The Sad Story of VC taking over EM

[Chartreuse Wombat]

A Major Medical Staffing Company Just Slashed Benefits for Doctors and Nurses Fighting Coronavirus

Alteon Health, backed by private-equity firms Frazier Healthcare Partners and New Mountain Capital, will cut salaries, time off and retirement benefits for providers, citing lost revenue. Several hospital operators announced similar cuts.

www.propublica.org

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[Mandelin Rain]

Physicians. Stop working for these ****ing companies. En masse. You are their only asset. If you all stop, they go away. Stop.

 

[scarbrtj]

A doctor's best, most trustworthy boss will always be himself/herself.
Relying on the kindness of strangers is such an ignominious-to-the-soul outcome after years of studying and working one's ass off... but been there, done that.
Better to rely on autokindness and one's own work ethic which will never, ever fail. IMHO.
Worker doctors of the world, unite. But dis-unite from whence thou art thus presently united.

 

[deleted941485]

Seriously...ED docs it’s time to call in sick.

 

[w00tz]

Super sad. Have a few friends in EM. I worry about their exposure/risk to COVID. This is just really kicking them while they are down.

This could be rad onc in the future with continued bloated residencies pumping out graduates. Simple supply and demand.

 

[medgator]

Super sad. Have a few friends in EM. I worry about their exposure/risk to COVID. This is just really kicking them while they are down.

This could be rad onc in the future with continued bloated residencies pumping out graduates. Simple supply and demand.

EM seeing it too, there was a thread about the mega hospital chains trying to expand em residency spots in their own self interest

 

[RadOncMegatron]

Really, unfortunate situation. The admin taking advantage of the situation. Most of us, would quit/strike in normal circumstances, but I bet the duty to the patients makes them unable to quit with so many lives on the line.

I would get them back after this is over. Shameful

 

[Neuronix]

Opinion | The Business of Health Care Depends on Exploiting Doctors and Nurses (Published 2019)

One resource seems infinite and free: the professionalism of caregivers.

www.nytimes.com

 

[medgator]

Opinion | The Business of Health Care Depends on Exploiting Doctors and Nurses (Published 2019)

One resource seems infinite and free: the professionalism of caregivers.

www.nytimes.com

It’s Not Burnout, It’s Moral Injury

It’s time to stop victim shaming and start calling it like it is.

zdoggmd.com

 

[Mandelin Rain]

“I will toil endlessly, and accept that which my paymaster deems appropriate.”

Hippocratic Oath, 2020

 

[Krukenberg]

Super sad. Have a few friends in EM. I worry about their exposure/risk to COVID. This is just really kicking them while they are down.

This could be rad onc in the future with continued bloated residencies pumping out graduates. Simple supply and demand.

if buying rad onc practices was profitable for PE they would have done it already. They tried protons and got burned, so an upside of rad onc is I see us as being protected from intrusion by Wall Street.

 

[Neuronix]

if buying rad onc practices was profitable for PE they would have done it already. They tried protons and got burned, so an upside of rad onc is I see us as being protected from intrusion by Wall Street.

Our masters are the academic and "non-profit" medical centers instead. Is that any better? I'm not sure. More stable maybe.

 

[medgator]

if buying rad onc practices was profitable for PE they would have done it already. They tried protons and got burned, so an upside of rad onc is I see us as being protected from intrusion by Wall Street.

Ever heard of vantage oncology or rtsx/21co?

 

[scarbrtj]

if buying rad onc practices was profitable for PE they would have done it already. They tried protons and got burned, so an upside of rad onc is I see us as being protected from intrusion by Wall Street.

Lest we forget radiation therapy was literally a Wall Street stock not that long ago.

 

[RadOncMegatron]

Lest we forget radiation therapy was literally a Wall Street stock not that long ago.

Don't forget you can always invest in Varian: Varian Medical Systems, Inc. (VAR) Stock Price, Quote, History & News - Yahoo Finance

Edit: This would be a colossal COI for any of us would it not? Been tempted, but not worth the heat. I know that certain trials forbid having lots of stock in the company running it and even seen someone with a "health mutual fund" not allowed to be an investigator.

