2020 Dumpster Fire (Enter at your own risk)

[wasmania]

1 minute ago, NDSU grad said:

So are you advocating for daily, rapid testing?  As far as I know Abott Laboratories has the only rapid test available, and it's only available in a medical setting.  And this technology is only a month old so I don't know if it's as accurate as PCR based testing.  IMO, a vaccine will come before that kind of testing becomes available.

not so much advocating as resignedly accepting that our lifestyles will likely need to change until vaccine or effective treatment is developed.   Maybe for a deeply rural state like North Dakota people will resist this consequences be damned, but the tone elsewhere, especially  in the major cities  and among those folks who can choose whether to use  public transport,  go to big events, travel freely, there is likely to be alot of people who simply will not resume their past behavior.  So back to normal may be kind of moot.  UND hockey will still sell out.  Will Madison Square Garden?  Business economics will change given the consumer behavior changes.   Calls to 'open up the states' by decree don't seem to get this.  

[802Sioux]

90 positives in North Dakota today. 68 in Grand Forks county. 

[dynato]

13 minutes ago, NDSU grad said:

So are you advocating for daily, rapid testing?  As far as I know Abott Laboratories has the only rapid test available, and it's only available in a medical setting.  And this technology is only a month old so I don't know if it's as accurate as PCR based testing.  IMO, a vaccine will come before that kind of testing becomes available.

Daily, rapid testing, that shows if you have it currently, or in the past, would speed up the process to opening dramatically. There would be less guessing and more confidence in the Cases-> Hospitalizations -> deaths. The total cases would go up, hospitalizations would remain near the same, death rate would fall significantly. A better, conclusive argument for re-opening and isolating the sick and vulnerable is formed. Currently, people are simply guessing what the infection rate is beyond positive tests, which is not enough evidence to make a major change. 

[dynato]

2 minutes ago, 802Sioux said:

90 positives in North Dakota today. 68 in Grand Forks county. 

Oh great. Now the models are going to freak out. I thought ND was immune to exponential growth? 

[wasmania]

12 minutes ago, Siouxphan27 said:

So if the models usefulness currently can be described as "not very", what is the point of constantly defending their results?   Instead of the roller coaster of calm and fear they are currently providing, why don't they just wait with the announcements until they can provide some useful stats with a margin of error something less than 1000's of percent?     

Defending the process of epidemiology is not the same as defending  results. The process is scientific method.  The results are what they are, objectively calculated given the data at hand but innacurate.   If by stating the obvious over and over, that the models are misspecified and wont be as accurate as you want until the data matures is 'defending the models', what do you want, should I join the tantrum and the conspiracy mongering?

[Nodak78]

10 minutes ago, dynato said:

We need a link showing sample size and confidence intervals in their estimate of 85 times higher. If the range is 2 to 85 times higher, and you are using the 85 times higher to fit your narrative, that needs to be stated. If it is an educated guess, that needs to be stated. Establish credibility and people will change their mind and believe you.

There is no doubt that the infectious rate is likely higher than what is being reported. To say this though you would also have to admit there is a possibility of deaths being missed as well. The only way to definitively prove this is widespread testing. Based on current reporting trend, the USA simply does not have capacity to run more than 30k tests a day. This is our limiting factor. 

The IHME are projections based on assumptions and current data (within several days recent). The "maybe possible" bit about opening up has always been tacked on there, so do not get angry that you are finally getting around to reading the model in detail. This is why I said lobby your governor, because he makes the final call. They will only make the call if enough people with valid concerns pressure them. 

I said before that ND will be one of the last to get hit. LM Windpower just faced an outbreak and Altru is already worried about their capacity. If Grand Forks community members need to be shipped down to the Fargodome for care, the sentiment will likely change.

This just in: Wyoming had zero covid deaths last year and zero covid deaths this year. This obviously can only mean one thing. They are immune to dying from the virus! 

