[tomtom]

There are no human studies that show whether NAD replenishment will in fact have any effect on COVID-19 symptoms. The animal studies suggest that it might. The human studies only show that Vitamin B3s are safe and effective at replenishing NAD.

Good enough for me to buy some and give it a try if any of my family get symptoms

Another study hypothesising the role of B3 (NR, NMN or Niacin) - among other strategies - in protection against severe covid symptoms.
https://www.aging-us.com/article/102988/text

That's at least three papers now hypothesising a role for B3.

I'd just be pretty careful at this point Pete. With CV19 everything is being published in pre-print format with scant or no peer review... this is important to save time getting any new ideas out - but also removes an important quality filter...

[mrjonathanr]

Where do you get 0.2% from?

[abarro81]

If our lockdown, flattens that curve and people who don’t need to die, don’t, then it’s worth it.

I love it when people make absolute statements that cover every option you can imagine (e.g. 2 deaths prevented) and so can easily be reduced to absurdity 

As a relevant aside, talking to my mum yesterday she said something along the lines of that she wouldn't want younger generations to be fucked for years/decades in order to save a chunk of her generation. So clearly at least some of the high-risk groups can countenance a debate about where a line should be (and might be, if an exit strategy doesn't emerge over the next few months) drawn

[Murph]

Where do you get 0.2% from?

Was that to me? Pete quoted it but it wasnt the first time I'd heard.

infection fatality rate estimate from Center for Evidence Based Medicine

[SA Chris]

Gav, all you have to do to know the future is scale up Holland's total infections (not reported infections) to the hundreds of thousands (or a million). Why wouldn't this happen? In a population not in isolation why wouldn't the infection spread in people there the same as anywhere else in the world not in isolation, all other things being equal.
Then, apply an infection death rate of 0.1% - 0.26%* of all infections (not reported infections). Tells you all you need to know.


* infection fatality rate estimate from Center for Evidence Based Medicine

Taking account of historical experience, trends in the data, increased number of infections in the population at largest, and potential impact of misclassification of deaths gives a presumed estimate for the COVID-19 IFR between 0.1% and 0.26%.
This site

The site above is updated regularly with latest estimates of IFR and CFR based on updated evidence. Good for getting your head around the various fatality estimates and why they're constantly fluctuating.

Pete referenced his source.

[petejh]

There are no human studies that show whether NAD replenishment will in fact have any effect on COVID-19 symptoms. The animal studies suggest that it might. The human studies only show that Vitamin B3s are safe and effective at replenishing NAD.

Good enough for me to buy some and give it a try if any of my family get symptoms

Another study hypothesising the role of B3 (NR, NMN or Niacin) - among other strategies - in protection against severe covid symptoms.
https://www.aging-us.com/article/102988/text

That's at least three papers now hypothesising a role for B3.

I'd just be pretty careful at this point Pete. With CV19 everything is being published in pre-print format with scant or no peer review... this is important to save time getting any new ideas out - but also removes an important quality filter...

Yep, aware of this TT but good point. I said in the earlier post about B3 to DYOR. Plus my disclaimer that I'm an investor in a company selling NR.

[Davo]

If the death rate is really in the 0.2% ballpark then I really cant see how this isnt a massive over reaction. We are going to be paying for this for years to come with ever decreasing living standards and hospital closures etc. That comes at a cost.

Theres some analysis to be done somewhere showing what lockdown policy is worth what death reduction and I'm not sure 0.2% justifies the current one.

Theres also the policy itself. I think a lot of countries have sort of followed china but not done a good job of it. If wuhan had a proper lockdown and lots of support from the rest of china to make that stick, then the uk lockdown is at best a minority fraction of it. Buses and trains are still running. By this stage in wuhan they had been cancelled for a fortnight.

An analogy with antibiotics - don't just take them every other day for two days, take the full dose for a week or dont bother.

