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Morgan Stanley's Medium COVID-19 Scenario
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View above about Model Issue: Odds that COVID-19 disruption ends in the second quarter
Scenario #2 – Escalation in new geographies, disruption extends into the second quarter: In this scenario, new cases continue to rise in other parts of the world, before peaking by the end of May. The disruption extends into the second quarter, affecting corporate profitability in select sectors, risking the emergence of corporate credit risks. If the dislocations in asset markets also persist into the second quarter, a sharp tightening in financial conditions may mark a tipping point, exacerbating the impact on growth via weaker corporate confidence, falling capital expenditures and cutbacks in hiring. In response, policymakers around the world would step up easing measures, with fiscal policy in Asia and Europe and monetary policy in the U.S. doing the heavy lifting. Today, the Fed announced an unexpected half-point rate cut and our Chief U.S. Economist, Ellen Zentner, expects the Fed to cut rates again by a quarter-point at its April meeting, with the risk of an earlier action given the “fluidity” of the situation. In this scenario, global growth averages just 2.4% in the first half of 2020, but starts to pick up in the third quarter.
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That Virus Spread Rate R0 Depends on Factors We Can Influence
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View above about Model Issue: Odds that COVID-19 disruption ends in the second quarter
To understand how the spread of such a disease can be contained, it helps to break R0 down to its constituent parts. A simple formula that I got from Buckee is: the probability of infection given contact with an infectious person (b), multiplied by the contact rate (k), multiplied by the infectious duration (d) In some cases you can shorten the infectious duration with treatment. Quarantining people once you know they’re infected effectively shortens it, too. Variables b and k, meanwhile, are clearly dependent on behavior. The probability of infection is reduced by things like frequent hand-washing, replacing handshakes with fist bumps and such. The contact rate is reduced by staying home. By putting much of the country on lockdown, Chinese authorities reduced the contact rate enough that Covid-19’s R0 in the country fell below one. They also incurred huge economic and social costs. Now, as China begins to go back to work, the big question is whether a less-draconian approach can keep the disease in check or whether it will just start spreading again. That’s the big question in the U.S., Europe and pretty much everywhere else on earth too. It can’t be answered entirely by professional epidemiologists, either.
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COVID-19 Outbreaks Correlated to Latitude So Far
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View above about Model Issue: Odds that COVID-19 disruption ends in the second quarter
A study uploaded to medical pre-print server MedRxiv Monday plots recorded cases against climate conditions to suggest that there is indeed a significant correlation between outbreaks and the weather. In extreme cold and very hot and wet conditions the virus is “largely absent,” the researchers from Spain, Portugal and Finland wrote, meaning that people in tropical and polar climates are unlikely to see local transmission of cases. Arid regions will see a higher rate of infections but the worst-hit areas will be temperate countries and high-altitude areas closer to the equator. The period between June and September should see a slowing rate of infections in much of Europe and North America, they wrote, although areas closer to the poles in Scandinavia, Russia and Canada may see worsening conditions as the climate warms enough to support local infections.
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COVID-19 Spread Rate Correlated to Temperature Across 100 Chinese Cities
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View above about Model Issue: Odds that COVID-19 disruption ends in the second quarter
Another pre-print study by four Beijing-based researchers uploaded to the arXiv server last week comes to a similar conclusion after analyzing the infection rates in 100 Chinese cities. That rate, known as the R0, is a key determinant of an infection’s propensity to spread. For Covid-19 it’s currently estimated to be around 2.2, but moving it below 1 should, if sustained, be enough to turn the current out-of-control epidemic into an outbreak that goes extinct on its own. Increasing the temperature by one degree centigrade reduces the R0 by 0.0383 and increasing humidity by 1% pushes it down by 0.0224, the researchers found. That should be particularly significant in places with hot, wet summers, they wrote: In the event the Tokyo Olympics goes ahead, the R0 in the city would likely be at extinction levels below 1, given normal summer conditions.
