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All things Novel Coronavirus (2019-nCoV)

mariomike

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Colin P said:
So how is that "Just in time" inventory system working for you?

Just fine, thank-you. Enjoying the comfort and safety of my home.  :)

But, I remember the back and forth on the N95. The union finally won. After that, no more of our friends were admitted to ICUs.
 

Remius

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daftandbarmy said:
Who needs to keep all their employees working when the Prime Minster just announced a juicy EI package and some low interest loans, plus a 75% wage subsidy? You can ditch 90% of the staff, keep a skeleton crew on to make sure the place is in good shape, then staff up again when the restrictions come off.

Unless, of course, you care about your brand, which is another matter entirely....

That is sort of the point.  Increase the wage to make it less attractive to go on EI.  If you ditch 90% of your staff you stop making money because you can’t operate.  Hours have already been cut and staff have been rerolled into things like crowd control.  The store I mentioned had two people outside Manning the doors.  They had another directing people at the cash area that was reduced to a sort of lane corral.  Only 4 cash registers were operating.  Other staff were cleaning carts.

Staff have already been reduced at most places but there is a limit on how much you can cut before:

A) not being able to operate and meet demand
B) burning out your skeleton staff resulting in A)

Food distribution stores have been designated essential so I doubt they could closed for long before the bit would mandate them open anyway.
 

SeaKingTacco

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FJAG said:
Hopefully that will include either limiting ridiculous corporate CEO and Board salaries or taxing the crap out of them.

:cheers:

Isn't that for the shareholders to deal with? Or do you want a government commission deciding what is "fair and reasonable" compensation for every job in Canada?
 

Journeyman

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Ides of March, indeed
https://twitter.com/i/status/1244119212701990913

I'll just leave this here, with no comment besides  :not-again:
 

SeaKingTacco

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Brad Sallows said:
The economic and fiscal situation is going to be so far away from anyone's ability to understand and manage it that everyone is going to race back to what they understand - ie. status quo c. Dec 2019 - as fast as they can.

"-the idea we are incapable of making massive changes for climate action is demonstrably wrong"

Highly unlikely.

I agree with Brad. This whole episode is a test run of exactly what climate action would look like on a permanent (vice temporary- hopefully) basis, on the scale envisioned by people like Greta Thunberg and her fellow travellers.

The average person is going to be a whole lot more concerned about their paycheque, mortgage payments/making rent and even where their next meal is coming from over the next few months than they will be about CO2 emissions. Woe to the politician who brings up carbon taxes when 30% of the Canadian population is unemployed.
 

The Bread Guy

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Remius said:
... If you ditch 90% of your staff you stop making money because you can’t operate ...
... notwithstanding, as others have pointed out, the profit made by price gouging demand-adjusting prices on things like toilet paper and hand sanitizer.

And once this is over, how many customers'll be willing to pay an extra buck above the pre-COVID price for a pack of toilet paper in order to at least increase the odds of better wages?  I'm going to guess not many, especially after the rough ride we're heading into.
 

daftandbarmy

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milnews.ca said:
... notwithstanding, as others have pointed out, the profit made by price gouging demand-adjusting prices on things like toilet paper and hand sanitizer.

And once this is over, how many customers'll be willing to pay an extra buck above the pre-COVID price for a pack of toilet paper in order to at least increase the odds of better wages?  I'm going to guess not many, especially after the rough ride we're heading into.

The organizations that will do well will be the ones who can operate the best online. Reducing the staffing and hard space overhead will help increase ‘mass customization’ while reducing prices through competition. My guess is you’ll see a lot of jobs lost in those service sector (including public sector) organizations that can do that well. Conversely, new jobs will become available that enable that online channels to exist and operate.
 

The Bread Guy

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Strange times -- RUS CBRN/NBC troops now appear to be disinfecting/sanitizing hot spots in Italy.

Attached photo caption:  "A Russian Army specialist walks outside the Honegger nursing home where 35 people have died so far from coronavirus in Albino, Italy, on March 28, 2020, amid the spread of the COVID-19 (new coronavirus) pandemic. (Piero CRUCIATTI / AFP)" (source)
 

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Kirkhill

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Some more commentary on the quality of the Observations and how they are Oriented as we Decide how to Act.

https://www.spectator.co.uk/article/how-to-understand-and-report-figures-for-covid-19-deaths-
Dr. John Lee is a recently retired professor of pathology and a former NHS consultant pathologist.

