Gives everyone more time to make sure all the political elite get the virus then 
This could be fucking ruinous.
Bloody right - businesses are now asking how much cash do we have? How long will it last? How can we make it last longer?
Mate has just been sent home from a building site.
If i was a tory iād be rubbing my hands together thinking about how little heād be prepared to work for in a week or two.
It certainly looks like itās going to show our way of living up for the disaster it always was.
Still look on the bright side, suns out and the temperature is rising, so time to get the veg planted. Might be required soon.
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Anyone else having trouble with impressing upon elderly relatives that this is serious and they need to stop carrying on as if it not going to affect them.
If Covid doesnāt do the job, I am likely to kill my parents myself.
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I love that, beautiful symmetry, those rafters and beams wonāt be cheap!
If theyāve shut the pubs in Ireland 2 days before St Patricks Day you know shit is about to hit the fan.
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If lockdown is imposed, it will be carnage. Construction will be well and truly fucked.
Just seen a snowflake mouthing off on FB because BA cancelled a flight she booked
Maybe a culling is in order.
Not sure where you are getting your āevidenceā from but the āinformationā that NSAIDS or Non-Steroidal anti-inflammatory drugs of which Ibruprofen is one is an internet rumour. There is currently No clinical evidence to support this claim
Please people do two things. Check the source of information and include the reference so folks can check it outā¦ too many rumours
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Including scaffold, to replaster and redecorate is coming in at about Ā£580 a metre.
Hate to think how much it would cost to replace the timbers, but the insurance companies first question āwill it be over Ā£150000ā would probably be answered in the affirmative.
They do look good.
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John Hopkins University Hospital.
And yes NSAIDS are showing positive results, especially some targeted at Arthritis and some HIV medications.
Iām happy yo take advice from a wise mentor who attends there & Columbia Presbyterian university hospital for his experimental Occular Melanoma treatments and links his sources, rather than Sharon in Grimsby.
Will start copy & pasting some if you like, heās been 1-3 days ahead on most stuff so far including the statistical data.just not easy on mobile the stuff is long detailed and a lot of complex stuff.
But the main one DONāT take Ibuprofen take Paracetamol if you think you may have it was repeated in more than one post with source name and details of their expertise.
The way the Virus attacks the bodyās ability to produce Iron was detailed in the report on how HIV meds attack the virus.
So actual today sources
So, yes you are correct, there is no specific test data YET but it is not just Social Media reporting it.
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Not sure where youāre getting your rebuttal from. It has all the evidence of an Internet rumour.
As Phil points out, itās from John Hopkins. Theyāre pretty good at this stuff.
Do you know better than them, or do you just assume that everyone posting something on the Internet is getting it from the Daily Mirror Book of Facts (Did you know?).
This is from a front-line ICU physician in a Seattle hospital 12th March
This is his personal account:
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we have 21 pts and 11 deaths since 2/28.
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we are seeing pts who are young (20s), fit, no comorbidities, critically ill. It does happen.
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US has been past containment since January
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Currently, all of ICU is for critically ill COVIDs, all of floor medsurg for stable COVIDs and EOL care, half of PCU, half of ER. New resp-sx pts Pulmonary Clinic offshoot is open
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CDC is no longer imposing home quarantine on providers who were wearing only droplet iso PPE when intubating, suctioning, bronching, and in one case doing bloody neurosurgery. Expect when it comes to your place you may initially have staff home-quarantined. Plan for this NOW. Consider wearing airborne iso PPE for aerosol-generating procedures in ANY pt in whom you suspect COVID, just to prevent the mass quarantines.
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we ran out of N95s (thanks, Costco hoarders) and are bleaching and re-using PAPRs, which is not the manufacturerās recommendation. Not surprised on N95s as we use mostly CAPRs anyway, but still.
*terminal cleans (inc UV light) for ER COVID rooms are taking forever, Enviro Services is overwhelmed. Bad as pts are stuck coughing in the waiting room. Rec planning now for Enviro upstaffing, or having a plan for sick pts to wait in their cars (that is not legal here, sadly).