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Odds of Longer Pandemic Look Higher Because Other Pandemic Flus Did Not Fade in Summer Like Endemic Flus
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View above about Model Issue: Odds that COVID-19 disruption ends in the second quarter
As the number of COVID-19 cases confirmed overseas daily have surpassed those within China, the draconian measures that appear to have quelled the outbreak domestically - particularly outside Hubei - are gradually being relaxed . . . Classes are gradually resuming after most students spent the last month or so at home and studying online . . Meanwhile, factories that were ordered to suspend operations are also starting to pick up their assembly lines . . . For example, the production line of Woniu, a Guangzhou-based kitchenware factory, came to a halt on January 20 - the day the government confirmed human transmission of the virus . . . But on March 9, their proposal to reopen was accepted by the government, and they are now back in business . . . Chengdu, famous for its hotpots and foodie culture, now has only a dozen cases remaining and the provincial government has said no new ones have been detected over the past three weeks. That has allowed a gradual reopening of restaurants, although people remain cautious. In videos shared online, restaurant patrons line up in front of the city's many hotpot restaurants - wearing masks and keeping a safe distance from each other . . . Apart from dining out, people are also gradually regaining their ability to travel. Many provinces and cities have steadily resumed their public transportation, including inter-provincial long-distance buses that were suspended across the country days after Wuhan was sealed off on January 23.
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April Conclusion for Phase III Trial of Kevzara to Treat COVID-19
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View above about Model Issue: Odds that COVID-19 disruption ends in the second quarter
On when a drug might be available: If [our approved anti-inflammatory drug Kevzara] is shown to work in hospitalized patients, we have lots of the drug on hand and can make much more. The best case is that people wouldn’t progress from let’s say needing a little oxygen to going on a respirator. If we all get sick at once, it could be a disaster because we won’t have enough intensive care beds. A drug like this could really slow down the number of people who needed really intensive respiratory therapy. This could go fairly quickly. There are unfortunately a lot of people in the hospital. If we can enroll the study quickly over the next month, you should know within a few weeks of treating people how they’re doing.
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After 6 Days, Only 25% of 26 Patients Given Hydroxychloroquine Had SARS-COV2 vs. 90% of 16 Patients Not Given It, and Odds Difference was Random are Only 0.1%
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View above about Model Issue: Odds that COVID-19 disruption ends in the second quarter
French Confirmed COVID-19 patients were included in a single arm protocol from early March to March 16th, to receive 600mg of hydroxychloroquine daily and their viral load in nasopharyngeal swabs was tested daily in a hospital setting. Depending on their clinical presentation, azithromycin was added to the treatment. Untreated patients from another center and cases refusing the protocol were included as negative controls. Presence and absence of virus at Day6-post inclusion was considered the end point . . . Twenty cases were treated in this study and showed a significant reduction of the viral carriage at D6-post inclusion compared to controls, and much lower average carrying duration than reported of untreated patients in the literature. Azithromycin added to hydroxychloroquine was significantly more efficient for virus elimination.
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Bill Gates Says ICL Study Inputs "Too Negative"
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View above about Model Issue: Odds that COVID-19 disruption ends in the second quarter
Fortunately it appears the parameters used in that [Imperial College London] model were too negative. The experience in China is the most critical data we have. They did their "shut down" and were able to reduce the number of cases. They are testing widely so they see rebounds immediately and so far there have not been a lot. They avoided widespread infection. The Imperial model does not match this experience. Models are only as good as the assumptions put into them. People are working on models that match what we are seeing more closely and they will become a key tool. A group called Institute for Disease Modeling that I fund is one of the groups working with others on this.
