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2020-03-22.log
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<xentrac>anyway, zooming out, violent coercion is a constant of human existence, and a significant obstacle in many cases to high communication bandwidth within a social grup <OriansJ>as the major limiting factor of survival is the secondary pneumonia which is usually what kills the infected if I remember correctly. <lfam>OriansJ: The issue was shortages of hospital space and personnel. Unfortunately they have had to let a lot of people die <lfam>They ran out of resources weeks ago <OriansJ>xentrac: as always technical possiblities are limited by social systems and structures in which they exist. <xentrac>pneumonia isn't an infection, OriansJ; it's a symptom <OriansJ>lfam: space is easy, rent buildings. Personnel is a much harder problem <xentrac>in Boston they're using collapsible tents, from news photos I've seen\ <OriansJ>xentrac: correct, but the infection is the current flu strain that is being discussed. <xentrac>no, the flu has nothing to do with it <OriansJ>Office buildings, indoor sports stadiums and the rest would solve the space issue. <xentrac>and what I mean there isn't necessarily a secondary infection, which is what you seemed to be suggesting; SARS-CoV-2 can cause ARDS all by itself, if I understand correctly <xentrac>this is only the beginning in Italy; they haven't yet reached 0.1% of the population <xentrac>so they'll be dealing with 100× as many cases in about three and a half weeks <xentrac>unless they can get it under control <xentrac>here in Argentina we're about 24 days behind Italy, with a slightly smaller population <xentrac>so I don't think the current measures are an overreaction. I think they're a misguided underreaction; what we need to fight contagion is primarily testing and social distancing, not obedience and arrests. arrests are highly counterproductive <lfam>I agree, we are totally underreacting <xentrac>also, we need some masks. I still see some police going around without face masks <lfam>Without either widespread testing or policing, we are screwed <xentrac>and the ones I see are the shitty single-elastic-string type that invariably rock up and down and leak air <lfam>Probably not very different though. I imagine the Argentine government is weak <xentrac>actually it seems like now we're about 27 days behind Italy; Italy has pulled ahead! <OriansJ>according to wikipedia: Most of those who died were elderly—about 80% of deaths were in those over 60, and 75% had pre-existing health conditions including cardiovascular diseases and diabetes. <lfam>I hope I am wrong and that we will be okay. But when comparing to the timeline of Italy we have not been doing near enough <lfam>As with most diseases, the elderly and sick are the most vulnerable <OriansJ>Shortness of breath only occurs in 18.6% of cases <xentrac>No, you're totally screwed. You elected a reality TV host who is the personification of the id as president, and unsurprisingly he put stupid people and fools in charge of federal agencies <lfam>And the populace is completely pacified <OriansJ>The most dangerous part: Fatigue 38.1% <OriansJ>Well Pence's policy is just pray the flu away <xentrac>OriansJ: yeah, actually those are only of symptomatic cases; the vast majority of cases are asymptomatic. that's why it's so hard to stop the contagion: it spreads rapidly through an apparently unaffected population <lfam>Pence is no fool. We'd be worse off with him in normal times. Maybe in a crisis he would be better <lfam>Pence knows how to set goals and accomplish them, unlike Trump <xentrac>so far the CFR (mortality) rates we've been seeing are about 1%-5%, but probably that would rise to around 12-15% if treatment were unavailable <xentrac>right, they're just shitty goals; he might be happy to just let people die <OriansJ>xentrac: asymptomatic people aren't dying though <lfam>xentrac: That's what he did with HIV <lfam>That's why I said he would be worse in normal times. I think his values are wrong <OriansJ>I'd argue from the available numbers that only an additional 3-4% (over the current medical baseline) would die if they did not have access to proper medical care. <lfam>Does that include non-COVID cases? <lfam>All the people who need emergency care but can't access it due to the hospitals being full <OriansJ>lfam: well that is a much harder number to pin down as I don't know most hospitial's capacity overhead numbers <lfam>I think that it's been calculated by experts in the field <lfam>And every hospital has calculated it and knows what to