- CLINICAL INFO based on our cases and info from CDC conf call today with other COVID providers in US:
- the Chinese data on 80% mildly ill, 14% hospital-ill, 6-8% critically ill are generally on the mark. Data very skewed by late and very limited testing, and the number of our elderly pts going to comfort care. - being young & healthy (zero medical problems) does not rule out becoming vented or dead - probably the time course to developing significant lower resp sx is about a week or longer (which also fits with timing of sick cases we started seeing here, after we all assumed it was endemic as of late Jan/early Feb). - based on our hospitalized cases (including the not formally diagnosed ones who are obviously COVID - it is quite clinically unique) about 1/3 have mild lower resp sx, need 1-5L NC. 1/3 are sicker, FM or NRB. 1/3 tubed with ARDS. Thus far, everyone is seeing: - nl WBC. Almost always lymphopenic, occasionally poly-predominant but with nl total WBC. Doesnāt change, even 10days in. - BAL lymphocytic despite blood lymphopenic (try not to bronch these pts; this data is from pre-testing time when we had several idiopathic ARDS cases) - fevers, often high, may be intermittent; persistently febrile, often for >10d. It isnāt the dexmed, itās the SARS2. - low ProCalc; may be useful to check initially for later trending if later concern for VAP etc. - up AST/ALT, sometimes alk phos. Usually in 70-100 range. No fulminant hepatitis. Notably, in our small sample, higher transaminitis at admit (150-200) correlates with clinical deterioration and progression to ARDS. LFTs typically begin to bump in 2nd week of clinical course. - mild AKI (Cr <2). Uncertain if direct viral effect, but notably SARS2 RNA fragments have been identified in liver, kidneys, heart, and blood.
- characteristic CXR always bilateral patchy or reticular infiltrates, sometimes perihilar despite nl EF and volume down at presentation. At time of presentation may be subtle, but always present, even in our pts on chronic high dose steroids. NO effusions. CT is as expected, rarely mild mediastinal LAD, occ small effusions late in course which might be related to volume status/cap leak.
- Note - China is CTāing everyone, even outpts, as a primarily diagnostic modality. However, in US/Europe, CT is rare, since findings are nonspecific, would not change management, and the ENTIRE scanner and room have to terminal-cleaned, which is just impossible in a busy hospital. Also, transport in PAPRs. Etc. 2 of our pts had CTs for idiopathic ARDS in the pre-test era; they looked like the CTs in the journal articles. Not more helpful than CXR. - when resp failure occurs, it is RAPID (likely 7-10d out from sx onset, but rapid progression from hospital admit). Common scenario for our pts is, admit 1L NC. Next 12hrs -> NPPV. Next 12-24hrs -> vent/proned/Flolan. - interestingly, despite some needing Flolan, the hypoxia is not as refractory as with H1N1. Quite different, and quite unique. Odd enough that youād notice and say hmmm. - thus far many are dying of cardiac arrest rather than inability to ventilate/oxygenate. - given the inevitable rapid progression to ETT once resp decompensation begins, we and other hosps, including Wuhan, are doing early intubation. Facemask is fine, but if needing HFNC or NPPV just tube them. They definitely will need a tube anyway, & no point risking the aerosols. - no MOSF. Thereās the mild AST/ALT elevation, maybe a small Cr bump, but no florid failure. except cardiomyopathy. - multiple pts here have had nl EF on formal Echo or POCUS at time of admit (or in a couple of cases EF 40ish, chronically). Also nl Tpn from ED. Then they get the horrible resp failure, sans sepsis or shock. Then they turn the corner, off Flolan, supined, vent weaning, looking good, never any pressor requirement. Then over 12hrs, newly cold, clamped, multiple-pressor shock that looks cardiogenic, EF 10% or less, then either VT->VF-> dead or PEA-> asystole in less than a day. Needless to say this is awful for families who had started to have hope. - We have actually had more asystole than VT, other facilities report more VT/VF, but same time course, a few days or a week after admit, around the time theyāre turning the corner. This occurs on med-surg pts too; one today who is elderly and chronically ill but baseline EF preserved, newly hypoTN overnight, EF<10. Already no escalation, has since passed, So presumably there is a viral CM aspect, which presents later in the course of dz. - of note, no WMAs on Echo, RV preserved, Tpns donāt bump. Could be unrelated, but Iāve never seen anything like it before, esp in a pt who had been HD stable without sepsis.
