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This virus is not being spread the way we're told.

Social distancing is close to worthless.

NY's data makes this quite clear.  So does Florida's.

Both slammed the door; SE Florida and NYC.

The bend should be evident in one viral generation time.  The new case rate should collapse in two viral generation times.  If Community Transmission via bars, restaurants and "social interaction" was more than 2/3rds of the total the effective R0 would go under 1.0 and community transmission would collapse.  If it was half then R0 would be 1.5 and we'd have transmission approximately equal to a bad seasonal flu.

IF you actually bent the curve.

These measures did not bend it to any material degree.  Enough time has passed to know this is true; at most they have lengthened a "turn time" by one day (in other words, R3.0 to R2.5.)  That's effectively nothing!

Why not?

It's being spread in the medical environment -- specifically, in the hospitals -- not, in the main, on the beach or in the bar.

When Singapore and South Korea figured out that if as a medical provider you wash your damn hands before and after, without exception, every potential contact with an infected person or surface even if you didn't have a mask on for 30 minutes during casual conversations with others (e.g. neither of you is hacking) transmission to and between their medical providers stopped.

Note -- even if you didn't have a mask on and were not social distancing in the work environment, which of course is impossible if you're working with others in a hospital, you didn't get infected.

And guess what immediately happened after that?  Their national case rate stabilized and fell.

The hypothesis that fits the facts is that a material part of transmission is actually happening in the hospital with the medical providers spreading it through the community both directly and indirectly.

Remember that all disease R0 is a composite of all the elements of transmission.  If any material part of transmission is happening in hospitals and other medical settings stopping that will stop or greatly attenuate community transmission.  Every medical provider goes home and interacts with the public.

Then the hospital fills up and guess what -- they call in more doctors, nurses, orderlies and other people.  In fact they've done exactly that; in hard-hit places they're getting volunteers.  Excellent, they need the workers, except every one of those new workers in the place is also a brand new vector to the rest of the community too unless they wash their damn hands before and after every contact with any item or person as well.

What's worse is that the data is that if you wind up on a vent you die nearly all the time.  They had a doc on Tucker Carlson last night confirming that we are not doing materially better than Wuhan in this regard.

 

We're wrong about how this thing is spreading and we're wrong about the silent attack rate.  The step functions in the data here in the United States cannot be explained by ordinary community transmission but they are completely explained if the transmission is happening not among ordinary casual contact -- that is, not "social distancing", but rather through the medical system itself.  That explains the step functions that are seen in places like Florida since it takes several days before you seek medical attention after infection and it also explains why NY, despite locking down the city and more than one viral generation time passing -- in fact two -- has seen no material decrease at all in their transmission rate.

In addition it further is supported by the fact that what we've seen here, in Italy, in Wuhan -- indeed everywhere is not an exponential curve.  It's a step-function flat acceleration graph.  Broad community transmission doesn't happen this way (you instead get a straight and continual exponential expansion until you start to obtain suppression via herd immunity) but if the spread happens as each "generation" gets driven to hospitals for testing and medical attention and the spread is largely happening there what we see here and in other nations in the case rate data is exactly the function you produce in terms of exposure rates.

In other words there should be no straight-line sections in the case rate graphs -- but there are.

Fix the protocols in the hospitals right damn now.  PPE is not the answer if your hands, gloved or not, become contaminated and not immediately washed off.  Hand-washing at an obsessive level -- before and after each patient interaction and before and after each contact with a piece of equipment that might be contaminated is.  In other words the monster vector (remember, R0 is a composite, not a single number) which I've hypothesized since this started is not oral droplets -- it's fecal.

This also correlates exactly with the explosive spread in nursing homes where many residents are incontinent.

Folks, by definition medical facilities concentrate sick people into small spaces.  If what's wrong with them is not infectious this doesn't matter.  But if it is you had better not transmit anything between them or between you and them or you instantly become one of the, if not the only vector that matters.

Then as the place fills up you have more people working and thus more vectors into the rest of the community.  Even if you have gotten the virus as a nurse or doctor and recovered and thus are immune if you have it on your hands and go down the escalator to the subway you can still contaminate the railing and the grab-rail in the car unless you wash your damn hands before and after any contact with any thing or person!

The presence of step functions and apparent linear-fit line segments in what should be a clean parabolic curve says this is exactly what has happened.

That in turn explains why the lockdowns are not doing a damn thing -- except destroying the economy, that we must do everything in our power to keep people out of the hospital in the first place and that, in turn, means using even potentially-valid prophylaxis and promising (but not yet proved) treatments early in the course of the disease so as to keep people out of the damned hospital in the first place while fixing the protocols in the hospitals so they stop transmitting the bug.

