incredibly difficult.

So you need to get both hardcore on the tracking (see South Korea and phone tracking) and on the hygiene (masks for everyone and wash your hands).

And if it all fails you are back to lockdown again. Repeat until vaccination arrives.

(Or countries like Sweden prove that you can achieve a good enough reduction of transmission with less draconian lockdowns and everyone switches to that model. This is what the UK was initially going for, until it recognised the NHS couldn’t cope with the increased level of cases this route entails)

I’m not sure this is true, as far as is currently known risk of catching from someone with no symptoms is low

You're less infectious (55% is the figure I just saw) but you're higher risk is the point, since you're going about in public rather than hunkering down.

Something I thought worth mentioning is the remarkable fact that 66%-80% of all COVID-patienst in Dutch hospitals and in ICU are obese. Has this been noticed anywhere else? Experts think it could be because people with diabetes are more at risk. Still a very high percentage imo.

From this: "‘Almost all the patients on an IC ward are overweight,’ Peter van der Voort of Groningen University’s teaching hospital said. ‘We don’t know why, but it is very noticeable.’"

In Italy, obesity is the most common comorbidity.

Visceral fat reduces lung tidal volume. And adipose tissue is a endocrine organ, producing more proinflammatory cytokines on its own.

I really wish I'd picked another drug to sedate me through the Trump presidency than alcohol, 7 kcal/g.

i have somehow lost weight during isolation, probably as my diet is now the healthiest diet anyone has ever had ever

(last night's found panettone excepted)

still overweight though. knew this would be a problem. knew it

I really wish I'd picked another drug to sedate me through the Trump presidency than alcohol, 7 kcal/g.

― Sanpaku, Monday, March 30, 2020 2:03 PM (twenty-five minutes ago) bookmarkflaglink

Quitting drinking three months ago has done fuck all for me in this regard :-/

i have somehow lost weight during isolation, probably as my diet is now the healthiest diet anyone has ever had ever

I'm not quite there, but definitely the healthiest diet I've ever had.

I've had a very healthy diet over the last two weeks of lockdown. Unfortunately, I've also had 2-3 beers pretty much every day of that two weeks, so, well.

Ha I've also been 'using up' the really crappy chocolate / gift set things we got at Christmas and had shoved to the back of the cupboard. Needs must!

idk how y'all are doing it. I've been stress eating a ton and haven't found the time to go for a run. luckily I haven't seemed to gain any weight...yet. I probably have but my belt still fits the same

I've lost weight, but I think that's just been having healthier snacks (even if it's just posh flat chocolate) than the tub of biscuits at work. Christ knows my cycling has dropped off.

I'd already started down the path when I moved five months ago and joined a gym (dropped 30 pounds). But I've also--even though I suspect it's completely irrelevant; contraction depends solely on interaction--been taking acetaminophen-related medication two or three times a day and eating really well the past three weeks hoping that'd be a slight edge in not getting sick.

Our diet has been pretty consistent for the past few weeks. That is, not much has changed. What has changed is my exercise habits, but that's mostly because I run inside and, with the gym closed and the weather cold and shitty, I haven't been doing that. My wife (and sometimes my kids, for that matter), have stayed pretty active inside with online exercise classes, yoga and the like, plus the occasional walk outside (weather permitting). I (and I assume some other people) tend to lose weight under stress, so it all seems to be balancing out, for the time being. The hardest thing, in a way, is waiting until the end of the day to have a beer or two.

xpost I have no idea how well they've run the data on underlying chronic conditions. For example, it was hypothesized that one reason it took off so fast in China was because so many people there smoke, and one reason it hit men harder than women was because more men smoked there then women. Logical, but I don't know if anything concrete came of that. Same with obesity in Italy (or wherever). For example, the United States might have the fattest people, but it will take some time for the data to shake out to determine if that really makes a big difference. Being overweight, or smoking, and so on, are innately not good for you, so one might assume they are bad conditions for this, but I have no real idea.

2-week period where you feel fine but are very infectious

This is something I still don't get. If you can feel fine, but still be very infectious, and yet the easiest way to transmit, at least for community transmission, is afaict via droplet - that is, coughing and sneezing. But if you're coughing and sneezing, then you're not feeling fine, are you?

I did see a medical review thingy on twit that suggested that smokers weren't dying in the US at anywhere close to the rates suggested by China.

Even with all that, the stats still point firmly towards men getting worse outcomes, and you could argue that this is due to some/all related factors mentioned above but it is very strange as a persistent finding.

I thought I saw something that said men get it *slightly* worse but not significantly. Like, of this group in the study, 106 men to 100 women or something.

There may be a genetic component to it as well. Pure speculation on my part, of course.

There usually is. He said completely unscientifically.

https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30117-X/fulltext

This sex predisposition might be associated with the much higher smoking rate in men than in women in China (288 million men vs 12·6 million women were smokers in 2018). Of note, one study (preprint)5 found that although ACE2 expression was not significantly different between Asian and white people, men and women, or subgroups aged older and younger than 60 years, it was significantly higher in current smokers of Asian ethnicity than Asian non-smokers; although no difference was found between smokers and non-smokers who were white. Nonetheless, the current literature does not support smoking as a predisposing factor in men or any subgroup for infection with SARS-CoV-2.

O_o

Behavioural factors seem to make more sense.

idk how y'all are doing it. I've been stress eating a ton and haven't found the time to go for a run. luckily I haven't seemed to gain any weight...yet. I probably have but my belt still fits the same

― frogbs, Monday, March 30, 2020 8:12 AM (eighteen minutes ago) bookmarkflaglink

Things could have gone a whole different way if, during my last week in the wild, I had stocked up on chips and Oreos instead of rice and beans. Believe me, I was tempted.

My bf pointed out days ago that when he went out in public, women were wearing gloves and masks and men weren't. And men definitely weren't respecting a 6' distance from me yes in the grocery store.

Well, men *are* stupider and more prone to risky behavior.

Nothing more manly than being in the running for a Darwin Award, really.