 

[deleted1002574]

Why is that COI? It's an item you use for work. Its like saying you can't buy most health care related stock.

 

[Neuronix]

In academics it definitely counts as a conflict of interest if you have stock in a company and publish or present anything using their equipment.

Will anyone care? Probably not.

Edit: Yes need to disclose.

 

[radiation]

In academics it definitely counts as a conflict of interest if you have stock in a company and publish or present anything using their equipment.

Will anyone care? Probably not.

University of Wisconsin cancer researcher quits amid conflict of interest investigation

A prominent UW-Madison cancer researcher has abruptly resigned after university officials began investigating a potential conflict of interest involving his outside business interests.

madison.com

 

[RickyScott]

University of Wisconsin cancer researcher quits amid conflict of interest investigation

A prominent UW-Madison cancer researcher has abruptly resigned after university officials began investigating a potential conflict of interest involving his outside business interests.

madison.com

I don’t see a problem as long as you disclose everything and comply with your institutions policies. Interesting comment there by Eli glatstein- 90% of opinions turned out wrong, so much greater than chance.

 

[RadOncMegatron]

Why is that COI? It's an item you use for work. Its like saying you can't buy most health care related stock.

If you have to choose been the an Elekta and Varian machine and you push hard for Varian, it looks really bad if you had $10,000 of stock in the company. For that reason, I try to avoid all healthcare sector stocks.

 

[deleted1002574]

Interesting. Many of the popular Index ETFs (sector and just general index) carry a lot of Varian. Does that matter? I mean any one who is doing SPY or VOO or IVV has Varian. Do you have to divest of those? Sounds fishy when it is a "household" item in a radonc's clinic. I see your point, but Varian is ubiquitous.

 

[Neuronix]

Stocks owned as part of an index fund do not count as conflicts of interest for any disclosure forms that I'm aware of.

 

[medgator]

Interesting. Many of the popular Index ETFs (sector and just general index) carry a lot of Varian. Does that matter? I mean any one who is doing SPY or VOO or IVV has Varian. Do you have to divest of those? Sounds fishy when it is a "household" item in a radonc's clinic. I see your point, but Varian is ubiquitous.

Ditto with jnj bmy etc. I think ETF or MF is fine

 

[Tigerstang]

if buying rad onc practices was profitable for PE they would have done it already. They tried protons and got burned, so an upside of rad onc is I see us as being protected from intrusion by Wall Street.

This is a joke right? 21C, US Oncology, Vantage, ION, Eplus (now ION)....

 

[medgator]

This is a joke right? 21C, US Oncology, Vantage, ION, Eplus (now ION)....

A lot of people in academics probably just don't know this stuff...

 

[deleted1002574]

A lot of people in rad onc probably don't know that 21C and US Oncology are not private equity companies.
For profit/public =/= private equity. I don't think Vantage or Ion are, either.

What are you talking about?

 

[medgator]

A lot of people in rad onc probably don't know that 21C and US Oncology are not private equity companies.
For profit/public =/= private equity. I don't think Vantage or Ion are, either.

What are you talking about?

What are you talking about?

Vantage was founded by PE prior to being bought out by McKesson. Uson was also bought by McKesson in 2010 and was PE with Welsh Carson before that.

McKesson to Pay $1.2 Billion for Pair of Oncology Businesses

McKesson revealed Thursday a pair of acquisitions that will grow its oncology business.

www.thestreet.com

The company said Feb. 24 it would acquire Oak Hill Capital Partners-backed Vantage Oncology LLC

Oncology on the Rise: Private Equity Investment in Cancer Care

Written by: Michael Miner and Vincent M. Kickirillo Dry powder in the private capital markets has been on the rise since 2012 and surpassed the $2 trillion mark for the first time in 2018.[1] With so much capital to deploy, and the rise of asset values since the Great Recession, private equity...

vmghealth.com

Why Did McKesson Buy U.S. Oncology?

