A question for Dr. John Carpenter

I just saw this for the first time, this morning, but this is pretty much where my line of thinking was taking me, yesterday. What do you think...does this look credible?:

https://threadreaderapp.com/thread/1239755910580322304.html?fbclid=IwAR3...

Here's our summary of this vitally important paper:

If no measures are taken... i.e. we carry on as normal

- 0.5 million people will die in the UK, 2.2 million in the US
- ICU's will be overwhelmed by 2nd week of April
- Demand for ICU's will reach 30x the available capacity
If basic mitigation measures are taken. These involve work / office continuing, social distancing of those over 70, isolating those who get sick, quarantine of family members.

- 250,000 deaths in the UK, around 1 million in the US
- ICU's overwhelmed 8x
If 'suppression' measures are taken. This is a full lockdown i.e. what is happening now

- Est. 25,000 deaths in the UK, 100,000 in the US
- ICU capacity should not be overwhelmed
- Huge economic effects
- On and off suppression needed until a vaccine is available (18 months)
Suppression is based on a 5 month initial lockdown. We know this paper has informed UK govt. policy - it says this, & is obvious from policies announced today - & we think it is for the US as well. This may explain Trump's messaging today that we are in this until July or August.
The most stunning conclusion is that suppression will need to stay in place until a vaccine is available, i.e. 18 months (EST.). Some on and off again restrictions are possible, albeit at the expense of some lives. The paper models this.

Summary: We'll be at home for a long time

It's looking a lot more grim than our governments have been telling us.

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Azazello's picture

based on what is happening in Italy. When ICU beds reach capacity there's talk about using empty schools or hotels as hospitals.
Are you working or has everything shut down at your company ?

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It didn't have to be this way.

Bisbonian's picture

@Azazello . I am supposed to be at work right now, but have a legitimate cold. Next week I will have to fly again, flying about 4-500 people a day to where they want to go, and walking past thousands more in the airport, hotels, restaurants, etc. If that doesn't change in the meantime, I won't be coming home with whatever I pick up.

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"I’m a human being, first and foremost, and as such I’m for whoever and whatever benefits humanity as a whole.” —Malcolm X

Azazello's picture

@Bisbonian
Self-quarantine in Phx. ?

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It didn't have to be this way.

Bisbonian's picture

@Azazello Still haven't fixed (or sold) the house in town, so I will go there, maintain some contact (not direct) with Taylor and her grand-daughter. Unless we all come down sick.

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"I’m a human being, first and foremost, and as such I’m for whoever and whatever benefits humanity as a whole.” —Malcolm X

In the first one we do not slow down the infection rate sufficient to stay out of ICU overload. Here are some simple numbers -
70% of US population will be infected until those with acquired immunity form a firewall.
330,000,000 * .70 = 231,000,000

Deaths as a percentage of all closed cases today 9%
(https://www.worldometers.info/coronavirus/#countries)

Total US deaths = 20,790,000

We can hope that the overall death rate in the US is much lower than the world death rate, but we do not have any good data. We will get that with time when the ratio of died to total outcome intersects with the ratio of died to infected. 9% CFR is considered too high. Initial WHO estimates were 3.4% and that's what the US was seeing initially. Wuhan China was 5.8% but other areas of China have clocked in at 0.7%, but their hospitals were not overwhelmed. My conclusion is that it is greater than 2 million and less than 20 million dead.

In the second case we do slow down the infection rate below hospital capacity. For the US this is a very low total instantaneous number of infections since we only have 2.7 hospital beds per 1000 people, and much of these are currently in use.

In this case the total number of ultimate cases is the same, it just takes longer. However you can assume a lower CFR - Case Fatality Rate, perhaps closer to 1%. In that case we are talking about 2 million deaths.

There are only two ways to stop this, that's a vaccine or it runs through the population. Making an effective vaccine will require good tech, lots of money and a huge helping of luck. There are some viruses that we have not been able to make a vaccine for -- the common cold for instance.

Trump has just changed his position on this. He was saying 14 day duration now he is saying July or August. Could it be that he wants it over and the economy recovered before the election? He also stated that he is not in favor of cancelling the election. He will change his mind on both of these issues as he runs fast and hard into reality. He stood at the podium and said not to get tested if you have no symptoms. Everyone behind him shook their heads yes in agreement. They are wrong! IF you know that you have been exposed to anyone with COVID-19 you need to be tested and self quarantine, not isolate, immediately as you are spreading viruses.

