A More Surgical Approach to the Crisis?

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A More Surgical Approach to the Crisis? - RJ_82 - 03-23-2020

This NYT opinion article proposes an alternative, more targeted response to the virus crisis. It has three primary elements/benefits: (i) greater focus of resources on those most at risk (the elderly), (ii) reduced co-habitation of multi-generational families, which inadvertently increases contagion, and (iii) dramatically less negative impact on the economy by enabling more people to work normally. This strategy seems superior than our current, broad shelter-in-place strategy, which may flatten the economy more than the curve.
https://www.nytimes.com/2020/03/20/opinion/coronavirus-pandemic-social-distancing.html

RE: A More Surgical Approach to the Crisis? - cardcrimson - 03-23-2020

(03-23-2020, 10:27 PM)RJ_82 Wrote: This NYT opinion article proposes an alternative, more targeted response to the virus crisis. It has three primary elements/benefits: (i) greater focus of resources on those most at risk (the elderly), (ii) reduced co-habitation of multi-generational families, which inadvertently increases contagion, and (iii) dramatically less negative impact on the economy by enabling more people to work normally. This strategy seems superior than our current, broad shelter-in-place strategy, which may flatten the economy more than the curve.
https://www.nytimes.com/2020/03/20/opinion/coronavirus-pandemic-social-distancing.html

Pay wall. Would be nice to have coronavirus articles for free. Even the Merc has loosened their pay wall. . . .

RE: A More Surgical Approach to the Crisis? - BostonCard - 03-23-2020

NY Times made their coronavirus coverage free. As much as it might kill you, I’d encourage you to register. You might even find yourself agreeing with some things (perhaps even that article).

A more targeted approach will be possible, but only if we get this thing under control first. Wuhan is scheduled to go out of lockdown April 6.

BC

RE: A More Surgical Approach to the Crisis? - magnus - 03-23-2020

One major assumption. Immunity.

RE: A More Surgical Approach to the Crisis? - admin - 03-24-2020

Even during a pandemic, journalists deserve to be paid. Please do not post entire articles, but instead point links to the site so that readers can see the ads.

RE: A More Surgical Approach to the Crisis? - 82 Card - 03-24-2020

I'm not sure I understand the proposal in the article. How does concentrating testing on the vulnerable protect the vulnerable. By the time they test positive, its too late without a treatment. Is the idea to send all vulnerable groups to concentration camps and weed out anyone that tests positive? Without testing the entire population, how would they know when it's ok to disband the camp? How will this help the medical providers getting the disease? Are the younger people that do get severe symptoms just going to be on their own?

RE: A More Surgical Approach to the Crisis? - M T - 03-24-2020

This isn't the first person to say, "What the hell, let everyone under age N just get exposed."

He speaks of "severe infection" as something only the elderly get. Too bad he didn't do his homework.

Quote:Well, we could focus our resources on testing and protecting, in every way possible, all those people the data indicate are especially vulnerable to severe infection: the elderly, people with chronic diseases and the immunologically compromised.

In China, in the 15-49 age group, 12% of the confirmed cases were considered "severe" (pneumonia or worse). 2.2% of those with confirmed cases in that age group wound up in the ICU, required mechanical ventilation, or died.
Does he really advocate for blatantly exposing the majority of the population to a disease where 12% of those that get symptoms get pneumonia.

In the US, if you somehow isolated 50+ and only allowed the 0-49 age group to get the disease, that would still be 25M cases of pneumonia including 3.3M critical cases (ICU, mech. ventilation, or death). If you want to scale that by some factor for what you might figure as asymptomatic cases. If you could magically set appointments for everyone to spend their 2 weeks in the hospital, that is 350M days of hospital beds. Let's say the 750,000 beds were increase to 1M, then that's a year's worth of every hospital bed in use. You'd better not get appendicitis or a heart attack!

If ICU stay averaged 14 days, then you need 46.2M days of ICU beds. There are roughly 70,000 adult ICU beds in the US. Then, all you need is 660 YEARS of all ICU beds to take care of the ICU cases in the 0-49 age group.

Again, you can scale that by, say, 1/100, and the numbers are still insane.

Sorry, David Katz, you flunked your Kobayashi Maru test.

And on the Korean CFR's that he used. This is why they are called a coarse or raw or naive CFR. They assume all sick patients will recover. The naive CFR is almost always going to be an underestimate. As the epidemic matures, the numbers will grow. Here are the CFRs published by Korea two weeks apart. (For source, click on the column heads below)

Age	Korean CFR Mar 10	Korean CFR Mar 24
Total	0.84%	1.33%
80+	8.23%	12.97%
70-79	4.83%	6.25%
60-69	1.44%	1.75%
50-59	0.40%	0.47%
40-49	0.12%	0.08%
30-39		0.11%

RE: A More Surgical Approach to the Crisis? - Farm93 - 03-24-2020

Remember, most in the 0-25 age group live at home often with parents or grandparents older than 50.

