Coronavirus COVID-19

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Re: Coronavirus COVID-19

Post by BDKJMU »

Ibanez wrote:
Fri Jul 31, 2020 9:58 am
BDKJMU wrote:
Fri Jul 31, 2020 9:49 am

No, chemical agent was dispersed on violent rioters because they were attacking police, and had injured reportedly 150..
I remember watching it LIVE...I don't recall seeing any police under attack.
150 cops injured/22 hospitalized didn’t happen during a peaceful protest.

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Re: Coronavirus COVID-19

Post by UNI88 »

BDKJMU wrote:
Fri Jul 31, 2020 12:34 pm
Ibanez wrote:
Fri Jul 31, 2020 9:58 am

I remember watching it LIVE...I don't recall seeing any police under attack.
150 cops injured/22 hospitalized didn’t happen during a peaceful protest.
So the clergy were violent?

Is there anything Trump does that you won't rationalize? For a supposed tough guy he sure likes to play the victim.

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Re: Coronavirus COVID-19

Post by BDKJMU »

UNI88 wrote:
Fri Jul 31, 2020 12:58 pm
BDKJMU wrote:
Fri Jul 31, 2020 12:34 pm

150 cops injured/22 hospitalized didn’t happen during a peaceful protest.
So the clergy were violent?

Is there anything Trump does that you won't rationalize? For a supposed tough guy he sure likes to play the victim.
Don’t be obtuse.

And I said the photo opp was a bad idea. I wish he hadn’t done it, or did it the next day. The perimeter still gets expanded when it did, and the left wouldn’t be able to claim it was for a photo op.

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Re: Coronavirus COVID-19

Post by SeattleGriz »

Ibanez wrote:
Fri Jul 31, 2020 11:58 am
SeattleGriz wrote:
Fri Jul 31, 2020 11:40 am


I'm totally fine with Trump being criticized by former Presidents. Trump is bashing most of them for selling America out to China, so they better stand up for what little legacy they have. Trump is the MOST criticized President in history in my opinion.

You want to know why Trump is liked? Because he doesn't put up with shit and speaks his mind - he fights back. You may not like it, but Republicans have folded over for far too long and thus why I say he is the perfect asshole to deal with our elected assholes.
He is certainly criticized - but it's his own doing so. It's also b/c the left became unhinged in 2016 but Trumps personality and inability to act like an adult doesn't help.
And that is why it is so delicious! The Left is being pummeled by a buffoon. He only needs to tweet his stance on a subject to see the Left reflexively go to the other extreme and come off as just as petulant.

So much for professionalism. The Trump detractors have been exposed as just as unhinged.

Me, I just sit back and enjoy the ride.
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Re: Coronavirus COVID-19

Post by UNI88 »

SeattleGriz wrote:
Fri Jul 31, 2020 1:25 pm
Ibanez wrote:
Fri Jul 31, 2020 11:58 am

He is certainly criticized - but it's his own doing so. It's also b/c the left became unhinged in 2016 but Trumps personality and inability to act like an adult doesn't help.
And that is why it is so delicious! The Left is being pummeled by a buffoon. He only needs to tweet his stance on a subject to see the Left reflexively go to the other extreme and come off as just as petulant.

So much for professionalism. The Trump detractors have been exposed as just as unhinged.

Me, I just sit back and enjoy the ride.
Trump responding to criticism from the left ...


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Re: Coronavirus COVID-19

Post by CID1990 »

kalm wrote:A nurse friend of mine rotates in and out of a Covid unit at a Spokane hospital. Whether you think you have it figured it out or not, read it...
I am an ICU Doctor. I just finished a 10 day working 12-14 hour days in my hospital's COVID ICU. I couldn't go one day without intubating someone. I couldn't go one day without asking my nurses and respiratory therapists to prone a patient to try and get them to breathe. I couldn't go one day without having a heart-and-soul wrenching video conference with a family, telling them their loved one was going to die despite everything we were doing. Every night I would walk out of the hospital, sit in my car, stare at my steering wheel, and sob. And then, after all of that, I see people all around me who still have the audacity to downplay, underestimate, and trivialize a pandemic that continues to spread illness, suffering, and death throughout the country. And doing so with no insight that the very ability to minimize or outright deny this is happening is a luxury that neither I, my fellow physicians, nurses, respiratory therapists, pharmacists, physical therapists, and most importantly the 151,077 (and counting) Americans who have died from this, get to have.