Have I got this wrong still - is no cost too high to save 0.2%?

I raised this exact point last week and generally got shot down. I have seen nothing published yet that explains how much we are spending and costing ourselves to save a certain percentage of the population.  Surely this is a valid question and deserves debate? Yet there has basically been nil discussion of this in the media or elsewhere (from what I have seen). I understand this is emotive stuff but it is also exactly the same kind of decision making that the health system and government makes on a day to day basis and I don’t see why this should be different

[petejh]

I think it's an inevitable question that will have to be faced down the line. But while there's a hope of a vaccine in the relatively near future it's political suicide for any government to not at least try to crawl over the vaccine line in a hypothetical future timeline.

edit: looks at the serious questions being asked of government about testing, timing of lock-down, effectiveness of lock-down, and PPE. These are based on perceptions of government not doing enough. Can you imagine the questions these same people would have if the government policy 'allowed' 100's of thousands to die in the next few months, as they would if everyone went back to work, uni and school.

When or if the evidence appears to show we aren't going to reach that line without totally destroying the global economy - not just recession but massive prolonged depression - then watch the policy change. All imo obvs.

[Oldmanmatt]

If our lockdown, flattens that curve and people who don’t need to die, don’t, then it’s worth it.

I love it when people make absolute statements that cover every option you can imagine (e.g. 2 deaths prevented) and so can easily be reduced to absurdity 

As a relevant aside, talking to my mum yesterday she said something along the lines of that she wouldn't want younger generations to be fucked for years/decades in order to save a chunk of her generation. So clearly at least some of the high-risk groups can countenance a debate about where a line should be (and might be, if an exit strategy doesn't emerge over the next few months) drawn

Tough.

You don’t think anybody is benefiting from the lockdown?

I think that’s pretty unlikely and as asinine as you think I am.

Rationalise away.

Here we are and here we’ll stay. I’m grateful that it’s not some of the posters here making the decisions.

I think Pete is almost certainly right, so see his posts (not the B3 thing, no idea about that).

One more time, it’s not just the people dying from C19, it’s the additional deaths from unrelated ailments etc due to and overwhelmed system. It’s about the many thousands who will end up critically ill, again, not just with C19, with other (normally) preventable/treatable afflictions.

I know I’ve said it, I know Pete’s said it, I know others have said it.
Without effective treatment or vaccine this thing is going to take who it wants. The best we can do is slow it to a manageable rate.

Exit strategy:

Actually, I reckon, the first  Lockdown, is to buy time to increase Care capacity. Let the deaths drop to a “tolerable” level. 
Then it will be eased and only brought back when the new capacity seems likely to be breached.

I suspect this is why testing is not the priority that “we” think it should be. It’s ultimately not worth it.
Others have already pointed out the issues with passport to work schemes. Likely so fullbof holes as to be pointless and only a couple of people slipping through and starting off the infection cycle again is enough.

We’re in this for the long haul and the lockdown is way more cynical than “we” think and almost certainly “they” think it the least worst option.

[Stabbsy]

Morning everyone - hope you’re all well.

Aside from the PPE/Testing coronashambles that’s unfolding - one article in the Indy caught my eye - https://www.independent.co.uk/news/uk/home-news/coronavirus-uk-cases-nhs-symptoms-111-update-death-toll-a9440246.html

Where 1.75 million 111 (online and phone) enquiries were flagged as being potential CV19. Whilst many of these could/were have been other viruses/colds it provides an upper limit on how wised spread it could be..

I think the upper limit could easily be higher than that. More Or Less did a piece on CV19 in Iran to try and decide whether we were seeing the whole truth of the outbreak there (we probably weren't). One of the bits of analysis was a back of the envelope calc for CV19 cases based on death numbers. A quick attempt to replicate for the UK - please feel free to critique the assumptions.

