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Post by dan1 on Feb 24, 2020 20:24:47 GMT
I know it's stating the obvious but as it doesn't appear to have been stated yet I'll do it..... when healthcare systems become saturated the mortality rate itself will increase dramatically (exponentially at first?). If it's 2% now then what would it be when all those with pre-existing medical conditions, inc respiratory illnesses, can't get admitted to HDU or ICU? And this ( I actually stated this too earlier in the thread). A consequence of overwhelmed medical facilities is that mortality rates for *everything* will go up. Not just coronavirus and related complications. apologies, I'm only dipping in and out.... call it blissful ignorance
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agent69
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Post by agent69 on Feb 24, 2020 20:26:38 GMT
I know it's stating the obvious but as it doesn't appear to have been stated yet I'll do it..... when healthcare systems become saturated the mortality rate itself will increase dramatically (exponentially at first?). If it's 2% now then what would it be when all those with pre-existing medical conditions, inc respiratory illnesses, can't get admitted to HDU or ICU? The current mortality rate is mainly based on what is happening in China, where facilities were probably overwhelmed a long time ago. Give the notice that other countries have had of the possible spread, you would think they would be better prepared, and the rate would would be lower.
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IFISAcava
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Post by IFISAcava on Feb 24, 2020 20:59:48 GMT
I know it's stating the obvious but as it doesn't appear to have been stated yet I'll do it..... when healthcare systems become saturated the mortality rate itself will increase dramatically (exponentially at first?). If it's 2% now then what would it be when all those with pre-existing medical conditions, inc respiratory illnesses, can't get admitted to HDU or ICU? The current mortality rate is mainly based on what is happening in China, where facilities were probably overwhelmed a long time ago. Give the notice that other countries have had of the possible spread, you would think they would be better prepared, and the rate would would be lower.It is
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IFISAcava
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Post by IFISAcava on Feb 24, 2020 21:05:11 GMT
Assuming your figures are correct that'd pay for an "anti-virus" mask for everybody in the country in a month, with fifteen million odd masks left over. And that's at current price gouge rates. So that's not very practical, helpful or targeted. But they bloody well better make sure our health professionals are well protected, and look after the vulnerable as well as possible. Many of them have retired early now because of the ridiculous pensions taxation. I don't reckon the prospect of exposing themselves to the Coronavirus will entice them back.
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michaelc
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Post by michaelc on Feb 24, 2020 21:08:28 GMT
I know it's stating the obvious but as it doesn't appear to have been stated yet I'll do it..... when healthcare systems become saturated the mortality rate itself will increase dramatically (exponentially at first?). If it's 2% now then what would it be when all those with pre-existing medical conditions, inc respiratory illnesses, can't get admitted to HDU or ICU? And this (I actually stated this too earlier in the thread). A consequence of overwhelmed medical facilities is that mortality rates for *everything* will go up. Not just coronavirus and related complications. By how much - do we even have a clue ? What is it fundamentally that helps in a clinical setting for this condition? Is it availability of a ventilator? I can believe there are one or two specific treatments like that but there's probably also a down side. If staying in an isolation ward with no contact and following the regime, it may be that things like sleep, food quality and even general happiness may affect the outcome. THe journey to hospital with a high fever probably doesn't help either. I'm not suggesting you're worse off in a hospital but just making the point maybe its only beneficial for the very worst cases. I know zero about medical stuff so look forward to being corrected.
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IFISAcava
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Post by IFISAcava on Feb 24, 2020 21:25:38 GMT
More seriously, I understand the concern. And I understand the messages you're receiving from your HK practice. Equally my doctor friends are... not panicking. If we take your example of it becoming as widespread as seasonal flu isolation and quarantine would be moot. And if it's as widepsread as seasonal flu, given a similarish mortality, why would medical facilities be stretched to breaking point more than they are with seasonal flu (though I grant you if it doubles up with seasonal flu....)? So I end up concluding that your ".... order of magnitude" is overly pessimistic. Mortality rates and critical/ICU percentages are already an 'order of magnitude' worse than seasonal flu. So if coronavirus becomes as widespread as seasonal flu, it is extremely plausible that the impact on medical facilities will be an 'order of magnitude' worse, by definition. HK/Singapore are seeing critical rates of 5%+. Globally (ex-China) more like 2-3%. Do some simple maths - UK population size, infection/transmission rate similar to flu, critical admission rates even close to these reported levels... then compare to the number of critical beds available in the UK. Go on. I dare you. In China outside of Wuhan, estimated mortality rates are 0.4%. Outside of China even less. For 'flu it's about 0.1%. It's a nasty virus, and the mortality rates are only estimates (for reasons we have discussed in this thread) but I doubt it is an order of magnitude more deadly in terms of mortality. In terms of how many need critical care - harder to know as that's a less definite outcome than death - e.g. if critical care facilities are available doctors may err on the more cautious side and use it more readily given the unknowns and novelty. The issue is of course whether the available resources are sufficient to manage the number of severe cases that may occur in a given country. The answer is no one knows, but that there is nothing major that can realistically be done as you cant build new facilities and train new staff in a few days or weeks (although there will be contingency plans to utilise beds differently if needs be). Hence the focus on containment, where you can realistically do something. I just saw the details of the 4 deaths in Italy: - a 62-year old man with pre-existing conditions - a 80-year-old man - a 84-year-old man with pre-existing medical conditions. - a 88-year-old man Exactly the population that 'flu targets.
