Neverending Covid-19 Coronavirus

My mom's 68 year old 1st cousin is a family physician (and a good one). She posted this on Facebook while practically begging people to read it.
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From a group of 50 Brookline, MA physicians (sigs at the bottom):

“As there is so much confusion, misinformation and denial on social media about the coronavirus we hope to explain, in plain language, why the experts see this as such an emergency. Many people are reading the claim online that this virus is a lot like the viruses that cause colds, and that if you get it, it will probably just seem like a bad cold and you are very unlikely to die. Depending on who you are, this may be true, but there is more to this story that is key to our outcome as a community.

This is a coronavirus that is new to the human population. Although it is related to the viruses that cause colds, and acts a lot like them in many ways, nobody has ever been exposed to this before, which means nobody has any immunity to it.

The virus is now moving explosively through the human population, spreading through respiratory secretions and 10 times more contagious that the flu or cold. Although many people will recover, about 20% will wind up with a serious pneumonia that will require hospitalization. Some will be so ill from the pneumonia that they will die. We estimate this may be 2-3%, but it is higher in Italy’s experience, partially because the healthcare system was overwhelmed so rapidly. In those over age 70, the death rate is 8-20%.

So if a child catches it on a playdate, they can easily transmit it to their grandmother as easily as touching the same doorknob or countertop.

Scientists measure the spread of an epidemic by a number called R0, or “R naught.” That number is calculated this way: for every person who develops the illness, how many other people do they give it to before they are cured (or dead) and no longer infectious? The R0 for coronavirus appears to be a number close to 3 – an extremely frightening number for such a deadly disease.

Suppose you catch the virus. You will give it to 3 other people, and they will each give it to three others, and so forth. Here is how the math works, where you, the “index case,” are the first line:
1
3
9
27
81
243
729
2,187
6,561
19,683
59,046
177,147
531,441
1,594,323
4,782,969
14,348,907
So, in just 15 steps of transmission, the virus has gone from just one index case to 14.3 million other people. Those 15 steps might take only a few weeks. With school out and lots of playdates, maybe less. The first person may be young and healthy Brookline child, but many of those 14 million people will be old and sick, and they will likely die because they got a virus that started in one person's throat.

R0 is not fixed – it can be lowered by control measures. If we can get the number below 1, the epidemic will die out. This is the point of the quarantines and social distancing, but we are not doing it fast enough.

In the US, we have to slow down the virus. American hospitals, Boston hospitals, have limited resources. We have a fixed number of ventilators and an impending calamity on our hands. Our Italian critical care colleagues have shared with us that they simply do not have enough resources (ventilators, physicians and nurse, critical care beds), and are forced to choose who lives and dies based on old tenets of wartime triage.

Older patients do not even get a ventilator and die of their pneumonia. These are decisions nobody should have to face, and we are only 11 days behind Italy’s fate. Their hospitals are quite advanced, and we are no better in Boston. As doctors, we are desperately trying to prepare for the onslaught of patients in the coming weeks. It is already beginning. This is an opportunity for you as the district leadership the time to be aggressive and help us fight this by “Flattening the Curve”.

We implore you, as a group of Boston’s doctors preparing to fight this, to help us. Please send a new email to ALL the Brookline school district families. Social distancing is painful. We know that kids have cabin fever, they are pleading to see their friends, they may have birthday parties coming up or special events they have been looking forward to. All of us need to work and childcare is a big worry. But we need to overcome these issues and boredom for the coming weeks so that we can survive this with as few deaths as possible. What does that mean?

1) No playdates, not even 1:1.
2) No small gatherings, no meetings between a couple families, even for birthday parties.
3) Avoid trampoline parks, climbing gyms, restaurants, movie theaters, anything in an enclosed area. Many of these places are advertising increased cleaning and hygiene. This is not sufficient! Do not go.
4) Cancel planned vacations for the next month. Avoid airline travel that is not an emergency. Many airlines and rental agencies are offering penalty free cancellations.
5) Stay at home as much as possible. Work from home if you possibly can. You may have to go buy groceries and medicine, of course, but make the trips quick and purposeful.
6) Wash your hands thoroughly after you have been in public places, for a full 20 seconds, soaping up thoroughly and being sure to get between the fingers.
7) Please avoid disseminating social media claims that the situation is not serious or is being exaggerated. This is a national crisis and conveying misinformation to your friends and family may put their lives in danger.

Thank you for taking the time to read this and stay safe and healthy in the coming weeks.”