Treatment -
*Remdesivir might work, some hosps have seen improvement with it quite rapidly, marked improvement in 1-3 days. ARDS trajectory is impressive with it, pts improve much more rapidly than expected in usual ARDS.
*Recommended course is 10d, but due to scarcity all hosps have stopped it when pt clinically out of the woods - none have continued >5d. It might cause LFT bump, but interestingly seem to bump (200s-ish) for a day or 2 after starting then rapidly back to normal - suggests not a primary toxic hepatitis.
*unfortunately, the Gilead compassionate use and trial programs require AST/ALT <5x normal, which is pretty much almost no actual COVID pts. Also CrCl>30, which is fine. CDC is working with Gilead to get LFT reqs changed now that we know this is a mild viral hepatitis.
-currently the Gilead trial is wrapping up, NIH trial still enrolling, some new trial soon to begin canāt remember where.
*steroids are up in the air. In China usual clinical practice for all ARDS is high dose methylpred. Thus, ALL of their pts have had high dose methylpred. Some question whether this practice increases mortality.
*it is likely that it increases seconday VAP/HAP. China has had a high rate of drug resistant GNR HAP/VAP and fungal pna in these pts, with resulting increases mortality. We have seen none, even in the earlier pts who were vented for >10d before being bronched (prior to test availability, again it is not a great idea to bronch these pts now).
- unclear whether VAP-prevention strategies are also different, but wouldnāt think so?
- Hong Kong is currently running an uncontrolled trial of HC 100IV Q8.
- general consensus here (in US among docs who have cared for COVID pts) is that steroids will do more harm than good, unless needed for other indications.
- many of our pts have COPD on ICS. Current consensus at Evergreen, after some observation & some clinical judgment, is to stop ICS if able, based on known data with other viral pneumonias and increased susceptibility to HAP. Thus far pts are tolerating that, no major issues with ventilating them that canāt be managed with vent changes. We also have quite a few on AE-COPD/asthma doses of methylpred, so will be interesting to see how they do.
12th March Jason Warner
This is a long post addressing two underlying issues with the current response to the pandemic that leave me concerned. Itās the longest post Iāve ever written.
For those of you not taking action, or believing the pandemic to be āover hypedā, you can make fun of me as much as you want now or when this is over. You can make me the subject of memes and post it everywhere. I will pose for the picture. I am not trying to convince you, but I do feel compelled to share information that I deem critical to all of us, which is why I am posting this at all.
WHY YOU SHOULD TAKE 5 MINUTES TO READ AND CONSIDER THE INFORMATION I AM SHARING:
As of 3/15/20 at 9 am PST this post has been shared over 50k times since it was posted 2 days ago. So a lot of people find value in the post and although itās a long read, I believe you will find this information valuable too.
For those of you who donāt know me well, I am analytical and metered. I donāt freak out nor do I respond emotionally. I also donāt post a bunch of bullshit or political or controversial stuff on Facebook. I founded and am CEO of a successful software company that provides SaaS based data, analytics, and dashboards to recruiting departments at companies we all know. As you would expect, I am data driven and fact based. Before founding my company I held executive roles leading very large recruiting teams at some of the worldās fastest growing companies such as Starbucks and Google. At Google I was fortunate enough to report to Sheryl Sandberg before she took the Facebook COO role. I was a Chemical Engineering major in college and have a business degree from a top undergraduate business school. I am not one for hyperbole or histrionics. My bullshit factor is close to zero.
I share all this personal information only to help solidify that this post may be worth reading and sharing with others. I would encourage you to forward or share this post at your discretion. Many people do not understand what is happening with the pandemic to the degree required which is why I took the time to write this and share this on Facebook.
Now that Iāve gotten the introduction out of the way, here are two issues I want to bring to everyoneās attention.
ISSUE ONE: SOCIAL NORMS ARE POWERFUL MOTIVATORS AND GETTING IN THE WAY OF PEOPLE TAKING THE RIGHT STEPS IN RESPONSE TO THE PANDEMIC:
One of the current problems with addressing the pandemic is the social pressures of taking action today. Itās awkward, and feels like an over-reaction. The reason it feels like an overreaction is that most people OVERWEIGHT the currently reported cases and inherently UNDERWEIGHT the mathematics of how the virus is spreading and what will happen in about 30 days time. This is because our brains tend to think linearly as opposed to logarithmically. Itās the same reason many people donāt save for retirement or understand compound interest.