Don't tell me about all the doctors and nurses doing this already.  That's a lie.  I've been in plenty of hospitals (and worse, in nursing homes) in my years and in exactly zero instances have I seen any evidence that before and after each contact, with zero exceptions, those hands go under a stream of water with soap.

And reopen the damned economy.

Now.

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2020-03-28 07:00 by Karl Denninger
in Editorial , 184 references
[Comments enabled]  

Healthcare is one dollar in five in our economy.

Every dollar of that spend is parasitic.  It produces nothing.  It is all in support of others producing something; after all, if you're not healthy you can't produce to a maximum capacity, and in many cases you can't produce at all.

Nonetheless it is parasitic -- and thus absolutely relies on a strong economy to exist, especially when it's one dollar in five.

Now it shouldn't be one dollar in five.  It should be 3-4% of GDP.  But it is almost 20% of GDP.

So here we have this behemoth that has no supplies stocked back for a potential epidemic on our shores.

Note that there is every reason to believe they should have done so across the board.  Beyond the 20% of the economy and the huge premiums and spend we all put up with there is history, which says that these sort of events come on an irregular basis and with little or no warning but they do, repeatedly, come.  Swine Flu was the last one, and of course there was HIV/AIDS before that.  There have been others before and there will be more in the future.

We should not accept the crying over ventilators and lack of PPE.  Nor should we accept that a drug tested in 2005 for SARS was not followed up and stocked back in reasonable quantity.  Nor should we accept any foreign supply chain links where at least the entirety of potential necessary supply for an epidemic and 12 months of supply for usual need, or whatever the amount of time is required to stand up supply here in the US, is not being held.

These were decisions made by local hospital administrators and big health care chains like Kaiser.  They weren't decisions made by you and I.  I do not set the requisitioning for such material in my local hospital and neither do you.  They do.  We must not let them cry poverty and woe when they made the decisions and had every reason in the world to believe that an epidemic would come some day in the United States.

We're actually quite lucky with this one.  If you're one of the people who gets hosed then obviously you don't see it that way but as a body politic this is not all that ugly.  The case fatality rate is a fraction of what we were being told and sold; when this is all said and done you'll see. As I've demonstrated with nothing more than basic mathematics even if we did nothing and "let it rip" the excess deaths from such an approach would not even total one moderate flu season's worth of ordinary death.  Oh sure, there would be some excess deaths and if you're one of them then that's going to suck -- but the "save" rate when you start talking about ventilators blows and always has.  It's just the nature of the device.

That rate sucks even when a virus isn't attacking your lungs.  The survival rate is about 30% for one year post-event, and approximately half the time you make it to the hospital door without being in a box.

Real life is not "House", "Marcus Welby" or "Emergency."  Going into the ICU and being intubated because your oxygen sat is collapsing and your lungs are inflamed and full of fluid is a last ditch attempt to save your ass -- and it fails far more often than not, especially when antibiotics are worthless which is the case with a virus.

I remind you we get an outbreak of the flu -- which, by the way, includes flu caused by coronoviruses -- every year.  We should most-certainly have the medical system capacity to handle it under any set of circumstances.  We should be able to handle something twice or thrice that bad at any time because that's not out of the range of normal expectation.  It doesn't even trip the 1SD confidence band, say much less the "six sigma" event people have been screaming about.

But that event will come.

It is a matter of time, but it will come.

It's not this virus, but it will be a future virus.

That's a certainty.

I remind you that we had a disease with a 100% fatality rate that coursed through this nation and indeed the world -- for years.  It was not that long ago either -- that was HIV.  We can "manage" it now but we sure couldn't when it started and for a hell of a long time afterward.  If that disease had been airborne or fecal/oral transmissible it would have wiped a huge percentage of the population of the planet out.  As it was it killed 450,000 Americans alone and countless others worldwide.

We were sold the same bull**** about vaccines then that we're being sold now.  Nearly 40 years later and.... no vaccine for HIV.  There is also no history of success for permanent immunity vaccines against coronaviruses in either humans or animals.  But what there is and have been, repeatedly, are blatant lies and false hope peddled by the medical and pharmaceutical industry.

Hopefully that next virus, when it comes, won't have a 100% fatality rate.  But even something as nasty in terms of fatality as SARS, which killed about 15% of those who caught and 50% or more of those over 65, would be catastrophic if it was anywhere as easy to transmit as COVID-19 is.

There are plenty of scolds who love to point to aggressive containment as the reason SARS disappeared, usually while preaching about what we're doing now.  That's a damnable lie.  The epidemiological truth is that it mutated into a much more severe but harder to transmit virus.  That version was essentially impossible to transmit until you were really sick, making it pretty easy.  It killed itself due to random bad selection, basically, although it isn't really gone -- it's still in animal reservoirs, likely bats in -- guess where -- China.  That means it's one bad (easier to transmit) mutation from coming back for another bite at humans.  Covid-19 is very unlikely to disappear in such a fashion irrespective of our "containment" efforts because it has a monstrous silent and mild-case attack rate, a very long incubation and thus "silent" period before symptoms appear if they ever do and eradicating a disease means killing every last instance of it plus all the reservoirs it is in.  If it is in and came from animals, as is postulated (and not an attenuated accidental release from Wuhan) then forget about it.