I think Oxbow is quote the study I linked to yesterday.  You Pooh poohed.  I'm on my phone and don't have time to find it.  It is 2 or 3 pages back.  Looks like a good study.  It is looking for peer review.  You try and help.

[Siouxphan27]

2 minutes ago, wasmania said:

Defending the process of epidemiology is not the same as defending  results. The process is scientific method.  The results are what they are, objectively calculated given the data at hand but innacurate.   If by stating the obvious over and over, that the models are misspecified and wont be as accurate as you want until the data matures is 'defending the models', what do you want, should I join the tantrum and the conspiracy mongering?

I think people are arguing two different points here.   Some are saying the modeling thus far is useless as it changes dramatically every day.  I don't think those same people are questioning the capability of the epi's; they're just questioning the value of their current info.  Others like yourself are taking great offense to this.  For what reason, I have no idea.  

Providing useless info over and over again will eventually result in lost confidence, and people will respect their info about as much as the boy who cried wolf.  

[wasmania]

4 minutes ago, keikla said:

I made a conscious effort to make medical posts as understandable to everyone as possible.  Even then, I'm sure there were terms that most people didn't understand (i.e QTc prolongation).  There were terms Yzerman used in relation to finance/insurance that went totally over my head.  The difference between those instances and what you've been doing is that we're not being a condescending twat whenever someone not in the specified field doesn't fully understand and/or asks a follow up question.

there is truth to this, the condescension, driven perhaps wrongly by assuming most questions posed were not really seeking an answer but expressing rage at being bottled up, anger over people from away making decisions that impact them, etc.   But the language - this is statistics and science after all.  Is the term 'asymptomatic' or 'confidence interval'  really just me boasting about my education, or might it be common language that needs to  understood (and googled if need be) before an answer is understood.  I'm being honest here I'd like your advice on this.

[dynato]

Just now, keikla said:

Legit, honest question....who would be doing this daily testing?  Everyone individually?  If general patient compliance is any indication, it's safe to say 20%-40% of people wouldn't consistently do the testing.

That is where the argument for more widespread testing falls apart. My point was we want to say, with utmost confidence, that the infection rate is much, much larger than what is being reported. But in order to have that evidence/confidence, we need a significant increase in testing. A significant increase in testing of the masses is likely not achievable. Which leads us to the position we are in now: being hopeful that the infection rate is higher without any great proof that it is for the time being.

If I were a government official, I would not know how to approach this mess besides only using concrete numbers that have been reported by medical professionals and waiting for the down-tick in hospitalizations to discuss the transition to opening up. 

[NDSU grad]

32 minutes ago, dynato said:

Daily, rapid testing, that shows if you have it currently, or in the past, would speed up the process to opening dramatically. There would be less guessing and more confidence in the Cases-> Hospitalizations -> deaths. The total cases would go up, hospitalizations would remain near the same, death rate would fall significantly. A better, conclusive argument for re-opening and isolating the sick and vulnerable is formed. Currently, people are simply guessing what the infection rate is beyond positive tests, which is not enough evidence to make a major change. 

I don't doubt what you say is true, I just don't think it's realistic.  There won't be a rapid test one can use in the home, and you would need 9.9 billion kits/month if you tested every single person daily in the U.S. for 30 days.  I believe Abbott laboratories said they would have 2 million rapid test kits available for the entire month of June.  

[iramurphy]

43 minutes ago, Oxbow6 said:

.....meanwhile since the healthcare systems are almost singlely focused on COVID and patients are fearful from the hype to seek care diabetics will need amputations as their foot ulcers worsen, people will experience permanent vision loss because they can't get their injections for exudative macular degeneration and orthopedic patients who need a total knee replacement wind up falling and now require surgery to boot for a torn rotator cuff injury.

