COVID-19 (f/k/a "the Coronavirus")

[jesmu84]

Fair point.

The Seattle VA has restricted access to the ER entry portal. They conduct a 100% screen of everyone, staff, patients, visitors, with testing for those exhibiting or stating symptoms of fever and respiratory issues.

Gotcha. Ya. That seems more in line with protocol.

So then you personally were not tested and you don't know if you did/didn't have it

[Dr. Blackheart]

I think this is how the New Rochelle, NY one happened.  Some guy was super-carrier.

Here is his sad story and the chucklehead public responses. Synagogue (funeral, Bar Mitzvah, court  and hospitals). NY was late with their response and the public blame of the patient is ridiculous.

https://www.google.com/amp/s/www.dailymail.co.uk/news/article-8097891/amp/Westchester-lawyers-wife-fears-people-blame-family-spreading-coronavirus.html

[Hards Alumni]

Did I say no effort anywhere? Clearly some effort is required, the question is how much?

Trillion dollar question.  Problem is we don't have data.  And we won't have real data for weeks.  Our testing is behind, and we are just at the upswing of this.  We are about two weeks behind Italy.  I think once Americans see the carnage of what a full exhausted hospital and staff look like, they may take this a bit more seriously.  For most people, this still isn't real.  And it won't be real until people they know and love are infected or die.

[GooooMarquette]

Did I say no effort anywhere? Clearly some effort is required, the question is how much?

How about more than we've been doing, but short of a national lockdown?

I don't know exactly where that line is, but our ever-escalating curve seems to indicate we aren't there yet.

[MU Fan in Connecticut]

This is why colleges and universities were so keen on getting their students out of their residence halls for a few weeks / the rest of the semester.

It's hurts to see firsthand with my daughter, but universities completely made the right call.

[mu03eng]

Trillion dollar question.  Problem is we don't have data.  And we won't have real data for weeks.  Our testing is behind, and we are just at the upswing of this.  We are about two weeks behind Italy.  I think once Americans see the carnage of what a full exhausted hospital and staff look like, they may take this a bit more seriously.  For most people, this still isn't real.  And it won't be real until people they know and love are infected or die.

Heres the problem, we can't even say we are behind Italy...we can think we are but there is no certainty that we are. For all we know we are on the sustain part of the curve. I'm sure that's not very likely but I keep hearing we are two weeks behind Italy and that started at least 7 days ago. We are certainly seeing more patients diagnosed but we aren't yet seeing a crush of hospitalizations. That very well may be coming and I think the steps we've taken to date are reasonable but what evidence do we have we are going to be Italy? Shouldn't we be seeing the first big wave of hospitalizations by now? Why didn't Seattle explode like Italy did, they were seeing significant community spread around the time northern Italy saw it, how are they different?

I'm not trying to say none of this is real and I support the actions being taken but I can also see why people have questions.

[ZiggysFryBoy]

This was on another board by a small business owner. A single point, but others seem to think it was accurate.

Unfortunately the answer we’re able to give everyone at this point isn’t a good one. Basically every property insurance policy written in the entire country has an exclusion for Virus/Communicable disease. Business Interruption coverage, which is a form of property insurance, is something that’s on your policies, but the attached exclusion also excludes coverage for business interruption from a virus. I’m not aware of an insurance carrier that has ever offered to provide a separate policy for something like this, and frankly I have no idea how they would even price/underwrite coverage for something like this in such an unpredictable and incredibly rare circumstance. This virus exclusion endorsement, or something similar is on basically every property insurance policy written in the US, which has us establishing a very low expectation with our clients from a coverage perspective. We’re all really in the same boat together right now.


That said, as the broker, we also are not the claims department for the insurance company deciding whether or not a claim gets paid/approved or declined. Property insurance (which in insurance origins was designed simply as ‘fire’ insurance) was created for physical losses (fire, wind, collapse, lighting strikes, cars/planes driving into buildings, theft, etc.). In this case, everyone’s building/property is still standing and physically capable of operating. This is all a very unprecedented circumstance, and the situation seems to be pretty fluid with government and financial institutions still determining the best course of action. It’s possible as the situation evolves we may recommend submitting a claim to the insurance company for a more formal up or down from them.

