Matthew J Poes

Matthew J Poes

Audioholic Chief
Staff member
What are your thoughts on the R0 of Measles being much higher than COVID-19? The R0 of Mumps and Smallpox was also higher than COVID-19.
I don't recall such a large reaction by the Press, or the panic buying of water and toilet paper, state of emergencies, etc.
Well, remember, I'm an intervention scientist, not a doctor or public health expert. I know what I'm told by the experts.

As I understand it, Measles, Mumps, and Smallpox all had their epidemic peaks long before modern medical science. Most of these viruses had their initial peaks 100's of years ago. So when you say you don't remember people freaking out like this, that is because you weren't alive during their epidemic phase. The case curve flattened naturally as people died out and natural immunity built up. But certainly they all remained serious viruses with serious implications until vaccines were created. When worldwide cases spiked in modern times, there was a panicked reaction to a point, but it was never like this situation either.

Now Mumps and Smallpox actually have a similar R0 value to the current predicted value for COVID-19, its not much more contagious, its about the same. Those were devastating viruses (especially Smallpox) so I think there was panic during their peaks.

Another thing to keep in mind, developed parts of the world haven't been inundated by these viruses you mention in modern times. They were at a steady state of cases prior to immunizations and as a result the medical system was sufficient to address the current norm. Our current medical system isn't set up for COVID-19. Immunizations have been highly effective, nearly eradicating those diseases. Because of a drop in immunization rates lately we are seeing a small rise in measles and one of the biggest problems we have is that most doctors don't recognize it. They've never seen a case. Measles hasn't been a big problem since the 80's worldwide, and since the 60's-70's in the USA.
 
mtrycrafts

mtrycrafts

Seriously, I have no life.
Well, remember, I'm an intervention scientist, not a doctor or public health expert. I know what I'm told by the experts.

As I understand it, Measles, Mumps, and Smallpox all had their epidemic peaks long before modern medical science. Most of these viruses had their initial peaks 100's of years ago. So when you say you don't remember people freaking out like this, that is because you weren't alive during their epidemic phase. The case curve flattened naturally as people died out and natural immunity built up. But certainly they all remained serious viruses with serious implications until vaccines were created. When worldwide cases spiked in modern times, there was a panicked reaction to a point, but it was never like this situation either.

Now Mumps and Smallpox actually have a similar R0 value to the current predicted value for COVID-19, its not much more contagious, its about the same. Those were devastating viruses (especially Smallpox) so I think there was panic during their peaks.

Another thing to keep in mind, developed parts of the world haven't been inundated by these viruses you mention in modern times. They were at a steady state of cases prior to immunizations and as a result the medical system was sufficient to address the current norm. Our current medical system isn't set up for COVID-19. Immunizations have been highly effective, nearly eradicating those diseases. Because of a drop in immunization rates lately we are seeing a small rise in measles and one of the biggest problems we have is that most doctors don't recognize it. They've never seen a case. Measles hasn't been a big problem since the 80's worldwide, and since the 60's-70's in the USA.
As one who is into genealogy, I see old records, newspaper accounts where whole towns or almost were wiped out by Smallpox.
And, as you so well stated about drop in immunizations is bringing some of this back and lack of seeing cases is telling how well modern science has dealt with them.
 
Matthew J Poes

Matthew J Poes

Audioholic Chief
Staff member
Got any insight on these programs?

I work only for HHS for the most part and I don't recognize any of those projects. I'm not an expert in all things that the government spends money on. It's very common for the government to fund, through its many agencies, small pilot projects. Sometimes what seems silly has some bigger benefit. For instance, the funding of solar panels for beer might have been a pilot project where there was a return on investment, and they wanted to see. I mean, the feds are spending billions on subsidizing solar all over the nation. There is a real cost benefit to that. The fact that they once spent a tiny amount of money on beer production solar doesn't seem that weird to me.

The $5000 fiddler documentary was strange, but that might have been from the National Endowment of the Arts. There may have been a desire to preserve some history there. It's a tiny amount of money.

I notice they aren't showing the real wastes. None of those are wasteful government programs of any significance. The waste comes from other things.

