“It could be like a Lehman Brothers scenario, where a couple of big health care companies take the economy down.”

[DocEspana]

More delta or is there some new badness that awaits us?

What they're saying to me is just that this stuff is cyclic and the cultural and behavioral patterns that trigger mass outbreaks and then spontaneous improvements tend to be way more predictable than our sense of "humans act independently" would suggest.

Really hard to predict when new strains (particularly ones of concern) will arise. Mutations are too random and plenty of new strains are not "worse" than the given dominant one and never supplant it

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[deleted1114045]

Epidemiologists (I hang with nerd crowds and am going to be a best man at TWO different epidemiologist's weddings... in 2023) are saying that Florida or southern georgia/alabama/lousiana will be an epicenter of a new outbreak in the last week of december. The increase will hit same week as christmas, it will be very noticeable by 2nd week of january and will pleateau sometime in february (for the epicenter) and then spread throughout the rest of the country with a geography-dependent delay pattern.

Its strange how certain they are about this stuff, but I see it being completely right - even down to knowing florida will be the cause of it all.

Have you been talking to them throughout the pandemic? Have they been right about their predictions? What have they been wrong about? Man, I’d LOVE to talk to them about their past 2 years.

 

[DocEspana]

Have you been talking to them throughout the pandemic? Have they been right about their predictions? What have they been wrong about? Man, I’d LOVE to talk to them about their past 2 years.

Oh yeah. They are like 2 of my 5 best friends since I moved down to Miami for my pgy infinity years.

I'll say at the beginning all of their predictions were really accurate in a broad sense but I thought that they were overreacting idiots.I don't think anyone predicted how things would go on the micro/local level at the start. They are no different. We just didn't know a lot so they didn't know a lot. The longer this has gone on though, the better they have got at being able to predict trends and the geography of those trends down to a week or two. They are really really good at it, and the more they have learned that people won't act ideally (the fact that vaccines got politicized and the fact that any number anyone uses will become a political cudgel broke their idealistic hearts) the more they have been able to correctly assume that something just short of the worst case scenario will always happen

 

[southerndoc]

Epidemiologists (I hang with nerd crowds and am going to be a best man at TWO different epidemiologist's weddings... in 2023) are saying that Florida or southern georgia/alabama/lousiana will be an epicenter of a new outbreak in the last week of december. The increase will hit same week as christmas, it will be very noticeable by 2nd week of january and will pleateau sometime in february (for the epicenter) and then spread throughout the rest of the country with a geography-dependent delay pattern.

Its strange how certain they are about this stuff, but I see it being completely right - even down to knowing florida will be the cause of it all.

Yes they predict the new epicenter while the country is still battling the fourth wave in Michigan and the midwest. Easy to predict since we had the last wave and virtually no activity currently. Wouldn't predict a fifth wave to start in the middle of a fourth wave.

 

[DocEspana]

Epidemiologists (I hang with nerd crowds and am going to be a best man at TWO different epidemiologist's weddings... in 2023) are saying that Florida or southern georgia/alabama/lousiana will be an epicenter of a new outbreak in the last week of december. The increase will hit same week as christmas, it will be very noticeable by 2nd week of january and will pleateau sometime in february (for the epicenter) and then spread throughout the rest of the country with a geography-dependent delay pattern.

Its strange how certain they are about this stuff, but I see it being completely right - even down to knowing florida will be the cause of it all.

I feel like my friends are about 1 week off from their predictions. These guys are very good at what they do.

Of note, the above comment is from before anyone has ever heard of the omicron strain.

 

[WilcoWorld]

I feel like my friends are about 1 week off from their predictions. These guys are very good at what they do.

Of note, the above comment is from before anyone has ever heard of the omicron strain.

I was thinking about this prediction last night.

I was also trying to recall who predicted that as COVID 19 mutated it would become less deadly, because of regression to the mean. Was it @RustedFox ? Seems to be coming true

 

[Arcan57]

I was thinking about this prediction last night.

I was also trying to recall who predicted that as COVID 19 mutated it would become less deadly, because of regression to the mean. Was it @RustedFox ? Seems to be coming true

The natural history of virus mutations is increasing transmissibility with decreasing virulence. Omicron mutated it's spike protein in a way that greatly increased infectivity in the upper respiratory tract but severely reduced it's ability to infect lung tissue. Hence all the URI symptoms with relatively minimal pulmonary problems.

Back on topic, Envision's debt is mostly the result of the leveraged buyout by KKR. You may remember leveraged buyouts from such success stories as Toys R Us. Ideally, you find an industry that has steady consistent profit but may have some vulnerabilities due to changing market conditions. You then acquire a business in that industry that has brand recognition. Since that can be expensive and risky, a significant portion (70-80%) of the purchase cost is actually a loan secured by the collateral of the company you just bought. Pump a bunch of cash into expanding the business (ie acquiring contracts) then take it public after showing explosive growth. Reap the windfall from the IPO, wait for the artificially pumped up growth to subside back to baseline levels, then repeat. If everything works as planned, PE acts as booster rockets for the CMG's growth. The problem is as the debt keeps increasing, the percentage of the business's profits spent servicing that debt rise. You're turning something that was safe and reliable into something that is more profitable and significantly more fragile. Which leads to things like APP (recapitalized in 2017 by Brown Brothers Harriman) forcing its private contractors to give them an involuntary loan during the pandemic so they didn't default in the summer of 2020.