Of more interest to me is how do we adjust our lifestyles over these next 12 to 18 months? I think that we need to engineer new solutions to how we go about living our lives. Should we form small social groups where everyone agrees to be tested and to isolate? How do we deliver groceries? I don't want to handle anything passed to me by the delivery person. I would like to not treat all packaging as infected, but it looks like we need to. There will be many "leaks" with social distancing and we need to find them all.

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Capitalism has always been the rule of the people by the oligarchs. You only have two choices, eliminate them or restrict their power.

Bisbonian's picture

@The Wizard . Trying to come to grips with this going on for months and months, but that's what it's looking like.

We have washed the packaging of everything we have brought into the house. Time consuming...but we have lots of time.

What do you think of a vaccine produced by a company owned by a Trump relative?

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"I’m a human being, first and foremost, and as such I’m for whoever and whatever benefits humanity as a whole.” —Malcolm X

Roy Blakeley's picture

There are a lot of imponderables. The spread of the virus may be reduced in hot weather. As young people get it and get over it, they will probably no longer spread the disease. This is a rarely mentioned advantage of doing lots of testing. If you are young, get minor symptoms, get tested and test positive, you can be pretty sure that you will not get it again and will not spread it after a couple of weeks so you can resume a more or less normal life. The UK seems not to want to do as much testing as I think is necessary. South Korea has done massive testing, and the disease seems to be dying out there and they still have less than 100 deaths, I believe. With sensible leadership we could still get out of this with relatively few deaths. At some point there should be antibody tests that can determine if a person has had the virus. Will we have "I survived the virus" certifications that will allow people to get out and about? Just locking down without comprehensive testing and without a game plan can slow the virus, but yeah things will be shut down for a long time if that is the strategy. We should get serious about face masks as well. They may not keep one from getting the virus, but they should cut down on you spreading the virus.

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magiamma's picture

@Roy Blakeley
After getting it according to this. There may have been getting false positives or negatives though.

https://www.latimes.com/world-nation/story/2020-03-13/china-japan-korea-...

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Cant Stop the Macedonian Signal's picture

@magiamma

which may explain this, according to Dr. John Campbell.

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"More for Gore or the son of a drug lord--None of the above, fuck it, cut the cord."
--Zack de la Rocha

"I tell you I'll have nothing to do with the place...The roof of that hall is made of bones."
-- Fiver

PriceRip's picture

@Cant Stop the Macedonian Signal

          Virology is a nightmare for many reasons. One bit is in the next two paragraphs:

          Your bodies reaction to a particular virus triggers a process that includes constructing a mechanism that responds to future viral intrusions via "Key to Lock" "targeted" attacks. Just try to say (or type) that fast.

          If a subsequent intrusion's virus is vulnerable to that previously constructed mechanism, some members of the community may respond differently than other members of the community. So, the pattern of infection and outcomes may, or may not match projected expectations by the medical community.

RIP

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Hawkfish's picture

@magiamma

Says that these appear to be people who never quite got over the initial infection (ie took longer to clear the virus than usual).

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We can’t save the world by playing by the rules, because the rules have to be changed.
- Greta Thunberg

Cant Stop the Macedonian Signal's picture

@Hawkfish

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"More for Gore or the son of a drug lord--None of the above, fuck it, cut the cord."
--Zack de la Rocha

"I tell you I'll have nothing to do with the place...The roof of that hall is made of bones."
-- Fiver

Roy Blakeley's picture

@magiamma The positive retest frequency is very low (0.2%) and is probably due to people being released from hospital before they were fully recovered. This low frequency would not negate any of my comments.

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Raggedy Ann's picture

I’m 67 and on blood pressure medication. That is a potential death sentence if I contract the virus. I’m self-isolating. Do I stop my meds for six months? What a dilemma!

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"The “jumpers” reminded us that one day we will all face only one choice and that is how we will die, not how we will live." Chris Hedges on 9/11

Lily O Lady's picture

@Raggedy Ann

day before yesterday and am self medicating with camomile tea. I’m probably a few months older than you. I’ll run out of tea at this rate though in a few weeks if not before.

My husband is staying on his meds as is our 31 yr. old son. It’s all an experiment.

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"The object of persecution is persecution. The object of torture is torture. The object of power is power. Now do you begin to understand me?" ~Orwell, "1984"

Lookout's picture

@Lily O Lady @Raggedy Ann

...and much more. It seems it is the ACE inhibitors that are problematic. I would drop those if I was on one, but wouldn't think other BP meds are harmful. At least I have not seen the data.