Points well taken. The reason for stopping elective surgeries was to preserve PPE’s and medications necessary for intubation. If we reach a time when we have adequate supplies and meds, I would strongly recommend resuming all necessary medical procedures. We never stopped seeing patients in our clinic,? but we see patients by appointment only and screen for potential Covid patients at time of appointment. . They are all screened at the door including temperature screening, when they get to the clinic. Anyone with upper respiratory illness/fever etc is diverted to a designated area at our clinic/hospital facility 15 min away. We are all screened daily for fever or respiratory/flu symptoms at the door before we come in to the clinic. Patients are probably safer coming to the clinic compared to Walmart or grocery store. There is no reason for patients to neglect their health. They should keep their routine appointments for physicals, chronic illnesses and be seen for acute care problems. We do virtual visits and verbal visits for those who don’t want to come in. That doesn’t guarantee no risk, but it minimizes risk. For the patients you refer to, it is probably riskier to neglect their routine chronic care follow up.  
I would also reopen dental offices. Neglected dental care can lead to other health care issues. Dentists and their assistants have gowned, gloved, worn masks and shields long before Covid. If they screen like we do it should minimize risk. 

[NDSU grad]

33 minutes ago, dynato said:

Daily, rapid testing, that shows if you have it currently, or in the past, would speed up the process to opening dramatically. There would be less guessing and more confidence in the Cases-> Hospitalizations -> deaths. The total cases would go up, hospitalizations would remain near the same, death rate would fall significantly. A better, conclusive argument for re-opening and isolating the sick and vulnerable is formed. Currently, people are simply guessing what the infection rate is beyond positive tests, which is not enough evidence to make a major change. 

In browsing Abbott's website something that caught my eye was that they would have 20 million antibody tests available sometime in June.  The antibody test will only determine if you've had the virus at some point in the past, not if you currently have it.  That may be more important than testing if you currently have the virus.

[NDSU grad]

Question for any medical professionals.  Let's say my antibody test comes back positive for Covid.  Let's assume I was completely asymptomatic, and let's also assume re-infection is not possible.  Can I still be a carrier for the virus?

[Cratter]

Gov. Walz issued an executive order allowing people to go golfing, fishing, boating, off road fun.

Summer is open in Minnesota!

Although camping still illegal in Minnesota. 

[90siouxfan]

https://www.npr.org/sections/coronavirus-live-updates/2020/04/17/836747242/in-south-korea-a-growing-number-of-covid-19-patients-test-positive-after-recover

 

way out of my depth, but wanted to contribute, flame away

[iramurphy]

55 minutes ago, wasmania said:

there is truth to this, the condescension, driven perhaps wrongly by assuming most questions posed were not really seeking an answer but expressing rage at being bottled up, anger over people from away making decisions that impact them, etc.   But the language - this is statistics and science after all.  Is the term 'asymptomatic' or 'confidence interval'  really just me boasting about my education, or might it be common language that needs to  understood (and googled if need be) before an answer is understood.  I'm being honest here I'd like your advice on this.

I think Keikla understands confidence intervals as well as asymptomatic. You have made a very valid point in that the important information being gathered by epidemiologists/statisticians is in a state of flux. I’m not sure until one reviews all of the variables, parameters etc that we can reach conclusions but I think that is one of the points you and others are debating. Unfortunately, that makes it almost impossible for the government leaders to know what to do next. 

[Oxbow6]

If.....big if.....early antibody testing continues to reveal a 20x, 50x, 85x higher infectious rate than thought at what point does trying to develop some herd immunity come into the conversation? 

Fauci has mentioned multiple times he thinks 25-50% of the infected are asymptomatic.

[iramurphy]

31 minutes ago, keikla said:

It depends.  We're still trying to determine how long before and after an infection someone is infectious, because we honestly don't know yet.  If the antibody test comes back positive, but you were always asymptomatic, it's possible you could be covid positive (and therefore a risk to others) at that very moment.

