Do we Cancel Everything? You still Travelling??

[SteveFx 258]

1 hour ago, birdguy said:

 

In most places the only numbers shown would be the 100 total and 33 dead.  In some places even the 50% discharged.  But nowhere have I seen the numbers of those currently being treated.

 

I can do better for you Noel but again uk only.

in the uk we have a minister present every day. This is the latest  slide set

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/882878/Slides_to_accompany_coronavirus_press_conference-_2_May_2020.pdf

in there are graphs showing numbers of patients over time, number icu beds over time etc.  

 

[SteveFx 258]

Now here is something interesting to discuss.  Ireland have published their roadmap about how they plan to open up.

https://www.gov.ie/en/press-release/e5e599-government-publishes-roadmap-to-ease-covid-19-restrictions-and-reope/

 

 

[birdguy 3,943]

Good graphs Steve and seemingly nothing left out.  And good enough for the geography and size of GB I suppose.

But in NA where our population densities are so diverse, our geography so diverse  and demographics so diverse a national graph doesn't tell you much about your location.

Noel

[Alan_A 1,650]

Now that I seem to be back in the neighborhood, just a couple of quick observations....

There are certain lines of argument here that I'll mostly try to avoid because they're heavy on opinion and light on information.  Going to aim to be factual and evidence-based as much as possible.

I do have one question for the "open up now" advocates (pausing for a moment to note that "open up now" vs. "hide completely" isn't a very high-resolution version of the policy discussion, which in practice is going to be more nuanced and gray than that).  The question is for those who've served as pilot in command, and the question is this: when you gave your passengers safety briefings, did you expect them to pay attention and comply?  If so, why did you expect that?  Was it because of your rank and formal position?  Was it because you were speaking from a basis of training and experience? Some combination of the two? I don't know the answer - I'm genuinely asking.

The follow-up question is: if your passenger had said, "I'm not going to wear that seatbelt because I'm not wired to, and it restricts my freedom," or "I'm not interested in hearing how to open up the emergency exit, I don't think I'll have to and I have more important things to pay attention to," or "I won't get out of the airplane right now and go down the slide, it's my right to sit here amid all the burning fuel and upholstery..." If your passenger had said that... how would you have reacted?

The third follow-up is, when a public health official or virologist with commensurate experience, like Dr. Fauci, says that the lockdown was necessary, and than any reopening is going to have to be gradual, cautious, and linked to our ability to pass certain measurable thresholds, why does that experienced-based and credentialed viewpoint not carry commensurate weight with you?  Why the continued shopping for alternative expert and studies that say that of course it's OK to sit in the burning airplane because you're in the back and most of the injuries in plane crashes happen in the front, or something along those lines?

A side note - I was reminded the other day that these debates and reactions are nothing new.

Now, back on track... something that was buried in the graphic in Scott Galloway's article (linked and quoted in my previous post) was this, in the "learning zone" - "I evaluate information before spreading something false."

That's a good standard, and I'm going to hold myself to it, and I'm going to ask others to hold themselves to it, too.  Here's a request - when you come across a study or article or video, especially if it supports your side of the argument, stress-test it. Try as hard as you can to poke it full of holes.  Look at the stats and the conclusions and probe for weaknesses.  Research the authors and find out about their track records - are there any questions or evident biases? This is what good scientists do when they're conducting research ("is this data really telling me what I think it is?") and what good journalists and especially editors do when developing a story ("is this good enough to go with? Have you covered all your bases?  Have you talked to X? Can you support Y conclusion?"

A few posts back, there was a reference to Dr. Wittkowski.  A few minutes of research would show that Dr. Wittkowski's video was taken off of YouTube not because of its content but because he misrepresented his affiliation with Rockefeller University.  That's a problem in itself and also undermines his credibility.  There's also the issue that he's a biostatistician but not a virologist or publi health professional, which might make him less than a go-to source on something like herd immunity.  It's as though you were getting your safety briefing from the security screener - someone who does an important job, but not the one that's relevant to the problem.

So please, be your own editor and resist your own confirmation bias.

I'm trying to do that myself at the moment, and my problem case is Sweden.  It doesn't seem logical to me that Sweden, with no lockdown, is producing numbers similar to the UK that did have a lockdown.  I don't think that description really tells the story - I think the data isn't high-resolution enough to support that conclusion.  But I'm not able to reject the idea yet. So I'm digging into it more and remaining open to the possibility that I or others have missed something.

I can try to do that better, and more often.  So can everybody here.

My $.02 for the moment.

 

[Alan_A 1,650]

@SteveFx - Those are two really great finds - thanks for sharing!

@birdguy - The quality of information does seem to be getting better over time, though the county-level data you're looking for is still hard to come by.  It'll get there.

About the question you're trying to dig into - what's the risk in your area, which is low density and has very few reported cases - the only other thing I'd want to look at it, how could more infections possibly get in?  That's fuzzier and hard to measure, but it's a big part of what a field epidemiologist would investigate.  It's why contact tracing matters so much.