To create a new social norm, human beings like to see behavior modeled. This serves as a signal that says, āoh, someone else is doing it so I should do it also.ā
SO HERE IS A SOCIAL BENCHMARK FOR REFERENCE - THIS IS WHAT IāVE DONE FOR MY FAMILY TO DATE:
I have already isolated my family. We have canceled EVERYTHING. We have canceled previously scheduled doctor visits. Social get togethers. No play dates. Normal routine meetings. Everything has been canceled. Itās difficult and socially awkward. Some of you think Iām crazy, but Iām doing it not because I am afraid, but because I am good at math (more on that in part 2). I had to have my 16 year old daughter quit her job coaching junior gymnasts at the local gym, with one dayās notice and also tell my kids they canāt attend youth group at church. Both of those were tough discussions. I told a very close friend he shouldnāt stay at my house this weekend even though he was planning to and had booked his flight from the Bay Area. I canceled another dear friendās visit for later this month to go snowboarding on Mt Bachelor.
We are not eating out. Our kids are already doing online school so we donāt have to make changes there. I would not send my kids to school even if they were in public or private school. We have eliminated all non-essential contact with other people. We will only venture out to grocery shop when required. We will still go outside to parks, go mountain biking, hiking, and recreate to keep ourselves sane and do other things as a family, just not with other people. We have stocked up on food and have a supply for ~2 months. We have stocked up on other goods that if depleted would create hardship, like medicines and feminine hygiene products. We have planned for shortages of essential items.
THE REASON I HAVE CHOSEN THIS ROUTE FOR MY FAMILY IS MULTI FACETED:
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Although my family is considered low risk (Iām 49 in good health, Angi is 46 and in good health, and our kids are 14 and 16), we must assume that the healthcare system cannot help us, because the hospitals will become overwhelmed very quickly. Most American hospitals will become overwhelmed in approximately 30 days unless something changes. More on this in part 2 below. So although we are in great health and unlikely to become gravely ill, the risk is greater if you do not have access to the medical care that you need. This is something for everyone to consider. As a society we are accustomed to having access to the best medical care available. Our medical system will be overwhelmed unless we practice social distancing at scale. That said, the medical teams in Italy are seeing an alarming number of cases from people in their 40s and 50s. Triage tents are already going up in the parking lots at many hospitals close to the epicenters in the United States.
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Itās not a matter of if social distancing will take place, itās a matter of when. This is because social distancing is the only way to stop the virus today.
As I will explain in part 2 below, starting now is FAR more effective than starting even 2 days from now or tomorrow. This has been proven by Italy and China (and soon to be France and other European countries who have been slow to respond.) [updated as of 3/14 France is now on lockdown mandated by the government]. Wuhan went on lockdown after roughly 400 cases were identified (and they had access to testing that America has systematically failed to do well to date). The US already has more than 4 times this number of known infected cases as Wuhan did when it was shut down, and our citizens are far more mobile and therefore spreading the virus more broadly when compared to Wuhan. Yet our response is tepid at best.
If hand washing and ābeing smartā were sufficient Italy would not be in crisis. So I pray the draconian measures are coming from our government, because they are required to stop the spread of the virus. Itās better to start sooner than later as the cost is actually far greater if we wait. I pray they close all schools and non-essential services the way that Italy and China have done.
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Spreading the virus puts those in the high-risk category at much greater risk. This is the moral argument. Itās a strong argument because there are only two ways, as of today, that the virus can be stopped: let it run its course and infect 100s of millions of people, or social distancing. There is no other way today. If you donāt practice social distancing, people downstream from you that you transmit the virus to will die, and many will suffer.
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The risk of infection is increasing exponentially, because the quantity of infected people, most who will not show symptoms, is doubling every three days. So the longer you wait to self-isolate, the greater the chance of you or someone you love becoming infected and then you infecting others because more of the population is becoming infected. There are twice as many infected people today as there was on Tuesday.
