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  #21  
Old 03-24-2020, 10:27 PM
Tiger80 Tiger80 is online now
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Post Re: The cost benefit analysis

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Originally Posted by tigerpawgt View Post
President Trump told America he wants to get the country back to work right after Easter. I donít want this to derail into a political argument, and understand he wants to protect our nations economy from a catastrophe. From what I see today, if we go back to social distancing only this virus will expand into hot spots in all populated areas. Heís basically staking his presidency on this. Keep America from a major economic collapse or have overrun hospitals all over the country. Itís a no win situation, and he will be held to blame for every death that occurs after he says go back work but wash your hands constantly.

Fortunately, he canít control what each state decides, so I expect putting America back into the schools, the workpkace, and sports areas is not something he can make happen if Americans decide thatís not a risk they will take.
In the article I shared I think Dr. Ioaninis discusses some of the concerns of people on this thread. We have been so busy treating the sick that we havenít taken any time to try to measure the percentage of Americans that have actually been infected. Think about it. We do random samples of Americans recording all kinds of issues. How hard and how long would it take to do a random sample of Americans to see the extent to which this thing has affected the USA? All we know is based on the people that have been treated and, sadly, those that have died. That is a very biased set of data. It tends to overstate the severity of the coronavirus.

Consider the impact of people not buying goods and services in several sectors of our economy for an extended period of time. Right now the airline industry is almost at a point of collapsing. The restaurant industry is in a similar situation. Wolfgang Puck was interviewed and pointed out that this industry alone contributes over $1 trillion to our economy and employees over 15.6 million Americans. What do we do when these people start filing unemployment claims and eventually or not able to pay the rent or pay their mortgage or other important bills? President Trump has not said we will encourage people to return to work by Easter. He has expressed that as a hope that will be based upon silence in the situation at that time. If this thing continues as it is and Americans are discouraged from leaving their homes we will end up in something that makes the great recession of 2007 look like insignificant.

One last point to make is what the doctor said in his article. The death rate of the coronavirus has been decreasing in the United States as we get more and more data on the number of cases in the number of deaths. Right now the death rate is around 1.2%. It was well over 3% when it first started.

I am hopeful that some of the experimental treatments such as the malaria medicines will prove successful under controlled experiments and be approved for more widespread use. Early successes in both France and China of this treatment suggest it is very promising with 100% success rates in groups of 40 and 20 patients, respectively.
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  #22  
Old 03-25-2020, 01:13 AM
tigerphins tigerphins is online now
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Default Re: The cost benefit analysis

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Originally Posted by LawStudent View Post
I'm not trying to minimize this, but this is disproportionately affecting the elderly with multiple comorbidities. There will always be exceptions, like the healthcare workers, who may have had underlying conditions.



What needs to be examined is why most of the doctors are dying suddenly. It seems to me that it's not the virus, but rather the stress: https://edition.cnn.com/world/live-n...e6eeebe098885a



https://www.bbc.com/news/health-51674743
https://www.vox.com/2020/3/23/211900...-deaths-by-age


Every article will tell you the same thing. The older and unhealthier you are, the more likely you are to die. HOWEVER, what is being missed is that it is not a death sentence if you fall into this range. You still have an 88-92% of survival.
So these doctors are dropping like flies bc of.... stress???
Thereís probably a wartime Combat Medic comment to be made here, but as far as I know, their greatest hidden enemy is PTSD, not sudden stress-related deaths.
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  #23  
Old 03-25-2020, 08:22 AM
LawStudent LawStudent is offline
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Default Re: The cost benefit analysis

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Originally Posted by WaxOn WaxOff View Post
I am an Internal Medicine Physician. I would not pretend to make national economic decisions. I can tell you this virus is a different animal than anything I have seen in my 25+ years in medicine. One of our otherwise healthy Ortho docs (mid 50s in age) is on a ventilator fighting for his life right now. Young people are facing being put on breathing machines as well. This is NOT typical for Influenza- I have never seen anything like this. Our death rate will soar when we run out of ventilators, just like Italy and Spain. Decisions about who has the greatest likelyhood of surviving will be made.



And don't trust the numbers from Germany. They don't count it a Covid-19 death if they can find any underlying health condition.

If there is an underlying health condition, did COVID-19 cause the death, then? This is the problem with reporting the deaths. At the end of the day, very few healthy individuals with no underlying health conditions are dying. This is a monumental distinction between the annual influenza and events like the 1918 Spanish Influenza, both of which killed young, middle-aged, and the elderly indiscriminately. Death sucks. There is no getting around that, but can you really compare the Spanish and Italian healthcare systems to the US?