Far more-likely is that it'll be back, maybe on an every flu season basis, mutated just enough to hose people once again.  And that means we're better off just dealing with the fallout instead of playing games with heartstrings and lying to the public because otherwise come October or November......surprise!

Oh, about that healthy at any size nonsense and that medicine will make it all ok to be fat, diabetic and lazy?  Well, go talk to Mother about your "wokeness."  Mother Nature, that is.  She doesn't give a wet crap about your namby-pamby social justice garbage and will be more than happy to send you down for a permanent visit with the dude in the Red Suit.  I was headed toward fat and diabetic ten years ago and decided to change it.  Had I not the virus I contracted the first week of January, which I believe may have been Covid-19, might well have killed me.

When you get down to it is not an industry that is one dollar in five in our economy responsible for its own provisioning?  Our Military is one fifth of the health care system in size and yet if there is a war -- it's expected to be ready for it.  That's why we spend all that money on ships, planes, missiles, submarines and people every single year.  Those ships sail the seven seas, our subs prowl with their nuclear missiles and our troops train, train and train some more.  They are ready for a war that could come any day, from anywhere, and not necessarily with much if any warning.

They hope it doesn't, but they better be ready if it does.

How is this any different?  This is an industry that claims the right to screw you in the ass financially any time it wants.  It price fixes in violation of 100+ year old felony criminal law and nobody goes to prison.  Ditto for buying up practices and destroying competition -- also illegal.  It lobbies governments to constrain entry of competitors via CON laws.  It lobbies for passing even more laws so you can't choose, in a fully-informed fashion, what drugs might work when an emergent threat comes upon you for which there are no solid scientific answers.  It parades women crying in front of the TV bemoaning a lack of masks and gloves when it decided not to buy them in the first place and to allow its sources to all be overseas rather than in a factory in the same town, state or even reachable with a couple of days drive by truck.  And it lies, repeatedly, about outcomes, pandering in the media with shows like "Emergency", "House" and "Marcus Welby" and through ballot initiatives all over the 50 states.

It's ridiculous, it's outrageous, it's felonious and when there are no masks and no gowns the people responsible for failing to acquire them and keep them stocked back need to go to prison.

They, not the virus, are responsible for not being prepared.  Cuomo, not the virus, is responsible for being short of ventilators; he canceled a huge order for them a few years ago.  Cuomo, Inslee and the rest, along with all the hospitals, pharmacies and related firms never mind people like Birx and Fauci who like to claim to be "experts" are responsible for sitting silently while national stockpiles were ignored and allowing supply chains to run through a nation that is both our enemy and the source of several of the most-recent nasty viruses that have emerged into the world.

All of this is criminally insane and stupid, and we must insist on accountability -- not a pat on the back.

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2020-03-27 16:15 by Karl Denninger
in Editorial , 562 references
[Comments enabled]  

CNBC is at it again with the "oh no, the hospitals will overload!"

Folks, here are the facts in the US:

1. About 15% of the tested are positive.  To be tested you must be symptomatic (or have a lot of money and/or power)  Note that the test has a roughly 30% false negative rate (you're positive, it misses it) so none of these cases wind up being considered for admission as Coronavirus cases.  These presumably all recover without admission, plus all those who are true negatives.

2. Of that 15% which test positive 12% (CDC numbers) meet criteria to be hospitialized.  Note that of these exactly zero require an actual hospital bed at that stage; oral medication and monitoring every few hours can be done anywhere, by anyone.

3. Of the 12% about one quarter wind up requiring an ICU.  Now we're truly in the "hospital required" category.  Invasive procedures (vent, whether positive pressure mask or intubation) or critical monitoring (e.g. heartbeat, SpO2 on an "always-on" rather than spot-check basis, etc) This is also where artificial feeding and hydration come into it because you literally have no choice; with a positive pressure vent required to breathe or a tube down your throat you can neither eat or drink so a tube for that goes SOMEWHERE. 

4. Of those who went on vents in Wuhan 95% did not survive.  That is, the "save" rate if you got there was five percent.  We do not know what it is here, but the "base" save rate for a vent in a US hospital from all causes is right at 50% to discharge and 30% one-year survival (vents invariably produce fairly serious damage to the victim and you frequently die not long after that.)  It is laughable that our hospitals can approach their "stock" 50% save rate - even if we're twice as good as the Chinese, which isn't implausible, our save rate is only 10%.