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The virus is already in your town. Itās everywhere. Cases are typically only discovered when someone gets sick enough to seek medical attention. This is important as it typically takes ~5 days to START showing ANY symptoms. Hereās the math: For every known case there are approximately 50 unknown cases. This is because if I become sick, I infect several people today, and they infect a few people each tomorrow (as do I), and the total count of infected people doubles every 3 days until I get so sick I get hospitalized or get tested and become a āknown caseā. But in the time it takes me to figure out I am sick 50 others downline from me now have the virus. So every third day the infection rate doubles until I get so sick that I realize I have the virus an am hospitalized or otherwise tested. Harvard and Massachusetts General Hospital estimate that there are 50x more infections than known infections as reported (citation below). The implication of this is that the virus is already āeverywhereā and spreading regardless if your city has zero, few or many reported cases. So instead of the 1573 reported known cases today there are likely 78,650 cases, at least, in the United States. Which will double to 157,300 by this Sunday. And this will double to 314,600 cases by this coming Wednesday. So in less than 1 week the number of total infected in the United States will quadruple. This is the nature of exponential math. Itās actually unfortunate that we are publishing the figures for known cases as it diverts attention away from more important numbers (like the range of estimated actual cases). [Update as of 3/15/20 - Iāve been sent more research that may add clarity to the ACTUAL cases vs CONFIRMED cases and will update this post with any conclusions]
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Some people cannot, or will not, practice social distancing for a variety of reasons and will continue to spread the virus to many people. So everyone else must start today.
The reasons above are why I have begun to practice social distancing. Itās not easy. But you should do it too.
The hospitals will be at capacity and there are not enough ventilators. You will hear a lot about this issue in the coming few weeksā¦ the shortage of ventilators.
ISSUE TWO: MANY PEOPLE ARE FOCUSED ON THE WRONG NUMBERS:
Yes, the virus only kills a small percentage of those afflicted. Yes, the flu kills 10s of thousands of people annually. Yes, 80% of people will experience lightweight symptoms with COVID19. Yes the mortality rate of COVID19 is relatively low (1-2%). All of this true, but is immaterial. They are the wrong numbers to focus onā¦
The nature of exponential math is that the infection rates start slowly, and then goes off like a bomb and overwhelms the hospitals. You will understand this math clearly in the next section if you do the short math exercise. Evergreen hospital in Seattle is already in triage. I have heard credible reports from people on the ground that they are already becoming overwhelmed. And the bomb wonāt really go off for a few more days. Probably by Wednesday, March 18th (next week). In just a few days from now we will hear grave reports from Seattle hospitals. [update as of 3/15/20 - see the comments section below for an update from a staff member at Evergreen Hospital in Kirkland, WA]
You should assume the virus is everywhere at this point, even if you have no confirmed cases in your area.
YOU SHOULD DO THIS SIMPLE 2 MINUTE MATH EXERCISE (NO REALLY TAKE TWO MINUTES AND DO IT):
To further understand exponential growth, take the number of confirmed cases in your area and multiply by 10 (or 50 if you believe Harvard and Massachusetts General estimations) to account for the cases that are not yet confirmed. If you have no confirmed cases choose a small number. Iād suggest 10 cases in your city, if no cases are yet reported. But you can use whatever number you like. This number of infected people doubles every ~3 days as the infection spreads. So literally take your number, and multiply by 2. Then do it again. Then do it again. Then do it again. Do this multiplication exercise 10 times in total.
2 x 2 x 2 x 2 x 2 x 2 x 2 x 2 x 2 x 2 x (the number of estimated infections in your city today (not just the reported cases)).
This result is the estimate for the actual cases in your area 30 days from now. The math will take 30 seconds to complete with a calculator and itās worth doing the math to see how it grows. This end number is the number of cases in your city 30 days from today if a large percentage of the population do not practice social distancing.
2 to the 10th power is 1024. When something doubles 10 times, itās the same as multiplying by 1024. The infection rate of the virus doubles every 3 days. In thirty days there will be 1,024 times the number of infected people in your area as there is today if your community does not immediately put social distancing into practice. One thousand and twenty four times as many infected people as there is today, in just 30 days.
Next, divide the final number (the scary big one) you just calculated by the current population of your city and you will be able to get the percentage of people THAT YOU KNOW PERSONALLY who will be infected 30 days from now.