This morning McKesson spent $2.16 billion today to buy U.S. Oncology--a physician practice management company for cancer doctors. U.S. Oncology went private in a $1.6 billion deal in 2006 led by the buyout firm Welsh Carson after new payment rules that affected how much the company could mark up...

www.forbes.com

 

[deleted1002574]

You're telling me that 21C and US Oncology and Ion were founded as PE companies? Are you hanging on that ? Like for real? You think that both were PE backed from the start?

 

[medgator]

You're telling me that 21C and US Oncology and Ion were founded as PE companies? Are you hanging on that ?

The facts would seem to support that more than this:

if buying rad onc practices was profitable for PE they would have done it already.

That's EXACTLY what vantage/USON etc did last decade, both of whom sold to a bigger fish (publicly-traded McKesson). Not sure what you're trying to argue here?

 

[Tigerstang]

You're telling me that 21C and US Oncology and Ion were founded as PE companies? Are you hanging on that ? Like for real? You think that both were PE backed from the start?

21C was backed by PE money, as was OnCure, as was Vantage. None were founded by VC, but acquired. ION is a VC company. It is just VC for radiation oncology, owned by Jeff Goffman. You might put provision in this category as well, depending on how you view Terry Douglas. Trust me I have very close friends in who were in executive leadership in all of those companies. Private equity has a very strong footing in radiation oncology.

 

[Haybrant]

As altruistic as we ought to be as physicians be careful right now. All this talk and adulation of health care workers is similar to firemen after 9/11; they were forgotten as will healthcare workers be. NYC is asking for medical volunteers. Sounds great but what will NYC do for the volunteers. Ever asked politely for a little bit of a nicer room away from the construction noise at a NYC hotel and been laughed at. That’s how healthcare workers will be treated after all this, nyc (and it’s hotels) aren’t going to care or remember. Want a nicer seat on a plane Bc you served in a time of need? Not happening. Maybe your luggage exceeds the limit by a pound. Sorry airlines wont be letting you go. Look out for yourself and family. Maybe you need supplemental insurance Bc you lost lung function from covid after helping on the front lines, sorry pre-existing condition.

Right now the government and all these for profit and fake non profit academic hospitals and their admin want to just get past the next 4-6 months to get the economy buzzing again. They can’t make $ off covid. If 100k or 200k people have to go (you do realize it will be 2-3x that right, maybe 5x) so be it including so many health workers. They just want to get past it

 

[RickyScott]

As altruistic as we ought to be as physicians be careful right now. All this talk and adulation of health care workers is similar to firemen after 9/11; they were forgotten as will healthcare workers be. NYC is asking for medical volunteers. Sounds great but what will NYC do for the volunteers. Ever asked politely for a little bit of a nicer room away from the construction noise at a NYC hotel and been laughed at. That’s how healthcare workers will be treated after all this, nyc (and it’s hotels) aren’t going to care or remember. Want a nicer seat on a plane Bc you served in a time of need? Not happening. Maybe your luggage exceeds the limit by a pound. Sorry airlines wont be letting you go. Look out for yourself and family.

Right now the government and all these for profit and fake non profit academic hospitals and their admin want to just get past the next 4-6 months to get the economy buzzing again. They can’t make $ off covid. If 100k or 200k people have to go then so be it including so many health workers. They just want to get past it

T-Mobile is offering a 1st responder discount, half off.
On a more serious note, I don’t personally believe that 0.5% death rate that disproportionately affects elderly justifies a Great Depression.

 

[medgator]

T-Mobile is offering a 1st responder discount, half off.

Free Crocs at Crocs website, free coffee at Starbucks.

 

[DoctwoB]

T-Mobile is offering a 1st responder discount, half off.
On a more serious note, I don’t personally believe that 0.5% death rate that disproportionately affects elderly justifies a Great Depression.