For example, in my company, if our project officer changes their mind about how to proceed (often for good reason, adapting to the times), we are very accommodating to the extent possible. Rarely do we charge more. Go look at the work of tech and military contractors. They charge for nearly every change that takes place and often the cost of those changes exceeds the total spending on health prevention programs. So changing our minds and lacking clear direction wastes billions. A lot of time we are all asked to do things for unrealistically small amounts of money. The norm is to go after it, tell them it can't happen for that amount, but then once the contract is awarded, ask for more money to finish the task. In my field, there isn't enough money for that to amount to much, nor does it happen often. Yet in military contracts I see cost overruns all the time. Making a project deliverable a moving target is really bad for budgets and its really common.

We also have a lot of regulations that people hear about, complain about, and yet, if they aren't there, everyone wonders how this happens. For example, many of you are probably very upset about all the data breaches that have caused your personal information to be stolen. Well, guess how much it costs to shore up, secure and protect, and then authorize a data system for use in federal contracts. Anywhere from $100,000 to well over a million dollars. That isn't development costs, that just the cost of documenting and monitoring the system to meet federal requirements. These requirements are great, very important, anyone who thinks their tech companies are already doing it right are nuts, so I applaud having something, but the costs are crazy. It ruins projects. Huge waste of money. Yet I don't have a better solution. As someone who manages this process for my company, I can tell you, even the big companies like Amazon and Google routinely screw this up. They do better than most though, I'd call them 90% reliable. Small companies are more like 10% reliable. Recognizing the high costs and work, they reinterpret the security concepts in inappropriate ways.

In the last 6 months my companies business contact information (which is publicly available) was compiled into business databases that were then stolen and misused. It made us a target for hacking groups with excess phishing which then puts our sensitive data at risk. Those companies failed to follow even the remotest of best practices.

You might argue this is wasteful bureaucracy but the costs are no different in the private sector. Those who hire professionals to just follow best practices (not government regulations) spend a fortune. Everything we do with data systems, websites, software, etc. is costing billions of dollars more just to address security. CISSO's are among the highest paid C level executives in companies these days. Pay as you Go CISSO consulting services outpace IT costs by a factor of 2. In fact the nice thing about the government regulation is that it also regulates cost. You can't charge the government as much as you charge in the private sector, so we get a sizable discount.
 
Matthew J Poes

Matthew J Poes

Audioholic Chief
Staff member
As one who is into genealogy, I see old records, newspaper accounts where whole towns or almost were wiped out by Smallpox.
And, as you so well stated about drop in immunizations is bringing some of this back and lack of seeing cases is telling how well modern science has dealt with them.
A lot of the interventions I work on make immunization a central part of our public health work. Helping educate families on the facts surround immunization is key. I've had to study many of our most successful public health interventions like fluoridation and immunization. People today have it so good because of modern health science that they quickly forget what it used to be like. Nobody alive today really remembers clearly what it was like. Most people alive in the 50's and 60's when most horrific diseases with pandemic reach were eradicated were kids. Those who weren't kids probably don't remember what they ate for breakfast.

Immunizations have been world changing in a positive way and if not for them, millions more would die every year. The anti-vaccination propaganda is scary and dangerous. We are seeing direct evidence that even small changes in vaccination rates are causing these diseases to come back.
 
Matthew J Poes

Matthew J Poes

Audioholic Chief
Staff member
Again we have to deal with identified cases. Italy started with a similar mortality to China. Italy has about 50% requiring hospital care. This is higher than when it started there, but they are reporting more patients getting into difficulty over time. China had 49%. needing hospital care and 10% required ICU care.. At this stage in China mortality was around 3.4%. In Italy good ICU care kept mortality at 2%. Now Italy is out of ventilators, and rigging make shift ICUs anywhere they can. 2 days ago the mortality was 5% and now climbing towards 6%.

Now Italy has more ICU beds and ventilators per capita than the US. China is sending medical personel and 1000 ventilators to Italy. The Italians are looking to increase their 3000 ventilators to 10,000.

This is why much more drastic action is required in the US, to slow progression. We are running out of time. They are threatening to call senile old medics like me out of retirement, like the UK is also threatening. I'm not at all sure if that will work well. I suspect I would soon get the virus in a clinical setting and have my half day out with the undertaker, and may be not time for that and thrown on the bonfire. The UK have already issued authority to local authorities to rapidly have bodies burned without benefit of clergy. May be less then an hour out with the undertaker or none. Anyhow I'm expendable now, so what will be will be.

