Miscellaneous And Off Topic Subjects

[froot loops]

Ultimately opening back up is going to be a long slow slog but I think a lot of the social distancing most of the public is doing is going to ensure that it won't come back as fierce. We still are lacking in supplies, there should be so much hand sanitizer and masks available that Amazon will need huge gigantic warehouses to store them.

I still worry about the hospitals, they survived the surge by maximizing everything available but that is not a long term strategy. These systems are going to go bankrupt.

[Dr. Strangelove]

This is perhaps the first well reasoned opinion piece, well, at least the first I've seen and you know I've been looking, that calls for something different for places that aren't "packed in a sardine can" like NYC. He's advocating for mitigated reopening where appropriate with testing scaled to the resources that are currently available. I have a particular kinship with this author's views.

"The US can't continue to hold it's breath .........."

https://www.nytimes.com/2020/04/24/opinion/coronavirus-lockdown.html

There was also a late evening BBC piece asking if Sweden has taken the correct course. You all probably know that Sweden eschewed the rigorous lock-downs of the EU and other Scandinavian countries. Sweden isn't killing it but they are at the same levels or slightly below their contemporaries. It really didn't say anything startling so, no link. Basically it says it's too early to tell and time will reveal who dealt with the pandemic the best when considering the tensions between those on one side or the other of the lock-down, don't lock-down argument.

Who are you considering their contemporaries? They have way more cases and deaths than any other country in Scandinavia and only test people if they are experiencing severe symptoms. Their economy is not booming either; they are as bad off or worse than all their neighbors.

If you're comparing them to the UK, Italy, Spain, etc. well all I can say is that their population is maybe 20% of any of those. And a lot less dense.

COVID Deaths Per 1,000 people

Sweden = 0.208
Germany = 0.069
Denmark = 0.069
Norway = 0.037
Estonia = 0.035
Finland = 0.032
Poland = 0.013
Latvia = 0.003

[Jeff Buchanan]

Well, I should have linked the article. The point of it was not that Sweden is doing better than it's contemporaries but rather it has about the same trend lines as the UK and their Scandinavian contemporaries - and in this case the graphs use to make the point in the article were total deaths. Moreover, they've achieved about the same level of disease control as their contemporaries as measured by flattening trend lines albeit while experiencing more deaths without closing their schools or shuttering their economy:

Sweden.PNG
The article, nor did I attempt to say, look, Sweden is doing great without a lock down. It looks like Sweden made a trade off accepting more deaths as the cost of their strategy that didn't lock down their economy. You know, I'm in that same camp ........ the US is going to have to learn to live with COVID and it's consequences, including people dying, while reopening it's economic engines.

https://www.bbc.com/news/world-europe-52395866

[iam416]

Ultimately opening back up is going to be a long slow slog but I think a lot of the social distancing most of the public is doing is going to ensure that it won't come back as fierce. We still are lacking in supplies, there should be so much hand sanitizer and masks available that Amazon will need huge gigantic warehouses to store them.

I still worry about the hospitals, they survived the surge by maximizing everything available but that is not a long term strategy. These systems are going to go bankrupt.

A couple things.

(1) I think it's hard to overestimate how much we've changed our behavior in since March. So, I absolutely agree that social distancing and even masks are here to stay for a long time. And that will continue to keep this thing in the manageable category.

(2) The effectiveness of re-opening the economy is directly tied to how safe people feel. No government body is going to force people to go and mingle or go to restaraunts or whatever if they don't feel safe. That's going to be in play fo a long time.

(3) If hospital systems go bankrupt -- and I haven't a clue if they will -- then it's quite possibly due to the fact that they have prepared for a shit-ton of capacity that never came.

(4) Fingers crossed for Mrs. Froot. That sounds extremely promising.

[iam416]

The article, nor did I attempt to say, look, Sweden is doing great without a lock down. It looks like Sweden made a trade off accepting more deaths as the cost of their strategy that didn't lock down their economy. You know, I'm in that same camp ........ the US is going to have to learn to live with COVID and it's consequences, including people dying, while reopening it's economic engines.

This is exactly right. The people who are comparing Sweden to Norway are missing the fucking point. Or, even worse, they have the wrong point entirely.

Our entire approach to this pandemic is management. Try to avoid the surge. Try to keep our systems from being overrun. The approach is NOT to make sure no one gets the disease or to make sure as few as people as possible get the disease.