Because .5-2% quickly becomes 5% when the hospitals are overwhelmed (see Italy). Which in reality is much higher since patients are dying from other preventable causes. And when that happens, keeping the economy running isn’t an option. You think NY economy would be humming right now without the stay at home order? The choice isn’t between tanking the economy and saving lives. It’s between tanking the economy and losing lives or tanking the economy and Savingn lives

 

[medgator]

Because .5-2% quickly becomes 5% when the hospitals are overwhelmed (see Italy). Which in reality is much higher since patients are dying from other preventable causes. And when that happens, keeping the economy running isn’t an option. You think NY economy would be humming right now without the stay at home order? The choice isn’t between tanking the economy and saving lives. It’s between tanking the economy and losing lives or tanking the economy and Savingn lives

Not even sure why this is still debated outside of some right wing denier circles. BJ over in the UK wanted to try that approach and pulled back last minute because the predictions were so grim

The UK abandoned its coronavirus plan after realizing it would have resulted in 'hundreds of thousands of deaths'

The previous UK plan would have caused 'hundreds of thousands of deaths' and overwhelmed the healthcare system, a new report estimates.

www.businessinsider.com

 

[RickyScott]

Not even sure why this is still debated outside of some right wing denier circles. BJ over in the UK wanted to try that approach and pulled back last minute because the predictions were so grim

The UK abandoned its coronavirus plan after realizing it would have resulted in 'hundreds of thousands of deaths'

The previous UK plan would have caused 'hundreds of thousands of deaths' and overwhelmed the healthcare system, a new report estimates.

www.businessinsider.com

Sweden adopted the model. Will see if they are any worse of for it or have same rates of death as neighboring countries. Virus will be here until we all get it or are vaccinated. High rate of asymptomatic spread combined with fact that in city like nyc so many people need to be out and about- garbage workers to elevator repair men really limits efficacy of quarantine. Think of how many people in elevators in high rises- everyone has to walk their dog?

China is reclosing all movie theaters this week nationally has led speculation that virus just re emerging when They relax draconian measures that we could never Have taken In first place.

Lastly, supply chain issues for testing reagents, which of course all come from China expected to really hamper role out of testing over next 3 months. Paradoxically testing may decrease as more people get sick and need to be tested in hospitals and if reagents are in short supply, May be able to do less screaning.

 

[maruchan]

T-Mobile is offering a 1st responder discount, half off.
On a more serious note, I don’t personally believe that 0.5% death rate that disproportionately affects elderly justifies a Great Depression.

This is dangerously wrong thinking.

I know it takes a lot to persuade a person to change the point of view. However, I will try and would encourage you to really read and analyze what has happened in China, Italy, etc with an open mind again. The death rate is not the primary, secondary, or even tertiary problem posed by coronavirus and is almost irrelevant. Personally, I don't care if the death rate is 0.5%, 1%, 2% or 5%, focusing on this number misses the point.

The high rate of hospital bed/critical care/vent utilization and the high transmission risk to healthcare workers are the real issues. COVID-19 is not even remotely comparable to any historical precedent in these aspects. The reality of this problem is undeniable at this point. The strain on the healthcare system (to the point of imminent collapse in Hubei and Italy) is frightening to behold. If you view the situation through that lens, you understand why a stringent lockdown is the only policy response. If you let the virus "run its course", you will end up running out of doctors, hospital beds, vents etc with a complete collapse of the healthcare system and people dying in the streets with no one to care for them. Obviously, the economy is going to tank too when that happens. I wish I was exaggerating, but I'm not.

 

[RadOncDoc21]

This is dangerously wrong thinking.

I know it takes a lot to persuade a person to change the point of view. However, I will try and would encourage you to really read and analyze what has happened in China, Italy, etc with an open mind again. The death rate is not the primary, secondary, or even tertiary problem posed by coronavirus and is almost irrelevant. Personally, I don't care if the death rate is 0.5%, 1%, 2% or 5%, focusing on this number misses the point.

The high rate of hospital bed/critical care/vent utilization and the high transmission risk to healthcare workers are the real issues. COVID-19 is not even remotely comparable to any historical precedent in these aspects. The reality of this problem is undeniable at this point. The strain on the healthcare system (to the point of imminent collapse in Hubei and Italy) is frightening to behold. If you view the situation through that lens, you understand why a stringent lockdown is the only policy response. If you let the virus "run its course", you will end up running out of doctors, hospital beds, vents etc with a complete collapse of the healthcare system and people dying in the streets with no one to care for them. Obviously, the economy is going to tank too when that happens. I wish I was exaggerating, but I'm not.