The real questions we need the answer to now, is to try and find the number of people who were exposed and did not get ill or not ill enough to come to medical attention. The Chinese are going to try and find the answer to that by seeing how many of the population have developed antibodies to the virus. Hopefully it is the majority of the population in the zone of infection. If not, now that restrictions are being eased in China, they will see another curve of peaking infections. This will be important information. If there are going to be multiple peaks, then the world will be turned on its head, as it now is until and effective vaccine is developed.
You are still talking about issues that I think are best addressed by social isolation. The peak in mortality is likely not a reflection of how deadly the virus truly is. Its the effect of an overwhelmed medical system. It's why I keep harping on flattening the curve. We need to be medically ready, but far better is prevention. If we can take steps now to prevent the spike in hospitalizations, that is the best possible outcome.

Your last point I think relates to the first. Based on data coming out of South Korea, who has the widest surveillance I'm aware of, there is evidence that young people are the number one carriers of this, and they aren't showing symptoms. They seem to be still contagious. That makes quarantine efforts all the more important. Right now young people are not taking this seriously. One of the biggest things we can do to help fix this is to better message the flatten the curve concept. The messaging right now is all wrong, following all the wrong practices. They are messaging guilt and shame. That doesn't work. They are focusing on the immediate in unrelateable ways. Telling people to stay home to protect the innocent. People are selfish, that doesn't work.

I really think people, in general, don't understand what happens when a medical system becomes overwhelmed. It isn't just those with COVID-19 that suffer. When doctors are distracted and overwhelmed by COVID-19 (and or being sick themselves) all care suffers. Manageable but difficult diseases become unmanageable. People who need routine heart surgery become far more likely to have a negative outcome.

I think that, along with efforts to improve surveillance and testing, shore up our medical systems, we need to really focus on true quarantine efforts and better education of the public. We know how to message this stuff, they need to get those experts involved (and Google isn't it).
 
Matthew J Poes

Matthew J Poes

Audioholic Chief
Staff member
Dude! Thanks for posting this. I just did my own primitive analysis in the same vein. I was trying to figure out how Dr. Fauci came up with a 1% mortality rate. I came up with a .74 mortality rate. I also calculated that more than 63% would need to be infected to achieve herd immunity based on an R 2.68. Once I put my kids to bed, I'll post my primitive data and Excel spreadsheets. I'm terrible at my math; I studied English in college.
I mean this as no offense, but how could you be calculating any of this? If math isn't your jam, how are you using excel to equal a complex Bayesian model developed by the finest minds at Columbia university?

Also, how does infection rate equal herd immunity? Where is that coming from?

Where did you come up with the R=2.68? That is far below the current estimates.
 
mtrycrafts

mtrycrafts

Seriously, I have no life.
...
The $5000 fiddler documentary was strange, but that might have been from the National Endowment of the Arts. There may have been a desire to preserve some history there. It's a tiny amount of money.

...
That doesn't even qualify as peanuts. ;)
It is nothing in a multi T budget, not even pocket change, a penny dropped, perhaps even a 1/2 penny or even an insignificant fraction of a penny. :D
 
Matthew J Poes

Matthew J Poes

Audioholic Chief
Staff member
I'm not sure I follow this: "there is zero evidence that it’s contagious and that is the big unknown"? Do you mean there's zero evidence for airborne transmission? In a more general sense, I would think it must be contagious in some way or it wouldn't be spreading?

Here's a snip from one article I found:

>>>Is coronavirus airborne like measles?

The jury is out. As of Thusday, it did not appear to be an airborne virus in the same vein as measles or chickenpox, said Luis Ostrosky, a professor and vice chairman of internal medicine at McGovern Medical School in Houston, Texas. “It’s a virus that travels in droplets. This is very good news. With an airborne virus, one person could infect the whole room.”<<<

Now for the bad news: Airborne transmission is “plausible,” according to a study (that has not been peer reviewed) posted online this week from scientists at Princeton University, the University of California, Los Angeles and the National Institutes of Health. The researchers concluded that the virus could remain airborne for “up to 3 hours post aerosolization.”