Respectfully,
Erika Rangel, MD, Director of Surgical Critical Care, Brigham and Women’s Faulkner Hospital
Shawn Rangel, MD, Pediatric Surgery, Children’s Hospital Boston
Asaf Bitton, MD, Executive Director Ariadne Labs and Internal Medicine, BWH
Daniel O’connor, MD, Pediatrics, Longwood Pediatrics and Children’s Hospital Boston
Beth O’connor, MD, Pediatrics, Roslindale Pediatrics
Vandana Madhavan, MD, Clinical Director of Pediatric Infectious Disease, MGH
Parag Amin, MD, Pediatrics, Centre Pediatrics
Christy Cummings, MD, Neonatology, Children’s Hospital Boston
Eric Bluman, MD, Orthopedic Surgery, BWH
Trimble Augur, MD, Internal Medicine, Hebrew Rehabilitation Center
Dasha Weir, MD, Pediatric gastroenterology
Amy Evenson Warren, Transplant Surgery, BIDMC
William Oldham, MD, PhD, Pulmonary and Critical Care Medicine, BWH
James Kryzanski, MD, Neurosurgery, Tufts Medical Center
Ben Zendejas-Mummert, MD, Pediatric Surgery, Children’s Hospital Boston
Johanna Iturrino Moreda, MD, Gastroenterology, BIDMC
David Berg, MD, Cardiology and Cardiac Critical Care, BWH
Jennifer Crombie, MD, Hematology Oncology, BWH
Jenifer Lightdale, MD, Chief of Pediatric Gastroenterology, U Mass Memorial Hospital
Wayne Tworetzky, MD, Pediatric Cardiology, Children’s Hospital Boston
Elaine Yu, MD, Endocrinology
Jonathan Li, Infectious Disease
Nancy Cho, MD, Surgical Oncology, BWH
Eric Sheu, MD, Minimally Invasive Surgery, BWH
Reza Askari, MD, Director, Surgical Critical Care, BWH
Cindy Lien, MD, Internal Medicine and Palliative Care, BIDMC
Hannah Parker, MD, OB/GYN
Alysa E. Doyle, PhD, Center for Genomic Medicine, MGH
Christopher Smith, MD, Internal Medicine, Charles River Medical Associates, Wellesley, MA
Maya Greer, NP, Children’s Hospital Boston
Rusty Jennings, MD, Pediatric Surgery, Children’s Hospital Boston
Emily Oken, MD, Professor of Population Medicine, BWH
Chinwe Ukomadu, MD, Head of Clinical Hepatology, Novartis
Jennifer Kaufman, MD, Internal Medicine, BWH
Ann Poduri, MD, MPH, Pediatric Neurology
Susan Yehle Ritter, MD, Rheumatology
Diego Martinucci, MD Psychiatry, Atrius Health
Shih-Ning Liaw, MD, Pediatric Palliative Care, Dana-Farber Cancer Institute/Boston Children’s Hospital
Wolfram Goessling, MD, Gastroenterology and Oncology, MGH
Paola Daza, Pediatrics, MGH
Juan Matute, Neonatology, MGH
John Ross, MD, Internal Medicine, BWH
Megan Sandel, MD, Pediatrics, Boston Medical Center
Kathy Calvillo, MD, Surgery, BWH
Christine Greco, MD, Anesthesia, Children’s Hospital Boston
Niteesh Choudhry, MD, PhD, Internal Medicine, BWH and Harvard T.H. Chand School of Public Health
Chandru Krishnan, MD, Ophthalmology, Tufts Medical Center
Amy Ship, MD, Internal Medicine, Associate Director of Medical Education, Atrius Health
Yen-Lin Evelyn Chen, MD, Radiation Oncology, MGH
Daihung Do, MD, Dermatology, BIDMC
Chloe Zera, MD, MPH, Maternal Fetal Medicine, BIDMC
Alejandra Barrero-Castillero, MD, MPH, Neonatology, Children’s Hospital Boston
Jesse Esch, MD, Pediatric Cardiology, Children’s Hospital Boston
Alison Packard, MD, OB/GYN, MGH
Vik Khurana, MD PhD, Chief Division of Movement Disorders, BWH
Tu-Mai Tran, MD, MSc, Family Medicine, BMC
Yu Liu, MD PhD, Internal Medicine, Bristol Myers Squibb
Yih-Chieh Chen, MD
Lily Li, MD, Allergy and Immunology, BWH
 
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Today was day 1 of MA's shelter in place order.

NBC 10 just had a story on the impacts to the economy today. They interviewed several people who are not essential workers and are not able to work from home.

The majority of which found themselves laid off and/or furloughed today.

It is estimated that a few hundred thousand may have lost their job today across the state.

