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Corona Virus
- Thread starter Cvargo
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You know you did not drink any whiskey. We know Megan took the bottle away from you haha
The Risks - Know Them - Avoid Them
Please read this link to learn about the author and background to these posts. It seems many people are breathing some relief, and I’m not sure why. An epidemic curve has a relatively predictable upslope and once the peak is reached, the back slope can also be predicted. We have robust data from...
Thanks for sharing Dave! This was a really good read. Outside of the science...it's even a very sensible analysis of the situation. REALLY good stuff.The Risks - Know Them - Avoid Them
Please read this link to learn about the author and background to these posts. It seems many people are breathing some relief, and I’m not sure why. An epidemic curve has a relatively predictable upslope and once the peak is reached, the back slope can also be predicted. We have robust data from...erinbromage.wixsite.com
This is a thread that I mostly read and avoid making posts in because the things that are often on my mind are the kind of things DAVE tells me I’m not allowed to talk about at parties or when the record light is on. There are a few things though that I wanted to say because I think they add a new twist to the conversation. As y’all know I’m a finance and investment guy, I’ve spent most of this YEAR looking at how the spread of the virus has/will/might/could/should/won’t impact various aspects of our lives. I am not claiming to be any better at predicting its spread or having any better understanding of its impact(s) or trajectory than anyone else, but I am and have been mindful of the various potentials.
The first thing to note is, from the onset the expected impact was FAR different than what has actually occurred. EVERYONE was caught flat footed, you can claim some politician somewhere should have done or known xy&z but the modeling and projections that were getting the most attention and head space had the virus contained within greater Asia. All possibilities were on the table and being explored but the dominant theory (perhaps based on bad intel?) was better containment. This meant a less worrisome epidemic not a worldwide health crisis of pandemic proportions. It also meant the economic impact would be modest and mostly limited to a supply side interruption while China shutdown to contain the virus. These models/theories remained the dominant ones at least through January if not into the first week or 2 of February. I know what I just said above about nobody saw THIS version of the pandemic coming has you saying “CBL you stupid fool, I saw it coming so did everyone else”. No you didn’t. Everything is clear in hindsight. Look up the definition of “black swan event” that’s what this is.
I don’t know exactly when the “it will be contained” theory stopped being the dominant one, I suspect it was pretty obvious to those in the know before the Super Bowl because I think by then sever mitigation steps had already begun behind the scenes. I am pretty sure the American population as a whole didn’t accept the reality until mid-March when Tom Hanks announced he was sick and the NBA announced players were sick...it hadn’t mattered people all over the world were sick and dying but by God any virus that makes our celebrities sick must be bad news, now go buy toilet paper!
On to the next twist
I have several personal issues and reservations with how the months long shutdown has and is being handled but I will make clear for the record that I think the premise is a solid one (both from a health/epidemiological perspective AND a governmental perspective), I support the concept but have many, many issues with the people, ideology and execution ...but other than one specific topic I will not be bringing any of that up here because it’s not useful here. ...and I suspect we can all find something to complain about anyway.
The one area of the lockdown that bothers me most is the way ‘elective’ healthcare was shutdown. It made sense in theory, if the hospitals might become overwhelmed with COVID19 patients you wouldn’t want unnecessary drain on the healthcare system. The reality was more than half of the 4.5% gdp loss in Q1 came from reduced consumer healthcare spending. More than 40k doctors and nurses were sent home without work. The average daily census in hospitals around the country has fallen so low they are sending staff home and running out of $ to pay bills.
‘More frighting to me, for 8 weeks or more there have not been any cancer screenings or treatments for high risk individuals. The delayed detection and treatment this downtime had created will be amplified by insurance approvals processing backlogs, backlogs in patients and requirements to improve social distancing. People who needed screening in March may not be screened until August or September and may miss an opportunity for less invasive treatments or face higher mortality rates because of the delay. The ripple effect of this quarter’s shutdown in ‘non-essential’ colonoscopy’s will go on for at least 18 months.
By applying a cookie cutter shutdown of all services for the last 2 months instead of allowing decision to be made more fluidly we have killed more hospitals and people than the virus.