So of those who meet the criteria to be tested in the US today (by definition if you wind up in the hospital with KungFlu you're going to get tested) 0.45% of those people wind up in intensive care (0.15 * 0.12 * 0.25) = 0.45%.

Except.... that's not the real rate.  Note that the test misses 30% of positives.  So those people are positive, but don't end up in the numbers (they go home and recover.)

So among the positives that wind up in the ICU are (0.12 * 0.7) * 0.24 = 2.0%.

Current estimates on the worst-case end that nine out of ten people do not develop symptoms sufficient to meet current testing criteria.  Therefore, of those who contract Coronavirus the percentage of those who wind up in an ICU is 0.2%, approximately.

By the way -- this clowns the "2% fatality rate" figure instantly.  Fatality is some fraction of the 0.2%, in other words.  But no, the media (obviously) cannot do multiplication -- we're talking grade school math here folks.

Incidentally that "9 out of 10" is probably low -- perhaps by a factor of 10 or even more  There is reason to believe, specifically, the Oxford paper, that the true rate positives compared with those who are sick enough to get a test is 100:1, not 10:1.  That's plausible given what we already know; among a very old population on the Diamond Princess they still only had 306 symptomatics out of 3,711 persons on board.  It's implausible the others on board were not exposed, which means either (1) they previously had the virus -- possibly on the cruise -- and recovered asymptomatically, thus testing negative or (2) R0 is wildly wrong, particularly considering that some of the "pairs" include couples in the same cabin where only one of them got sick and the other tested negative.

That would make the fatality rate 0.02%.

Everyone who does not require ICU care requires no hospital at all; we can provide drugs, we can provide at-home monitoring of SpO2, we can provide at-home monitoring of BP and heart rate and temperature and we can provide at-home supplemental oxygen.  All of these are trivial to do and cheap.  Such data can be transmitted in or care-givers can be given thresholds where transport is actually required.

Keeping people out of the hospital when no actual intensive, "always on" care is required improves outcomes; you immediately remove all the instances of hospital-acquired infections, for one, and if you're already fighting a virus the last thing you need is an infection you acquire in the hospital on top of it.  If said person lives alone with nobody willing and able to help (e.g. nobody seropositive and thus immune) then we may well need someone for them to be, but it doesn't have to be what you think of as a "hospital."

Now let's face facts: If you wind up on a vent in the ICU with this virus you are almost-certain to die.  That probability is almost-certainly less than or equal to 95% but materially greater than 50%.  The hospitals aren't publishing those numbers (gee, I wonder why?) but you can bet the odds suck.  Let's call it 90% failure.

Ok, so now of the cases, assuming we have 100 who get infected but do not qualify for a test for everyone who does we can change the outcome of 0.002% of the cases by not overloading the medical system.

Because the outcome is so bad if you wind up on a vent we must be extremely aggressive in trying to prevent that.  We have evidence, but not scientific proof, that a number of said therapies (e.g. hydroxychloroquine, etc) are effective.  Exactly how beneficial is not known but avoiding the ICU, given the stats, is the key to not being dead.  We have to use what we've got; any improvement is better than none, and while I'm sure there is a range of effectiveness for what is being tried until something proves better you use what you got.

Let's say that out of the 330 million people in the US 70% will eventually get the infection.  I have no reason to doubt this.  The idea that we can actually repress math is laughable.  The idea that we're going to get a vaccine with persistent immunity is contrary to every piece of science on coronaviruses to date, both in humans and animals.  The data in fact does not support any other conclusion; either this thing is not nearly as transmissible as we think it is (unlikely), the percentage of people who have or have gotten "silent" infections is outrageously high or the range of people who cannot get it for some other reason (e.g. cross or natural immunity) or some combination of those elements has to be true.  Diamond Princess along with South Korea, Japan and Italy all demonstrate this conclusively.  Anyone arguing otherwise is arguing against all of the existing data.

So we have 230,100,000 people who get this thing (immunity level is reached by whatever means) before it's over in the United States.

230,100,000 * 0.002% = 4,602.

Of those we can change the outcome from dead to not-dead by not overloading the hospitals in 4,602 instances.  Maybe.

We just took a 30% stock market crash and destroyed the jobs of over 3 million people in the last week over what looks like 4,602 possible lives saved.

Now maybe that estimate is very low.  But even on the higher end of reason for silent or minimally-symptomatic attack; that is, 1 in 10 people get ill enough to meet testing criteria rather than 1 in 100 we're talking less than a moderate flu season's excess mortality.

For reference approximately 8,000 people die every single day in the United States.

We took an intentional depression in what appears to be an attempt to save less than a day's mortality.  Will suicides exceed this when you throw five to ten million, maybe even twenty million people out of work -- three million last week alone?