Companies are not keeping people are the payroll or giving paid leave during these hard times.
 
RenegadeMonster said:
Today was day 1 of MA's shelter in place order.

NBC 10 just had a story on the impacts to the economy today. They interviewed several people who are not essential workers and are not able to work from home.

The majority of which found themselves laid off and/or furloughed today.

It is estimated that a few hundred thousand may have lost their job today across the state.

Companies are not keeping people are the payroll or giving paid leave during these hard times.
Click to expand...
Most employers aren’t large companies or corporations with billions in cash reserves. Most people in this country actually work for what are considered small businesses. These businesses do not have the ability to spend months shut down and recover. A conservative estimate is that over 1 million small businesses in this country will not survive this. So the folks yes I’m including some of y’all in this category, who think the economy can weather a long-term shut down are just as ignorant (lack of knowledge, not dumb) as the people who think the virus is no big deal and everyone should all go back to normal tomorrow.

The economy isn’t Wall Street, it’s every day people going to work, buying goods, paying rent/mortgages and living their lives. A balance will have to be struck between the risks posed by the virus and the risks posed to the lives and livelihoods of tens of millions of people in this country. Where that balance is, I have no clue. What I do know is that just because someone is concerned about the economic impact all of this is having doesn’t make them a greedy monster obsessed with money. Many of them are just as concerned with their fellow citizens, They’re just looking at a different threat to them than you are.
 
Chucktshoes said:
Most employers aren’t large companies or corporations with billions in cash reserves. Most people in this country actually work for what are considered small businesses. These businesses do not have the ability to spend months shut down and recover. A conservative estimate is that over 1 million small businesses in this country will not survive this. So the folks yes I’m including some of y’all in this category, who think the economy can weather a long-term shut down are just as ignorant (lack of knowledge, not dumb) as the people who think the virus is no big deal and everyone should all go back to normal tomorrow.

The economy isn’t Wall Street, it’s every day people going to work, buying goods, paying rent/mortgages and living their lives. A balance will have to be struck between the risks posed by the virus and the risks posed to the lives and livelihoods of tens of millions of people in this country. Where that balance is, I have no clue. What I do know is that just because someone is concerned about the economic impact all of this is having doesn’t make them a greedy monster obsessed with money. Many of them are just as concerned with their fellow citizens, They’re just looking at a different threat to them than you are.
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I haven't seen a single person in here say that the economy can "weather a long term shutdown." Just that people don't believe we should let millions of people die to avoid severe negative impacts to the economy. Of course it will be a disaster, but not only is it horrific to suggest we let millions of people die, but the idea that if we just ignore it, and abandon any quarantine policies, the economy won't still be severely affected is ignorant as well.

The problem is, you can't strike a balance on quarantining. Unless you have sufficient testing early enough to only quarantine a few places. But we blew that, because we ignored it. If we half ass the quarantine, it is the worst of both worlds.
 
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Chucktshoes said:
Most employers aren’t large companies or corporations with billions in cash reserves. Most people in this country actually work for what are considered small businesses. These businesses do not have the ability to spend months shut down and recover. A conservative estimate is that over 1 million small businesses in this country will not survive this. So the folks yes I’m including some of y’all in this category, who think the economy can weather a long-term shut down are just as ignorant (lack of knowledge, not dumb) as the people who think the virus is no big deal and everyone should all go back to normal tomorrow.

The economy isn’t Wall Street, it’s every day people going to work, buying goods, paying rent/mortgages and living their lives. A balance will have to be struck between the risks posed by the virus and the risks posed to the lives and livelihoods of tens of millions of people in this country. Where that balance is, I have no clue. What I do know is that just because someone is concerned about the economic impact all of this is having doesn’t make them a greedy monster obsessed with money. Many of them are just as concerned with their fellow citizens, They’re just looking at a different threat to them than you are.
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The problem is that our government is not shutting down things NATION wide while implementing social safe guards (1k checks, a halt on mortgages and rent) and utilizing mass testing. Which most experts say is how you squash things and return to normalcy sooner than later.

Instead, states are doing their own thing (& enforcement is lax), Trump is intentionally limiting the production of key goods in an attempt to maximize profits for certain people, there has been nothing but talk as it pertains to helping normal people, the right continues to downplay the situation (which prevents the lockdowns of certain states from having the intended effect) and we are waaaay behind on testing.
 
dhodo said:
I haven't seen a single person in here say that the economy can "weather a long term shutdown." Just that people don't believe we should let millions of people die to avoid severe negative impacts to the economy. Of course it will be a disaster, but not only is it horrific to suggest we let millions of people die, but the idea that if we just ignore it, and abandon any quarantine policies, the economy won't be affected is stupid as well.
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What has been repeated here time and time again is that any time anybody expresses any concern about the economic impact of all of this is a monster who’s willing to sacrifice millions of elderly people for the sake of their portfolio. That view is just as ignorant and shortsighted as the folks who think it’s all much ado about nothing. There’s a lot of hysteria going around and I think everybody could do with taking about 20 to 25% off the top there Squirrley Dan.