The question isn't whether a non-lockdown approach is causing more cases versus a lockdown approach. We know the answer to that. That's easy. The question is whether the non-lockdown approach has led to the catastrophic system overload that everyone feared. That's the fucking question.

Sweden is not overrun. Sweden's curve is starting to flatten. Both those absolute facts suggest the Swedish approach wasn't some sort of crazy ass idea. Now, whether that's translatable to the United States, I dunno. We are different countries.

[iam416]

I will say that it's gonna be hilarious watching all the Ds, who think we ought to replicate anything Sweden does in terms of massive government systems, scream "not comparable!" And, of course, vice versa.

Unlike massive systemic overhaul comparisons, I actually think there's some data points that are applicable. I don't think it'll be particularly instructive for the high population density areas, but density and population wise it may be fairly comparable to, e.g., Ohio. The density is harder to figure out because so many people live in like half the country. It's like, say, Quebec. I'm sure the population density is low because it's huge, but Montreal is a huge-ass, dense MSA.

Anyway, some of what comes from Sweden will probably be useful for SOME US decision-makers.

[Jeff Buchanan]

The impact of the changed behavior factor of consumers is huge. Business is already planning for it among their employees and consumers of their products (see my post yesterday). I find that encouraging especially as it relates to how businesses are adapting to a new global reality. There's going to be a lot of rearranging of the business landscape over the next 12-24 months.

While the stock market isn't always a great gauge of things, that it appears to have found a bottom and has now remained around its 12 month moving average would seem to me to signal investors feel while this isn't the boom times before COVID, neither is it 1929.

Re the folks reluctance to go out there eat, drink, be merry and buy stuff ....... here in S. FL and in GA too there's a lot of push back on reopening from local officials, this being driven by what kind of feed back they are getting from vocal residents and business owners. Miami-Dade's plan to reopen parks, golf courses, marinas and boat ramps hasn't happen despite the view that it would happen either Thursday or Friday last week. Push back against Governor Kemp's reopening plans in GA are significant in their impact. Right now paranoia predominates and, to a large extent,that is being stirred up by misleading media reports and the awful messaging from the WH.

In contrast, I've read a lot of good stuff about how many other countries have done a much better job of messaging, controlling the narrative, generally remaining positive and creating the image that the government is both in control and trustworthy. That's a big deal IMO and something sorely lacking in the US. That is feeding American paranoia, it's now set in stone, and it's not going to change unless something amazing happens. Little bits of good news are getting drowned out by bad news along with a sense that the US government is both untrustworthy and not at all in control of the situation.

All of that is bad news for any return to normalcy or, for that matter, even testing the waters. People are hunkered down, that behavior warranted or not, and likely to stay that way at least through early to mid-June, maybe longer.

[iam416]

Sorry. You can't have people enjoying outdoors. If you want that then BLOOD ON YOUR HANDS!

[froot loops]

A couple things.

(1) I think it's hard to overestimate how much we've changed our behavior in since March. So, I absolutely agree that social distancing and even masks are here to stay for a long time. And that will continue to keep this thing in the manageable category.

(2) The effectiveness of re-opening the economy is directly tied to how safe people feel. No government body is going to force people to go and mingle or go to restaraunts or whatever if they don't feel safe. That's going to be in play fo a long time.

(3) If hospital systems go bankrupt -- and I haven't a clue if they will -- then it's quite possibly due to the fact that they have prepared for a shit-ton of capacity that never came.

(4) Fingers crossed for Mrs. Froot. That sounds extremely promising.

On point 3 I can only speak for the Detroit area the surge did come and they were prepared for it, there was literally no way the hospital could have done business as usual and dealt with it. This meant only essential cases, no elective surgeries and no visitors. The hospital normally may have 20 ICU beds instead they had 80 setup and almost full. So it is this weird dynamic where the hospital appears to be a ghost town but has a lot of critical patients. The hospitals generally don't make the money from the ICU, it is from the elective surgeries.

Some hospitals in the same systems didn't get the patients initially until they were transferred over. It's not a sustainable model. In the future they will have to get more efficient at how you deploy the resources to ramp up capacity without killing other aspects of the operation but I think you are making gains at the margins.

Beaumont and Henry Ford have already laid off thousands.