As to meds...have them delivered or pick them up at the drive through? I'm sure lucky to have no scipts. I am taking 1g of C, 250mmg D, Mg water I make (pm me if anyone has an interest), and vinegar (2 TSP AM and PM with some pomegranate juice and water). My partner takes elderberry juice which has experimental evidence of viral suppression. Guess I ought to have some at least on days when I venture out.

I'm going out early tomorrow when fewer folks are about. Need to recycle and pick up a few items. I wear gloves, and come home and shower and wash my clothes. I'm wearing gloves for mail too. Probably OCD.

Y'all are smart. Just be prudent. I continue to think this whole catastrophe might be an opportunity...(9 min)

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“Until justice rolls down like water and righteousness like a mighty stream.”

@Lily O Lady If your med is an ACE inhibitor, you might be able to switch to a beta-blocker. Or there might be indications that require that particular med even more than the increased risk from the virus, depending on your situation. Not all high blood pressure is the result of stress, although our current reality is stressful enough to make even the robustly healthy sick! If you find that your standard coping mechanisms aren't enough, chamomile is a natural relaxant that many people find helpful. If you have access, CBD is great for handling stress (be sure to get organic from a trustworthy source). There is also an amino acid supplement called L-Theanine that is nonprescription, relatively cheap, safe, and nonaddictive.

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Creosote.'s picture

@Raggedy Ann
and my meds are not for blood pressure.
I'll need to call on others to lend a hand with groceries if they can.
No car here or family
Bit cheered to think that at least River Lover will be safe!

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Raggedy Ann's picture

@Creosote.
I thought of River Lover yesterday for some reason, too. Her and Native - I interacted with them, now they are free from this menace.

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"The “jumpers” reminded us that one day we will all face only one choice and that is how we will die, not how we will live." Chris Hedges on 9/11

@Raggedy Ann You should definitely discuss this with your doctor, but if you are taking a beta-blocker like propranolol, that should not increase your odds of a bad outcome if you contract this virus. The problem lies with ACE inhibitors (generic drug names end in -pril) which are commonly prescribed for congestive heart failure and for high blood pressure caused by diabetes and kidney problems. The dangerous SARS, MERS, and COVID-19 viruses can bind to the ACE2 enzyme found on the alveoli cell surfaces deep inside your lungs. ACE inhibitor drugs seem to open the door wider for the coronaviruses to infect those cells. Common NSAID drugs like ibuprofen, aspirin, and naproxen have a similar effect so you should avoid them if you think your flu-type symptoms may be caused by COVID-19. I usually avoid Tylenol, but it might be your friend in this case. But seriously, don't just stop taking your blood pressure med without discussing it with your doctor! We want to keep you around!

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Roy Blakeley's picture

@Raggedy Ann is from a letter to The Lancet. It is not peer reviewed and is the scientific equivalent of a letter to the editor. It is an opinion, nothing more. I have read it and the papers it cites. The letter raises a hypothesis that can be tested with simple epidemiology. They do not suggest that people stop taking ACE inhibitors. They indicate that if their hypothesis is correct, it would create a treatment dilemma because there is evidence that ACE2 reduces lung inflammation which would be helpful with COVID-19 infections. The letter is not a paragon of scientific excellence. It miss-cites the scientific literature (i.e. the papers they cite do not say what they claim). The epidemiological data they cite are very small samples and they are inconsistent with each other and don't really support their contention. There are now good papers showing that the COVID-19 virus binds to the ACE2 receptor. That is clear. However, there is no evidence as yet that Ace inhibitors will potentiate COVID-19 infections. There are animal studies that suggest the opposite, but they should not be interpreted as definitive either. It should be possible to determine rather easily if individuals treated for high blood pressure with Ace inhibitors have higher mortality than those treated with other classes of medications.

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Lily O Lady's picture

@Roy Blakeley

restarting my lisinopril. Thank you.

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"The object of persecution is persecution. The object of torture is torture. The object of power is power. Now do you begin to understand me?" ~Orwell, "1984"

Cant Stop the Macedonian Signal's picture

@Roy Blakeley

it's NSAIDS (non-steroidal anti-inflammatories--aspirin, ibuprofen, aleve, and everything else except tylenol) that are seriously problematic, according to the French health minister (via John Campbell).

He says steroidal drugs are also shown to be problematic, but that people should talk to their doctors about that, given that they are prescription drugs.