In other words for those who say "any sacrifice is worth it for even one life" you're the ******* because you're killing more people than you're saving.

Stop the stupid folks.

Ed 2020-03-28: Error of both inclusion and exclusion (which pretty-much canceled each other out) pointed out to me on Twatter and fixed.

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2020-03-27 07:00 by Karl Denninger
in Editorial , 840 references
[Comments enabled]  

Ok, so Dr. Fauci and Dr. Birx have both walked away bigly from the "scare everyone" prediction that 2 to 10 million Americans are likely to die if we don't lock down cities and stop going to the bar -- in short if we don't hide in our homes for the next six months.

A prescription that, even if it was warranted on the math, is unsupportable.  Collapsing the economy will destroy the health care system.  Health care is symbiotic -- that is, it enhances productivity but without the symbiant it ceases to exist.  The only way to have a functional health care system is for the state, local and federal governments to have a functional tax system and the people to have functional incomes so those services can be paid for.

Further, exponential math is quite-clear.  If you have an R0 of 3.0 for a virus you need about 66-70% "herd immunity" to suppress it.  Functional suppression that materially reduces the rate of spread happens at about half that.  But because of how exponential series work you get almost nothing until you're nearly done -- that is, the curve continues to explode higher right up until it folds over; there is very little perceptible "slowing" first.

If you repress R0 through "social distancing", "lockdowns" and other actions you can, if you choose the actions correctly, depress R0.  But this is not a panacea.  By depressing R0 you slow the rate of growth of cases but you also slow the rate of acquisition of immunity at the same time, and the suppression rate is likewise lowered.  This means that no matter how long you hold those measures in place unless you extinguish the last case as soon as you release them the infection comes roaring back.

Even worse than that, however, is that there are multiple strains of all viruses; it's natural and the longer a virus circulates the more of them there are.  You want natural selection to favor the less-damaging strains.  If you lock down people you run the very real risk of concentrating the nastiest strains in hospitals, and if those are the ones that remain when you release the constraints you get a second wave that is deadlier in percentage terms than the first because you've favored the nasty strains over the benign ones.  That's backwards.

Note that repressing R0 requires that you know how the virus actually spreads.  Theory is not good enough.  If, for example, non-symptomatic people are inefficient at spreading it via exhaling droplets from their lungs, but fecal/oral transmission is very efficient then being 6' apart is worthless when I ride down the escalator to the subway with my hand on the railing and you follow me at some distance.  I leave virus on the rail and you pick it up --it matters not how far apart we are.

The presumption, and it's probably a good one, is that someone who is symptomatic is always contagious via cough or sneeze, and quite efficient at it.  But the rest with this virus -- not so much.

Then there's the study people; one was modified, then "oh no, he tried to backtrack" late last night, claiming that "social distancing" was responsible for the change in predicted death rate.  That's risable to the point of lunacy; the claim is actually that whether a hospital bed is available or not (due to overload, etc) changes the outcome of death by a factor of 1,000?  Note that the documentation thus far says that only about 12% of cases that are known (that is, confirmed positive) result in hospital admission and of those 1 in 4 result in an ICU requirement (where you actually need a hospital; laying in a bed can be done anywhere.)  Further, most of the people who wind up on vents -- by a large margin (95% in Wuhan!) expire anyway.  Thus the actual number of deaths we can avoid from not overloading hospitals is extremely small; first you have to have a serious enough case to get tested, then it has to be serious enough to "require" hospitalization (~12% today according to the CDC), which at that level of care can be provided and monitored at home or in a non-hospital environment, only 20-25% of those people wind up in ICU (where you actually need a hospital) and then of those, only survivors count.  If you'd die anyway it doesn't matter whether you do so in or out of a hospital.  The author of that "revised" paper literally clowned himself by trying to claim that "overloading" the system will lead to one thousand times more deaths.  That author proved by such a statement that his paper is nothing more than a demand to act predicated on a laughable and demonstrably false premise.  Since he hasn't released his model so it can't be critiqued on the merits I think we're done with him.  Oxford, on the other hand, included enough to reproduce their results -- or at least close enough.

My point all along has been that we presume we know R0 and we also presume nobody has any immunity to it at all.  But we know the latter is false.  There were couples on the Diamond Princess in a tiny cooped up stateroom (and presumably sleeping in the same bed for days on end) where one of them got sick and the other one did not.  That's implausible unless one of them was immune or got such a mild case it didn't bother them.

The problem with non-hotspot areas (e.g. Telluride, which is now testing seroconversion on their own due to a family that owns a biolab doing it) is that this can only tell you in a place that is very "leaky" (in other words it behaves as one cohesive group) what you've got.  It's useful data otherwise, and very useful for individuals in terms of whether they've had a "silent" case but lack of seropositive results there doesn't mean that in a "hot" area such as Chicago, NY or LA you would get similar results.