The 25-49 group includes a large number of workers without healthcare insurance. When those without insurance and those under insured get sick it will mean financial issues for hospitals and/or massive bailouts by government for hospitals coupled with financial ruin for those young workers that would almost certainly be burdened by those unpaid hospital bills for a decade or more.

RE: A More Surgical Approach to the Crisis? - burger - 03-24-2020

This is an op-ed by Tom Friedman which I mentioned yesterday in a comment that has probably already scrolled off the first page here. As far as I'm concerned, he's one of the stupidest people writing on any op-ed page and hasn't had a good or original idea in decades.

MT pointed out the stupidity of this idea . It's the same idea being floated by Trump (who wants to reopen the economy in "weeks not months") and others, all conservatives. Dan Patrick, Lt. Governor of Texas (Republican) took it to its logical conclusion and suggested that grandparents should sacrifice their lives so that their grandkids can have a better economy. I guess money is more important than lives to these people.

And that's not to mention that if we do open things up again and loads of people start getting sick, people will voluntarily stay home even if not forced to, and the economy will still tank. The only outcomes here are: 1) bad economy + relatively few lives loss or 2) bad economy + even more lives lost. Anyone arguing otherwise has no idea what they are talking about.

RE: A More Surgical Approach to the Crisis? - donkey687 - 03-24-2020

If you don't social distance and let it play through, there will be about 2 million more American deaths. That is more deaths than the number of Americans who have died combined in every war in the history of the USA. I think we can handle staying home for two months and a temporarily soft economy to save 2 million lives. We can do this.

RE: A More Surgical Approach to the Crisis? - 2006alum - 03-24-2020

We should also be wary of any models that require optimistic assumptions about CFRs and don't also incorporate other loss of life associated with overrun hospitals. There is lots of good reason to think that once hospital systems get overrun, a lot of non-COVID-19-infected individuals are also put at higher risk of death. See these unfortunate stories, for example:

[tweet]https://twitter.com/Mtneedle/status/1242489534513807361?s=20[/tweet]

[tweet]https://twitter.com/DellAnnaLuca/status/1242298460251910144?s=20[/tweet]

This thread is also very helpful in clarifying why our assumptions about loss of life associated with the virus may be faulty, because we are assuming that the reported data is an accurate picture of the virus's impact:

[tweet]https://twitter.com/DellAnnaLuca/status/1242298444716228608?s=20[/tweet]

RE: A More Surgical Approach to the Crisis? - oldalum - 03-24-2020

(03-24-2020, 07:43 AM)burger Wrote: And that's not to mention that if we do open things up again and loads of people start getting sick, people will voluntarily stay home even if not forced to, and the economy will still tank.

Yes! It's not an either/or scenario. There is a spectrum of risk of opening up society prematurely, re-energizing the spread of the virus, and requiring an even longer and stricter shut-down to regain control of it. This is going to be a very tough call to make, with enormous consequences for getting it wrong on the side of opening up too soon. And getting people to stay at home twice is a much tougher route (and deadly politically) than doing it once for longer than one might prefer in terms of the economy.

(03-24-2020, 12:45 AM)82 Card Wrote: How does concentrating testing on the vulnerable protect the vulnerable. By the time they test positive, its too late without a treatment. Is the idea to send all vulnerable groups to concentration camps and weed out anyone that tests positive? . . . Are the younger people that do get severe symptoms just going to be on their own?

Yes, he would enroll the vulnerable in treatment trials, but that doesn't mean the treatment would be effective (and some wouldn't get the experimental treatment anyway). And letting the virus run through the non-elderly non-sick population would overwhelm hospitals: as reported in the NY Times, a study of the first 2500 reported cases in the U.S. showed:

"But of the 508 patients known to have been hospitalized, 38 percent were notably younger — between 20 and 54. And nearly half of the 121 patients who were admitted to intensive care units were adults under 65, the C.D.C. reported."

I think the proposal is incoherent.

RE: A More Surgical Approach to the Crisis? - BostonCard - 03-24-2020

Also worth noting that older patients need to go to the hospital for other issues. Heart attacks, for example, don't stop happening just because of coronavirus. Patients who enter a hospital that is full of sick younger people who will survive but eat crucial resources won't do well, and more importantly, will be at very high risk of acquiring Covid-19 while in the hospital. In Italy, there are a ton of coronavirus infections among healthcare workers (something like 10%).

BC

RE: A More Surgical Approach to the Crisis? - chrisk - 03-24-2020

(03-24-2020, 10:59 AM)BostonCard Wrote: Also worth noting that older patients need to go to the hospital for other issues. Heart attacks, for example, don't stop happening just because of coronavirus. Patients who enter a hospital that is full of sick younger people who will survive but eat crucial resources won't do well, and more importantly, will be at very high risk of acquiring Covid-19 while in the hospital. In Italy, there are a ton of coronavirus infections among healthcare workers (something like 10%).