This is exactly correct.  ISO (Insurance Services Office, the organization that writes most coverage forms) has introduced a few advisory forms relating to viruses and business income, but those are 1) just advisory, 2) not filed by any company or approved by any state insurance commissioner, and 3) even if they were approved, no insurer would voluntarily expose themselves to millions of dollars of losses during the middle of a pandemic.

The problem with business income is that there needs to be a covered cause of loss to trigger coverage.  Fire, burglary, planes crashing into buildings, etc are all losses that would trigger business income.   There is civil authority as a cause of loss that is included in most policies; however, that is subject to the reason that civil authorities are mandating the shut down (usually an explosion, tornado, etc.) that would be a covered cause of loss if the peril impacted the particular building, but under civil authority, impacted nearby properties instead of the particular building.

Some companies might have limited coverage included on property enhancements, but those will be few and far between and very limited in scope and coverage.

A good comparison to make would be flood insurance.  Most flood insurance is written through the National Flood Insurance Program.  Individual insurance companies might write their own, but claims are paid out by the NFIP.  Since flooding is so wide-spread, no private insurer wants to/is able to take on that much risk.

If the gov't is going to provide a bailout to businesses, the best option might be to mandate that insurers cover the business income exposure, and then the feds could make payment to the insurers (a relatively small number of companies) instead of having to do so for millions of small and mid-sized businesses.  Plus, the insurers have adjusters and forensic accountants that know how to accurately calculate business income loss, vs millions of small and mid-sized businesses all trying to figure out how much to claim and the feds trying to reconcile those amounts.

[skianth16]

How about more than we've been doing, but short of a national lockdown?

I don't know exactly where that line is, but our ever-escalating curve seems to indicate we aren't there yet.

South Korea didn't have to go with the lockdown route. They were able to slow the spread through self-quarantine. Their testing capacity helped immensely by clearly identifying who should be quarantined, but they still only administered tests to a very tiny portion of the population. I think it's less than half a percent.

Couldn't we take the lessons from Korea without having testing being the primary driver for self-quarantine? Why not push for quarantining anyone over 65 or 70 and anyone in their households? Then add in those with related comorbidities like diabetes and pre-existing respiratory ailments? Of course, anyone who experiences any symptoms should also self-quarantine. Aid packages could be directed to these people rather than broader portions of the population. This could greatly reduce the painful impacts of mass lockdowns.

I recognize the challenges with this approach, which essentially asks people to make smart decisions for themselves and for others. This is probably not realistic. But I do think there's something to be said about limiting the impacts to those who are not infected and are not likely to be affected. Thinking about ways to lessen the negative impacts on the (tens of) millions who could face challenges from broader measures seems like a good way to approach this.

[Hards Alumni]

Heres the problem, we can't even say we are behind Italy...we can think we are but there is no certainty that we are. For all we know we are on the sustain part of the curve. I'm sure that's not very likely but I keep hearing we are two weeks behind Italy and that started at least 7 days ago. We are certainly seeing more patients diagnosed but we aren't yet seeing a crush of hospitalizations. That very well may be coming and I think the steps we've taken to date are reasonable but what evidence do we have we are going to be Italy? Shouldn't we be seeing the first big wave of hospitalizations by now? Why didn't Seattle explode like Italy did, they were seeing significant community spread around the time northern Italy saw it, how are they different?

I'm not trying to say none of this is real and I support the actions being taken but I can also see why people have questions.

I think the thing you keep forgetting, is that a positive case doesn't mean a person is at a hospital hooked up to a ventilator.  The disease takes a while to develop and takes longer to become serious.  We are detecting cases which will become severe in the coming days and weeks.   We aren't seeing enough people diagnosed because there still isn't adequate testing.  Seattle and NYC are going to be the first to get hit hard.  NY State added 30% to their total this morning.  Assuming 15% (current percentage of people who need medical care) of them become serious enough for beds and ICU, that is 63 beds that will be full soon.  And this number keeps adding up.  People don't go in, and then come out two days later all better in those cases.  We are talking about extended stays.  Tomorrow if NYC adds another 30% (it will most certainly be higher in the coming days when tests start coming back) and 15% of those get added to beds.  New York State has 3000 beds total.  When those are full we start the awful job of deciding who lives and who dies.  Most likely the people who arrive first in those beds won't be yanked out of them.  That's why the next two weeks will be deadly.