• Fatality rate of 1% - the 0.2% quoted a couple of posts up might be right but gives some ridiculous numbers. 1% seems broadly in line with the Chinese case fatality rate of 4% and three-quarters of cases not requiring hospitalisation.
• Delay from infection to death of 3 weeks - the range I've seen quoted elsewhere is 2 - 4 weeks, so taken a midpoint.
• Cases doubling every 7 days - I've heard much lower figures than this, but let's assume the lockdown is working and social distancing was working before that.

Based on yesterday's 2,352 deaths, that gets you to 1.9 million people infected and those aren't particularly prudent assumptions.

[Murph]

Well I'm not shooting the idea down Davo.

If this thing is costing us £500bn - a figure that admittedly I just made up but which must surely be in the low end ballpark - and it saves 130k lives all in net of the additional deaths caused by the lockdown measures and resulting economic collapse then that's nearly £4m per life saved. For £4m theres a few more cost effective life saving measures I could think of.

People cant go bouldering but they can still go to the shops and buy fags. It doesn't make completely coherent sense. How about banning fags... Boom. You've just saved (extended) lives by more than all the world's lockdowns added up together.

My hope - if you can call it that - is that 0.2% is way short of the mark and the unobservable/hypothesized counterfactual is it is actually masses more dangerous, mutated, comes around every few months etc and kills in the millions so by having a semi lockdown we are buying a month or two for the scientists to get working on a miracle.

But in the absence of that, having a lockdown while smoking is still a thing is some form of mental gymnastics. I know, it's all about the peak but really is this the only way? Theres a luxury lockdown for at risk groups option too. I know it's where we are and theres no going back I'm just interested in how the numbers stack up. History is full of decisions made that turned out to be a really bad idea but which must have made sense at the time - the fourth crusade attacking it's own city, italy entering ww1, credit default swaps etc... I wonder if this is one of them?

We are certainly living through a bit of history anyway. Something that will be studied for years to come. Maybe the Dutch are right. We wont know in a week or two but probably will know in a year or two.

[petejh]

• Fatality rate of 1% - the 0.2% quoted a couple of posts up might be right but gives some ridiculous numbers. 1% seems broadly in line with the Chinese case fatality rate of 4% and three-quarters of cases not requiring hospitalisation.
• Delay from infection to death of 3 weeks - the range I've seen quoted elsewhere is 2 - 4 weeks, so taken a midpoint.
• Cases doubling every 7 days - I've heard much lower figures than this, but let's assume the lockdown is working and social distancing was working before that.

Based on yesterday's 2,352 deaths, that gets you to 1.9 million people infected and those aren't particularly prudent assumptions.

This isn't in line with the current estimates from here: https://www.cebm.net/covid-19/global-covid-19-case-fatality-rates/

....................................................................................
Estimating COVID-19 Infection Fatality  Rates (IFR) (Update 29TH March)
The current COVID outbreak seems to be following previous pandemics: initial CFRs start high and trend downwards. For example, In Wuhan, the CFR  has gone down from 17% in the initial phase to near 1% in the late stage. It is increasingly clear that current testing strategies are not capturing everybody.  In South Korea, considerable numbers who tested positive were also asymptomatics-  likely driving the rapid worldwide spread.

CFR rates are subject to selection bias as more severe cases are tested – generally those in the hospital settings or those with more severe symptoms. The number of currently infected asymptomatics is uncertain: estimates put it at least a half are asymptomatic; the proportion not coming forward for testing is also highly doubtful (i.e. you are symptomatic, but you do not present for testing). Therefore we can assume the IFR is significantly lower than the CFR.

Emerging evidence suggests many more people are infected. than tested. In Vo Italy, at the time the first symptomatic case was diagnosed, about 3%, had already been infected –  most were completely asymptomatic.