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IFISAcava
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Post by IFISAcava on Feb 24, 2020 21:27:47 GMT
Mortality rates and critical/ICU percentages are already 'orders of magnitude' worse than seasonal flu. So if coronavirus becomes as widespread as seasonal flu, it is extremely plausible that the impact on medical facilities will be 'orders of magnitude' worse, by definition. HK/Singapore are seeing critical rates of 5%+. Globally (ex-China) more like 2-3%. Do some simple maths - UK population size, infection/transmission rate similar to flu, critical admission rates even close to these reported levels... then compare to the number of critical beds available in the UK. Go on. I dare you. But I take some solace (rightly or wrongly) from the indication that active cases are overall on the decline globally, despite the outbreaks in new countries... www.worldometers.info/coronavirus/coronavirus-cases/#active-cases I really doubt it. Italy is way ahead of us, do you reckon they are going to be screwed in a week? Let's recongregate here next Monday and see.
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IFISAcava
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Post by IFISAcava on Feb 24, 2020 21:30:30 GMT
CNBC compares US seasonal flu mortality rate of 0.095% vs Coronavirus rate of 2%, making the latter 20 times more deadly. 2% is the rate in China, specifically Wuhan. We don't really know what it is in the West with prior knowledge of the virus and good access to medical care - but so far it seems much less. Time will, of course, tell.
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IFISAcava
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Post by IFISAcava on Feb 24, 2020 21:37:58 GMT
And this (I actually stated this too earlier in the thread). A consequence of overwhelmed medical facilities is that mortality rates for *everything* will go up. Not just coronavirus and related complications. By how much - do we even have a clue ? What is it fundamentally that helps in a clinical setting for this condition? Is it availability of a ventilator? I can believe there are one or two specific treatments like that but there's probably also a down side. If staying in an isolation ward with no contact and following the regime, it may be that things like sleep, food quality and even general happiness may affect the outcome. THe journey to hospital with a high fever probably doesn't help either. I'm not suggesting you're worse off in a hospital but just making the point maybe its only beneficial for the very worst cases. I know zero about medical stuff so look forward to being corrected. it's viral pneumonia. It will eventually pass as the body fights off the virus, but in the interim the risks to those with prior respiratory/other medical conditions are large, there is a risk of secondary bacterial infection, there is a risk of organ failure due to septic shock - these risks are much less with good supportive and interventional care as necessary.
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foolsgold
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Post by foolsgold on Feb 24, 2020 22:13:27 GMT
Me too (except more like 20-30). Thing is, it's easy to say "sell now, wait for it to settle down", but then the danger is that the waters either always look too dangerous to go back into, or stocks shoot up before you get there and you don't want to invest because you've missed the boat. This. Only a fool tries to time the market. Only a fool behaves irrationally and takes a binary view of risk. Selling the majority of your holdings because of the virus ? Seriously ? Brokers love these sort of people, more churn than an ice cream factory in their portfolio, bring on the commission $$$ ! Either a person is a serious long-term investor or they are not. I've said it before and I'll say it again. By all means adjust your portfolio weightings if medium-term conditions deserve it. But going all-in/all-out is incredibly naïve and does you more harm than good on a long-term timeline. Personally I have a better property option just now which I am taking as it gives me a 22 percent annual return on investment and 20 percent immediate upside in value against leaving the cash in Investment trusts which at best will be stagnant or at worse crash so it a no brainer for me but will be back in the market shortly and usually take a 5 year minimum view of investments.Ive still got a substantial SIPP investment though which I will be topping up next month anyway.
My personal view is that the world economy will be hit once the production figures feed through and then there will be an even bigger drop.
Nothing wrong in taking the very long term view such as 10-20 years and then you will look back at this as a mere blip...best of luck anyway
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Post by mrclondon on Feb 25, 2020 0:08:03 GMT
CNBC compares US seasonal flu mortality rate of 0.095% vs Coronavirus rate of 2%, making the latter 20 times more deadly. 2% is the rate in China, specifically Wuhan. We don't really know what it is in the West with prior knowledge of the virus and good access to medical care - but so far it seems much less. Time will, of course, tell. The main issue here is WHO is using a definition of mortality rate that makes zero sense because it is not taking into account it takes 2 to 3 weeks to die if that is the outcome. Hence the mortality rate calculated as deaths over current confirmed cases will lag reality significantly. That said, it is the only easy calculation that can be done to see how things compare to n days ago. Hubei Prov. = 2495/64482 = 3.9% Other China = 97 / 12863 = 0.75% Rest of World = 36 / 2429 = 1.5% (has been creeping up steadily day on day) Unfortunately given the skew in age profile of the cruise ship cases, and Japan likely to be somewhat overwhelmed I suspect the RoW figure will increase markedly over the next month.