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Pessmistic ICL Study Made Several Structural Mistakes
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View above about Model Issue: Odds that COVID-19 disruption ends in the second quarter
Neil Ferguson and an Imperial College team . . . make structural mistakes in analyzing outbreak response. They ignore standard Contact Tracing [2] allowing isolation of infected prior to symptoms. They also ignore door-to-door monitoring to identify cases with symptoms [3]. Their conclusions that there will be resurgent outbreaks are wrong. After a few weeks of lockdown almost all infectious people are identified and their contacts are isolated prior to symptoms and cannot infect others [4]. The outbreak can be stopped completely with no resurgence as in China, where new cases were down to one yesterday, after excluding imported international travelers that are quarantined.
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Adequate Data May Show COVID-19 Death Rate 0.05%-1.00% Instead of 1-3% Guess Today
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View above about Model Issue: Odds that COVID-19 disruption ends in the second quarter
This evidence fiasco creates tremendous uncertainty about the risk of dying from Covid-19. Reported case fatality rates, like the official 3.4% rate from the World Health Organization, cause horror — and are meaningless. Patients who have been tested for SARS-CoV-2 are disproportionately those with severe symptoms and bad outcomes. As most health systems have limited testing capacity, selection bias may even worsen in the near future. The one situation where an entire, closed population was tested was the Diamond Princess cruise ship and its quarantine passengers. The case fatality rate there was 1.0%, but this was a largely elderly population, in which the death rate from Covid-19 is much higher. Projecting the Diamond Princess mortality rate onto the age structure of the U.S. population, the death rate among people infected with Covid-19 would be 0.125%. But since this estimate is based on extremely thin data — there were just seven deaths among the 700 infected passengers and crew — the real death rate could stretch from five times lower (0.025%) to five times higher (0.625%). It is also possible that some of the passengers who were infected might die later, and that tourists may have different frequencies of chronic diseases — a risk factor for worse outcomes with SARS-CoV-2 infection — than the general population. Adding these extra sources of uncertainty, reasonable estimates for the case fatality ratio in the general U.S. population vary from 0.05% to 1%. That huge range markedly affects how severe the pandemic is and what should be done. A population-wide case fatality rate of 0.05% is lower than seasonal influenza. If that is the true rate, locking down the world with potentially tremendous social and financial consequences may be totally irrational. It’s like an elephant being attacked by a house cat. Frustrated and trying to avoid the cat, the elephant accidentally jumps off a cliff and dies.
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After 6 Days, Only 25% of 26 Patients Given Hydroxychloroquine Had SARS-COV2 vs. 90% of 16 Patients Not Given It, and Odds Difference was Random are Only 0.1%
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View above about Model Issue: Odds that COVID-19 disruption ends in the second quarter
We were able to compare the negativation of viral carriage in patients who followed the protocol, with patients from Avignon and Nice who did not receive the treatment. Those who have not received the Plaquenil [medicament a base d'hydroxychloroquine] are still 90% of carriers of the virus after six days, while 25% are positive for those who received treatment.
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Bayer Donates 3 Million Doses of Chloroquine
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View above about Model Issue: Odds that COVID-19 disruption ends in the second quarter
Biopharma companies have scrambled to start new R&D projects and repurpose existing medicines amid the COVID-19 crisis. Now, Bayer is donating an older treatment to the U.S. government for potential use. The company is donating 3 million tablets of malaria medicine chloroquine, a decades-old drug that's available for cheap. Axios first reported news of the donation Wednesday, citing a senior HHS official and another source with knowledge of the plan. Bayer confirmed the donation Thursday.
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Over 1 Week After Bars Reopen in Shanghai, Still No New Cases . . . Officially
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View above about Model Issue: Odds that COVID-19 disruption ends in the second quarter
At 44KW, a nightclub in Shanghai, life almost feels normal again . . . Groups sit close together without face masks on, talking and sipping their drinks . . . [at] the club, which reopened its doors last Thursday after more than a month of staying shuttered as Shanghai joined cities across China in various levels of lockdown to contain the coronavirus outbreak.