In short the elements of risk from a public health perspective are:

1. What is the level of previous infection/antibodies in your population that is interconnected?

2. What is the R0, and what are the elements of it?  If you wish to suppress R0 can you with reasonable measures or is locking the entire place down and destroying the economy the only option?

3. If someone gets infected what percentage of them have no (or non-clinical) symptoms, what percentage have clinical symptoms, and what percentage of those go on to have a bad outcome.

Diamond Princess conclusively demonstrated that the premise that the population on board either didn't include people who were immune or silently seroconverted is false.  With an R0 of 3 it's ridiculously implausible that someone who slept in the same tiny cabin and in the same bed with someone who was positive didn't get it unless they couldn't get it.

The experience of other nations demonstrates that R0 is not fixed.  Japan, for example, has not had an explosion of cases -- yet they didn't lock anything down.  Then again Japanese people are fastidious about personal hygiene in general, and especially with regards to anything related to their back door.

There is much hay that has been made about a vaccine.  Politicians need to stop lying to the public and, specifically, we need to stop public companies from lying.  Coronaviruses are nothing new.  They exist in the animal husbandry world too.  Typical vaccines in veterinary practice are not permanent for those viruses.  Scientists have been trying to come up with a permanent vaccine for coronaviruses in humans for a long time and have never succeeded.  We must all personally accept that eventually it is a near-certainty that you will get this virus just as it is a near-certainty that you will get the flu or a cold.  We cannot set public policy based on a premise that has never before been true.  It's possible that someone will "crack the code" so to speak but remember that this very same con-job and abuse of public policy was run with HIV and yet here we are almost forty years later with no success.

So let's take a reasonable approach to public health and economic stability.  We have to, and we have to do it now, because we've already done critical damage to the economy and are likely to take a deep recession as a result.  If we don't cut this crap out right here and now that's going to turn into an economic Depression with privation and the destruction of our hospitals and other health care infrastructure.  This will do far more damage than the virus; 1.5 million heart attacks and strokes happen in the US every year and if we trash the hospital infrastructure most of those people are going to die.

I remind you, for perspective, that 160,000 people under 65 die of cardiovascular disease in the United States annually and the total for cardiovascular disease each year is over 600,000 people dead in the United States alone.

However you feel about Covid-19 and whether you're scared of it the facts are that we cannot just lock ourselves in our homes.  Destroying the tax base of our local, state and federal governments, putting millions of people out of work (3 million already in one week alone!) and permanently destroying small businesses, especially service businesses such as restaurants and bars, is criminally insane.  The Federal Government can send you a check but they can't pay your mortgage, property taxes, light and water bill forever.  Those obligations remain -- and not just for you, but also for all those firms.  They will not be able to pay any more than you will.  Many of those closed thus far will never reopen and those employees will not be rehired, because the company they worked for no longer exists.  Every day this goes on that count grows.  And remember -- the price of this insanity is that if you have a heart attack, which is quite capable of killing far more people than this virus ever could, the hospital will have no power, no doctors, no nurses and no drugs.

In addition those who had employer health insurance are about to find out exactly how expensive un-subsidized health care really is.  It's called COBRA and you're entitled to it but you have to pay for it.  That is, you can stay on your employer's plan but they're not obligated to cover you, and won't.  I ran into this all the time when I ran MCSNet; people would flip **** when they got those COBRA statements, accusing me of stealing and calling me every name in the book.  Nope -- by law I could only charge 101% maximum of what I was paying (the extra 1% to handle the money) but I never did charge the extra 1%.  Most people covered by employer plans who got laid off are going to start getting $500-1,000+ a month surprise bills in the mail within weeks. They won't be paid; in many states they also can't go on Medicaid and while you can try to go on Obamacare if your income was beyond $25k or so you're going to pounded on the premium you have to pay, which means that's not affordable either.  The backlash from this and the hardship for millions is going to be extraordinarily severe.  For those with serious pre-existing conditions who need fairly continual attention or expensive drugs this could literally kill them.

And finally all those things someone doesn't pay another person doesn't get.  Those other people include local, county and state governments, businesses, pension funds and ordinary individuals.  Every bit of "forbearance" or "forgiveness" is money directly out of their pockets that they cannot spend in the economy.  All of that activity that would take place but doesn't means taxes are not collected and public goods and services you want, including police, fire, water, sewer and hospitals are not able to be provided.

We must reopen the economy -- whether I'm right or wrong about the virus.  I'm quite sure I'm right -- which is why I was and am willing to put my own ass on the line.  If I get it, the hospital is overloaded and there's no place for all the people triage is going to take place and some will be turned away.  I'm ok with putting that triage point at an arbitrary age of 55.  I'm 56.