It is absolutely a legitimate concern to worry about what happens when we come out the other side of this and anywhere between one 1/5 and 1/3 of our economy is gone.

In this nation we have transitioned to a service/consumer-based economy. This is all made very clear to me that is something we should seriously reconsider. I would go so far as to say that the manner in which we have outsourced manufacturing and supply chain logistics to the third world is a national security issue.
 
DownIsTheNewUp said:
The problem is that our government is not shutting down things NATION wide while implementing social safe guards (1k checks, a halt on mortgages and rent) and utilizing mass testing. Which most experts say is how you squash things and return to normalcy sooner than later.

Instead, states are doing their own thing (& enforcement is lax), Trump is intentionally limiting the production of key goods in an attempt to maximize profits for certain people, there has been nothing but talk as it pertains to helping normal people, the right continues to downplay the situation (which prevents the lockdowns of certain states from having the intended effect) and we are waaaay behind on testing.
Click to expand...
There are some very serious constitutional issues and questions regarding the ability of the federal government to take those actions. The reason why most of these actions are being taken at the state level is because that’s their job.
 
Chucktshoes said:
What has been repeated here time and time again is that any time anybody expresses any concern about the economic impact of all of this is a monster who’s willing to sacrifice millions of elderly people for the sake of their portfolio. That view is just as ignorant and shortsighted as the folks who think it’s all much ado about nothing. There’s a lot of hysteria going around and I think everybody could do with taking about 20 to 25% off the top there Squirrley Dan.

It is absolutely a legitimate concern to worry about what happens when we come out the other side of this and anywhere between one 1/5 and 1/3 of our economy is gone.

In this nation we have transitioned to a service/consumer-based economy. This is all made very clear to me that is something we should seriously reconsider. I would go so far as to say that the manner in which we have outsourced manufacturing and supply chain logistics to the third world is a national security issue.
Click to expand...

No one is saying anyone who is expressing any concern about the economic impact of this a monster or think they want to sacrifice millions of elderly.

We are only calling those out who are actually willing / saying we should sacrifice millions.

For example, Dan Patrick.

I'm very concerned about the economy myself. We should be looking for that fine line. I like Governor Cuomo's approach where he says we should test people and anyone who has the antibodies get back to work. We need to be smart about it.
 
Chucktshoes said:
There are some very serious constitutional issues and questions regarding the ability of the federal government to take those actions. The reason why most of these actions are being taken at the state level is because that’s their job.
Click to expand...

The problem with that is that certain states are literally incompetent. Take a look at these #'s:

Coronavirus Update (Live): 421,413 Cases and 18,810 Deaths from COVID-19 Virus Outbreak - Worldometer

Notice how we have a very small amount recovered compared to the the # sick? That's because we are early in the cycle of things compared to the other countries with high case #'s. Notice how we have double the amount dead to recovered? That should be closer to a 1:1 ration ESPECIALLY because we haven't yet hit the point where our hospitals are overwhelmed.

No matter how you slice it, we are doing an abusurdly poor job of handing things. In large part because Trump is anti-science and in large part because he is prioritizes the 1% and their wealth over all else. And the really fucked up part is that likely means the economic impact gets dragged out (while Trump and the right prioritize corporate bailouts- many of which are companies whose problems predate the virus- instead of helping working people). Which means not only do I have to worry about my life (as a 33 year old who takes care of myself but has respitory and auto-immune disorders) for the foreseeable future-- I also have to watch as a good chunk of my friends face potential homelessness for the foreseeable future.

Like nobody is saying the economic impact isn't dire. We are saying that it could have been blunted while flatlining the curve. But we are likely past that point now because of GOP incompetence.
 
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Chucktshoes said:
What has been repeated here time and time again is that any time anybody expresses any concern about the economic impact of all of this is a monster who’s willing to sacrifice millions of elderly people for the sake of their portfolio. That view is just as ignorant and shortsighted as the folks who think it’s all much ado about nothing. There’s a lot of hysteria going around and I think everybody could do with taking about 20 to 25% off the top there Squirrley Dan.