The first thing to note is, from the onset the expected impact was FAR different than what has actually occurred. EVERYONE was caught flat footed, you can claim some politician somewhere should have done or known xy&z but the modeling and projections that were getting the most attention and head space had the virus contained within greater Asia. All possibilities were on the table and being explored but the dominant theory (perhaps based on bad intel?) was better containment. This meant a less worrisome epidemic not a worldwide health crisis of pandemic proportions. It also meant the economic impact would be modest and mostly limited to a supply side interruption while China shutdown to contain the virus. These models/theories remained the dominant ones at least through January if not into the first week or 2 of February. I know what I just said above about nobody saw THIS version of the pandemic coming has you saying “CBL you stupid fool, I saw it coming so did everyone else”. No you didn’t. Everything is clear in hindsight. Look up the definition of “black swan event” that’s what this is.
I don’t know exactly when the “it will be contained” theory stopped being the dominant one, I suspect it was pretty obvious to those in the know before the Super Bowl because I think by then sever mitigation steps had already begun behind the scenes. I am pretty sure the American population as a whole didn’t accept the reality until mid-March when Tom Hanks announced he was sick and the NBA announced players were sick...it hadn’t mattered people all over the world were sick and dying but by God any virus that makes our celebrities sick must be bad news, now go buy toilet paper!
On to the next twist
I have several personal issues and reservations with how the months long shutdown has and is being handled but I will make clear for the record that I think the premise is a solid one (both from a health/epidemiological perspective AND a governmental perspective), I support the concept but have many, many issues with the people, ideology and execution ...but other than one specific topic I will not be bringing any of that up here because it’s not useful here. ...and I suspect we can all find something to complain about anyway.
The one area of the lockdown that bothers me most is the way ‘elective’ healthcare was shutdown. It made sense in theory, if the hospitals might become overwhelmed with COVID19 patients you wouldn’t want unnecessary drain on the healthcare system. The reality was more than half of the 4.5% gdp loss in Q1 came from reduced consumer healthcare spending. More than 40k doctors and nurses were sent home without work. The average daily census in hospitals around the country has fallen so low they are sending staff home and running out of $ to pay bills.
‘More frighting to me, for 8 weeks or more there have not been any cancer screenings or treatments for high risk individuals. The delayed detection and treatment this downtime had created will be amplified by insurance approvals processing backlogs, backlogs in patients and requirements to improve social distancing. People who needed screening in March may not be screened until August or September and may miss an opportunity for less invasive treatments or face higher mortality rates because of the delay. The ripple effect of this quarter’s shutdown in ‘non-essential’ colonoscopy’s will go on for at least 18 months.
By applying a cookie cutter shutdown of all services for the last 2 months instead of allowing decision to be made more fluidly we have killed more hospitals and people than the virus.
I know our numbers are still going up too so Monday we are opening up dine in restaurants among other things opening too. This is crazy, unless they are trying to have a good reason to shut it down again. I don't see the country being open for long before we are all shut down again...
MilkCrate
"I am a Milk Crate with Dreams"
Maybe it’s population control.
Very spot on!
Yeah maybe. I know myself nor my family are going to be going into any restaurants for quite a while. Nor will we be going into stores any more than we have to. We will not be participating in the local cities dining outside where they have completely shut down the main streets in one of our local cities and turned them into an outside dining area for the restaurants in those areas.....we will continue to stay in place....
Dave in KY
Shave Newbie
Invested HEAVY in Healthcare did ya ? I"M KIDDING !! All very good points and why my procedure yesterday was delayed till yesterday.
If possible you should look at the ‘rate of positive’ test results not the number of positives being reported. Both are flawed in some respects but as more test kits are available and more tests are actually conducted per day (assuming more are actually being done) you will inevitably get more positives. One thing that is typically more telling is the percentage of positive tests per 100 collected. That will stay consistent unless one of 2 things changes, you get a change in the rate of spread (up or down) or you get a change in the criteria used to select the test pool. They will usually announce changes in the criteria so you can make note of that but even then the impact won’t be big. We’ve been running about 9.5% positive with a spike to about 9.8-9.9%, recently we had a 2 day period with ZERO new cases followed by 161 new cases which was the highest single day spike...the lab didn’t report over the weekend so they reported everything on one day but the percent positive was still 9.5%. San Diego county re-opened beaches then the next day the news paper reported they had the highest single day spike in positive cases (sensational headline to be sure), what they didn’t say was the county also completed more than 5000 tests in one day and had only a 6.5% positive rate which was consistent with its historic rate.