For those of you that point out a declining mortality rate is reason to disregard it, all I can say is, of course it's going down. After the entire world has seen over 17 million confirmed cases (again, and counting) over the past 6 months, my medical brothers and sisters and I have had no choice but to rapidly evolve and get better at managing this disease under the most dire of circumstances. Calculating a mortality rate is an incredibly complicated thing to do, and is continuously affected by countless things: our understanding of medical management like timing of intubation for respiratory failure, prone positioning, using medications that have actually shown benefit in prospective randomized controlled trials and avoiding medications that have not passed this standard, population behaviors like staying away from large crowds and properly wearing masks (yes, just putting a mask on doesn't mean you're doing it right), regional hospital bed availability and capacity to take new patients, availability of rapid testing, to name just a few off the top of my head. In fact, if the mortality rate was not going down that would be absolutely terrifying. That would mean that no matter what we've learned or what we try, our efforts have been completely ineffective and this disease is going to kill the same percentage of people no matter what we do. But that is the beauty of modern medicine; when done properly we have the capacity to learn, improve, and save lives that otherwise would be lost.

I think it is also important to point out what a mortality rate doesn't take into account. It doesn't take into account the morbidity and mortality of other diseases and conditions that are affected when a medical system becomes strained. Every other condition that leads to critical illness and death is still happening and needs care. It's not like hospitals are trading other ICU patients for COVID patients. We are having to taking care of heart attacks, strokes, septic shock, kidney failure, liver failure, traumatic injuries, and everything else an ICU does PLUS the added number of COVID patients. So having a 60 bed ICU doesn't mean you have room for 60 critically ill COVID patients. In fact, most major ICU's in this country run at 80-90% capacity ALL THE TIME. So even if elective surgeries and procedures get cancelled in an area, it's important to understand that there is not a lot of capacity to handle a surge of patients. And when that capacity gets overwhelmed, you can reliably expect that not only will your COVID-related mortality go up, but every other condition that requires critical care will as well.

While we're on the subject of percentages, let's make a few clarifications. In our everyday lives, I understand that 1-5% seems really small. But PLEASE understand that what counts as a large percentage in medicine is completely different. Medicine is not everyday life. It is exquisitely complex. Seasonal influenza usually has a quoted mortality rate of 0.1%. So even at the lowest estimated mortality rates right now, a group of COVID patients is dying at 10 times the amount a similar group of influenza patients does. It is also important to ask, what is the absolute number that the percentage is being applied to? 1% of 100 people is 1 person. 1% of 1 million people is 10,000 people. 1% of 370 million people (roughly the US population) is 3.7 MILLION PEOPLE. And to anyone who doesn't think that could happen, all is can say is, what evidence do you have? This virus has done nothing but spread to any place it has available to it. It spread from a single Chinese province to every single major metropolitan area in the world in less than 2 months. The US continues to post 60,000-70,000 new cases per day. There is not a single shred of evidence to suggest that will change unless we make it change. Everyone needs to understand that this virus will continue to infect until it has nowhere to go, either because it has infected everyone (see the above scenario to see how that will work out), it is cut off from a supply of new hosts (distancing and masks), or everyone it comes in contact with is immune (immunizations, which as yet do not exist for COVID and in the best case are still months to years away).