Hospital crush comes within the next week or two.  That's the current timeline.

[GooooMarquette]

South Korea didn't have to go with the lockdown route. They were able to slow the spread through self-quarantine. Their testing capacity helped immensely by clearly identifying who should be quarantined, but they still only administered tests to a very tiny portion of the population. I think it's less than half a percent.

Couldn't we take the lessons from Korea without having testing being the primary driver for self-quarantine? Why not push for quarantining anyone over 65 or 70 and anyone in their households? Then add in those with related comorbidities like diabetes and pre-existing respiratory ailments? Of course, anyone who experiences any symptoms should also self-quarantine. Aid packages could be directed to these people rather than broader portions of the population. This could greatly reduce the painful impacts of mass lockdowns.

I recognize the challenges with this approach, which essentially asks people to make smart decisions for themselves and for others. This is probably not realistic. But I do think there's something to be said about limiting the impacts to those who are not infected and are not likely to be affected. Thinking about ways to lessen the negative impacts on the (tens of) millions who could face challenges from broader measures seems like a good way to approach this.

Theoretically, I agree. But you identified the two major factors that will likely prevent this type of response here:

* the lack of available testing capacity
* the assumption that asymptomatic people in the US would even get tested, and then self-quarantine

[Hards Alumni]

South Korea didn't have to go with the lockdown route. They were able to slow the spread through self-quarantine. Their testing capacity helped immensely by clearly identifying who should be quarantined, but they still only administered tests to a very tiny portion of the population. I think it's less than half a percent.

Couldn't we take the lessons from Korea without having testing being the primary driver for self-quarantine? Why not push for quarantining anyone over 65 or 70 and anyone in their households? Then add in those with related comorbidities like diabetes and pre-existing respiratory ailments? Of course, anyone who experiences any symptoms should also self-quarantine. Aid packages could be directed to these people rather than broader portions of the population. This could greatly reduce the painful impacts of mass lockdowns.

I recognize the challenges with this approach, which essentially asks people to make smart decisions for themselves and for others. This is probably not realistic. But I do think there's something to be said about limiting the impacts to those who are not infected and are not likely to be affected. Thinking about ways to lessen the negative impacts on the (tens of) millions who could face challenges from broader measures seems like a good way to approach this.

We have started weeks behind South Korea.  That's the problem.  We drag our feet, we discuss things in committees, we bargain in congress about crap that doesn't matter.  Our time to be South Korea was back in February when I was suggesting it.  Moving past this, we are also now aware of people being Asymptomatic carriers.  So without adequate testing (which always seems to be a week away, unfortunately) we can dream of being South Korea.  And without adequate testing, the people who are going to work to carry on with business as usual might be unknowingly spreading thinking they are fine and should continue to work.

THAT is why this is going to be bad to continue on as usual.  We need to lock it down, take our medicine, or we will be doing it in a week anyway with a much larger death toll.

[Dr. Blackheart]

This is a great documentary if interested

https://www.pasteurfoundation.org/news-article/unseen-enemy-cnn-documentary

[Hards Alumni]

This is exactly correct.  ISO (Insurance Services Office, the organization that writes most coverage forms) has introduced a few advisory forms relating to viruses and business income, but those are 1) just advisory, 2) not filed by any company or approved by any state insurance commissioner, and 3) even if they were approved, no insurer would voluntarily expose themselves to millions of dollars of losses during the middle of a pandemic.

The problem with business income is that there needs to be a covered cause of loss to trigger coverage.  Fire, burglary, planes crashing into buildings, etc are all losses that would trigger business income.   There is civil authority as a cause of loss that is included in most policies; however, that is subject to the reason that civil authorities are mandating the shut down (usually an explosion, tornado, etc.) that would be a covered cause of loss if the peril impacted the particular building, but under civil authority, impacted nearby properties instead of the particular building.

Some companies might have limited coverage included on property enhancements, but those will be few and far between and very limited in scope and coverage.