Worth repeating here that the mortality rate for seasonal flu is believed to be c. 0.1%. I really doubt it. Italy is way ahead of us, do you reckon they are going to be screwed in a week? Let's recongregate here next Monday and see. At 229 cases / 7 deaths undetected in Italy until 4 days ago, Italy may already be approaching the point of no return (I'd classify Japan, South Korea and Iran as already out of control). The point being that everything looks like its under control ... until all of a sudden it isn't.
A post over the weekend noted the significant size of the Italian community in the UK, and another that until now travellers to/from northern Italy would be unaware of the risk. Whether true or made up, one thing I did spot today was a report by a GP of a guy who had flown home from Milan yesterday and arrived at a GP surgery this morning with symptoms that fit. Said GP phoned 111 for advice to be told 'Italian travel doesn't fit the criteria for covid-19 testing'. If true, then the implication is obvious and frightening (though this guy may well only have the flu).
Across the world with only a few exceptions (e.g. Singapore, South Korea) the testing is no where near as comprehensive as we might imagine, and it feels that China isn't the only country to be misreporting the severity of what is actually known.
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Post by bernythedolt on Feb 25, 2020 3:51:47 GMT
Mortality rates and critical/ICU percentages are already 'orders of magnitude' worse than seasonal flu. So if coronavirus becomes as widespread as seasonal flu, it is extremely plausible that the impact on medical facilities will be 'orders of magnitude' worse, by definition. HK/Singapore are seeing critical rates of 5%+. Globally (ex-China) more like 2-3%. Do some simple maths - UK population size, infection/transmission rate similar to flu, critical admission rates even close to these reported levels... then compare to the number of critical beds available in the UK. Go on. I dare you. I really doubt it. Italy is way ahead of us, do you reckon they are going to be screwed in a week? Let's recongregate here next Monday and see. I was responding to @eurasian69's premise, " if coronavirus becomes as widespread as seasonal flu". I doubt that's the case in Italy. And if it were, I suspect they'd be in difficulty pretty quickly, as would we in the UK.
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Post by bernythedolt on Feb 25, 2020 4:58:05 GMT
2% is the rate in China, specifically Wuhan. We don't really know what it is in the West with prior knowledge of the virus and good access to medical care - but so far it seems much less. Time will, of course, tell. The main issue here is WHO is using a definition of mortality rate that makes zero sense because it is not taking into account it takes 2 to 3 weeks to die if that is the outcome. Hence the mortality rate calculated as deaths over current confirmed cases will lag reality significantly. That said, it is the only easy calculation that can be done to see how things compare to n days ago.
I laboured that exact point for a while upthread, and believe 2% is an under-estimate. We've now had 30,000 resolved and closed cases, more than enough to give an indication of death rate. If it were truly 2%, we should have expected 600 of them to succumb. The figure is actually 2,700. Some have argued, not unreasonably, "What about those who are mildly infected and don't report it?". WHO's own definition of fatality rate is based only on known, reported cases. Others don't figure in the mortality calculation, and never did (eg. for SARS) - if you don't know about them, it makes it hard to count them. WHO has previous form on this. During the SARS outbreak they were reporting 4% death rate. When it finished, the rate was actually found to be 9.6%, so they are known to underestimate. As you've deduced, a better estimate is deaths over (confirmed cases T days ago), where T is the period between case confirmation and death. In fact, exactly as it says here. The fatality rate is slowly falling and currently being reported as 9% by those keeping a close daily watch.
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Post by bracknellboy on Feb 25, 2020 9:10:56 GMT
... Whether true or made up, one thing I did spot today was a report by a GP of a guy who had flown home from Milan yesterday and arrived at a GP surgery this morning with symptoms that fit. Said GP phoned 111 for advice to be told 'Italian travel doesn't fit the criteria for covid-19 testing'. If true, then the implication is obvious and frightening (though this guy may well only have the flu).
That doesn't change the implications of course, which is up to now the message would have been "low risk" and therefore how many carriers are potentially wafting around all over the place. Which is quite possibly why we are now seeing outbreaks which are difficult to trace to the "index case" .
I'm not sure quite what else might have been expected though, because the alternative is that everyone who had flu like symptoms, regardless of travel or even non-travel be treated as a suspect case until proven otherwise. Very difficult to do/justify in the middle of winter. The fact that it is supposedly infectious prior to showing symptoms also hardly helps.
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easynow
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Post by easynow on Feb 25, 2020 9:11:41 GMT
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