expect. Hence the panic <lfam>Sorry, I just wanted to push back on the idea that it's "just the flu" and that we are overreacting. I can't provide citations <OriansJ>for example a city of 100,000 => 4-5,000 people needing medical treatment. Hospital has capacity for 2,000 => runs overtime to provide for 3-4,000 <OriansJ>lfam: I am more than happy to be on the overprepared side <OriansJ>but I want to understand they how and why to know what the proper response is <OriansJ>Yes, things can go really wrong and yes sometimes we need to plan for major disasters/plagues <OriansJ>hell everyone here thinks about worst case first <OriansJ>otherwise you wouldn't be a bootstrapper <OriansJ>but I also know an overreaction can end alot of lives too <lfam>I would pick a news source you trust and read the news from Asia or Italy <lfam>Those are the places that got it first <OriansJ>lfam: I don't trust news sources. I go with CDC and other medical specialists who have a duty to inform the public <lfam>We are gonna have trouble communicating <OriansJ>lfam: of course and it is heathy to have these sort of discussions to clarify our own understandings <OriansJ>Taiwan's solution seems the most reasonable to ensure success <OriansJ>Give everyone face masks, promote hand cleaning and social distancing. Without proper propagation factors R0 drops below 1 and the disease dies out. <xentrac>OriansJ: right, asymptomatic people don't tax the hospitals; they make it harder to stop contagion, because it isn't enough for sick people to wear face masks <xentrac>lfam: I think the number of people who need emergency care for non-COVID-19 reasons is very small compared to the expected case load <OriansJ>xentrac: not if a society simply says: Ok everyone where this cheap mask everyday when you go out for the next 60 days. Spread drops considerably <xentrac>typically a hospital for a "city" of 100,000 people will not have 2000 hospital beds. Korea did have 13 beds per 1000 people, which would be 1300 beds in such a town; the US has 3 per 1000, which would be 300 <OriansJ>xentrac: that seems massively foolish in terms of long term planning <xentrac>with 60,000 infected and 12% "serious", you have 7200 serious cases who will probably die without hospital treatment for those 300 beds <xentrac>and of those you have 3000 critical cases (5%) who need an ICU bed to survive <xentrac>yeah, I agree about wearing cheap masks. but here in Argentina I'm only beginning to see mask adoption, and on Tuesday when I gave away a mask to an old man, everyone started asking me where I'd been able to buy it <xentrac>so we're potentially talking about 5-10% of the population dying because we'd need 20× more medical facilities than we have in order to treat them <OriansJ>xentrac: actually the cheap masks only prevent you from spreading the disease to others, not the reverse. <xentrac>but they're more effective for the former <xentrac>the CFR for the seasonal flu in the US is about 0.1%, btw <OriansJ>xentrac: depends upon the age group in question honestly <xentrac>that's the average across all age groups <xentrac>that's why this is a PHEIC: it's as contagious as the flu but about 10 to 50 times more deadly <xentrac>in Italy (3.4 beds per 1000) we're starting to see what happens when the health care system gets overwhelmed, but we're still two or three orders of magnitude away from the peak <OriansJ>xentrac: ideally we already passed the peak but that is just me wishing people acted rationally <xentrac>well, in Taiwan, South Korea, mainland China, Japan, and Hong Kong, we probably have <OriansJ>unfortunately we exist in a social system which reacts badly to plagues and is really good at creating them <xentrac>but in Italy and the US this is just the beginning <xentrac>part of the problem is Prisoners'-Dilemma situations <xentrac>I bought 12 days' worth of food today at the supermarket, for example <xentrac>this kind of thing is putting a lot of strain on the retail supply chain in many countries, and it is not responding well <xentrac>but I really don't want to have to go outside during the peak of the pandemic in May <xentrac>our food supply chain here in Argentina seems to be holding up just fine, but facemasks and alcohol have been out of stock everywhere for a week <OriansJ>give supply chains 2-4weeks to adjust to the new higher demand level <xentrac>they won't and can't; that would involve carrying 10× higher inventory, which will then rot once people are fully stocked up <xentrac>but there are also outright-irrational responses; in the UK, for example, they're limiting people to two instances of each supermarket