I actually only have one individual healthcare stock that I own personally and in a few client accounts. I don’t recall specifically when I bought it but it was before the COVID19 poopy hit the fan. Fortunately I bought it at a price that was quite favorable so it’s doing well today.
I had a doctors appointment scheduled later this month that was rescheduled for earlier this week so she had better flow of patients. We had a similar discussion. Her family has been hit hard but she herself and nobody local has had it.
First I appreciate @CBLindsay adding to the discussion with a tempered and no triggering response. I would like to move that we proceed with vote to accept him into the Cadre.
And you may notice I actually rarely comment on posting about medical issues or problems other than to say I'm sorry for the struggles people are going through. I do sincerely feel bad that not everyone can be part of a medical system like the one I work for because while we're not perfect by any means, we don't suffer from many of the complaints I read on these forums. I do think I'll add in a few things that have gone into some of our decisions making as a healthcare system as well as an individual hospital hopefully without being specific enough to find any body part in a wringer by the compliance police. Maybe just to comment that not everyone is reacting or can react the same way. Or maybe some of you inside baseball people will find it interesting.
Related to the shut down of elective heath care and staffing. As like everyone else we eventually did shut down the hospital for everything other than urgent procedures. As is obvious, the scare was that our hospital would be full of COVID patients and we would need every open bed we could get. Turns out the Bay Area did an excellent job of flattening the curve despite some very public knuckleheads that don't understand germ theory apparently. We didn't get close to filling our bed, but we were on the trajectory to for a while. Actions were taken to expand our ICU multiple times its standard capacity and it was all hands on deck to do so. Without a page of details, how these patients needed to be cared for in a logistical way has changed drastically over the many weeks, and at the beginning we did need to put more things into place than we had just to care of those patients we did have. BUT, surgeries were still taking place. If it would be harmful to wait, it happened and again with a ton of manpower to make it so. This included cancer surgeries which are often urgent once a diagnosis is made. The COVID patients themselves also need more staffing than our standard patient mix. Needless to say, on the hospital side our census was not lower than it normally was or not lower by much, but the staff needs were much higher than usual. It takes more time having to don PPE every time you got into a room. You've heard of very sick COVID patients being laid on their stomachs to take the weight of the heart off their lungs? That takes a good 8 people to do safely. And with the visitor restrictions in place and temp monitoring of everyone coming into the building, every body can be put to use to man our security check points. Or check out scrubs to staff that don't want to wear their clothes home now, or distribute the food donations from the community. in the outpatient arena our visits to our clinics were DRASTICALLY cut, but not the care being provided. At the same time our phone and video visits multiplied by a factor and when needed for the proper care to be given, some in-person appointments were still being done. Cancer screenings for high risk individuals for example. We haven't actually closed any clinics totally. These will be interesting times because we showed in a few short weeks that we could transition from a mostly office based service to mostly remote. Our pharmacy even started to do parking lot delivery of meds to keep the number of people inside the pharmacy to a minimum.
Now, PPE. Ya'll hear about this every 10min on the news now. It's real. Thanks to whoever that we didn't get the spike that NY saw because even with what we do have, we're have to practice some pretty tight stewardship to make sure there's something for "tomorrow". It hasn't helped that FEMA has commandeered more than one huge shipment our organization arranged from overseas. I bring up PPE because it's not just the COVID patients. As we're looking to start up elective procedures again. The gowns and masks used for a joint replacement surgery are also ones that we get through those disrupted supply chains. Or outside hospital areas. The hand gel sitting on the office desk in the podiatry office can be used by a nurse taking off their PPE from a COVID patient. The more activity there is outside the patient care areas, the faster we burn through everything. We're finding that the longer this goes on, supplies that aren't even COVID specific are something we need to track because we can't just place an orders for anything any more and know that will appear without problem.
Anyway, halfway through that I realized it sounded pretty boring, but there it is. Even without the strain on our healthcare system, there is still a strain. We saw in the beginning that it only takes one night of a busy ED for our COVID numbers to jump, so things had to be played pretty closely for that possibility. Now they have to be played carefully because there is still a looming unknown and an ongoing supply problem.