It is absolutely a legitimate concern to worry about what happens when we come out the other side of this and anywhere between one 1/5 and 1/3 of our economy is gone.

In this nation we have transitioned to a service/consumer-based economy. This is all made very clear to me that is something we should seriously reconsider. I would go so far as to say that the manner in which we have outsourced manufacturing and supply chain logistics to the third world is a national security issue.
Click to expand...
Again, I'm just going to say, I am very much worried about coming out the other side. I have investments that are my only current safety net, a significant percentage of my 401k is in a single company that has absolutely tanked. I am lucky enough to not be laid off yet, but I'm not sure what's going to happen in the coming weeks.

I haven't gotten the impression you have from people. What I've heard is people reacting to what the experts say will happen (millions of people dying) if we reopen the economy too soon. Yes the crash of the economy is horrible, for pretty much everyone except the idiots in charge, but the economy would still be crippled if hospitals are so overrun that thousands of people are dying per day due to lack of care, including from non-coronaviris related issues.

I agree with you at least on some degree about manufacturing even if we probably have different preferences about how to bring it back. I'm not sure that would significantly help this disaster though.
 
DownIsTheNewUp said:
The problem with that is that certain states are literally incompetent. Take a look at these #'s:

Coronavirus Update (Live): 421,413 Cases and 18,810 Deaths from COVID-19 Virus Outbreak - Worldometer

Notice how we have a very small amount recovered compared to the the # sick? That's because we are early in the cycle of things compared to the other countries with high case #'s. Notice how we have double the amount dead to recovered? That should be closer to a 1:1 ration ESPECIALLY because we haven't yet hit the point where our hospitals are overwhelmed.

No matter how you slice it, we are doing an abusurdly poor job of handing things. In large part because Trump is anti-science and in large part because he is prioritizes the 1% and their wealth over all else. And the really fucked up part is that likely means the economic impact gets dragged out (while Trump and the right prioritize corporate bailouts- many of which are caused by problems predating the virus instead of helping working people). Which means not only do I have to worry about my life (as a 33 year old who takes care of myself but has respitory and auto-immune disorders) for the foreseeable future-- I also have to watch as a good chunk of my friends face potential homelessness for the foreseeable future.

Like nobody is saying the economic impact isn't dire. We are saying that it could have been blunted while flatlining the curve. But we are likely past that point now because the GOP is shortsighted and anti-science.
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Both sides of the aisle have attempted to use this crisis for their own pet projects and policies. It’s fucking disgusting all the way around. So returning to the subject files being willing to sacrifice the elderly, to be perfectly blunt, it wouldn’t hurt my feelings a bit if Rand Paul managed to infect the vast majority of both houses of Congress and most of those fuckers didn’t fare so well.
 
Chucktshoes said:
Both sides of the aisle have attempted to use this crisis for their own pet projects and policies. It’s fucking disgusting all the way around. So returning to the subject files being willing to sacrifice the elderly, to be perfectly blunt, it wouldn’t hurt my feelings a bit if Rand Paul managed to infect the vast majority of both houses of Congress and most of those fuckers didn’t fare so well.
Click to expand...

By the way-- we 1000% agree on the need to bring manufacturing back into the US. That's been clear for a long time and I'm glad it's being exposed now. Where we likely disagree is that I would argue that this virus is making it clear that certain industries also need to be nationalized.
 
dhodo said:
Again, I'm just going to say, I am very much worried about coming out the other side. I have investments that are my only current safety net, a significant percentage of my 401k is in a single company that has absolutely tanked. I am lucky enough to not be laid off yet, but I'm not sure what's going to happen in the coming weeks.

I haven't gotten the impression you have from people. What I've heard is people reacting to what the experts say will happen (millions of people dying) if we reopen the economy too soon. Yes the crash of the economy is horrible, for pretty much everyone except the idiots in charge, but the economy would still be crippled if hospitals are so overrun that thousands of people are dying per day due to lack of care, including from non-coronaviris related issues.

I agree with you at least on some degree about manufacturing even if we probably have different preferences about how to bring it back. I'm not sure that would significantly help this disaster though.
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The medical experts say that if we don’t stay locked down the infection rates will soar and people will die. Economist say that if we don’t get back to work the economy will completely crash and people will die.

They’re both right.
 
DownIsTheNewUp said:
By the way-- we 1000% agree on the need to bring manufacturing back into the US. That's been clear for a long time and I'm glad it's being exposed now. Where we likely disagree is that I would argue that this virus is making it clear that certain industries also need to be nationalized.
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For once we have agreement. Both in the things that you think we agree and disagree on.
 
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