2019-nCoV / Corona virus Pt 2

[Ampulla of Vater]

We're not saving many lives, just flattening the curve, saving the deaths for later. In a really bad case like Italy, some extra lives are lost because of overloaded medical services. I can't see any scenario were we can save 20 million lives though.

Flattening the curve doesn’t just save the deaths for later. It helps ensure there are enough resources to handle those who need critical care at any given time, thereby cutting down on the mortality rate.

 

[Darat]

I can see this ending up like the millennium bug, "they said there'd be 20 million dead but only 1 million died". Well yes because we did something!

 

[Marcus]

Bear in mind that many of those things listed in the top ten causes of death cover things like heart attacks, strokes, accidents and injuries etc...

These are things that are often treated by emergency services and the death toll would presumably be even higher if the emergency services are stretched beyond capacity due to the massive influx of COVID 19 patients.

You have been doing a lot of cherry-picking of data and concluding that there is too much fuss about this disease, but for some reason the healthcare institutions around the world disagree with that conclusion. Why do you think that is?

Is it cherry picking? I used the tenth leading cause of death in the US for comparison, would the leading cause be more appropriate? heart disease, 647k in 2017. We're very used to people dying of heart disease, it's not new , and it's not infectious. I'm not suggesting that we don't respond to coronavirus, just that the cure may be worse than the disease.

 

[Marcus]

That doesn't really explain how you worked out that "the risk seems way out of proportion with the economic destruction already caused".

What would be in proportion?

It's an opinion, indicated by the word "seems". The opinion was arrived at by a subjective comparison of the number of deaths with the economic hardship observed and predicted.


ETA: I'm not sure what number of deaths would be proportional, although I could think about it. What number of deaths do you think would be proportional to this worldwide economic chaos?

 

[angrysoba]

Is it cherry picking? I used the tenth leading cause of death in the US for comparison, would the leading cause be more appropriate? heart disease, 647k in 2017. We're very used to people dying of heart disease, it's not new , and it's not infectious. I'm not suggesting that we don't respond to coronavirus, just that the cure may be worse than the disease.

The projection I showed you from that model suggests COVID 19 could kill 2.2 million in America.

So what is the correct response to it?

 

[The Atheist]

I can see this ending up like the millennium bug, "they said there'd be 20 million dead but only 1 million died". Well yes because we did something!

Damned if you do and damned worse if you don't.

I did say it was the greatest conundrum for mankind since WWII, and it might even be the greatest of all time, because WWII didn't require much thought.

 

[Fast Eddie B]

I may have mentioned I have been selected for the position of "Enumerator" for the 2020 Census. I can't help but wonder if that's going to be delayed.

I wouldn't be thrilled sitting in a classroom any time soon, nor going door-to-door counting folks.

 

[Meadmaker]

Is it cherry picking? I used the tenth leading cause of death in the US for comparison, would the leading cause be more appropriate? heart disease, 647k in 2017. We're very used to people dying of heart disease, it's not new , and it's not infectious. I'm not suggesting that we don't respond to coronavirus, just that the cure may be worse than the disease.

I think the point that a couple of people were making is that the difference between surviving a heart attack and not surviving it might be the quality of care received, and a Covid-19 epidemic would lower the quality of care available to the heart attack victim. Therefore, in addition to the Covid-19 deaths, the deaths from other causes would increase during a Covid-19 epidemic.

Does that make it "worth it"? Is the economic disruption worth it? I can't answer that. However, I can note that it seems that a lot of people think it must be, because governments around the world have agreed to engage in that economic destruction in order to lessen the effects of coronavirus.

It took a while for the Italians to decide, but other countries saw what happened in Italy and decided it was worth it to avoid that.

 

[Skeptic Ginger]

Are you saying those masks are not available without a physician's clearance?

How is that enforced?

On the job*, yes, I am saying that.

OSHA Respiratory Protection

1910
Part Number Title:Occupational Safety and Health Standards
Subpart:1910 Subpart I
Subpart Titleersonal Protective Equipment
Standard Number: 1910.134
Title: Respiratory Protection.
Appendix:AB-1B-2CD
GPO Source:e-CFR...


1910.134(c)(1)(ii)
Medical evaluations of employees required to use respirators;...

You start with this questionnaire:

Appendix C to Sec. 1910.134: OSHA Respirator Medical Evaluation Questionnaire (Mandatory)

To the employer: Answers to questions in Section 1, and to question 9 in Section 2 of Part A, do not require a medical examination.

To the employee:

Your employer must allow you to answer this questionnaire during normal working hours, or at a time and place that is convenient to you. To maintain your confidentiality, your employer or supervisor must not look at or review your answers, and your employer must tell you how to deliver or send this questionnaire to the health care professional who will review it.

Part A. Section 1. (Mandatory) The following information must be provided by every employee who has been selected to use any type of respirator

After the employees fill it out these medical questionnaires, a medical provider evaluates the answers and decides if the employee needs further evaluation.

It is enforced through OSHA or the equivalent state agency. Employers must keep the record of the evaluations for the term of employment or longer.

If OSHA comes to inspect an employer's respiratory protection program they will ask for these records.


*If the respirator is required for the hazard as it is with infectious disease exposure. An employer can give employees respirators when they are not required for a specific hazard and in that case no fit testing or a medical evaluation is required.

 

[Marcus]

The projection I showed you from that model suggests COVID 19 could kill 2.2 million in America.

So what is the correct response to it?

The correct response is that the model is off by orders of magnitude.