Right, this is a marathon not the 100m dash. We need good leadership and guidance at this point in history.

 

[RickyScott]

This is dangerously wrong thinking.

I know it takes a lot to persuade a person to change the point of view. However, I will try and would encourage you to really read and analyze what has happened in China, Italy, etc with an open mind again. The death rate is not the primary, secondary, or even tertiary problem posed by coronavirus and is almost irrelevant. Personally, I don't care if the death rate is 0.5%, 1%, 2% or 5%, focusing on this number misses the point.

The high rate of hospital bed/critical care/vent utilization and the high transmission risk to healthcare workers are the real issues. COVID-19 is not even remotely comparable to any historical precedent in these aspects. The reality of this problem is undeniable at this point. The strain on the healthcare system (to the point of imminent collapse in Hubei and Italy) is frightening to behold. If you view the situation through that lens, you understand why a stringent lockdown is the only policy response. If you let the virus "run its course", you will end up running out of doctors, hospital beds, vents etc with a complete collapse of the healthcare system and people dying in the streets with no one to care for them. Obviously, the economy is going to tank too when that happens. I wish I was exaggerating, but I'm not.

The “ run its course”argument is based on the idea that the restrictive measures do not have much of an impact ie the virus will overun hospital system anyway. There is no stringent lockdown in the USA, nothing like in Asia! Take nyc, no one is completely sealed in their apartment. Most still leave via elevators walk their dog, along with all the essential workers (like gun store staff in certain states) and when one of these guys gets the virus, decent chance he has no symptoms and spreads it everywhere and that is happening at exponential rate. Saw on cnn that foot traffic on streets of San franciso is 50-60% of normal- not going to have much of an impact. 80-90% of Chinese on vents died?

You also have to make morbid assessment of what difference hospitalization makes to someone who is very sick. What is number needed to vent to save one person.

Now of course, I very well could be totally wrong, and so if I was a policy maker, would initially favor restrictive measures -even if I was 90% confident they were not very helpful - because you are absolutely going to be held accountable -issue of risk assymetry- if you get this wrong! Question will obviously have to re evaluate in 2 months if we are still in similar position.

 

[seper]

Re: risk to healthcare workers. Are there data to suggest higher risk of severe COVID with a larger magnitude of exposure (like seeing more, sicker patients up close)?


Sent from my iPhone using SDN mobile

 

[PleaseRemainCalm]

The “ run its course”argument is based on the idea that the restrictive measures do not have much of an impact ie the virus will overun hospital system anyway. There is no stringent lockdown in the USA, nothing like in Asia! Take nyc, no one is completely sealed in their apartment. Most still leave via elevators walk their dog, along with all the essential workers (like gun store staff in certain states) and when one of these guys gets the virus, decent chance he has no symptoms and spreads it everywhere and that is happening at exponential rate. Saw on cnn that foot traffic on streets of San franciso is 50-60% of normal- not going to have much of an impact. 80-90% of Chinese on vents died?

You also have to make morbid assessment of what difference hospitalization makes to someone who is very sick. What is number needed to vent to save one person.

Now of course, I very well could be totally wrong, and so if I was a policy maker, would initially favor restrictive measures -even if I was 90% confident they were not very helpful - because you are absolutely going to be held accountable -issue of risk assymetry- if you get this wrong! Question will obviously have to re evaluate in 2 months if we are still in similar position.

If we don't try to flatten the curve there will be no room in the hospital for anyone to get any elective or urgent but not emergent procedures or medical problems taken care of. That means, just putting it crudely, that as an oncologist most of your income is out the window until a vaccine is approved. These stay at home orders are in your own personal interest.

In addition even though death rate is relatively low people will still be terrified to leave their homes which will affect commerce anyway. People are not stupid. There is no group of people that seems completely impervious to the virus so people won't go out in public for discretionary or optional spending which is much of our economy until they have some reassurance that it is all under control. So again, economy will tank anyway.