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Novartis & Teva Donating Over 140 Million Doses of Hydroxychloroquine, While Mylan & Amneal Ramp Production to Tens of Millions
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View above about Model Issue: Odds that COVID-19 disruption ends in the second quarter
Chloroquine and hydroxychloroquine, a more tolerable formulation, are not approved to treat COVID-19. Still, U.S. authorities and others are exploring their potential following encouraging preliminary results. In response, Novartis has pledged a global donation of up to 130 million hydroxychloroquine tablets, pending regulatory approvals for COVID-19. Mylan is ramping up production at its West Virginia Facility with enough supplies to make 50 million tablets. Teva is donating 16 million tablets to hospitals around the U.S. On Friday afternoon, Amneal pledged to make 20 million tablets by mid-April.
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Novartis Donating its Inventory of 50 Million Doses of HCQ Plus Another 80 Million Doses Produced by May
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View above about Model Issue: Odds that COVID-19 disruption ends in the second quarter
When supported for use in COVID-19 infected patients by regulatory authorities, Novartis intends to donate up to 130 million 200 mg doses [of hydroxychloroquine] by the end of May, including its current stock of 50 million 200 mg doses. The company is also exploring further scaling of capacity to increase supply and is committed to working with manufacturers around the world to meet global demand.
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Stanford Med School Profs Say COVID-19's True Death Rate May be Too Low to Justify Universal Quarantine
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View above about Model Issue: Odds that COVID-19 disruption ends in the second quarter
These numbers imply a fatality rate from Covid-19 orders of magnitude smaller than it appears . . . [because] the confirmed cases are likely orders of magnitude less than the true number of infections . . . We don’t know the true infection rate in the U.S. Antibody testing of representative samples to measure disease prevalence (including the recovered) is crucial. Nearly every day a new lab gets approval for antibody testing, so population testing using this technology is now feasible . . . A universal quarantine may not be worth the costs it imposes on the economy, community and individual mental and physical health. We should undertake immediate steps to evaluate the empirical basis of the current lockdowns.
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Coronavirus Task Force Leaders Reassure that Experience Suggests that Last Week's Forecasts Were Far Too Pessimistic
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View above about Model Issue: Odds that COVID-19 disruption ends in the second quarter
Yesterday, the Imperial College London team whose model alarmed us last week reduced its UK death estimate from over 500,000 to under 20,000, so we are looking at that change. Overall, the predictions of models are not matching the reality on the ground. There is no reality on the ground that supports those models that predict > 50% of the US will become infected. The US models would predict that Italy would have 400,000 deaths, and they are not tracking to anywhere close to that. Also, people are discussing risk of "Do Not Resuscitate" decisions, but we are nowhere near that risk. New York is the worst hot spot now, and even so, it still has 2,000 ventilators that have not been utilized yet.
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FDA Approves 5-Minute Test from Abbott, Which Will Produce 1.5 million per month
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View above about Model Issue: Odds that COVID-19 disruption ends in the second quarter
Abbott Laboratories is unveiling a coronavirus test that can tell if someone is infected in as little as five minutes, and is so small and portable it can be used in almost any health-care setting. The medical-device maker plans to supply 50,000 tests a day starting April 1, said John Frels, vice president of research and development at Abbott Diagnostics. The molecular test looks for fragments of the coronavirus genome, which can quickly be detected when present at high levels. A thorough search to definitively rule out an infection can take up to 13 minutes, he said.Abbott has received emergency use authorization from the U.S. Food and Drug Administration “for use by authorized laboratories and patient care settings,” the company said on Friday.
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Distribution of progression rates lower since Kevzara efficacy may be clear in 2 weeks
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View above about Model Issue: Odds that COVID-19 disruption ends in the second quarter
We could be one to two weeks - at most a month or so - away from knowing whether [approved arthritis drug Kevzara] is really making a difference or not [in COVID-19 patients].

reuters.com
Data on arthritis drug to treat coronavirus could come within weeks: Regeneron executive
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