Let’s look at the UK numbers. As of 9 a.m. on Saturday there were 1,019 deaths and 17,089 confirmed cases – a death rate of 6.0 per cent. If one third of the deaths are caused by Covid-19 and the number of cases is underestimated by a factor of say 15, the death rate would be 0.13 per cent and the number of deaths due to Covid-19 would be 340. This number should be placed in perspective with the number of deaths we would normally expect in the first 28 days of March – roughly 46,000.

Dr Lee believes that there is reason to suggest that the number of CoVid 19 deaths may considerably lower than reported.  He also suggests that the actual infection rate is still unknown.  Also the time factor is undefined.

We are still more reliant on throwing dice and relying on probabilities and possibilities than having a clear view of the field and knowing what outcomes are most likely.

Also, there is this article.

https://www.amgreatness.com/2020/03/28/its-not-a-choice-between-lives-or-the-economy/
The article has a bias and is a bit of proselytizing but this comment stands out:

Some numbers: According to the CDC, during the 2018-2019 flu season, there were some 810,000 hospitalizations in the United States for flu and 61,000 deaths. As of March 26, we have seen more than 490,000 hospitalizations and 34,000 flu deaths. Add in the COVID-19 numbers and you get 565,000 hospitalizations and 35,264 deaths. In other words, seen in context, COVID-19 cases are a barely discernible blip.

With these differences: the patients suffering from the effects of COVID-19 tend to be much sicker, taking up hospital beds for longer, and they are arriving more quickly and in bigger clumps.

The comment based on this work
https://behindtheblack.com/behind-the-black/essays-and-commentaries/covid-19-is-not-going-to-overwhelm-our-healthcare-system/

covid19.jpg

covid19fluOnly.jpg


There is, absolutely, justifiable grounds for concern, for caution.  There is also justification for optimism. 

What was Phase 2?  After that Dash, Down, Crawl?  Observe was it?
 

OceanBonfire

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Journeyman said:
Ides of March, indeed
https://twitter.com/i/status/1244119212701990913

I'll just leave this here, with no comment besides  :not-again:

Wait until you see mid-April where, according to experts, it's the peak.
 

Good2Golf

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Like they say, Chris, "lies, damed lies, and statistics."

What Dr. Lee doesn't fully include in his assessment's charts is mention of cases identified/confirmed, which would have tied more closely to how COVID-19 stats are being reported by John Hopkins and other similar means.  CDC figures for US flu for 2018-2019 indicate of 35M cases, there were approximately 35K deaths, or a 0.10% mortality rate for the 12-month period.

LINK: CDC estimates that influenza was associated with more than 35.5 million illnesses, more than 16.5 million medical visits, 490,600 hospitalizations, and 34,200 deaths during the 2018–2019 influenza season. This burden was similar to estimated burden during the 2012–2013 influenza season1.

As of 29 March, the US COVID-19 numbers are: 125,313 confirmed cases and 2,197 deaths, or a 1.75% mortality rate for the assessed period (20 January to 29 March). 

So up to now (and US cases/deaths are still growing exponentially at the moment), COVID-19 proportionately in the U.S. has been 1.75÷0.10=17.5x more deadly than the flu was in the U.S. in 2018-2019.  Absolute case/death numbers lower, yes...proportionately higher though...a LOT (17.5x) higher and the exponential case/death climb continues.  I hope I'm wrong, but I'm willing to wager that the absolute COVID-19 numbers for 2020/2021 for the US are going to be worse than the standard influenza.  I suppose we'll see in 9-10 months' time.

Regards
G2G
 

dapaterson

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A big part of leadership is showing up...

The heads of NYC's Mount Sinai hospital group are holed up in their Florida homes, far away from the crisis in NYC

https://nypost.com/2020/03/28/mount-sinai-hospital-leaders-holed-up-in-florida-vacation-homes-during-coronavirus-crisis/amp/?__twitter_impression=true
 

Kirkhill

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Good2Golf said:
Like they say, Chris, "lies, damed lies, and statistics."

What Dr. Lee doesn't fully include in his assessment's charts is mention of cases identified/confirmed, which would have tied more closely to how COVID-19 stats are being reported by John Hopkins and other similar means.  CDC figures for US flu for 2018-2019 indicate of 35M cases, there were approximately 35K deaths, or a 0.10% mortality rate for the 12-month period.