When it comes to properly interpreting studies, data, claims by people on TV, I get that there is an enormous amount of data circulating and that it is overwhelming to try and figure out what is true and what isn't. I would be wary of anyone claiming to have "absolute knowledge" or "found a cure" or "this works in their personal experience." This pandemic continues to humble me over and over again, and I've spent 4 years of college, 4 years of medical school, 3 years of Internal Medicine Residency, 1 year as chief resident, and 2 years of Critical Care Medicine Fellowship (roughly 35,000 hours of study, training, and clinical practice) to try and be ready for something like this. For anyone that doesn't have a similar background, I wish I could make this simpler, but I can't. This is complicated. Being able to have a truly informed conversation about this requires knowledge of concepts like Ro (R-naught), ID50, Absolute mortality, number needed to treat, number needed to harm, sensitivity, specificity, positive predictive value, negative predictive value, droplet vs airborne transmission, pharmacokinectics, drug clearance in renal and liver failure, why prospective blinded placebo controlled trials are the Gold Standard and why retrospective studies are so limited to the point that they by definition cannot establish a cause-and-effect relationship, the difference between a statistically significant and clinically significant result, identifying clinically relevant endpoints in a study (mortality or time to clinical improvement, as opposed to viral clearance with no regard for patient clinical status), basic and advanced respiratory mechanics, identifying impending respiratory failure and properly timing intubation/mechanical ventilation, pathophysiology of exudative vs fibroproliferative phases in ARDS, calculation of ventilator tidal volumes based on Ideal Body Weight to prevent ventilator-induced lung injury, proper titration of PEEP, limiting ventilator pressures and understanding the difference between peak pressure and plateau pressure, permissive hypercapnia, preventing hyperoxia, appropriate use of neuromuscular blockade to prevent ventilator dyssynchrony, the benefit of prone positioning and understanding how long to leave someone prone, preventing complications of critical illness in particular venous thromboembolism and choosing appropriate anticoagulation agents, recognizing secondary bacterial infections and treating with appropriate antibiotics, managing volume status and diuresing appropriately, performing adequate spontaneous-breathing trials and extubating patients appropriately to prevent deconditioning... This and more. And while I don't expect people to have this knowledge if you don't do this for a living, if you feel like you "know" this disease without understanding the above concepts, then let me be the one to tell you that you are not an expert. If you are making decisions based purely on your own thoughts and opinions because you "don't trust the experts" but either have never heard of or don't understand everything I just mentioned above, then I hope you will see this and see that you are wrong to do so. What I listed above is the bare minimum needed to even approach understanding this disease at an expert level. So for anyone who doesn't, but feels confident that they have it all figured out, I would suggest some caution and humility, because likely the trained experts are taking things into consideration you have no idea even exist. Medical professionals who have devoted their entire lives to things like this are still grinding away and learning more. And while we may not always get it right, we're always getting better, and the expertise we've attained has been earned over years and decades. It is not something you can spend an afternoon or a weekend reading about. And I would encourage you to hold medical professionals to the same standard. If they spend too much time talking about "their experience and what they know works" and don't attempt to mention a single prospective, randomized controlled trial to support their thoughts, then you are right to not listen to them. Because they are in fact not an expert, they are someone in a white coat pretending to be. I'm not a farmer, I would never in a million years think that I could read a couple memes and youtube videos and walk away thinking I could just go out and plant crops and raise livestock, much less tell an actual farmer what to do.

If you read this, and nothing I've said resonates with you, nothing I've said convinces you, then at the very least think about me, how you know me. If the data, the math, the scientific jargon sounds hollow, then hopefully you can look at the person it's coming from and find a reason to believe. To you, maybe I'm the little boy your kids played with growing up. Maybe I'm the kid you sat next to in high school. Maybe I'm the young man you saw nervously running through the hospital as a medical student. Maybe I'm someone you consider a friend. Maybe I'm the doctor who helped you or your loved one when all seemed lost. Maybe I'm the doctor who sat with you when your loved one was dying and I wished I could do more. Regardless, I hope that you can see me as one person trying to help others and do the best I can in the face of an absolutely overwhelming enemy in COVID. I'm one doctor, working alongside the bravest nurses, NP's, PA's, RT's, PT's, OT's, Pharmacists, Nurse's Aides, Cleaning staff, Kitchen staff imaginable. Together, despite our very best efforts, we've lost many patients to COVID-19, and we face it knowing we are going to lose more. I'm not a conspiracy, I'm not tyranny, I'm not an assault on freedom, I'm not the enemy. And if you can believe that, then I am pleading with you to take this as seriously as you possibly can. Limit the number of people you are around as best you can, wear the masks, listen to the experts about which medications work (Remdesivir and Dexamethasone) and which ones don't (Hydroxychloroquine and Azithromycin) because they are the ones with the technical knowledge to properly figure it out. And if a safe, effective vaccine comes out, I beg you to get it. Because even if you don't know someone who had died from COVID-19, those of us who work in medicine have known them ALL. And if we don't work together to beat this, eventually you will too.
Apparently Trumpies know better than the experts about epidemiology and the proglodytes know better than the experts on fiscal policy, foreign policy, policing, math... pretty much everything else


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Re: Coronavirus COVID-19

Post by SeattleGriz »

CID1990 wrote:
Fri Jul 31, 2020 1:41 pm
kalm wrote:A nurse friend of mine rotates in and out of a Covid unit at a Spokane hospital. Whether you think you have it figured it out or not, read it...
Apparently Trumpies know better than the experts about epidemiology and the proglodytes know better than the experts on fiscal policy, foreign policy, policing, math... pretty much everything else


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Not sure the person Klam quoted was an Epidemiologist, but your point is correct. I put GPs in the category below when compared to Epidemiologists.