 

[DocEspana]

The natural history of virus mutations is increasing transmissibility with decreasing virulence. Omicron mutated it's spike protein in a way that greatly increased infectivity in the upper respiratory tract but severely reduced it's ability to infect lung tissue. Hence all the URI symptoms with relatively minimal pulmonary problems.

Back on topic, Envision's debt is mostly the result of the leveraged buyout by KKR. You may remember leveraged buyouts from such success stories as Toys R Us. Ideally, you find an industry that has steady consistent profit but may have some vulnerabilities due to changing market conditions. You then acquire a business in that industry that has brand recognition. Since that can be expensive and risky, a significant portion (70-80%) of the purchase cost is actually a loan secured by the collateral of the company you just bought. Pump a bunch of cash into expanding the business (ie acquiring contracts) then take it public after showing explosive growth. Reap the windfall from the IPO, wait for the artificially pumped up growth to subside back to baseline levels, then repeat. If everything works as planned, PE acts as booster rockets for the CMG's growth. The problem is as the debt keeps increasing, the percentage of the business's profits spent servicing that debt rise. You're turning something that was safe and reliable into something that is more profitable and significantly more fragile. Which leads to things like APP (recapitalized in 2017 by Brown Brothers Harriman) forcing its private contractors to give them an involuntary loan during the pandemic so they didn't default in the summer of 2020.

Only really going to discuss the top part. I always have one little bone to pick with people who comment that viruses regress towards a more contagious and less virulent form over time. A much smaller bone with people who say it as a fact than people who say it as a way to pooh pooh covid (you aren't a part of the second group).

Viruses aren't smart. They don't know what they're supposed to do or really have a strategy to mutating. When we talk about this trend, we leave out that the timeframe can be months or it could be decades. It will eventually happen as a sort of function of the inevitability of selective forces, but if it's doing just fine in a moderately contagious and moderately lethal form (or any combination except for the "ideal") it can stay that way for months, years, decades, generations. You need both a selective pressure and a good bit of luck to get to that ideal mixture of virulence and contagiousness. And a lot of the previous variants really didn't have too much selective pressure on them. We all sort of lucked out that it happens to be a very mutation prone virus.

 

[AlmostAnMD]

Picking my brain all the way back to medical school

This reminds me of my immunology course. One of the ID docs said virulence and mortality are on a spectrum, and that more deadly disease will not be easily spread. That's why when Ebola broke out it didn't take over the entire globe. You basically get it and die quickly or recover, you don't run around and cough it on people for a week.

Omicron follows that somewhat. More easily spread, less dangerous. So if a super deadly version of covid comes out, in theory, it won't spread as easily? This is all stuff from med school

 

[bravotwozero]

I mean at this point, variants or not, the virus is running out of people to infect. This isn’t like 2020 anymore where nobody on this planet had any immunity or exposure to it. You now have much higher circulating levels of immunity through vaccination or prior infection, or both.

Huge swaths of people who were vulnerable and at high risk of death have also gotten the virus and died, necessarily leaving behind people who are at lesser risk of severe disease and hospitalization.

The above two factors should be more than enough to cause further outbreaks to be less severe and/or deadly, even with waning antibody related immunity (as opposed to b and T cell), and even put selective pressure on the virus to become less deadly.

 

[GassYous]

I mean at this point, variants or not, the virus is running out of people to infect. This isn’t like 2020 anymore where nobody on this planet had any immunity or exposure to it. You now have much higher circulating levels of immunity through vaccination or prior infection, or both.

Huge swaths of people who were vulnerable and at high risk of death have also gotten the virus and died, necessarily leaving behind people who are at lesser risk of severe disease and hospitalization.

The above two factors should be more than enough to cause further outbreaks to be less severe and/or deadly, even with waning antibody related immunity (as opposed to b and T cell), and even put selective pressure on the virus to become less deadly.

Right...

 

[DocEspana]

Picking my brain all the way back to medical school

This reminds me of my immunology course. One of the ID docs said virulence and mortality are on a spectrum, and that more deadly disease will not be easily spread. That's why when Ebola broke out it didn't take over the entire globe. You basically get it and die quickly or recover, you don't run around and cough it on people for a week.

Omicron follows that somewhat. More easily spread, less dangerous. So if a super deadly version of covid comes out, in theory, it won't spread as easily? This is all stuff from med school

actually ebola (and west nile) is one of the examples used for diseases that mutated to be more deadly one day and just stayed that way because its already contagious enough that it doesnt really impact its "survival" (quotes because viruses arent really alive) to be more deadly even if killing faster represents slight decrease in its ability to spread - it really doesnt make a difference on an already highly contagious disease.

this is a sort of pedantic point, but I had to add it since you referenced ebola.