Additionally, please read the article I cited in a previous post. The Italians are not turning anyone away that they wouldn't have turned away 6 months ago. They already make the decision on a daily, non-pandemic, basis about who gets treatment based on their medical profile.
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  #24  
Old 03-25-2020, 08:24 AM
LawStudent LawStudent is offline
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Default Re: The cost benefit analysis

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Originally Posted by tigerphins View Post
So these doctors are dropping like flies bc of.... stress???
Thereís probably a wartime Combat Medic comment to be made here, but as far as I know, their greatest hidden enemy is PTSD, not sudden stress-related deaths.

It could be PTSD. It could be heart attacks. I don't know. I think asking the question does matter because the answer could be used to prevent the deaths.


And, dropping like flies is a bit extreme.
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  #25  
Old 03-25-2020, 08:30 AM
LawStudent LawStudent is offline
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Default Re: The cost benefit analysis

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I agree!

So open the beaches?

I think so, so long as there are ways to enforce the social distancing. Being outside in the sun is good for people. We should be encouraging people to get outside.
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  #26  
Old 03-25-2020, 03:10 PM
cdtbud cdtbud is online now
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Default Re: The cost benefit analysis

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Originally Posted by LawStudent View Post
I think so, so long as there are ways to enforce the social distancing. Being outside in the sun is good for people. We should be encouraging people to get outside.
Well the way to enforce social distancing would be to close the beaches, no? Are we trying to do what's best for people? or Do we try to do what's best for the economy?
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  #27  
Old 03-25-2020, 04:57 PM
tigerpawgt tigerpawgt is online now
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Default Re: The cost benefit analysis

Remember folks, case fatality rate identifies the risk of experiencing the worst outcome. We also need to consider the volume of patients that are serious to critical condition. The more we get out and interact with others the larger the infection rate becomes which in turn becomes a larger population needing hospital care. There simply arenít enough health care resources if the infection rate continues at an exponential growth. Nothing I see right now makes me optimistic the infection rate is under control by Easter. I support President Trumpís concern for the economic damage, but I just donít see how we can back off the current lockdowns within the next month. I think he will conclude the same as various areas of the country get worse over the next week. I dread the idea of a 2 trillion dollar rescue plan. Geez, our country was irresponsible to rack up a 23 trillion dollar national debt over the last 30 years. A terrible position to be in when the inevitable national disaster occurs.
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  #28  
Old 03-25-2020, 08:46 PM
goindownsouth goindownsouth is offline
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Default Re: The cost benefit analysis

Not all geographies are created equal here. That, perhaps more so than any other variable, is what makes this pandemic challenging when it comes to issuing any blanket statements. Having started on Washington (state) and California and now, New York is considered the epicenter. Most of the locations that seem okay with reopening their parts of the country are generally those with lesser density in terms of infections.

About an hour away from where I am (provincial, suburban NJ) right now is New York City. That there is another story.

One thing I have discovered during this whole thing. There are no universal maxims. That is for certain.
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  #29  
Old 03-25-2020, 10:29 PM
LawStudent LawStudent is offline
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Default Re: The cost benefit analysis

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Originally Posted by cdtbud View Post
Well the way to enforce social distancing would be to close the beaches, no? Are we trying to do what's best for people? or Do we try to do what's best for the economy?

Therein lies the problem. Whats the balance? We have to figure out how to do both. Tanking the economy is going to cost lives as well.
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  #30  
Old 03-26-2020, 08:57 AM
CU311 CU311 is offline
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Default Re: The cost benefit analysis

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Originally Posted by LawStudent View Post
Therein lies the problem. Whats the balance? We have to figure out how to do both. Tanking the economy is going to cost lives as well.
My thoughts exactly. It's a fine line, but there has to be a balance. You can't shut everything down. If the economy collapses, the government falls shortly after. No government, no police. No police... you see where it can lead. How many will die when there are no more grocery stores?

It's an extreme example, but it's not hard to see there's a legit path to it from where we are right now. On the other hand, if we don't slow it and the hospital system collapses, we can end up in the same place when the panic leads to riots.
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  #31  
Old 03-26-2020, 09:18 AM
LawStudent LawStudent is offline
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Default Re: The cost benefit analysis

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Originally Posted by CU311 View Post
My thoughts exactly. It's a fine line, but there has to be a balance. You can't shut everything down. If the economy collapses, the government falls shortly after. No government, no police. No police... you see where it can lead. How many will die when there are no more grocery stores?

It's an extreme example, but it's not hard to see there's a legit path to it from where we are right now. On the other hand, if we don't slow it and the hospital system collapses, we can end up in the same place when the panic leads to riots.

I found this on another site. These are not my words (credit goes to tabbyplague), but it sums up the situation pretty well. The original post mentioned annual deaths to smoking, flu, etc.