For a good illustration of how it works - the foundation case in modern epidemiology, the thing every epidemiology 101 class starts out with, is John Snow and the Broad Street Pump.  There's a nice article about it here.  Snow basically invented the modern approach to the field - this was during a cholera outbreak in London in 1854.  He mapped - literally - individual cases and tracked them back to a source, then removed the source.

The same principles still apply.  Every epidemic spreads one contact at a time, and you can trace how it happens.  This is true even in a high-density area like New York.  Population density is a big issue but you can still map how the coronoavirus got into the area.  More work needs to be done on this but it doesn't seem like a coincidence that the first big concentration of cases was in Queens.  Queens is of course home to JFK and LaGuardia, and lots of airline and airport workers live there.  So a possible path is from the airports into the borough of Queens, and then to the other boroughs (Manhattan ramped up after Queens did).

In areas like yours, the public health question is going to be, are there big concentrations of cases somewhere nearby, and could they possibly get in?  Some current examples affecting lower-density areas are the meat packing plants (a big problem because everybody goes home at night) and prisons (officers and staff go home at night). Nursing homes might be more of an urban/suburban thing but I'd want to know how close they are and what kind of traffic they generate.  And in New Mexico you've got big case clusters on the reservations, so same question there - how many people go in and out (delivery people, service people like plumbers, social services people, residents going out on different kinds of errands) and where do they go?

Factor that in with the other data and you get an even more developed picture.

Edited May 2, 2020 by Alan_A

[MartinRex007 390]

33 minutes ago, Alan_A said:

during a cholera outbreak in London in 1954.

1831-1832, he died in 1858, and yes you're right every student of epidemiology will know who John Snow was. What made this cases particularly interesting is he was able to stop the outbreak and not even know what was causing it. V. cholerae was first isolated as the cause of cholera by Filippo Pacini in 1854, many years after John Snows work. The beauty of epidemiology is you don't necessary have to know the etiology of a disease in order to stop it, this study showed how mapping, contact tracing and using some simple statistics can stop an outbreak without having to know its cause. Some would consider John Snow as the Father of Modern Epidemiology.

Martin

Edited May 2, 2020 by MartinRex007

[KevinAu 441]

1 hour ago, Alan_A said:

I'm trying to do that myself at the moment, and my problem case is Sweden.  It doesn't seem logical to me that Sweden, with no lockdown, is producing numbers similar to the UK that did have a lockdown.  I don't think that description really tells the story - I think the data isn't high-resolution enough to support that conclusion.  But I'm not able to reject the idea yet. So I'm digging into it more and remaining open to the possibility that I or others have missed something.

 

Sweden is a smaller country. I was looking at a list yesterday, ranked by deaths per so many people. Sweden was just above the usa in deaths per however many people. The Uk also tried herd immunity at first before changing their minds about that.

[Bob Scott 7,721]

1 hour ago, Alan_A said:

The question is for those who've served as pilot in command, and the question is this: when you gave your passengers safety briefings, did you expect them to pay attention and comply?

The pilot in most transport aircraft doesn't give safety briefings...in my experience it was loadmasters and flight attendants.  And usually the pax actually do not pay much attention.

1 hour ago, Alan_A said:

if your passenger had said, "I'm not going to wear that seatbelt because I'm not wired to, and it restricts my freedom," or "I'm not interested in hearing how to open up the emergency exit, I don't think I'll have to and I have more important things to pay attention to," or "I won't get out of the airplane right now and go down the slide, it's my right to sit here amid all the burning fuel and upholstery..." If your passenger had said that... how would you have reacted?

a) if you refuse to put on your seat belt, you'll be removed from the aircraft  b) if you're next to the emergency exit, the crew will ask if you are able and willing to handle the exit door...if not, they move you to another seat  c) if you want to sit in the burning airplane while we evacuate, OK be my guest, but we're leaving.

1 hour ago, Alan_A said:

when a public health official or virologist with commensurate experience, like Dr. Fauci, says that the lockdown was necessary, and than any reopening is going to have to be gradual, cautious, and linked to our ability to pass certain measurable thresholds, why does that experienced-based and credentialed viewpoint not carry commensurate weight with you?  Why the continued shopping for alternative expert and studies that say that of course it's OK to sit in the burning airplane because you're in the back and most of the injuries in plane crashes happen in the front, or something along those lines?

His opinion carries weight, but not unilateral authority.  Why shop for alternative expert opinions?  For the same reason I'd shop for a second opinion if given a diagnosis and treatment plan for a serious, life-altering disease like ALS, cancer, Parkinson's etc...even by a doctor I know and trust.  In fact obtaining second opinions is accepted protocol for important medical decision making everywhere except for, apparently, here. 