We could make a simple estimation of the IFR as 0.26%, based on halving the lowest boundary of the CFR prediction interval. However, the considerable uncertainty over how many people have the disease means an IFR of 0.26 is likely an overestimate. In Swine flu, the IFR ended up as 0.02%, fivefold less than the lowest estimate during the outbreak (the lowest estimate was 0.1% in the 1st ten weeks of the outbreak). In Iceland, where the most testing per capita has occurred, the  IFR lies between. 0.01% and 0.19%.

Taking account of historical experience, trends in the data, increased number of infections in the population at largest, and potential impact of misclassification of deaths gives a presumed estimate for the COVID-19 IFR between 0.1% and 0.26%.*
.....................................................................................


For more on the *, see here: https://www.cebm.net/covid-19/global-covid-19-case-fatality-rates/

[mrjonathanr]

My hope - if you can call it that - is that 0.2% is way short of the mark and the unobservable/hypothesized counterfactual is it is actually masses more dangerous, mutated, comes around every few months etc and kills in the millions so by having a semi lockdown we are buying a month or two for the scientists to get working on a miracle.

But in the absence of that, having a lockdown while smoking is still a thing is some form of mental gymnastics. I know, it's all about the peak but really is this the only way? Theres a luxury lockdown for at risk groups option too. I know it's where we are and theres no going back I'm just interested in how the numbers stack up. History is full of decisions made that turned out to be a really bad idea but which must have made sense at the time - the fourth crusade attacking it's own city, italy entering ww1, credit default swaps etc... I wonder if this is one of them?

Hi Murph, yes, hadn't seen TT's post above mine about 0.2%
The current case fatality rate currently is about 8% in UK so for a 0.2%  rate per infection you need reported:actual infections rate to be 1:40. Are we only reporting 0.25 of all infections? I know we are massively under, but that's a lot.

I have read a few times that fatality rate is nearer 2% of infections. That does not take into account an increase in deaths due to an overwhelmed health service (if this occurs) or other preventable deaths no longer effectively treated due to impact of CV19 on health services.

OMM:

One more time, it’s not just the people dying from C19, it’s the additional deaths from unrelated ailments etc due to and overwhelmed system. It’s about the many thousands who will end up critically ill, again, not just with C19, with other (normally) preventable/treatable afflictions.

This graph from Tomas Pueyo gives pause for thought, do have a look:

http://twitter.com/tomaspueyo/status/1243648422403440640/photo/1

edit overlapping posts, yes, that's where I went:  https://www.cebm.net/covid-19/global-covid-19-case-fatality-rates/

[mrjonathanr]

Regarding Trump's idea that some oldies will be willing to take one for the team to keep the economy moving, Andrew Cuomo said this:

My mother isn't expendable

[nik at work]

Morning everyone - hope you’re all well.

Aside from the PPE/Testing coronashambles that’s unfolding - one article in the Indy caught my eye - https://www.independent.co.uk/news/uk/home-news/coronavirus-uk-cases-nhs-symptoms-111-update-death-toll-a9440246.html

Where 1.75 million 111 (online and phone) enquiries were flagged as being potential CV19. Whilst many of these could/were have been other viruses/colds it provides an upper limit on how wised spread it could be..

I agree with Stabbsy the upper limit could be higher than that ( in fact fuck it, I’ll speculate, in all likelihood is a deal higher than that). Or is that what you were implying? It wasn’t completely clear to me.

[abarro81]

Regarding Trump's idea that some oldies will be willing to take one for the team to keep the economy moving, Andrew Cuomo said this:

My mother isn't expendable

Yeah, but my mum thinks differently to at least some extent as I said above...

[nik at work]

Regarding Trump's idea that some oldies will be willing to take one for the team to keep the economy moving, Andrew Cuomo said this:

My mother isn't expendable

To him...

[Stabbsy]

• Fatality rate of 1% - the 0.2% quoted a couple of posts up might be right but gives some ridiculous numbers. 1% seems broadly in line with the Chinese case fatality rate of 4% and three-quarters of cases not requiring hospitalisation.
• Delay from infection to death of 3 weeks - the range I've seen quoted elsewhere is 2 - 4 weeks, so taken a midpoint.
• Cases doubling every 7 days - I've heard much lower figures than this, but let's assume the lockdown is working and social distancing was working before that.