So here's my view, and what I believe we should do.  We can talk about retribution later, and we had better too, because there are people who need to pay for what they've done -- the literal millions of American lives and jobs they've destroyed.  The truth about whether these acts were justified will be known in the fullness of time; mathematics will provide the answer as to whether the "doomsday" scenarios were in fact averted. But that's a debate to be had later, when that data is in.  For now, here's the plan.

  • Drop the constraints.  All of them, everywhere.  Go back to work.

  • STRONGLY URGE control measures that are focused on fecal/oral transmission.  Folks, I'm not going to mince words here -- restaurant back end worker hygiene in this regard is a damned joke.  I wouldn't be surprised if the reason NY hasn't seen much of an inflection is that all the take out places are still seeding and propagating infections.  Remember, a lot of them are "silent"; the person in question never gets sick.  It's highly improbable they are spreading it through droplets but one trip to the bathroom or one scratch of the ass and.....  This is to some serious degree a cultural thing and we must address it going forward but for right now surveillance, shaming and even enforcement up and down the line has to be Job #1 with no exceptions permitted.  That will bend the curve from the data we have.

  • For those at high risk, and you know who you are, self-isolate.  That means kicking everyone who won't do it with you in the house out.  You leave only for essential purposes or to do things singly, without others than those who are doing so with you.  It means making tough decisions.  It means considering prophylaxis, if you consider the risk to be worth it for something that isn't proved but looks promising (look at the rate of Covid transmission in nations with a lot of malaria cases .vs. those with none, for example.)  The government must get out of the way here and allow those who choose to take the risk to do so.

  • Accept that people will die and stop sensationalizing it.  People die every day.  Over a half-million Americans die of heart disease every year; that's more than 40,000 every month.  This virus is claimed to have killed just over one thousand Americans thus far, but not all died of the virus -- many died with the virus.  In Italy only 12% of the deaths allegedly from Covid can be directly pinned on it.  The same is and will be true here.  The latest updated model now says, instead of 2 million Americans will die, that perhaps as many as 80,000 will.  Well, 80,000 is a big number but for perspective that's a bad flu season.  Is this bug awful if you get a bad case of it?  Yep.  But nearly everyone doesn't get a bad case, especially if you're not at particular risk.

  • Tell people the truth about things they can change right here and now that may reduce risk.  We believe smoking and nicotine use in any form raises risk.  That includes vapes.  Warn people that there is some evidence, but not scientific proof, that the use of aspirin, naproxen and ibuprofen may make a case materially worse; in the event of a fever use only acetaminophen (Tylenol) until and unless you've been cleared as not having the bug.

  • Set a known, public triage policy if overloads occur.  Overloads may occur.  We can try to stop them and anticipate where they'll be, moving equipment and setting up temporary facilities, but we have to assume and honest with people that we will blow it somewhere.  Tell people in advance what you're going to do so they can make individual decisions on managing their personal risk.  As I said, I'm perfectly ok with it being a simple age test, and if you're over 55 and the system is overloaded, no soup for you.  I'm 56 -- I'm putting my own ass on the line and I'm ok with that.  The greater good means that we must make choices; resources are never unlimited.  Remember that if we wreck the economy by listening to the scolds nobody's going to get that ICU bed or ventilator and that is exactly what allowing people who put emotion before logic to make these decisions is going to lead to.

  • Quarantine known positives, trace contacts, and test.  If someone has to be quarantined and isn't ill enough for a hospital bed then either everyone in the house or apartment quarantines or the victim goes somewhere else until he or she is free of the virus.  If they leave then everyone in the house is subject to testing every 2-3 days for two weeks.  The only exception is someone in the household who tests negative for virus but positive for antibodies, indicating they are immune and cannot spread it to others.  You ought to stay home if you're sick anyway, but few people usually do.

  • Do everything possible to keep positives out of the hospitals.  This sounds counter-intuitive but it is the only smart public policy.  You're far safer in terms of not infecting others if you quarantine at home provided you do not need services that can't be handled in your house or apartment.  All the way up to supplemental O2 can be easily done this way.  This is both for you (you're far more comfortable in your own bed, are you not?) and for everyone else.  In addition the drug protocols that appear to work should be used aggressively where medically ok (e.g. no known contraindications); they won't work for everyone and we'll figure out which ones beat which other ones as we go along, but the data is strong that some of them (e.g. the anti-malarial + specific antibiotics with anti-inflammatory properties) have a good safety profile and are likely effective.  Waiting until someone gets critically ill before using these protocols in an attempt to "rescue" patients is flat-out crazy.