I used to sell laboratory testing to providers. One of the tests I used to sell to Urologists was FISH (Florescent In Situ Hybridization), testing.

A basic concept. If certain genetic markers for bladder cancer were detected in your urine, you either had bladder cancer or were well on your way to developing. It was a simple positive. The test assay would bind to the cancerous genetic sequence and "floresce" when exposed to florescent microscope. Essentially, you see either a red, green or yellow light and you had proof of genetic abnormalities.

We had to create a special Pathology review test code, just so we could get paid when the Urologists couldn't understand that a light equals a positive.

Ive seen some stupid doctors out there. I could have saved many an insurance plan $175 if the doctor would have simply listened to me...or simply read the test information we provided.
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Re: Coronavirus COVID-19

Post by kalm »

SeattleGriz wrote:
Fri Jul 31, 2020 3:02 pm
CID1990 wrote:
Fri Jul 31, 2020 1:41 pm

Apparently Trumpies know better than the experts about epidemiology and the proglodytes know better than the experts on fiscal policy, foreign policy, policing, math... pretty much everything else


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Not sure the person Klam quoted was an Epidemiologist, but your point is correct. I put GPs in the category below when compared to Epidemiologists.

I used to sell laboratory testing to providers. One of the tests I used to sell to Urologists was FISH (Florescent In Situ Hybridization), testing.

A basic concept. If certain genetic markers for bladder cancer were detected in your urine, you either had bladder cancer or were well on your way to developing. It was a simple positive. The test assay would bind to the cancerous genetic sequence and "floresce" when exposed to florescent microscope. Essentially, you see either a red, green or yellow light and you had proof of genetic abnormalities.

We had to create a special Pathology review test code, just so we could get paid when the Urologists couldn't understand that a light equals a positive.

Ive seen some stupid doctors out there. I could have saved many an insurance plan $175 if the doctor would have simply listened to me...or simply read the test information we provided.
No doubt on stupid doctors. Highly specialized experts are often so. See Ben Carlson.

Read the article and you will find that this guy is an ICU doc who admits the complexity of the situation, backs up what he’s observed with data, and is anything but stupid.
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Re: Coronavirus COVID-19

Post by SeattleGriz »

kalm wrote:
Fri Jul 31, 2020 3:48 pm
SeattleGriz wrote:
Fri Jul 31, 2020 3:02 pm


Not sure the person Klam quoted was an Epidemiologist, but your point is correct. I put GPs in the category below when compared to Epidemiologists.

I used to sell laboratory testing to providers. One of the tests I used to sell to Urologists was FISH (Florescent In Situ Hybridization), testing.

A basic concept. If certain genetic markers for bladder cancer were detected in your urine, you either had bladder cancer or were well on your way to developing. It was a simple positive. The test assay would bind to the cancerous genetic sequence and "floresce" when exposed to florescent microscope. Essentially, you see either a red, green or yellow light and you had proof of genetic abnormalities.

We had to create a special Pathology review test code, just so we could get paid when the Urologists couldn't understand that a light equals a positive.

Ive seen some stupid doctors out there. I could have saved many an insurance plan $175 if the doctor would have simply listened to me...or simply read the test information we provided.
No doubt on stupid doctors. Highly specialized experts are often so. See Ben Carlson.

Read the article and you will find that this guy is an ICU doc who admits the complexity of the situation, backs up what he’s observed with data, and is anything but stupid.
I read about 2/3s and never called him stupid. In fact I specifically mentioned General Practitioners (GP).

For you to call Ben Carson stupid is atrocious though. Shame on you.
Carson's SAT college admission test scores ranked him somewhere in the low 90th percentile,
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Re: Coronavirus COVID-19

Post by kalm »

SeattleGriz wrote:
Fri Jul 31, 2020 4:00 pm
kalm wrote:
Fri Jul 31, 2020 3:48 pm


No doubt on stupid doctors. Highly specialized experts are often so. See Ben Carlson.