As of 29 March, the US COVID-19 numbers are: 125,313 confirmed cases and 2,197 deaths, or a 1.75% mortality rate for the assessed period (20 January to 29 March). 

So up to now (and US cases/deaths are still growing exponentially at the moment), COVID-19 proportionately in the U.S. has been 1.75÷0.10=17.5x more deadly than the flu was in the U.S. in 2018-2019.  Absolute case/death numbers lower, yes...proportionately higher though...a LOT (17.5x) higher and the exponential case/death climb continues.  I hope I'm wrong, but I'm willing to wager that the absolute COVID-19 numbers for 2020/2021 for the US are going to be worse than the standard influenza.  I suppose we'll see in 9-10 months' time.

Regards
G2G

The CDC charts were not from Dr. Lee G2G. They were from the other sources I mentioned. Regardless.  I take your point about statistics.  And I agree fully.  Statistics are arguable.  Even by the experts.

So I will take that wager - a bottle of Jamesons to an Auchentoshan - that the glass is half-full.  ;)
 

tomahawk6

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When the after action report is done I think the WHO will be marked as the villains along with China.
 

Kirkhill

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While on the subject of statistics - has anyone heard of any indication of polling of the general populace to find out what the daily spread of infection is like?

It seems to me that the Angus Reids of this world should be engaged devising sampling plans for home testing during this lockdown/slowdown to determine the current spread and the rate of spread.

That is ultimately what their skill sets were designed for.  Not for opinions.  But for accurate analyses of populations.
 

FJAG

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Chris Pook said:
The CDC charts were not from Dr. Lee G2G. They were from the other sources I mentioned. Regardless.  I take your point about statistics.  And I agree fully.  Statistics are arguable.  Even by the experts.

So I will take that wager - a bottle of Jamesons to an Auchentoshan - that the glass is half-full.  ;)

Over and above the fact that statistics are often open to interpretation is the fact that these viruses are different. Covid 19 seems to be a "stickier" virus meaning that once in the system it isn't cleared out as well as others. On the other hand we've had vaccinations for flu which protects a lot of people. Those facts skew results.

The significant statistic is the mortality rate which seems to indicate a ten-fold + rate over the flu from those cases that enter the hospitalization stream.

We'll never be able to do a clear comparison because many people take very little precaution (other than flu shots) to stop transmission of the flu while we are taking steps to slow Covid transmission in a fairly large way.

Another skew is that while we do gather statistics on hospitalizations, we don't really know how many actual cases there have been because many cases of both viruses are never reported.

:cheers:
 

Kirkhill

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FJAG said:
Over and above the fact that statistics are often open to interpretation is the fact that these viruses are different. Covid 19 seems to be a "stickier" virus meaning that once in the system it isn't cleared out as well as others. On the other hand we've had vaccinations for flu which protects a lot of people. Those facts skew results.

The significant statistic is the mortality rate which seems to indicate a ten-fold + rate over the flu from those cases that enter the hospitalization stream.

We'll never be able to do a clear comparison because many people take very little precaution (other than flu shots) to stop transmission of the flu while we are taking steps to slow Covid transmission in a fairly large way.

Another skew is that while we do gather statistics on hospitalizations, we don't really know how many actual cases there have been because many cases of both viruses are never reported.

:cheers:


And those are among the points that Dr Lee was making.

How to understand – and report – figures for ‘Covid deaths’
29 March 2020, 8:07am

Every day, now, we are seeing figures for ‘Covid deaths’. These numbers are often expressed on graphs showing an exponential rise. But care must be taken when reading (and reporting) these figures. Given the extraordinary response to the emergence of this virus, it’s vital to have a clear-eyed view of its progress and what the figures mean. The world of disease reporting has its own dynamics, ones that are worth understanding. How accurate, or comparable, are these figures comparing Covid-19 deaths in various countries?

We often see a ratio expressed: deaths, as a proportion of cases. The figure is taken as a sign of how lethal Covid-19 is, but the ratios vary wildly. In the US, 1.8 per cent (2,191 deaths in 124,686 confirmed cases), Italy 10.8 per cent, Spain 8.2 per cent, Germany 0.8 per cent, France 6.1 per cent, UK 6.0 per cent. A fifteen-fold difference in death rate for the same disease seems odd amongst such similar countries: all developed, all with good healthcare systems. All tackling the same disease.