Next take 15% (multiply by 0.15) of that final 30 day number of total infected people (the number you calculated by multiplying by 2 ten times). This will provide an estimate of the serious cases which will require hospitalization, and compare it to the number of beds and ventilators available at your local hospital. Google the ānumber of bedsā and the name of your local hospital now. It takes 2 seconds and the number of beds is easy to find. 65% of beds are already occupied by patients unrelated to the coronavirus. St Charles in Bend, Oregon where I live, has 226 beds and the town is roughly 100,000 people. Most hospitals have on average, 40 or fewer ventilators. 5% of patients require ICU treatment. There are very few ICU beds compared to regular beds in hospitals. There are very few negative pressure areas in any hospital to deal with the containment of airborne diseases.
These numbers you just calculated are the Big Problem: Too many patients, not enough beds, and a serious shortage of ventilators (the biggest problem) if we donāt immediately begin social distancing. More on this biggest problem related to the insufficient quantity of ventilators is below.
COUNTRIES THAT GET OVERWHELMED WILL HAVE A MUCH GREATER MORTALITY RATE BECAUSE THEY WONāT BE ABLE TO ADEQUATELY CARE FOR THE SICK.
And by sick I mean not just coronavirus patients. Your son or daughter that needs acute care surgery this May for his badly broken leg will be attended to by an orthopedic doctor that has been working at maximum capacity and working 18 hour shifts for 7 days every week for 6 weeks because it was required to care for all the coronavirus patients at her hospital. Or the orthopedic surgeon will be sick with the virus and your son or daughter will be operated on in a tent in the hospital parking lot by a non-expert or a member of the National Guard. Your elderly Mom that has diabetes and goes into acute distress next month may not receive ANY medical care because the doctors are consumed and have to prioritize patients based on triage guidelines based on success rate probabilities. Your siblingās family that are all injured in a terrible car crash in June will have diminished care. If one of them needs a ventilator there will be none available because all of them will be in use by critical coronavirus patients. Your young friend with cancer and a compromised immune system from treatment will succumb even though the cancer was curable and the treatment was working, because their body was too fragile to combat the coronavirus due to the chemotherapy and they couldnāt receive the customized, acute care required due to the hospital being overwhelmed. All of the above is currently happening in Italy, who had the same number of infections we have today just 2 weeks ago. You must start social distancing today.
The count of actual virus infections doubles every ~3 days. The news and government agencies are lagging in their response. So we hear that the US only has 1573 cases today (3/12/20) [update as of 3/15/20: 3115 confirmed cases), ( see https://www.worldometers.info/coronavirus/) and it doesnāt seem like a lot. It would be better to report the estimated actual cases, since reported cases donāt tell us much. However, we know from China that the actual number of cases are at least an order of magnitude greater than the reported cases, because people get infected and do not display symptoms. In math, an āorder of magnitudeā means ten times difference, or put another way, a factor of 10. 100 is 10 times greater than 10, so itās an order of magnitude greater.
Harvard Medical School / Massachusetts General Hospital just released their estimate (recording is here: https://externalmediasite.partners.org/ā¦/53a4003de5ab4b4da5ā¦) that the actual cases are 50x greater than the reported cases. So we likely have 75,000 cases in the United States already. The number of reported cases is not that important.
But letās assume the current number of cases is only 10,000 ACTUAL cases in the United States just to be conservative and model out what will happen:
If we donāt stop the virus from spreading, in 30 days we will have 2 to the 10th power more cases of infected people because the infection count doubles every 3 days (the virus doubles every 3 days and there are 10, 3 day periods in 30 days).
The math: 2 to the 10th power means 1,024 times as many cases as we have today (2 times 2 repeated 10 times).
This number is a catastrophically big problem for all of us: We will have 10 million+ actual cases (10,000 actual cases today x 1,024) in the United States in just 30 daysā time if we continue without extreme social distancing. 10 million people with the virus. And it will keep doubling every 3 days unless we practice social distancing.
15% of cases require significant medical attention, which means that 1.5 million people will require significant medical attention if 10 million people get infected (15% of 10 Million total infections = 1.5 million people requiring hospitalization).