[Jeff Buchanan]

The financial straights that some of the nation's biggest hospital systems will find themselves after COVID is demonstrative of how poorly the US's HC system is equipped to deal with something like this. Clearly, going forward you don't redesign your HC system model for a single black swan event that is unlikely to repeat itself while at the same time be met with the lack of preparedness in that system demonstrated in COVID. It did show it's resilience though I'd rather see better coordinated and implemented plans in place from the federal level down.

Just as clearly the current free market system has to adapt to that contingency. The worry is that the environment will be perfect for liberals to call for its nationalization. That would be a mistake. What we should be looking at is a greatly expanded US PHS that could provide fee free basic health care services greatly expanded from what it is now. The infrastructure is there. It needs to be resourced. IOW something that looks like the UK's public NHS underpinning a private system. The UK system actually has the private system doing that. I'd reverse it.

Along with that, free market hospital systems need the ability to flex capacity for the next pandemic. I'd consider having a state's PHS fall-in on and collaborate with the physical and resource expansion that a subsidized free market system would provide.

[Jeff Buchanan]

This is good stuff. Released this morning based on 4/22 data. I've been following it for a while and linked to it up thread.

It is the updated IMHE (U-Dub) model that provides predictions for planning purposes involving hospital (ICU, Beds) peak demand and peak deaths. It predicts a date at which locations in Europe and in the US by states can relax social distancing measures based on getting deaths down to what IMHE calculates is the number of deaths per day required to do that (0.3 deaths per million population). The model uses deaths as it's primary measure because deaths are more accurately reported than case numbers. Going into that calculation is assurance that the model is projecting a date where the spread of COVID is not only controlled but also completely contained. That is a high bar!

Lots of places have reached and are past the date of peak deaths and peak demand on hospital space (they did not calculate ventilator demand because data is unavailable). Wuhan China past that date long ago and if their reports are to be believed, the pandemic in China is contained. I tend to think it is given what I read.

Some other models use the date of peak deaths and a downward sloping spline of either total deaths (not a bad proxy) or total cases (a less good proxy becasue of variance in testing processes) to be sufficient to consider reopening. Not this one and the model does not care about total cases. The IMHE model suggests that social distancing is either completely on or completely off. It does not suggest intermediate levels of those things might make it OK to reopen. It is black and white. It does not say a state can't open but it's pretty clear that the modelers don't think the virus can be contained if states decide to open earlier than the IMHE model projected dates with other forms of mitigation measures in place (e.g., some level of social distancing implied). I don't have a problem with doing that.

If state PH authorities are using this IMHE model to advise state and local officials on reopening, and they probably are because it may be the best model out there, it might explain the reluctance of states to reopen, except GA among others that are getting ham-blasted for even considering let alone doing it like Governor Kemp of GA has done. So, there's probably some legs to that ham-blasting...... although I doubt that politicians or the media understand any of this. They're more likely to be pulling it out of their asses because, well, they heard something about this and politics..

IMO the risk/benefit calculation still pertains. According to the article I obtained the link from (2nd link below), the IMHE modelers are getting calls from states asserting we think we can do better; can you model, say 1 or 2 deaths per 1 million population and give us reopening dates? It's an interesting question and one that suggests that risk/benefit calculations are being run by decision makers and, it would seem to me, reflects a trend for the need for perfect data - or as perfect as is possible. Given our discussions of the current BLOOD ON YOUR HANDS narrative for any governor or mayor that says it's time to reopen, I get it.

BTW, FL's IMHE date for relaxation of social distancing measures, based on the current data, is June 14th. These dates can change as data is received and the model is refined.

https://covid19.healthdata.org/united-states-of-america

https://www.npr.org/sections/health-shots/2020/04/25/844088634/when-is-it-safe-to-ease-social-distancing-heres-what-one-model-says-for-each-sta?utm_medium=RSS&utm_campaign=news#table

[Dr. Strangelove]

TMZ isn't right 100% of the time but...

There's been rumors about him being dead for days. He hasn't been seen in public for weeks and didn't appear at the country's "Founding Day" celebrations.

https://www.tmz.com/2020/04/25/north-korea-dictator-kim-jong-un-dead-dies-heart-surgery-reports/

[iam416]

[Dr. Strangelove]

Either his sister takes over or the military finally stages a coup against "da family". Not sure which outcome is better.

[iam416]

I doubt any outcome improves things much.