You might think it would be easy to calculate death rates. Death is a stark and easy-to-measure end point. In my working life (I’m a retired pathology professor) I usually come across studies that express it comparably and as a ratio: the number of deaths in a given period of time in an area, divided by that area’s population. For example, 10 deaths per 1,000 population per year. So just three numbers:

The population who have contracted the disease
The number dying of disease
The relevant time period


The trouble is that in the Covid-19 crisis each one of these numbers is unclear.

1. Why the figures for Covid-19 infections are a vast underestimate


Say there was a disease that always caused a large purple spot to appear in the middle of your forehead after two days – it would be easy to measure. Any doctor could diagnose this, and national figures would be reliable. Now, consider a disease that causes a variable raised temperature and cough over a period of 5 to 14 days, as well as variable respiratory symptoms ranging from hardly anything to severe respiratory compromise. There will be a range of symptoms and signs in patients affected by this disease; widely overlapping with similar effects caused by many other infectious diseases. Is it Covid-19, seasonal flu, a cold – or something else? It will be impossible to tell by clinical examination.

The only way to identify people who definitely have the disease will be by using a lab test that is both specific for the disease (detects this disease only, and not similar diseases) and sensitive for the disease (picks up a large proportion of people with this disease, whether severe or mild). Developing accurate, reliable, validated tests is difficult and takes time. At the moment, we have to take it on trust that the tests in use are measuring what we think they are.

So far in this pandemic, test kits have mainly been reserved for hospitalised patients with significant symptoms. Few tests have been carried out in patients with mild symptoms. (Edit: And virtually none, it would seem, on those exhibiting no symptoms - see my Angus Reid comment) This means that the number of positive tests will be far lower than the number of people who have had the disease. Sir Patrick Vallance, the government’s chief scientific adviser, has been trying to stress this. He suggested that the real figure for the number of cases could be 10 to 20 times higher than the official figure. If he’s right, the headline death rate due to this virus (all derived from lab tests) will be 10 to 20 times lower than it appears to be from the published figures. The more the number of untested cases goes up, the lower the true death rate.

2. Why Covid-19 deaths are a substantial over-estimate
Next, what about the deaths? Many UK health spokespersons have been careful to repeatedly say that the numbers quoted in the UK indicate death with the virus, not death due to the virus – this matters. When giving evidence in parliament a few days ago, Prof. Neil Ferguson of Imperial College London said that he now expects fewer than 20,000 Covid-19 deaths in the UK but, importantly, two-thirds of these people would have died anyway. In other words, he suggests that the crude figure for ‘Covid deaths’ is three times higher than the number who have actually been killed by Covid-19. (Even the two-thirds figure is an estimate – it would not surprise me if the real proportion is higher.)

This nuance is crucial ­– not just in understanding the disease, but for understanding the burden it might place on the health service in coming days. Unfortunately nuance tends to be lost in the numbers quoted from the database being used to track Covid-19: the Johns Hopkins Coronavirus Resource Center. It has compiled a huge database, with Covid-19 data from all over the world, updated daily – and its figures are used, world over, to track the virus. This data is not standardised and so probably not comparable, yet this important caveat is seldom expressed by the (many) graphs we see. It risks exaggerating the quality of data that we have.

The distinction between dying ‘with’ Covid-19 and dying ‘due to’ Covid-19 is not just splitting hairs. Consider some examples: an 87-year-old woman with dementia in a nursing home; a 79-year-old man with metastatic bladder cancer; a 29-year-old man with leukaemia treated with chemotherapy; a 46-year-old woman with motor neurone disease for 2 years. All develop chest infections and die. All test positive for Covid-19. Yet all were vulnerable to death by chest infection from any infective cause (including the flu). Covid-19 might have been the final straw, but it has not caused their deaths. Consider two more cases: a 75-year-old man with mild heart failure and bronchitis; a 35-year-old woman who was previously fit and well with no known medical conditions. Both contract a chest infection and die, and both test positive for Covid-19. In the first case it is not entirely clear what weight to place on the pre-existing conditions versus the viral infection – to make this judgement would require an expert clinician to examine the case notes. The final case would reasonably be attributed to death caused by Covid-19, assuming it was true that there were no underlying conditions.