  • Fix the protocols in the hospitals.  We cannot toss a dozen doctors and nurses out for 2 weeks when they walk into a room without full PPE on and the person in there later tests positive.  That's ridiculous and will lead to a hospital with no doctors or nurses. We also have to drop the rate of them popping up positive or getting sick themselves.  The answer for health-care providers was already developed on South Korea, and it's this: Hands must be washed with soap and water (or Hibiclens, etc) before and after each patient or person is contacted -- no exceptions.  A simple surgical loop mask is sufficient; it's primary value is in stopping you from touching your mouth or nose (not inhaling things.)  If you come in contact with someone and don't have one on, so long as you do not have personal physical contact you're fine unless you spent 30 minutes in their presence.  Again, after any physical contact with surfaces or persons hands are washed in every instance.  Exam tables and similar are wiped down with sanitizing solution and the person doing the wiping also washes their hands both before and immediately after.  For all high-aerosol procedures you kit up with the face mask, gown and similar (e.g. intubations) but not for general work and patient care.  This all sounds basic and what should be done but having been around hospitals I assure you it is not, ever, in our hospitals today and it is spreading this bug.  You can't possibly maintain supplies of PPE if you're donning and doffing for each person, and further, if you don't properly manage cross-contamination while doing so it's worthless anyway.

  • No non-US nationals may enter the US, without exception, and while you may travel internationally if you do you're subject to a 2 week quarantine on re-entry.  Sorry; other nations cannot be policed in terms of any of the above, and so until there's no reasonable threat of bringing new cases back into the US at a rate of hundreds or even thousands a day those have to be the rules.  No exceptions.  Modify protocols for trucking; trailers are dropped at the border and hooked and driven on each side, with the driver immediately returning across with no opportunity to infect anyone on either side in the process.  When we get to where rapid (~10 minute) seroconversion tests are widely available then we can modify that; if you're seropositive for more than 2 weeks (thus if you had an active infection when tested, it is resolved) you don't need to serve the 14 days.  But for now, it has to stand to prevent importing new cases by the thousands every day.

That's it.  Will there be hot spots?  Yep.  Will it move from place to place?  Yep.  Be honest, keep the people informed, show data county-by-county but stop with the sensationalism and promises with no basis in scientific fact.  There is going to be no vaccine.  We probably will catch a break into the spring and summer.  We probably will have this thing come back this fall and winter.  Everyone will probably get it, if they haven't already had it.  We should make easy and fast antibody tests available to anyone who wants them, so you can tell if you, personally, have been exposed and recovered, possibly without knowing it.

This will protect as much of our economy as possible while still protecting the public.

It's workable, it can be done right now, and we need to take these steps because this won't be the last dance with a virus.

Up until now we've done it wrong.

Let's do it right.

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2020-03-26 18:45 by Karl Denninger
in Editorial , 4616 references
[Comments enabled]  

Just now....

She just stated what I've been saying since the Diamond Princess.

Either (1) R0 is wrong (e.g. as I've postulated, perhaps -- likely -- a trinominal) or (2) the virus has a very high silent attack rate, was here for months before we knew it, and the cases it generated were in the noise of ordinary flu with negative tests, which are endemic every year.

Or both.

Literally since Diamond Princess was quarantined I've stated one or both had to be true.  I've pointed it out every single day in podcasts and Tickers.  It was obvious from the experience on the ship.  It was also obvious when Wuhan unlocked and didn't have an instant explosion in new cases.  It was obvious when South Korea was able to get the virus under control.  It was obvious when Japan didn't instantly detonate when they didn't lock anything down.

Sweet Jesus... now Birx has flipped, along with Fauci.

WE SHUT DOWN THE NATION WITHOUT EVIDENCE AND WE STILL HAVE GRANDSTANDING MAYORS AND GOVERNORS TRYING TO OUT-STUPID EACH OTHER!

Yes, this bug is bad, especially if you're already medically compromised.  But then again so is pneumonia from any source in such an individual, and the "regular" flu nails plenty of people with those sorts of conditions all the time -- to the tune of tens of thousands of people a year in the United States.

So what -- you mean when your chief scary model dude says "aw ****, whack a few zeros -- like three -- off my prognosticated death rate" you might have a problem trying to continue defending destroying the economy on purpose?

GO BACK TO WORK NOW.

If you're at high risk then self-isolate.  Anything that can kill me at a 1 in 10 rate I'll take a good crack at trying to avoid through my own personal behavior.  Figure out if you can use prophylaxis and, if you choose, be the guinea pig to see if it works.  The data (look at malarial nations .vs. non-malarial ones for transmission rates) says it probably does, but that's an anecdote.  Your ass, your choice.

As for both Fauci and Birx, neither of whom has apologized for making statements and setting policy that has likely destroyed a quarter to a half of all small-business restaurants and bars, which will never re-open, while notching three million unemployed in the last week alone and ruining pension and retirement accounts that millions of people rely on?

smiley

and, from all those workers and destroyed small business owners:

smiley

 

smiley

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