item, which drastically increases the amount of time people spend in supermarkets coughing on each other <OriansJ>xentrac: I expect similiar supply levels to what occured the last time in my life there was a massive toilet paper shortage here in michigan <xentrac>a friend of mine in Boston who's caught COVID-19 reports diarrhea <OriansJ>some jackass on TV started saying the stores were going to run out of toilet paper in days and people started hoarding like crazy <xentrac>a rational government regulator would be guaranteeing retailers' stock so that they can increase their stock without fear, thus helping everyone to stock up in preparation for dramatically increased social distancing in May <xentrac>weird, I don't remember that, but I didn't live in Michigan <OriansJ>took 4 weeks before toilet paper was back on store shelves <xentrac>here in Argentina people carry much higher inventory levels because there are constantly strikes, power outages, and protests with burning tires <OriansJ>Currently DTMB technical staff are all working remotely until further notice. <xentrac>that sounds like a good measure. when did they do that? <OriansJ>I've been largely staying home with the wife and son. <OriansJ>but I see people's panic behavior and ineffective government planning bite everyone in the ass. The local government might have the right ideas about remote work but federally things are far worse whan you could imagine. (Literally policy is pray the flu away) <xentrac>well, at least today we saw Trump paying lip service to the idea of removing bureaucratic obstacles to rolling out experimental chloroquine treatments <xentrac>one of the few sensible things he's ever said <xentrac>nothing yet about removing bureaucratic obstacles to certifying new N95 mask fabrication <OriansJ>xentrac: well experimental treatments have body counts too and bureaucratic obstacles usually exist for very good reasons <OriansJ>N95 mask fabrication doesn't have bureaucratic obstacles from what I understand, only technical <xentrac>both kinds of obstacles exist and are important <OriansJ>bureaucratic usually tend to save more lives then they cost; technical is just nature being a cruel bitch. <xentrac>I don't know that I agree about bureaucratic obstacles in general, but it's at least a plausible point, especially if you restrict it to places like Michigan <xentrac>but it's quite clearly false in this case <OriansJ>xentrac: the twitter requires javascript, what is the contents? <xentrac>you can actually view it successfully in links without JS <xentrac>it just has 16 screenfuls of crap before the actual tweet <xentrac>Matt Parlmer -> **** **** **** Retweeted Eric Lipton <xentrac>I've been working on an N95 mask production project with a team for about a week now. We just got off the phone with NIOSH. They told us that approval for a new mask production facility in the US will take at minimum 45 days, but more likely 90. A lot of people are gonna die. https://twitter.com/EricLiptonNYT/status/1240467730689593344 <xentrac>there's a lot more detail in the thread though <OriansJ>that seems more about the labeling of the masks as N95; not the manufactor, distribution and sale of said masks <xentrac>yes, but labeling the masks is very important <OriansJ>not if the company actually cares about saving lives <xentrac>if the hospital cares about saving lives <xentrac>if you have doctors working day in and day out in an isolation clinic using masks they hope are N95-ratable, even though they haven't been rated... <OriansJ>the public is the part that needs the excess supply not hospitals <xentrac>it's not going to take very many fly-by-night suppliers before your entire ICU team is out of commission due to exposure to high viral loads <xentrac>the public definitely needs masks, yes, but hospitals need them even more <xentrac>and there aren't enough for hospitals now. the CDC is suggesting for doctors to put bandannas over their noses and mouths <xentrac>an infected average person will infect on average about 3 other people. an infected doctor can infect several hundred, and then be unavailable to save the lives of hundreds more <xentrac>an uninfected average person can avoid, say, 0.1 infections, if we optimistically assume that the epidemic in the US will infect 10% of the population <xentrac>remember, also, that currently about 0.008% of the US population is infected. so we should expect the number of masks needed to climb by several orders of magnitude, and they're already scarce <xentrac>two tweets down the thread: "This process [of getting a production facility NIOSH-certified] can't