You're projecting Fauci as the pilot in command...no, he's more analogous to the flight engineer.  His viewpoint is focused on a technical subset of the big picture to the exclusion of other factors that may be just as important.  Our experienced flight engineer sees vibrations and oil pressure fluctuations on engine #3 and tells the pilot that "we need to land right away" an hour from coasting-in near Maputo, Mozambique.  But the pilot is told by dispatch that if he lands at Maputo, the closest and first available airport on the coast, there's no maintenance there and the crew and pax will be stranded there with no facilities and a Cat 5 Typhoon expected to make landfall there 48 hours from now.  The engineer's advice is sound, but the action he recommends could put everyone into the path of a killer storm.  The pilot in command would consider both the engineer's expert opinion and the dispatcher's as well.  Similarly, any decision on re-establishing commerce has to consider both the medical opinion as well as others such as economic/finance experts, law enforcement, legal, etc.  A best-case medical course of action very well could put us into the path of an economic freight train, push the population into riots and other catastrophic civil unrest, or violate the Constitutional rights of the people.

[Alan_A 1,650]

36 minutes ago, MartinRex007 said:

1831-1832, he died in 1858

Sorry, 1954 was a typo (corrected) - but all the references I've found give the date of the outbreak as 1854.  Maybe they're conflating the date with Pacini's discovery? 

It really is a fascinating story (maybe that's why it's such a great introduction).  And that's a really interesting point about his not knowing the cause.  The other one I was taught in the same class was about Hippocrates associating malaria with swamps, even though he had no idea about mosquitoes.  IIRC it was a Roman physician who picked up on that and suggested draining the swamps - again indicating that you can solve the problem without ever knowing what the cause was. 

I was never involved in any of this except as a spectator but I find it endlessly interesting.

[Alan_A 1,650]

14 minutes ago, KevinAu said:

Sweden is a smaller country. I was looking at a list yesterday, ranked by deaths per so many people. Sweden was just above the usa in deaths per however many people. The Uk also tried herd immunity at first before changing their minds about that.

One thing that stood out when I was looking at the Johns Hopkins data is that Sweden's case and death rates are about quadruple the rates for Denmark, Norway and Finland.  Now I don't know how comparable those are - they come to mind because there might be cultural similarities.  On the other hand, it's dangerous to conclude that based on limited knowledge.  An outsider might decide that the US and Canada are broadly similar, and miss all the differences about culture and health systems, among other things.

About herd immunity - it's been driven back into the foreground but I have yet to find a reputable health professional who favors generating herd immunity with an uncontrolled pathogen.  That's a disease thing, not an outbreak thing.

[MartinRex007 390]

24 minutes ago, Alan_A said:

I've found give the date of the outbreak as 1854

Correct Alan, my reference to 1831-32 was his encounter with his first apparent outbreak of cholera, but you are correct the London outbreak was later in 1854.  

Edited May 2, 2020 by MartinRex007

[Alan_A 1,650]

Just now, MartinRex007 said:

the London outbreak was later in 1854. 

But not 1954!

Glad we made it to the right date - proving once again that science is collaborative.

[Alan_A 1,650]

I see that my post using the Titanic as an analogy was taken down.

Is that because it was political?  I'm not sure that it was.  We were talking about the relative roles of technical expertise and leadership, expanding on the pilot-in-command analogy that I'd introduced earlier, and that was under discussion.

I'd be interested to know why that post was considered political while earlier ones weren't - or if there was some other reason for its removal.

Edited May 2, 2020 by Alan_A

[dave2013 1,130]

2 hours ago, Alan_A said:

A few posts back, there was a reference to Dr. Wittkowski.  A few minutes of research would show that Dr. Wittkowski's video was taken off of YouTube not because of its content but because he misrepresented his affiliation with Rockefeller University.  That's a problem in itself and also undermines his credibility.  There's also the issue that he's a biostatistician but not a virologist or publi health professional, which might make him less than a go-to source on something like herd immunity

Here's what I found regarding his credentials:

PhD in computer science from the University of Stuttgart, Germany; ScD (Habilitation) in Medical Biometry from the Eberhard-Karls-University Tuüingen, Germany; 15 years working with Klaus Dietz, a leading epidemiologist who coined the term “reproduction number”, on the Epidemiology of HIV.; Head of The Department of Biostatistics, Epidemiology, and Research Design at The Rockefeller University, New York. and CEO of ASDERA LLC, a company discovering novel treatments for complex diseases from data of genome-wide association studies.

Rockefeller University issued a statement in which they state that his views on Covid-19 do not represent the University, and that he was not a professor there.  Not that he wasn't a scientist there, but not a "Professor".

So he was indeed a scientist working in epidemiology and biostatistics at Rockefeller University.

Dave

Edited May 2, 2020 by dave2013

[Bob Scott 7,721]

31 minutes ago, Alan_A said:

I see that my post using the Titanic as an analogy was taken down.

Is that because it was political?  I'm not sure that it was.  We were talking about the relative roles of technical expertise and leadership, expanding on the pilot-in-command analogy that I'd introduced earlier, and that was under discussion.

I'd be interested to know why that post was considered political while earlier ones weren't - or if there was some other reason for its removal.

Yup, we were starting down the politics rabbit hole again.  Trying to keep finger-pointing, blame games, defense of and/or bashing of governments out of this, myself included.