 

[RickyScott]

Re: risk to healthcare workers. Are there data to suggest higher risk of severe COVID with a larger magnitude of exposure (like seeing more, sicker patients up close)?


Sent from my iPhone using SDN mobile

Yes, former fda director has been incredibly helpful and informative for this disease:

 

[maruchan]

The “ run its course”argument is based on the idea that the restrictive measures do not have much of an impact ie the virus will overun hospital system anyway. There is no stringent lockdown in the USA, nothing like in Asia! Take nyc, no one is completely sealed in their apartment. Most still leave via elevators walk their dog, along with all the essential workers (like gun store staff in certain states) and when one of these guys gets the virus, decent chance he has no symptoms and spreads it everywhere and that is happening at exponential rate. Saw on cnn that foot traffic on streets of San franciso is 50-60% of normal- not going to have much of an impact. 80-90% of Chinese on vents died?

You also have to make morbid assessment of what difference hospitalization makes to someone who is very sick. What is number needed to vent to save one person.

Now of course, I very well could be totally wrong, and so if I was a policy maker, would initially favor restrictive measures -even if I was 90% confident they were not very helpful - because you are absolutely going to be held accountable -issue of risk assymetry- if you get this wrong! Question will obviously have to re evaluate in 2 months if we are still in similar position.

I think this misses the central idea behind "flattening the curve." Maybe a large proportion of the population will end up getting it anyway, but there's tremendous value in spreading out that peak to allow for the healthcare system time to expand capacity and obtain supplies. It's not just about the end number but about how we get there as well.

Additionally, the difference between exponential spread and declining spread is actually a thinner margin than you may think. You don't need a China-level lockdown to prevent exponential spread. You just need to get R0 (the average number of other people infected by each infected person) under 1.

Most estimations of R0 that I've seen put coronavirus in the 2-2.5 range. Obviously I don't know the truth of the universe but I would think that reducing the foot traffic by half along with cancelling all large gatherings is likely enough to get the average people infected count down to under 1, or at least near 1. Even if some of the essential workers infect 50-100 people, they make up a small proportion of the population and if most other infected people are infecting 0-1, you can get that R0 under 1.

 

[scarbrtj]

Re: risk to healthcare workers. Are there data to suggest higher risk of severe COVID with a larger magnitude of exposure (like seeing more, sicker patients up close)?


Sent from my iPhone using SDN mobile

To my surprise that's what an MD expert on CNN was saying could be the case last night; analogous she said to a sort of viral load high/low being bad/good in HIV.

 

[RickyScott]

I think this misses the central idea behind "flattening the curve." Maybe a large proportion of the population will end up getting it anyway, but there's tremendous value in spreading out that peak to allow for the healthcare system time to expand capacity and obtain supplies. It's not just about the end number but about how we get there as well.

Additionally, the difference between exponential spread and declining spread is actually a thinner margin than you may think. You don't need a China-level lockdown to prevent exponential spread. You just need to get R0 (the average number of other people infected by each infected person) under 1.

Most estimations of R0 that I've seen put coronavirus in the 2-2.5 range. Obviously I don't know the truth of the universe but I would think that reducing the foot traffic by half along with cancelling all large gatherings is likely enough to get the average people infected count down to under 1, or at least near 1. Even if some of the essential workers infect 50-100 people, they make up a small proportion of the population and if most other infected people are infecting 0-1, you can get that R0 under 1.

We clearly need to flatten the curve, what is in dispute is whether the measures we are taking will have much of an effect on that. R0 is not a great way of thinking about this according to many because it singular number that is not a biologic property of virus and tells you nothing about distribution. For example, with SARS, superspreaders may have huge effect. (Just saw news story how some asymptomatic member of choir infected pretty much everyone in the room) Very possible that ro differs between symptomatic and asymptomatic ....

only pure controlled closed system where everyone was tested we have to date is princess diamond.