All societies grow to accept certain risks and behaviors that, in it's worst case, result in a certain amount of deaths among it's citizenry. The mortality numbers sited in the OP are in fact, acceptable to the majority of people in the USA as a "price" for living. The citizenry may try to reduce those mortality numbers through education programs and medical treatment but death from those issues are still acceptable to the majority in such a way as to not destroy their freedoms and prosperity.

Enter COVID-19. The US data is still in it's early stages where we are still grappling with what the acceptable risk is for this disease. As I have commented elsewhere, one thing is for certain; the USA will not survive as a nation if we keep the whole country locked down until the risk of COVID-19 infection and death is zero. Rational people understand this and yet we can't seem to have an honest national discussion about it right now without people being vilified as "heartless", "not caring" or some other overly emotional response by our media and many politicians. The typical emotional response is that "no death is acceptable" and that we must do everything we can to prevent a COVID-19 death even if it means locking everyone down indefinitely. That is simply not rational, not sustainable, and not within the norm of any society since the beginning of time. At some point the scale of acceptable risk vs death must be balanced or we will cease to be a functioning society.

As the OP points out, the USA has always operated under the construct that a certain amount of risk and death are acceptable in order for us to remain a free and prosperous society. Our society constantly seeks that balance between risk, freedom and prosperity - now that COVID-19 is here to stay, we will have to deal with it in that same light.
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  #32  
Old 03-26-2020, 10:24 AM
Tiger80 Tiger80 is online now
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Post Re: The cost benefit analysis

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Originally Posted by LawStudent View Post
I found this on another site. These are not my words (credit goes to tabbyplague), but it sums up the situation pretty well. The original post mentioned annual deaths to smoking, flu, etc.



All societies grow to accept certain risks and behaviors that, in it's worst case, result in a certain amount of deaths among it's citizenry. The mortality numbers sited in the OP are in fact, acceptable to the majority of people in the USA as a "price" for living. The citizenry may try to reduce those mortality numbers through education programs and medical treatment but death from those issues are still acceptable to the majority in such a way as to not destroy their freedoms and prosperity.

Enter COVID-19. The US data is still in it's early stages where we are still grappling with what the acceptable risk is for this disease. As I have commented elsewhere, one thing is for certain; the USA will not survive as a nation if we keep the whole country locked down until the risk of COVID-19 infection and death is zero. Rational people understand this and yet we can't seem to have an honest national discussion about it right now without people being vilified as "heartless", "not caring" or some other overly emotional response by our media and many politicians. The typical emotional response is that "no death is acceptable" and that we must do everything we can to prevent a COVID-19 death even if it means locking everyone down indefinitely. That is simply not rational, not sustainable, and not within the norm of any society since the beginning of time. At some point the scale of acceptable risk vs death must be balanced or we will cease to be a functioning society.

As the OP points out, the USA has always operated under the construct that a certain amount of risk and death are acceptable in order for us to remain a free and prosperous society. Our society constantly seeks that balance between risk, freedom and prosperity - now that COVID-19 is here to stay, we will have to deal with it in that same light.
Excellent commentary - thank you for sharing. I'm not sure it could be explained much better than that.
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  #33  
Old 03-26-2020, 01:20 PM
tigerpawgt tigerpawgt is online now
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Default Re: The cost benefit analysis

I have no idea how to process what is the right solution.

Below is a Facebook link to a video from an ER nurse from yesterday. She speaks about what is happening at her suburban Detroit hospital. What is normally a well resourced hospital. This is not a known epicenter like New York city. If you decide to watch her, I hope this can help bring this situation from hypothetical to real world. Please, Iím not trying to inflame the discussion, I just thought we need to see how cost benefit is getting handled on the front lines in US hospitals. Warning, I found her message difficult to see and hear.

https://m.facebook.com/story.php?sto...sn=mo&d=n&vh=e
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  #34  
Old 03-27-2020, 07:05 AM
cdtbud cdtbud is online now
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Default Re: The cost benefit analysis

This is going to reek havoc if it spreads to the rural parts of the country.




Quote:
Originally Posted by tigerpawgt View Post
I have no idea how to process what is the right solution.

Below is a Facebook link to a video from an ER nurse from yesterday. She speaks about what is happening at her suburban Detroit hospital. What is normally a well resourced hospital. This is not a known epicenter like New York city. If you decide to watch her, I hope this can help bring this situation from hypothetical to real world. Please, Iím not trying to inflame the discussion, I just thought we need to see how cost benefit is getting handled on the front lines in US hospitals. Warning, I found her message difficult to see and hear.

https://m.facebook.com/story.php?sto...sn=mo&d=n&vh=e
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  #35  
Old 03-27-2020, 08:15 AM
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Robert Thorne MacRae Robert Thorne MacRae is online now
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Default Re: The cost benefit analysis

It is definitely a difficult balancing act. There will be areas they can start to open up more after a few more weeks.
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