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"More for Gore or the son of a drug lord--None of the above, fuck it, cut the cord."
--Zack de la Rocha

"I tell you I'll have nothing to do with the place...The roof of that hall is made of bones."
-- Fiver

I am actually not a doctor but, I believe Alligator Al is. However, I don't think he's a real alligator and... I might be. Smile

FWIW, I do agree with your assessment.

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Idolizing a politician is like believing the stripper really likes you.

Cant Stop the Macedonian Signal's picture

the thing can survive on a surface that isn't alive and in the range of mammalian body temp.

Wiping every bit of groceries off with disinfectant is going to be a hard sell. I'm buying things that are IN packages, rather than just buying loose produce, because that limits the amount of contact with the food itself. But damn.

I am wiping off the mail, from here on out. I just saw our postal worker handling mail without gloves. For the love of Christ, and for her sake as well as mine, why can't we distribute simple freaking gloves to postal workers?

Big efficient powerful best of all possible worlds economic engine yada yada yada yada yay capitalism what a load of shit.

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"More for Gore or the son of a drug lord--None of the above, fuck it, cut the cord."
--Zack de la Rocha

"I tell you I'll have nothing to do with the place...The roof of that hall is made of bones."
-- Fiver

Lookout's picture

@Cant Stop the Macedonian Signal

Several days on most things, and clothes are one of the longest.

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“Until justice rolls down like water and righteousness like a mighty stream.”

magiamma's picture

@Cant Stop the Macedonian Signal

https://www.mercurynews.com/coronavirus-can-live-on-plastic-steel-surfac...

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Roy Blakeley's picture

Lookout's picture

At least it seems some US doctors and hospitals are thinking ahead. (12 min)

John Campbell asked today about the end game. That's my question too. Is it going to be self-quarantine till the vaccine? I don't see how that happens.

As to your work bisbonian, I heard 80% of flights have been canceled, but certainly you know more about that than me.

No doubt we have to get out of our box and think about our options.

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“Until justice rolls down like water and righteousness like a mighty stream.”

Bisbonian's picture

@Lookout . I keep hoping that will change, soon.

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"I’m a human being, first and foremost, and as such I’m for whoever and whatever benefits humanity as a whole.” —Malcolm X

@https://www.livescience.com/how-long-coronavirus-last-surfaces.html

They find that similar viruses can live for days on resilient surfaces. However, no one knows if they exist on sufficient numbers to actually have a high likelihood of infecting people. They say the main mode it's likely to be inhaling droplets emitted by another person. Makes you wonder about all the poohpoohing regarding face masks.

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@MinuteMan
to catch "droplets" that an infected person spews. They are worthless to protect an uninfected person from breathing in "droplets" in the air. Other than the massive problem of masks being unavailable -- because we don't have a national public health agency to anticipate such a need and have the means to distribute them to sick people that should wear them -- indications are that COVID-19 is a silent stalker, meaning people become infectious before they have any symptoms. That last point may not be true and an artifact of people not recognizing the earliest symptoms.

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@Marie
uninfected health care professionals where masks. Masks are much better at containing infection than preventing infection. But they can catch droplets and are much better than nothing.

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TheOtherMaven's picture

The SCA has already canceled Gulf Wars and practically all March and April events. If the lockdown continues, they will have to come up with contingency/alternative measures for Spring Coronation and Crown Tourney - neither of which can be postponed indefinitely. Maybe the would-be contestants will have to write essays on why they would make a good King/Queen? (Just spitballing here....)

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There is no justice. There can be no peace.

Sima's picture

@TheOtherMaven My kingdom (An Tir) has cancelled everything until the end of the first week of May or so. The next weekend would be that of Crown. I'm hoping that things ease off, so there is a Crown tourney, but who knows?
On the other hand, I do like the idea of writing papers to win crown. But then, I would! I'm really into research in the SCA.

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If you're poor now, my friend, then you'll stay poor.
These days, only the rich get given more. -- Martial book 5:81, c. AD 100 or so
Nothing ever changes -- Sima, c. AD 2020 or so

TheOtherMaven's picture

@Sima

Not sure what Atlantia is doing about Coronation, but Aethelmearc's is "by invitation only" to keep it small. At last report Pennsic is still on, but who knows.

Some things can't be done online (fighter practices, dance practices, archery, etc) and will probably have to be done without for the time being.

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There is no justice. There can be no peace.

(not good for the Disaster Capitalists)

A Swiss Doctor on Covid-19

For comparison: here's the CDC 2019-2020 US Flu Season: Preliminary Burden Estimates (click on "Past Seasons" to see the numbers for prior years)

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