 

[deleted1114045]

Okay, am I the only one asking WTF is the OP talking about?

Also, wtf are you talking re covid?

 

[turkeyjerky]

Still far from the ‘deadliest surge of covid’ and, based on what I’ve seen clinically as well reports from SA, England, etc I doubt it will be. Majority of the hospitalized cases I’ve seen recently were incidentally positive.

 

[thegenius]

Yea I don't think Omicron is deadly, kind of weak.

If one can develop some sort of immunity to a variety of subtle variants, getting immunity from Omicron is the way to go

 

[deleted1114045]

Still far from the ‘deadliest surge of covid’ and, based on what I’ve seen clinically as well reports from SA, England, etc I doubt it will be. Majority of the hospitalized cases I’ve seen recently were incidentally positive.

Knock on wood, we shouldn’t get as many ICU patients with this wave. The persistent nature of the pandemic is stressing our hospital system to the max. In the past 6 months, we’ve had 40% turnover in ER nursing staff. My hospital is the redheaded stepchild to a big mother hospital down the road. Between our two hospitals, we are down 300 nurses. That is a huge financial strain. Hopefully, this is the last hurrah for the virus. I don’t think anybody comes through this year without immunity, one way or another.

 

[turkeyjerky]

Knock on wood, we shouldn’t get as many ICU patients with this wave. The persistent nature of the pandemic is stressing our hospital system to the max. In the past 6 months, we’ve had 40% turnover in ER nursing staff. My hospital is the redheaded stepchild to a big mother hospital down the road. Between our two hospitals, we are down 300 nurses. That is a huge financial strain. Hopefully, this is the last hurrah for the virus. I don’t think anybody comes through this year without immunity, one way or another.

Yeah. We're really seeing the indirect effects of covid leading to the majority of current systemic stress, rather than the direct effects of illness. We've seen the overall M&M of this virus cut down by 90% or so, due the combination of vaccinations, prior infections and intrinsic changes to the virus, yet when the public health authorities try to adjust their messaging they get flooded w/ criticism.

I don't think that many people realize that this country ended up 'flattening the curve' quite successfully in 2020 (despite the rampant flub-ups and ratfukkery). In my view, Covid-19 was akin the 1918 flu and omicron is like the 2009 flu.

 

[thegenius]

“ratfukkery” is a new one. Never heard that before

 

[RustedFox]

“ratfukkery” is a new one. Never heard that before

It's a military term.

 

[deleted1114045]

I don't think that many people realize that this country ended up 'flattening the curve' quite successfully in 2020 (despite the rampant flub-ups and ratfukkery). In my view, Covid-19 was akin the 1918 flu and omicron is like the 2009 flu.

Again and again, my anti-vaxxer and Republican friends brought up the lack of Influenza cases and blamed it on us just not looking for it or blaming things on COVID. I repeatedly told them that we continued to look for alternative virus etiology in severely ill patients. I pointed out that I and all of my colleagues that I know went over a year without seeing a single fever or case of croup in a kid. We drastically decreased the likelihood of viral transmission. Way more people would have died and hospitals would have been much more full had we not masked, hand washed and socially distanced.

 

[thegenius]

Again and again, my anti-vaxxer and Republican friends brought up the lack of Influenza cases and blamed it on us just not looking for it or blaming things on COVID. I repeatedly told them that we continued to look for alternative virus etiology in severely ill patients. I pointed out that I and all of my colleagues that I know went over a year without seeing a single fever or case of croup in a kid. We drastically decreased the likelihood of viral transmission. Way more people would have died and hospitals would have been much more full had we not masked, hand washed and socially distanced.

Some people just don't get it.

 

[aafisahar]

Again and again, my anti-vaxxer and Republican friends brought up the lack of Influenza cases and blamed it on us just not looking for it or blaming things on COVID. I repeatedly told them that we continued to look for alternative virus etiology in severely ill patients. I pointed out that I and all of my colleagues that I know went over a year without seeing a single fever or case of croup in a kid. We drastically decreased the likelihood of viral transmission. Way more people would have died and hospitals would have been much more full had we not masked, hand washed and socially distanced.

The orange man said that masks and vaccines are for wimps and he is God's ordained leader on earth.

 

[bravotwozero]

The orange man actually got vaccinated himself, and told his supporters to do so, and was booed by them.

 

[thegenius]

What color would the orange man turn if someone gave him methylene blue? Brown?

 

[aafisahar]

The orange man actually got vaccinated himself, and told his supporters to do so, and was booed by them.

after he railed against them for >12 months. you can't un**** that genie.

 

[deleted1114045]

I d

after he railed against them for >12 months. you can't un**** that genie.

I don’t follow Trump closely, but I don’t remember him railing against vaccines.