Read the article and you will find that this guy is an ICU doc who admits the complexity of the situation, backs up what he’s observed with data, and is anything but stupid.
I read about 2/3s and never called him stupid. In fact I specifically mentioned General Practitioners (GP).

For you to call Ben Carson stupid is atrocious though. Shame on you.
Carson's SAT college admission test scores ranked him somewhere in the low 90th percentile,
You jumped to “stupid doctors” as an example.

There are some stupid - dumb people out there. Hell, we’re all stupid on our ways.

Carson May have high test scores but...still stupid.
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Re: Coronavirus COVID-19

Post by SeattleGriz »

kalm wrote:
Fri Jul 31, 2020 5:26 pm
SeattleGriz wrote:
Fri Jul 31, 2020 4:00 pm


I read about 2/3s and never called him stupid. In fact I specifically mentioned General Practitioners (GP).

For you to call Ben Carson stupid is atrocious though. Shame on you.

You jumped to “stupid doctors” as an example.

There are some stupid - dumb people out there. Hell, we’re all stupid on our ways.

Carson May have high test scores but...still stupid.
Sure. Citikalm Grad. Whatever you say.

I was replying to Cid's post.

Because I know what you are digging at, can you explain radiocarbon dating without looking it up?

Beliefs are different than intelligence.
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Re: Coronavirus COVID-19

Post by CID1990 »

kalm wrote:
SeattleGriz wrote:
Fri Jul 31, 2020 3:02 pm
Not sure the person Klam quoted was an Epidemiologist, but your point is correct. I put GPs in the category below when compared to Epidemiologists.

I used to sell laboratory testing to providers. One of the tests I used to sell to Urologists was FISH (Florescent In Situ Hybridization), testing.

A basic concept. If certain genetic markers for bladder cancer were detected in your urine, you either had bladder cancer or were well on your way to developing. It was a simple positive. The test assay would bind to the cancerous genetic sequence and "floresce" when exposed to florescent microscope. Essentially, you see either a red, green or yellow light and you had proof of genetic abnormalities.

We had to create a special Pathology review test code, just so we could get paid when the Urologists couldn't understand that a light equals a positive.

Ive seen some stupid doctors out there. I could have saved many an insurance plan $175 if the doctor would have simply listened to me...or simply read the test information we provided.
No doubt on stupid doctors. Highly specialized experts are often so. See Ben Carlson.

Read the article and you will find that this guy is an ICU doc who admits the complexity of the situation, backs up what he’s observed with data, and is anything but stupid.
Ben Carson the brain surgeon is stupid?

Or is he just odd and you disagree with him personally

That was a very JellyAZBDKdawg comment you made

disappointed


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Re: Coronavirus COVID-19

Post by Skjellyfetti »

"The unmasking thing was all created by Devin Nunes"
- Richard Burr, (R-NC)
Cid1990 wrote:It is going to be a sad day for a lot of people when all that comes of all of this is Flynn getting whacked.

Mueller is going to take a beating on the left before this business is over

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Re: Coronavirus COVID-19

Post by kalm »

CID1990 wrote:
Fri Jul 31, 2020 5:33 pm
kalm wrote:
No doubt on stupid doctors. Highly specialized experts are often so. See Ben Carlson.

Read the article and you will find that this guy is an ICU doc who admits the complexity of the situation, backs up what he’s observed with data, and is anything but stupid.
Ben Carson the brain surgeon is stupid?

Or is he just odd and you disagree with him personally

That was a very JellyAZBDKdawg comment you made

disappointed


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Yes.
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Re: Coronavirus COVID-19

Post by AZGrizFan »

Skjellyfetti wrote:
Sat Aug 01, 2020 6:19 pm
Gigantic outlier.
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Re: Coronavirus COVID-19

Post by kalm »

AZGrizFan wrote:
Sat Aug 01, 2020 8:20 pm
Skjellyfetti wrote:
Sat Aug 01, 2020 6:19 pm
Gigantic outlier.
2nd MLB player with this post recovery condition.