1.5 million hospitalizations is way more than we have beds for at hospitals in the United States. And 65% of all beds are already occupied in our hospitals. But many patients (5%) with the virus need ICU beds, not just any old hospital bed. Only about 10% of hospital beds are considered intensive care beds. So we will have a huge bed shortage, but that is not the biggest problem, as we can erect temporary ICU shelters and bring in more temporary beds, as Italy has already done, and California and Washington hospitals have already done. Evergreen Hospital in Seattle has already erected temporary triage tents in the parking lot as of 3/13/20. All regular beds are full at Evergreen Hospital as of yesterday.
Once the government of China, Norway, and Italy came to understand this math, they reacted accordingly and shut EVERYTHING down. [update as of 3/15/20 now France has done the same lockdown]. Extreme social distancing is the only response available to stop the virus today. The United States is not responding well nor are other countries like the UK. Countries that do not respond well will pay a much larger, catastrophic price.
But hospital beds are not the big problem. The lack of ventilators is the big problem. Most estimates peg the ventilators in the United States at roughly 100,000 to 150,000 units. See the study from last month: http://www.centerforhealthsecurity.org/ā¦/200214-VentilatorAā¦
The primary and most serious comorbid (comorbid is a medical term that means co-existing or happening at the same time) condition brought on by the Coronavirus is something called bilateral interstitial pneumonia which requires ventilators for treatment of seriously ill patients. So if 1.5M people of the 10 million infected 30 days from now require hospital care (15% of the 10M estimated total infections), 1.3M may not get the care that they need because we donāt have enough ventilators, beds, and ICU beds in the United States. And remember, this is only if ALL OF US EFFECTIVELY start social distancing by April 11th (30 days from today). This increases the mortality rate significantly.
BUT IF WE START EXTREME SOCIAL DISTANCING BY MARCH 23 (12 days from original writing), WE AVOID OVER 1.4 MILLION PEOPLE GETTING CRITICALLY ILL AND OVERWHELMING THE HOSPITALS:
If everyone takes extreme measures to social distance, and the United States can dramatically reduce the spread of the virus 12 days from now, the math is very different, as the exponential growth will only be 2 to the 4th power (12 days divided by the doubling rate of every 3 days equals the exponent of 4):
2 x 2 x 2 x 2 = 16
So instead of 10 Million cases in the United States if we wait 30 days, if we act 18 days sooner, we will have only 160,000 cases (16 times the estimated 10,000 actual cases as of today), of which 15% are likely to require hospitalization. This is 24,000 critical patients (a huge difference compared to 1.5 million acute patients). The difference between taking extreme measures now, versus waiting even a few days, is very large due to how exponents work in math.
THE OUTCOME IS EVEN BETTER IF WE TAKE ACTION IN THE NEXT 6 DAYS: If the vast majority of the population self isolates and implements social distancing in only 6 days from now the exponential math is 2 to the 2nd power (6 days divided by the 3 days it takes the virus to double means the exponent is only 2). In math this is ātwo squaredā.
2 x 2 = 4
Multiplied by the estimated 10,000 ACTUAL cases as of today (3/12/20) that means only 40,000 total cases will develop, 15% of which may be critical which is 6,000 critical patients.
This is why you should share this post broadly. If people begin social distancing in the next 6 days it will greatly reduce the impact on all of us. Itās why they say a āpost goes viralā.
SOCIAL DISTANCING WILL REDUCE THE FINANCIAL IMPACT TO YOU AND YOUR FAMILY:
Finally, the longer everyone waits to practice significant social distancing the greater the economic hardship will be on all of us. Lost jobs. Mortgage defaults. Closed businesses. Bankruptcies. All will be minimized if you start social distancing today.
Some of the reasons the economic impacts will be reduced are worth mentioning: If we stop the virus now the overall duration of the outbreak will be far shorter. The stock market will normalize more quickly and recover more quickly. Businesses and people will be able to survive a shorter duration outbreak vs a longer duration outbreak. More companies will avoid bankruptcy if we begin to practice social distancing now.
This is a big financial reason to begin social distancing if you are employed by any company: if companies see that the virus is being slowed, they will be less likely to conduct layoffs. You will be more likely to be laid off or experience a job-related event if we donāt practice social distancing immediately. As an HR executive, Iāve been involved in many, many layoffs. Itās the last thing companies want to do. But if they see that the pandemic will be shorter lived vs long and drawn out, they are less likely to make the permanent decision of laying off staff.