 

[quadraginta]

Even with N95 masks, anyone with health problems needs a physician (or NP/PA) clearance that determines if they will have trouble with the restricted breathing.

Yeah, I know. I've had the training, fitting, etc., and worn the masks.

It still seems to me that nine layers of heavy tee shirt cotton might be a bit tougher to breathe through.

Just a passing thought. Not really a big deal.

 

[Skeptic Ginger]

Yeah, I know. I've had the training, fitting, etc., and worn the masks.

It still seems to me that nine layers of heavy tee shirt cotton might be a bit tougher to breathe through.

Just a passing thought. Not really a big deal.

Not having tried the homemade version, I have no opinion on that.

 

[angrysoba]

The correct response is that the model is off by orders of magnitude.

How do you know this? What are your credentials for saying this?

 

[The Atheist]

The correct response is that the model is off by orders of magnitude.

In which direction, and what orders?

Based on what evidence?

Right now, we seem to have clear evidence that lack of preparedness costs many lives (Iran), while preparedness and diligence saves them. (SK)

I'd be interested to see your reasoning, because all medical science is pretty well lined on the same track here, but you could be smarter than all of them.

 

[quadraginta]

Are you saying those masks are not available without a physician's clearance?

How is that enforced?

On the job*, yes, I am saying that.

<snip>

*If the respirator is required for the hazard as it is with infectious disease exposure. An employer can give employees respirators when they are not required for a specific hazard and in that case no fit testing or a medical evaluation is required.

Which spans a multitude of issues.

It can be (and has been) argued in some civil suits that the act of an employer giving an employee such PPE (Personal Protective Equipment) is a prima facie admission that such a specific hazard existed and that the employer was aware of it.

The training aspect gets even weirder. By requiring or even offering such training the employer can be deemed to have recognized the existence of such a hazard. And if they offer any training they'd better offer all of it, including the doctor's review. On the flip side of the coin the employer can be found negligent if they offer such equipment without proper training. This is a tightrope that is always walked where OSHA and employee safety issues are concerned.

Fortunately the insurance companies tend to fall heavily on the side of proper training, even if the employers aren't all that happy about the potential for legal exposure.

Tough for them, I say. Training always won in my view as well.

 

[casebro]

In which direction, and what orders?

Based on what evidence?

Right now, we seem to have clear evidence that lack of preparedness costs many lives (Iran), while preparedness and diligence saves them. (SK)

I'd be interested to see your reasoning, because all medical science is pretty well lined on the same track here, but you could be smarter than all of them.

But Iran v SK- is there a difference in areas under the curves, or just the time to peak? Are SKs stopped dying?

 

[quadraginta]

Not having tried the homemade version, I have no opinion on that.

Me either. Like I said, just a passing thought.

I don't know if I have any tee shirts packed away that would make for an appropriate test. I've never been much for tee shirts, and I don't think I have anything which would fit the heavy duty, two-ply description.

 

[marting]

The problem I see with this is that there seems to be increasing evidence that pre-symptomatic (if not asymptomatic) carriers can still shed virus, and possibly even more than the ones who have become symptomatic.

Not according to this:
https://science.sciencemag.org/content/early/2020/03/13/science.abb3221

In the earliest days at Wuhan, much of the spread was from people that hadn't been tested because they far outnumbered the known cases. Still, the infectiousness of these people with minimal or no symptoms was significantly less than those that had been identified.

 

[Blue Mountain]

That may be true for those of us who live in the US.

The governments of China, Macau, Singapore, Hong Kong, Taiwan, S Korea, maybe even N Korea, and Japan (?), and ... seem to be working very very hard to ensure that there is no such eventual universal exposure*.

The UK government has apparently concluded, recently, that this is not possible, that eventually almost everyone in the UK will be exposed.

I do not know what the governments of, say, New Zealand, Saudi Arabia, Bahrain, or even Canada (to pick just a few examples of places with enough resources - including legal - to at least try) are aiming to do.

*Once (if?) a highly effective vaccine becomes widely deployed, this may become a rather moot concept.

Canada appears to be trying a containment strategy, but I think we started too late and there are serious gaps. For example, Ontario and BC have already closed all the schools while in Manitoba they're still open this week

So now the strategy is flattening the curve. On that I think we're doing well, but we won't know for a month. Then we'll need to compare our effort against other countries who adopted different strategies.

As of this post, the Government of Canada's Coronavirus website website has not received its expected evening update. The time is still showing 10:30 AM EST, and those numbers are unchanged from last night, which I posted yesterday. CBC News reports 583 cases and 8 deaths (7 in BC, one in Ontario.) Health Canada reported 424 cases yesterday, a 38% increase over the day before. Another 38% increase tomorrow would bring the total to 800, so I'm still seeing a doubling every 2 and a bit days. I certainly hope this starts improving soon.

Canada's population is just a touch over 10% of the USA, meaning a lot of metrics run 10:1 for the US vs Canada. The US has recorded 6,518 cases (but with probably less testing than Canada has done) and 108 deaths (source: Wikipedia.) So the US is running slightly ahead of Canada here. Given that the two countries addressed COVID-19 differently at the start—Canada activated an epidemic plan back in January—once things have settled down we can use the 10:1 metric to see if the delayed American response had a huge or a small impact.

 

[Skeptic Ginger]

Which spans a multitude of issues.

It can be (and has been) argued in some civil suits that the act of an employer giving an employee such PPE (Personal Protective Equipment) is a prima facie admission that such a specific hazard existed and that the employer was aware of it.

There is a general statute that says something akin to "employers must protect the worker from known hazards" essentially whether OSHA has a specific rule or not.