 

[maruchan]

To be honest, I'm pretty confused at what exactly is being expressed now. The point you're making seems to have changed with every post or maybe I just never understood it...not trying to be difficult but I honestly am confused. Are you saying that because the measures we take won't perfectly control the virus, we should just give up on flattening the curve and do nothing and that would be better for the economy? Or are you advocating a different set of lockdown policies other than what we have put in place since our current measures aren't going far enough to be effective?

 

[Mandelin Rain]

The issue is there is no “business as usual” with this virus. Say the death rate is 1% at first and 5% after medical care is overrun (which is almost immediately in this scenario) and 75% of people get it (doctors and nurses at a higher rate) because we did nothing to slow the spread.

In that scenario, there’s bodies in the streets. You, yourself personally know a dozen or two people who have died of COVID. You know several more who died of other conditions who couldnt get cared for.

People then get terrified and self select out of society. They don’t need the president to tell them to when 3 of their friends died yesterday.

Or, the guy who owns your business dies. And his heir. No one cuts your checks anymore. There is no company to come back to anymore. Or half your staff dies after that bitching cocktail hour you held.

Panic abounds and people go crazy.

The economy crashes FAR worse in this scenario, with no immediate path to get back on track.

 

[medgator]

The issue is there is no “business as usual” with this virus. Say the death rate is 1% at first and 5% after medical care is overrun (which is almost immediately in this scenario) and 75% of people get it (doctors and nurses at a higher rate) because we did nothing to slow the spread.

In that scenario, there’s bodies in the streets. You, yourself personally know a dozen or two people who have died of COVID. You know several more who died of other conditions who couldnt get cared for.

People then get terrified and self select out of society. They don’t need the president to tell them to when 3 of their friends died yesterday.

Or, the guy who owns your business dies. And his heir. No one cuts your checks anymore. There is no company to come back to anymore. Or half your staff dies after that bitching cocktail hour you held.

Panic abounds and people go crazy.

The economy crashes FAR worse in this scenario, with no immediate path to get back on track.

Contagion really worth a watch for some

 

[evilbooyaa]

We clearly need to flatten the curve, what is in dispute is whether the measures we are taking will have much of an effect on that. R0 is not a great way of thinking about this according to many because it singular number that is not a biologic property of virus and tells you nothing about distribution. For example, with SARS, superspreaders may have huge effect. (Just saw news story how some asymptomatic member of choir infected pretty much everyone in the room) Very possible that ro differs between symptomatic and asymptomatic ....

only pure controlled closed system where everyone was tested we have to date is princess diamond.

Agree with maruchan that I'm not sure what your preference would be: What are you advocating for?
1) No restrictive measures in place at all
2) Current level of shelter-in-place
3) Wuhan style lock-down with national guard patrolling the streets
4) Something more than #3?

Personally, I think we're taking steps but given the crowds I still see from pictures of NYC in recent history, that we should start trending towards something like #3. I think what the Washington DC mayor did to potentially fine somebody (likely if they refused to go back indoors for non-critical things) is reasonable, but the US of A is not going to accept that on a national level, cause 'Murica freedom.

Super-spreader also an issue in coronavirus, given that something like a large number of initial cases in I believe both South Korea and Washington were traced back to one person, respectively, in each region.

 

[RickyScott]

I am questioning if anything short of a national Wuhan style lockdown can substantiatively flatten the curve for this disease, given asymptomatic spread and fact that we missed the boat on testing (for which one of our own had a role) Half measures may give you the worst of both worlds- not flatten the curve much but still create a lot of economic damage. Fragmented Shelter in place has been a joke in many places with gun stores and golf courses being deemed essential businesses. I am seriously concerned it just creates economic hardship but does little to flatten curve.
It also obvious that China is completely untrustworthy with their figures so hard to learn lessons from them. They dropped ball for a few months but only saw 3000 deaths wtf? Think we are going to be up the creek until widespread antibody testing available, and am hearing that supply chain for this may be a real issue because all reagents are manufactured in guess where and every country will be trying to get their hands on them.

Will soon to be able to compare death rates of Sweden with neighboring countries to see real life impact of restrictions on flattening the curve.