Based on yesterday's 2,352 deaths, that gets you to 1.9 million people infected and those aren't particularly prudent assumptions.

This isn't in line with the current estimates from here: https://www.cebm.net/covid-19/global-covid-19-case-fatality-rates/

Pete - I'm not disagreeing with the CEBM numbers - the 4% CFR for China came from your link posted above (first table). My calc was just a back of the envelope attempt to come up with case numbers via a different route to see where it landed and decide whether the 1.75m NHS111 calls really was an upper limit or not. If you plug in the 0.2% IFR as your fatality rate then your case estimate goes up to c.9m from 1.9m. When I said the numbers looked ridiculous, it wasn't a criticism of the 0.2% figure, just that 9m cases seemed a bit of an overestimate.

[abarro81]

Does anyone else get bored of OMM not writing what he later says he means, and not reading other posts properly? 

[Oldmanmatt]

Does anyone else get bored of OMM not writing what he later says he means, and not reading other posts properly? 

Evidence.

I think you come across as rather cold.

You only wish to prove yourself correct and everyone else to simply agree with you.

If it makes you happy, yes, you irritate me. If you wish to make this a personal attack debate, you have succeeded.
Well done.
Give my regards to your mum.

[abarro81]

Ironic as f

[Offwidth]

Maybe the Dutch are right. We wont know in a week or two but probably will know in a year or two.

I can't see how the Dutch can be right on deaths. We will see that by two weeks anyhow, as if the numbers follow the same trends, deaths will start to overwhelm their hospitals by then. It's not just their people they are risking by laxer social distancing, given the open borders. In the ten days after their total deaths exceeded a hundred their level was 864 (and 1039 the next day) and our total in comparison was 1019 after ten days...pretty similar in logarithmic terms when estimating the exponential growth rate. They are about 2 to 3 days behind us (growing slightly less fast at the current time) and their population would have seen more about things being bad elsewhere and likely have been more cautious with their own choices of social distancing as a result. Our population is just under 4 times theirs so their per capita deaths are right now almost exactly twice ours. Deaths follow infections roughly by 3 weeks so if our state social distancing worked better we will see in a week and a half to two weeks.

[JamieG]

I don't agree with the idea that because we are going to overburden younger generations with footing the bill to save a few oldies the lockdown might not be worth it. Apart from some of the problematic ethics surrounding this idea and me not personally wanting to put my older relatives in the firing line, I think the idea the younger generation will need to pay is unfair. That is just the status quo of our economy and I feel it seriously needs dealing with.

It already is very hard for the young. Rising house prices, tuition fees, cuts to social security services. This country for a long time worked for the older generations and made it hard for the younger. Why can't the older generations help pay for it too? Loads of people are sitting on massively overvalued properties and land. Why don't we have much fairer tax system to help ease the burden? We used to have a fairer tax system that better supported the younger generations.

In summary, I think it is important to cut the number of deaths to as little as possible, but then we really need to make a fair tax system to get the country back on its feet. None of this 'all in this together' nonsense which was essentially an excuse to cut services but not change a thing regarding taxation.

Maybe I'm being naive.

[mrjonathanr]

^ Broad agreement on that.
Looks like Holland expects not social distancing won't result in massive increase in infections, with inevitable consequences. I can't see how the virus is going to behave differently in NL compared to everywhere else. Am I missing something?

[ali k]

Does anyone else get bored of OMM not writing what he later says he means, and not reading other posts properly? 

I think you come across as rather cold.

You only wish to prove yourself correct and everyone else to simply agree with you.

If it makes you happy, yes, you irritate me.

Fight. Fight. Fight.

God I'm bored.