What I was told is that Measles is considered airborne because it spreads through droplets. It doesn't just float in the room.

A new recently posted study found it remained airborne for 9 hours! I've been waiting to see the study to figure out how they figured that out.

As for not contagious, a virus being in the air or on a surface doesn't mean its contagious. It's unclear that just because the virus showed up 9 hours later doesn't mean its viable. The expert I was talking to suggested that the jury is still out in that regard. That a next step would be to test the viability of the virus to spread contagiously over various lengths of time.

I'm supposed to get copies of these studies later today.
 
Matthew J Poes

Matthew J Poes

Audioholic Chief
Staff member
That doesn't even qualify as peanuts. ;)
It is nothing in a multi T budget, not even pocket change, a penny dropped, perhaps even a 1/2 penny or even an insignificant fraction of a penny. :D
Given the waste in other departments, I would say, anyone trying to fix our budget or reduce our deficit based on $5000 projects is looking in the wrong places.

One problem many don't understand is that they often treat government spending as open ended and disconnected from the economy. As if spending a trillion dollars on healthcare is just money spent with nothing in return. It doesn't work that way. Many programs have a return on investment to them. Money spent to resolve one problem pays for itself (and often then some) somewhere else. That is not waste. So one way to cut the waste is going to be more about focusing on things like evidence of effectiveness and return on investment, which is a major part of how programs are funded in government. Sadly some programs are politicized and so, regardless of the evidence, are de-funded as wasteful because they are politically distasteful.
 
M

Mr._Clark

Audioholic Samurai
What I was told is that Measles is considered airborne because it spreads through droplets. It doesn't just float in the room.

A new recently posted study found it remained airborne for 9 hours! I've been waiting to see the study to figure out how they figured that out.

As for not contagious, a virus being in the air or on a surface doesn't mean its contagious. It's unclear that just because the virus showed up 9 hours later doesn't mean its viable. The expert I was talking to suggested that the jury is still out in that regard. That a next step would be to test the viability of the virus to spread contagiously over various lengths of time.

I'm supposed to get copies of these studies later today.
Thanks!

When you say "A new recently posted study found it remained airborne for 9 hours!" I think "it" is the coronavirus, not the Measles virus you mentioned in the preceding paragraph?

Thanks again, I'm not trying to troll you in any way shape or form! I'm just trying to understand.
 
Matthew J Poes

Matthew J Poes

Audioholic Chief
Staff member
Thanks!

When you say "A new recently posted study found it remained airborne for 9 hours!" I think "it" is the coronavirus, not the Measles virus you mentioned in the preceding paragraph?

Thanks again, I'm not trying to troll you in any way shape or form! I'm just trying to understand.
Yeah the 9 hour study was for COVID-19. The group I'm part of is really questioning that length of time. We question how they were able to test for it over that long of a time. So I'm sharing it because its an impressively long number (and might be correct), but we think its too long. There are some study design limitations that make it really hard to test for something like that over that length of time without other factors coming into play.

Airborne is really widely defined so I wonder if some of this is just semantics. https://en.wikipedia.org/wiki/Airborne_disease

That shows that there are two means by which a virus is considered airborne, liquid droplets large in size and aerosolization (which also includes dry). The former we know for sure COVID-19 spreads by, so its airborne by that definition. The latter is the area being debated, but when the expert I talked with corrected me, he was suggesting we know it spreads through aerosolization, which increases it reach dramatically.

Assuming I am fully understanding what I am being told, this is a fully airborne virus, but its liquid borne no matter what. It isn't like anthrax, which can spread dry. But does that really matter? Someone sneezes or coughs and it can potentially spread 6+ feet and stay in the air for anywhere from 3 to 9 hours. That is not great news for something that is also easily spread.
 
mtrycrafts

mtrycrafts

Seriously, I have no life.
...

Assuming I am fully understanding what I am being told, this is a fully airborne virus, but its liquid borne no matter what. It isn't like anthrax, which can spread dry. But does that really matter? Someone sneezes or coughs and it can potentially spread 6+ feet and stay in the air for anywhere from 3 to 9 hours. That is not great news for something that is also easily spread.
I would think anthrax being dry would stay in the air and spread further for longer time than virus that needs liquid droplets with more mass to sink, no? And if that droplet evaporates?
 
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