Edit: same one as reported earlier.
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Re: Coronavirus COVID-19

Post by Gil Dobie »

AZGrizFan wrote:
Sat Aug 01, 2020 8:20 pm
Skjellyfetti wrote:
Sat Aug 01, 2020 6:19 pm
Gigantic outlier.
Why, the CDC date reports 2.8 to 4% of deaths are in this age range. You also going to get a good amount of health related problems coming from survivors. They are still learning as we go deeper into the Pandemic.
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Re: Coronavirus COVID-19

Post by CID1990 »

AZGrizFan wrote:
Skjellyfetti wrote:
Sat Aug 01, 2020 6:19 pm
Gigantic outlier.
I’ve been talking about chronic aftereffects of the virus for several weeks now because they are actually a thing -

and now it appears that they pop up even in people who do not suffer from severe COVID symptoms.

It may be statistically low but I wouldn’t put it in the outlier category


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Re: Coronavirus COVID-19

Post by SeattleGriz »

I'll just throw this out there. Would COVID been as bad 10 years ago. How about 20?

I ask because you see two of the biggest comorbidities are diabetes and high blood pressure.

There are other larger comorbidities, but I am talking lifestyle choices here.

https://www.cdc.gov/nchs/nvss/vsrr/covi ... /index.htm
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Re: Coronavirus COVID-19

Post by AZGrizFan »

CID1990 wrote:
Sun Aug 02, 2020 6:38 am
AZGrizFan wrote:
Gigantic outlier.
I’ve been talking about chronic aftereffects of the virus for several weeks now because they are actually a thing -

and now it appears that they pop up even in people who do not suffer from severe COVID symptoms.

It may be statistically low but I wouldn’t put it in the outlier category


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By definition if it’s statistically low probability it’s an outlier. :suspicious:
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Re: Coronavirus COVID-19

Post by ∞∞∞ »

AZGrizFan wrote:
Sun Aug 02, 2020 6:43 am
CID1990 wrote:
Sun Aug 02, 2020 6:38 am

I’ve been talking about chronic aftereffects of the virus for several weeks now because they are actually a thing -

and now it appears that they pop up even in people who do not suffer from severe COVID symptoms.

It may be statistically low but I wouldn’t put it in the outlier category


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By definition if it’s statistically low probability it’s an outlier. :suspicious:
That's not the definition at all.

If being born gay is a 1% chance, that's low probability but not an outlier. Being born gay without arms and legs is an outlier.

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Re: Coronavirus COVID-19

Post by AZGrizFan »

∞∞∞ wrote:
Sun Aug 02, 2020 6:47 am
AZGrizFan wrote:
Sun Aug 02, 2020 6:43 am


By definition if it’s statistically low probability it’s an outlier. :suspicious:
That's not the definition at all.

If being born gay is a 1% chance, that's low probability but not an outlier. Being born gay without arms and legs is an outlier.
Mmmkay. On a bell curve, 1% is an outlier. You define it however the fuck you want.
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Re: Coronavirus COVID-19

Post by ∞∞∞ »

AZGrizFan wrote:
Sun Aug 02, 2020 6:57 am
∞∞∞ wrote:
Sun Aug 02, 2020 6:47 am


That's not the definition at all.

If being born gay is a 1% chance, that's low probability but not an outlier. Being born gay without arms and legs is an outlier.
Mmmkay. On a bell curve, 1% is an outlier. You define it however the fuck you want.
Wrong again as 1% lies within the three standard deviations and an outlier on a bell curve would lie outside the deviations.

You're the only one defining it however you want.

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Re: Coronavirus COVID-19

Post by 89Hen »

CID1990 wrote:
Fri Jul 31, 2020 5:33 pm
That was a very JellyAZBDKdawg comment you made

disappointed
Yes, the new and regressed kalm is a very large disappointment.
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Re: Coronavirus COVID-19

Post by kalm »

89Hen wrote:
Sun Aug 02, 2020 7:10 am
CID1990 wrote:
Fri Jul 31, 2020 5:33 pm
That was a very JellyAZBDKdawg comment you made

disappointed
Yes, the new and regressed kalm is a very large disappointment.
Obsess much? :|

We discussed Carson’s intelligence 4 years ago and my position hasn’t changed. Like I posted, there are some really dumb (but often highly specialized expert) smart people out there...and I said we can all be stupid in our own way, including me

Feel free to disagree. It won’t disappoint me. :thumb:
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