It should be noted that there is no international standard method for attributing or recording causes of death. Also, normally, most respiratory deaths never have a specific infective cause recorded, whereas at the moment one can expect all positive Covid-19 results associated with a death to be recorded. Again, this is not splitting hairs. Imagine a population where more and more of us have already had Covid-19, and where every ill and dying patient is tested for the virus. The deaths apparently due to Covid-19, the Covid trajectory, will approach the overall death rate. It would appear that all deaths were caused by Covid-19 – would this be true? No. The severity of the epidemic would be indicated by how many extra deaths (above normal) there were overall.

3. Covid-19 and a time period

Finally, what about the time period? In a fast-moving scenario such as the Covid-19 crisis, the daily figures present just a snapshot. If people take quite a long time to die of a disease, it will take a while to judge the real death rate and initial figures will be an underestimate. But if people die quite quickly of the disease, the figures will be nearer the true rate. It is probable that there is a slight lag – those dying today might have been seriously ill for some days. But as time goes by this will become less important as a steady state is reached.

Let me finish with a couple of examples. Colleagues in Germany feel sure that their numbers are nearer the truth than most, because they had plenty of testing capacity ready when the pandemic struck. Currently the death rate is 0.8 per cent in Germany. If we assume that about one third of the recorded deaths are due to Covid-19 and that they have managed to test a third of all cases in the country who actually have the disease (a generous assumption), then the death rate for Covid-19 would be 0.08 per cent. That might go up slightly, as a result of death lag. If we assume at present that this effect might be 25 per cent (which seems generous), that would give an overall, and probably upper limit, of death rate of 0.1 per cent, which is similar to seasonal flu.

Let’s look at the UK numbers. As of 9 a.m. on Saturday there were 1,019 deaths and 17,089 confirmed cases – a death rate of 6.0 per cent. If one third of the deaths are caused by Covid-19 and the number of cases is underestimated by a factor of say 15, the death rate would be 0.13 per cent and the number of deaths due to Covid-19 would be 340. This number should be placed in perspective with the number of deaths we would normally expect in the first 28 days of March – roughly 46,000.

The number of recorded deaths will increase in the coming days, but so will the population affected by the disease – in all probability much faster than the increase in deaths. Because we are looking so closely at the presence of Covid-19 in those who die – as I look at in more detail in my article in the current issue of The Spectator – the fraction of those who die with Covid-19 (but not of it) in a population where the incidence is increasing, is likely to increase even more. So the measured increase in numbers of deaths is not necessarily a cause for alarm, unless it demonstrates excess deaths – 340 deaths out of 46,000 shows we are not near this at present. We have prepared for the worst, but it has not yet happened. The widespread testing of NHS staff recently announced may help provide a clearer indication of how far the disease has already spread within the population.

The UK and other governments have no control over how their data is reported, but they can minimise the potential for misinterpretation by making absolutely clear what its figures are, and what they are not. After this episode is over, there is a clear need for an internationally coordinated update of how deaths are attributed and recorded, to enable us to better understand what is happening more clearly, when we need to.

John Lee is a recently retired professor of pathology and a former NHS consultant pathologist.
 

Colin Parkinson

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A good video if you have diabetes or know someone who does https://www.youtube.com/watch?v=V3BXqYzTTSQ&fbclid=IwAR3Mr0VIADw_X-1YjctUjTfMvmVPfjr372ehJTaX9NFVkT1Xvp7ArmULClw


Risk factor for type 2 is higher than type 1 generally speaking.
 

mariomike

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May be upsetting to sensitive viewers.

Reefer trucks being loaded in NYC.
https://twitter.com/gotmybelton/status/1244369597861703685

They are building a hospital inside Central Park.

https://www.ny1.com/nyc/all-boroughs/news/2020/03/29/emergency-hospital-being-constructed-in-central-park?cid=twitter_NY1

 

OceanBonfire

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mariomike said:
...

They are building a hospital inside Central Park.

https://www.ny1.com/nyc/all-boroughs/news/2020/03/29/emergency-hospital-being-constructed-in-central-park?cid=twitter_NY1

The provinces here are also preparing for makeshift hospitals:

https://www.cbc.ca/news/politics/covid-19-makeshift-hospitals-1.5513846

Also:

President Trump has reversed his call to reopen businesses by Easter and now says he will extend the nation's coronavirus social distancing guidelines to April 30.

https://twitter.com/ABC/status/1244393976846626816
 
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