The overall economic impact that hits your bank account will be greater if you wait or you donāt practice social distancing. This is why Norway acted now, because itās less economic impact to take drastic measures early than to do them later, and it saves a lot of lives and suffering by doing so. And Norway has only one confirmed death as of this writing.
Many people have suggested they want to support local restaurants and other businesses, who have seen sales drop by 50-90%. Stopping by and visiting them wonāt save them. What will save them is social distancing and what you do after the pandemic is over. If you are concerned, call them and buy a gift certificate over the phone.
START TODAY. I CANāT STRESS THIS ENOUGH. YOU MUST START TODAY.
Finally, the article that I posted yesterday written by Tomas Pueyo has been read 30M times in the last few days and has been updated with new information. Itās worth reading again.
Hereās that link.
https://medium.com/ā¦/coronavirus-act-today-or-people-will-dā¦
Other up to date data I frequently consult regarding the pandemic is here:
https://www.worldometers.info/coronavirus/
I hope this is helpful and useful. My brain focuses on the math and I try and be fact based in my analysis and interpretation of how I should respond.
THERE IS MORE INFORMATION IN THE COMMENTS BELOW WORTH READING AND I WILL BE UPDATING THIS POST, AND THE COMMENTS, WITH MORE INFORMATION, (AS OPPOSED TO CREATING NEW POSTS).
MY FINAL PARTING THOUGHT: Please share or forward this post at your discretion. If everyone shares this post and two of your friends share this post and so on, we use the power of exponential math to work in our favor, which seems appropriate given the virus is using that same exponential math against us.
HOW YOU CAN REALLY HELP: If you know people who have large numbers of followers, or people in the media, please leverage your personal relationship with them and ask them to amplify this post by sharing it.
For people not on Facebook you can email or text the link. It would be useful to get the post on Twitter and LinkedIn. If you know people in government this fact-based post may help inform them to make the best decisions.
Itās time for us humans to go on the offensive against the virus. We must fight back.
There is only one way to do so: Social Distancing.
Do it today.
NOTE: Anyone, including the media, is free to use this post, any related content, in all or in part, for any purpose, in any format, with no attribution required. Please direct message me if you have other ideas for how to raise awareness.
Finally, I can no longer keep up with friend requests given how much this post has been shared. To receive updates or follow me, please use the āFollowā button on Facebook.
I should do the Lottery.
Only this morning I mentioned how long until the 1st Drunk Brit gets shot in Spain.
Well, looks like they are tryingā¦
Fucking hell, Phil. It took me 10 minutes just to scroll through all that. No way Iām reading that lot. Keep it brief.
2 Likes
Please do wind your neck inā¦ you are missing several important pointsā¦(not for the first time)
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There remains NO published clinical evidence to suggest ibuprofen makes COVID-19 worseā¦ (which was the claim made in the post, without any referencing)
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There remains no published clinical evidence that NSAIDS make COVID-19 worse
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YES there is published clinical evidence that there is a RISK of using NSAIDS if you have fever or infection (viral and or bacterial) because of the mechanism of action of NSAIDS can RISK a negative impact on the immune system
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If older folks are currently being prescribed NSAIDS for their underlying conditions, such as Arthritis or HIV, then they and are also showing flu like symptoms, then they should consult their specialist docs BEFORE ceasing their prescribed medication.
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The French health minister advice in the link provided again only refers a risk if you suffer from an infection or feverā¦ it does not refer to any clinical evidence.
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Do I think I know better than John Hopkins? NO, where have I said that? but I DO expect evidence or cited sources when āclinical adviceā is being provided on a web forumā¦ we all should, its just common sense.
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There is a shit load of crap being spread by the Twitterazzi who believe that because they are not MSM, they dont need to provide any evidence or sourcesā¦ I work in healthcare, have done for nearly 30 years, and the importance of sharing sources of information and using published evidence when making any clinical claims cannot be underestimated
Iāll summarise
We are fucked
You are all going to die
It will be painful, particularly if you are overweight.
3 Likes