And you may notice I actually rarely comment on posting about medical issues or problems other than to say I'm sorry for the struggles people are going through. I do sincerely feel bad that not everyone can be part of a medical system like the one I work for because while we're not perfect by any means, we don't suffer from many of the complaints I read on these forums. I do think I'll add in a few things that have gone into some of our decisions making as a healthcare system as well as an individual hospital hopefully without being specific enough to find any body part in a wringer by the compliance police. Maybe just to comment that not everyone is reacting or can react the same way. Or maybe some of you inside baseball people will find it interesting.
Related to the shut down of elective heath care and staffing. As like everyone else we eventually did shut down the hospital for everything other than urgent procedures. As is obvious, the scare was that our hospital would be full of COVID patients and we would need every open bed we could get. Turns out the Bay Area did an excellent job of flattening the curve despite some very public knuckleheads that don't understand germ theory apparently. We didn't get close to filling our bed, but we were on the trajectory to for a while. Actions were taken to expand our ICU multiple times its standard capacity and it was all hands on deck to do so. Without a page of details, how these patients needed to be cared for in a logistical way has changed drastically over the many weeks, and at the beginning we did need to put more things into place than we had just to care of those patients we did have. BUT, surgeries were still taking place. If it would be harmful to wait, it happened and again with a ton of manpower to make it so. This included cancer surgeries which are often urgent once a diagnosis is made. The COVID patients themselves also need more staffing than our standard patient mix. Needless to say, on the hospital side our census was not lower than it normally was or not lower by much, but the staff needs were much higher than usual. It takes more time having to don PPE every time you got into a room. You've heard of very sick COVID patients being laid on their stomachs to take the weight of the heart off their lungs? That takes a good 8 people to do safely. And with the visitor restrictions in place and temp monitoring of everyone coming into the building, every body can be put to use to man our security check points. Or check out scrubs to staff that don't want to wear their clothes home now, or distribute the food donations from the community. in the outpatient arena our visits to our clinics were DRASTICALLY cut, but not the care being provided. At the same time our phone and video visits multiplied by a factor and when needed for the proper care to be given, some in-person appointments were still being done. Cancer screenings for high risk individuals for example. We haven't actually closed any clinics totally. These will be interesting times because we showed in a few short weeks that we could transition from a mostly office based service to mostly remote. Our pharmacy even started to do parking lot delivery of meds to keep the number of people inside the pharmacy to a minimum.
Now, PPE. Ya'll hear about this every 10min on the news now. It's real. Thanks to whoever that we didn't get the spike that NY saw because even with what we do have, we're have to practice some pretty tight stewardship to make sure there's something for "tomorrow". It hasn't helped that FEMA has commandeered more than one huge shipment our organization arranged from overseas. I bring up PPE because it's not just the COVID patients. As we're looking to start up elective procedures again. The gowns and masks used for a joint replacement surgery are also ones that we get through those disrupted supply chains. Or outside hospital areas. The hand gel sitting on the office desk in the podiatry office can be used by a nurse taking off their PPE from a COVID patient. The more activity there is outside the patient care areas, the faster we burn through everything. We're finding that the longer this goes on, supplies that aren't even COVID specific are something we need to track because we can't just place an orders for anything any more and know that will appear without problem.
Anyway, halfway through that I realized it sounded pretty boring, but there it is. Even without the strain on our healthcare system, there is still a strain. We saw in the beginning that it only takes one night of a busy ED for our COVID numbers to jump, so things had to be played pretty closely for that possibility. Now they have to be played carefully because there is still a looming unknown and an ongoing supply problem.
Dave in KY
Shave Newbie
I was ONLY joking about the investment.
I have needed an appointment at my doc to address some things but am waiting as many are and ones with more serious things than me. I appreciate the focus on percentage of positives relative to number of tests rather than just numbers. That's been my focus as well. Past 3 days KY has ticked down to between 7 and 8 %
FREE THE WAGE SLAVES!!!
FWIW Thank you all for keeping this subject civil and professional, it just shows the level of humanity, and class that you all have. This type of quorum and level headed thinking and debate could solve the worlds problems, again my thanks, as one whom has lost 4-people in my life due to this sickness, as well as taking care of an "high risk" parent, and being a former healthcare worker, it is a subject very close and very emotional for me. I am a researcher and fact checker, so seeing this type of discussion, really now-a-days, is the only one that has not been corrupted by hatred and someones agenda. It is appreciated
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