A good comparison to make would be flood insurance.  Most flood insurance is written through the National Flood Insurance Program.  Individual insurance companies might write their own, but claims are paid out by the NFIP.  Since flooding is so wide-spread, no private insurer wants to/is able to take on that much risk.

If the gov't is going to provide a bailout to businesses, the best option might be to mandate that insurers cover the business income exposure, and then the feds could make payment to the insurers (a relatively small number of companies) instead of having to do so for millions of small and mid-sized businesses.  Plus, the insurers have adjusters and forensic accountants that know how to accurately calculate business income loss, vs millions of small and mid-sized businesses all trying to figure out how much to claim and the feds trying to reconcile those amounts.

All great information that business owners need to be aware of.  The flood portion is a great comparison.  A mass event like this would bankrupt insurance companies if they are expected to be on the hook.  It simply isn't reasonable.

[skianth16]

Heres the problem, we can't even say we are behind Italy...we can think we are but there is no certainty that we are. For all we know we are on the sustain part of the curve. I'm sure that's not very likely but I keep hearing we are two weeks behind Italy and that started at least 7 days ago. We are certainly seeing more patients diagnosed but we aren't yet seeing a crush of hospitalizations. That very well may be coming and I think the steps we've taken to date are reasonable but what evidence do we have we are going to be Italy? Shouldn't we be seeing the first big wave of hospitalizations by now? Why didn't Seattle explode like Italy did, they were seeing significant community spread around the time northern Italy saw it, how are they different?

I'm not trying to say none of this is real and I support the actions being taken but I can also see why people have questions.

I have a ton of questions about what's going on in Italy that I'm really struggling to find answers to. To me, a lot of the basic questions I would expect to be asked don't seem to be very prevalent in most articles on this topic.

We know some hopsitals in Italy have been overrun with cases. But how many? What is the current ICU capacity? How does the capacity vary by region? Does Italian ICU capacity rank highly in the world, or is it near the bottom? If only 3 hospitals in northern Italy have faced capacity issues, that's a much different situation than 50% of all hospitals now being at or above capacity throughout the whole country. If Italy was ill-prepared for this due to low ICU capacity per capita, then it's probably not a great case study for other countries.

We've also heard about the triage guidance that has been shared in Italy and how this prioritizes some patients over others. And we've heard about doctors electing to not treat older patients, essentially making the decision that the patient will die. But how widely has this guidance been put to use? How many hospitals are turning positive cases away due to age or comorbidities? Is this happening all over the country? Like the above, if 2 doctors at the same hospital reported a case where they turned away an 85 year old with the virus, that's a bad scenario, but it would represent an extreme. If a dozen hospitals in the north were forced to turn away patients who were able to receive care at a hospital and hour or two away, that's not ideal, but it's not the death panel scenario we all fear.

The stories coming out of Italy are horrible and scary. But there are so few details about how prevalent they are that I struggle to understand just how likely those scenarios are elsewhere. To me, it seems like we are hearing about the worst cases and simply extrapolating from there that this is the scene in most hospitals throughout the country.

[jesmu84]

https://twitter.com/JakeSherman/status/1239971756686757889?s=19

Seems checks might be coming

[The Hippie Satan of Hyperbole]

https://twitter.com/JakeSherman/status/1239971756686757889?s=19

Seems checks might be coming

End of April?

[TSmith34, Inc.]

https://twitter.com/JakeSherman/status/1239971756686757889?s=19

Seems checks might be coming

[jesmu84]

https://twitter.com/BethanyAllenEbr/status/1239957782125662208?s=19

China covering up recovery?

[forgetful]

https://twitter.com/MC_of_A/status/1239739685490102278?s=20

Shut down the quarantine. Get back to work. Open everything up.

Let's mentally prepare now.

3500 new cases again today. So has flattened off. I think this does reflect their testing capacity. But it still means that the average infection rate has leveled off, which is good.

A better metric to watch may sadly be deaths. It is a lagging indicator but has also leveled off the last two days (and today), in Italy.