Correct. The other issue is that we need to figure out what the antibody testing tells us. We test for IgM and IgG antibodies. Results can vary. Patient can be positive for IgM and negative for IgG. Does that mean they have the disease but aren’t yet immune?  If positive for both antibodies does that mean infected and now immune?  If positive for IgG only can we conclude anything?  In South Korea they have over 150 patients who had Covid recovered and are now positive for Covid again. That is why we are struggling medically and why the decision makers are struggling. We just don’t know. 

[FSSD]

13 hours ago, UNDlaw80 said:

Cuomo explains why he asked for so much equipment.  

 

It was pure political theater.  When I heard about his request for 30,000 ventilators.  It took about 5 minutes of searching to find that the national reserve had 12,700 ventilators at the start of this mess.  He was publicly asking for the impossible and he knew it.  And of course Trump walked right into it..

[wasmania]

29 minutes ago, iramurphy said:

I think Keikla understands confidence intervals as well as asymptomatic. You have made a very valid point in that the important information being gathered by epidemiologists/statisticians is in a state of flux. I’m not sure until one reviews all of the variables, parameters etc that we can reach conclusions but I think that is one of the points you and others are debating. Unfortunately, that makes it almost impossible for the government leaders to know what to do next. 

Yes I know he understands but I'm being criticized for talking down to the average joe on this site, which I cop to but also want to note that the subject matter is inherently complex.  Perhaps my hot button is that some posters seem to want to conflate the nature of the epidemiology beast with malevolent intent and/or sheer incompetence of the epidemiologist.  If I didnt feel like I was battling that, perhaps it would be easier for me to tone it down.

[iramurphy]

2 minutes ago, FSSD said:

It was pure political theater.  When I heard about his request for 30,000 ventilators.  It took about 5 minutes of searching to find that the national reserve had 12,700 ventilators at the start of this mess.  He was publicly asking for the impossible and he knew it.  And of course Trump walked right into it..

Well, we went went for an hour or two before someone felt the need to inject politics. 

[SWSiouxMN]

Speaking of Models.  This tweet thread gives an explaination into the one MN is using. 

 

[NDSU grad]

24 minutes ago, iramurphy said:

Correct. The other issue is that we need to figure out what the antibody testing tells us. We test for IgM and IgG antibodies. Results can vary. Patient can be positive for IgM and negative for IgG. Does that mean they have the disease but aren’t yet immune?  If positive for both antibodies does that mean infected and now immune?  If positive for IgG only can we conclude anything?  In South Korea they have over 150 patients who had Covid recovered and are now positive for Covid again. That is why we are struggling medically and why the decision makers are struggling. We just don’t know. 

Regarding the South Korea cases, are they testing positive and showing symptoms or testing positive and asymptomatic?  The latter would not surprise me at all.  But that would probably mean they have the possibility of infecting others.

[UND1983]

 

[Oxbow6]

10 minutes ago, keikla said:

Couple things related to this:  have they developed a more accurate antibody test?  Last I saw was that most antibody tests weren't very accurate because they were cross-reacting with more common coronavirus strands that are prevalent in kids.

The other part of this is that herd immunity assumes people can't get reinfected.  Otherwise everyone is still always at risk.

The most frustrating part of all of this is that so much is still unknown.  Projection models are wrong because we find out new information about the virus and the spread every day.  Treatment models continue to be proven wrong, as we find out new information about disease presentation every day.  Plans for using antibody testing to open up society are also built on the assumption that reinfection (or reactivation of a dormant virus such a mono or shingles) are not a factor.  I'm not saying this to say we should never open up society, but I'm saying it is very well likely going to be an ongoing process of trial and error, protraction and retraction to find what works.

So I have read on this thread the infectious positive testing....... inaccurate. The antibody testing..... inaccurate. Any model one can review is bipolar.... inaccurate. Yet unemployment is around 13%. When do kids get to be kids again? When do they go back to school? When is the unemployment rate going to go down into single digits instead to climbing to 20%?