BC

Now Trump is saying he would like to have it "open" by Easter (April 12)

RE: A More Surgical Approach to the Crisis? - Goose - 03-24-2020

(03-24-2020, 07:43 AM)burger Wrote: And that's not to mention that if we do open things up again and loads of people start getting sick, people will voluntarily stay home even if not forced to, and the economy will still tank. The only outcomes here are: 1) bad economy + relatively few lives loss or 2) bad economy + even more lives lost. Anyone arguing otherwise has no idea what they are talking about.

I simply don't believe you really mean there are only two possible outcomes. The "outcome space" has lots of possibilities. Some of them trade off economic consequences against deaths. Characterizing these outcomes has to take into account that these are not linearly dependent on each other. Bad economic conditions can cause deaths, and deaths can cause bad economic conditions in non-linear ways. Avoiding health care system saturation is one such non-linearity. If you were correct, and there were only two possible outcomes, life would be easy. If we even really knew what the interactions of the two would be, it would be easier. Unfortunately, we don't even have a probability density function for these things, as this type of event hasn't happened in the USA for at least 100 years. Even then, the conditions were so different that it is dangerous to extrapolate to today, and it is a N of 1.

RE: A More Surgical Approach to the Crisis? - burger - 03-24-2020

(03-24-2020, 10:59 AM)BostonCard Wrote: Also worth noting that older patients need to go to the hospital for other issues. Heart attacks, for example, don't stop happening just because of coronavirus. Patients who enter a hospital that is full of sick younger people who will survive but eat crucial resources won't do well, and more importantly, will be at very high risk of acquiring Covid-19 while in the hospital. In Italy, there are a ton of coronavirus infections among healthcare workers (something like 10%).

BC

I recall reading that some country (China?) designated some hospitals as covid-19 hospitals and others for "regular" illnesses to keep the infected and vulnerable apart. Is anyone discussing that here, and if not, why not? In an emergency, surely, the government should be able to dictate which hospital does what.

RE: A More Surgical Approach to the Crisis? - 2006alum - 03-24-2020

(03-24-2020, 11:06 AM)burger Wrote: I recall reading that some country (China?) designated some hospitals as covid-19 hospitals and others for "regular" illnesses to keep the infected and vulnerable apart. Is anyone discussing that here, and if not, why not? In an emergency, surely, the government should be able to dictate which hospital does what.

FWIW, Newsom has leased two empty (private and recently furloughed) hospitals specifically for COVID-19 patients. And I believe the Javits Center in NYC is also being converted for use for COVID-19 patients. One of the most effective things China did was to separate COVID-19 patients from all others, because, as Italy has learned the hard way, one of the chief modes of transmission is in hospitals.

RE: A More Surgical Approach to the Crisis? - fullmetal - 03-24-2020

I believe the Navy's mercy ships (hospital ships) are being stationed and prepped to handle non-covid cases. I would hope the national guard and any other military medical units would/could do the same in that those units would be in their element and not exposed to covid.

We can't let the virus burn through the population. We don't even know who's vulnerable and who isn't -- it's the younger people who we'll miss, thinking they're less vulnerable. Also, when the healthcare system gets overwhelmed, we'll start losing doctors, nurses, RTs, and techs, which will destabilize our ability to respond as well as gut the healthcare provider population in America where we were already facing a nursing shortage (and we don't graduate enough doctors as it is).

No economist I know is advocating anything less than "get this under control immediately," whether by quarantine, shelter-in-place, etc. (The longer we drag this out, the worse the damage!) No economist is advocating for half-hearted measures. We can point at the economic consequences all we want, but that does not change our best and only option.

RE: A More Surgical Approach to the Crisis? - Mick - 03-24-2020

(03-24-2020, 11:04 AM)Goose Wrote: Some of them trade off economic consequences against deaths.

We trade off economic consequences against deaths all the time. The side effects of guns, cigarettes, alcohol, even automobiles...all of them play a part in massive numbers of deaths each year. Medicine comes with side effects. Sometimes they're worth it, sometimes not.

https://youtu.be/eSdNMRtvq5g?t=84

RE: A More Surgical Approach to the Crisis? - Goose - 03-24-2020

(03-24-2020, 11:28 AM)Mick Wrote:
(03-24-2020, 11:04 AM)Goose Wrote: Some of them trade off economic consequences against deaths.

We trade off economic consequences against deaths all the time. The side effects of guns, cigarettes, alcohol, even automobiles...all of them play a part in massive numbers of deaths each year. Medicine comes with side effects. Sometimes they're worth it, sometimes not.

https://youtu.be/eSdNMRtvq5g?t=84

For sure. Even in the best case, these trade offs are not simple. In this case, nobody really knows much about how long we need to do the shut-down and distancing to achieve what level of residual disease. We also don't know exactly how to reverse the process safely. In this case, the medicine for sure has major side effects. We are doing an experiment. No other nation has exactly our disease profile. California certainly has a different profile than New York, and the mitigation steps were different. Decision making in this case will be difficult at best.