[mu03eng]

I think the thing you keep forgetting, is that a positive case doesn't mean a person is at a hospital hooked up to a ventilator.  The disease takes a while to develop and takes longer to become serious.  We are detecting cases which will become severe in the coming days and weeks.   We aren't seeing enough people diagnosed because there still isn't adequate testing.  Seattle and NYC are going to be the first to get hit hard.  NY State added 30% to their total this morning.  Assuming 15% (current percentage of people who need medical care) of them become serious enough for beds and ICU, that is 63 beds that will be full soon.  And this number keeps adding up.  People don't go in, and then come out two days later all better in those cases.  We are talking about extended stays.  Tomorrow if NYC adds another 30% (it will most certainly be higher in the coming days when tests start coming back) and 15% of those get added to beds.  New York State has 3000 beds total.  When those are full we start the awful job of deciding who lives and who dies.  Most likely the people who arrive first in those beds won't be yanked out of them.  That's why the next two weeks will be deadly.

Hospital crush comes within the next week or two.  That's the current timeline.

Fine, what's our current hospitalfixation rate, what are other countries hospitalization rates?

If there is any truth to the A) northern Italy is the epicenter because of the concentration of Wuhan factory workers and B) Viral loading impacting case severity then there is reason to believe Italy is the worst case especially given everything else that increases their risk model.

I can engineer the safest car in the world, but it'll cost you a million dollars, you buying? I support current measures but they can only be sustained for a couple of weeks before the cure is worse than the disease so to speak

[skianth16]

We have started weeks behind South Korea.  That's the problem.  We drag our feet, we discuss things in committees, we bargain in congress about crap that doesn't matter.  Our time to be South Korea was back in February when I was suggesting it.  Moving past this, we are also now aware of people being Asymptomatic carriers.  So without adequate testing (which always seems to be a week away, unfortunately) we can dream of being South Korea.  And without adequate testing, the people who are going to work to carry on with business as usual might be unknowingly spreading thinking they are fine and should continue to work.

THAT is why this is going to be bad to continue on as usual.  We need to lock it down, take our medicine, or we will be doing it in a week anyway with a much larger death toll.

My whole point was that maybe we can be South Korea without the testing. My 73 year old diabetic father doesn't need a test to know that he's part of the high risk population and needs to stay home. Similarly, if you have a cough or a fever, you should just take the same precautions you would if you had tested positive. We don't need everyone to be tested to take those measures.

The medicine you referred to us taking likely means long-term financial consequences for a significant percentage of the population. The much larger death toll you mentioned might only be a couple hundred. I think you're either overlooking or just downplaying the impacts to tens of millions of these large scale decisions. There are more than just 2 options. This isn't black and white.

[Hards Alumni]

My whole point was that maybe we can be South Korea without the testing. My 73 year old diabetic father doesn't need a test to know that he's part of the high risk population and needs to stay home. Similarly, if you have a cough or a fever, you should just take the same precautions you would if you had tested positive. We don't need everyone to be tested to take those measures.

The medicine you referred to us taking likely means long-term financial consequences for a significant percentage of the population. The much larger death toll you mentioned might only be a couple hundred. I think you're either overlooking or just downplaying the impacts to tens of millions of these large scale decisions. There are more than just 2 options. This isn't black and white.

We literally cannot be south Korea without testing.  That is pure fantasy.  As to your and mu03eng questions about hospital capacity, that sort of thing is easily searchable on the internet.

[forgetful]

https://twitter.com/JakeSherman/status/1239971756686757889?s=19

Seems checks might be coming

$250B for $1000 checks says they are going out to 250M Americans. Given that it is means tested, sounds like it is going to everyone, including dependents.

[mu03eng]

We literally cannot be south Korea without testing.  That is pure fantasy.  As to your and mu03eng questions about hospital capacity, that sort of thing is easily searchable on the internet.

I've negotiated enough contracts to know what it looks like when someone doesn't have the data for their position.

I know what capacity is.....in the US at what rate are we seeing positive cases turn into hospitalization? I almost don't care how many positives we see, its death rate and hospitalization rate that means anything

[mu03eng]

$250B for $1000 checks says they are going out to 250M Americans. Given that it is means tested, sounds like it is going to everyone, including dependents.

Only complaint is I'd like to see it early to mid-April but other than that good plan