even begin until we have our facility set up, even if we're planning to use equipment and material identical to other N95 mask fabricators. My dad is gonna be intubating people with a bandana [sic] around his face by the end of next week. <xentrac>This process [of getting a production facility NIOSH-certified] can't even begin until we have our facility set up, even if we're planning to use equipment and material identical to other N95 mask fabricators. My dad is gonna be intubating people with a bandana [sic] around his face by the end of next week. <OriansJ>knowing federal regulators, how the fuck is that company that stupid. Just do a good faith waiver with personal penalties for the board and they will get their approval today. <xentrac>they've been talking to NIOSH employees, but if you want to contact them and act as a go-between, I'm sure they'd be grateful if you can make it rain <xentrac>if you can convince them of your bona fides anyway — similar market-for-lemons problem as the one the N95 certification defends against in the first place <OriansJ>simply do a $1B bond on the line in the event of future fail to comply <OriansJ>it'll cost more than NIOSH compliance but there isn't a regulator who wouldn't buy that as worthy of a 90 day exception. <OriansJ>(or 180 days if you play your cards right) <xentrac>maybe you should talk to them if you think that's a reasonable option. seems like that bond would probably come with a hefty insurance premium but maybe they can get donations to cover that <OriansJ>It is a reasonable option only if they can make up the difference in the market premium prior to a standard approval. Otherwise a cost benefit analysis says it is more profitable to let people die. <OriansJ>So it was always an option but probably not one with a high enough profit margin to justify to shareholders. <OriansJ>The insurance premium would probably end up costing them $30M worst case, assuming they are not a fly-by-night operation with a reasonable plan with a high likelihood of success. <OriansJ>I've seen companies like SAS get a $1B bond for $100K to cover a risk complaince requirement they need an exception to buy them time. <OriansJ>So, I can only imagine they either know nothing of buying government exceptions or simply calculated the cost as being too high. <OriansJ>Heck why do you think every Health provider running Windows 10 isn't getting its ass handed to them over Windows 10 HIPPA compliance. (Windows 10 super violates the federal law) <OriansJ>The federal government is generally reasonable people, who have faith in parties they have long term experience with. <xentrac>I don't think the dude has shareholders <xentrac>But I don't know, you can talk to him <xentrac>What he wants is to enable every hospital to fabricate their own masks with a well-tested design and supply chain if necessary <xentrac>But it seems pretty clear that the Feds are not helping in this case. They could be assuming the risk; you're suggesting that instead of dealing with NIOSH bureaucracy he could deal with an insurance company's bureaucracy. That might or might not be an improvement <xentrac>But in any case the cost and delay due to the potential liability for failing to solve the problem is clearly enormously larger than the cost and delay due to actually solving it <OriansJ>hmmm, if it was just an Open hardware design this would be a far easier problem to solve <xentrac>Yes, he's doing it as an open hardware design; that's part of the difficulty <xentrac>Long-term mask suppliers of course don't want to take the risk of going bankrupt with an unsellable inventory of billions of unused masks, like in SARS <OriansJ>then just appeal directly to the doctors to do it regardless of regulations <OriansJ>The cert can come later and the doctors can use it only when the certified masks become unavailable <OriansJ>to do anything else would smell too much like a fly-by-night money grab <xentrac>it's important to get some kind of trustworthy testing in place so that hospitals can tell what is and what isn't adequate protection <OriansJ>The bond bit is the sort of thing governments do to provide exceptions to businesses they have no long term relationship with (or a very bad relationship with previous bad behavior). I am honestly siding with the NIOSH bureaucracy here. <xentrac>maybe he should be working on a mask-testing machine instead of making masks <xentrac>maybe it wouldn't have to be NIOSH that does the testing; we have to be able to do better than bandannas <OriansJ>well doctors are not entirely stupid <OriansJ>given the option of buying a machine which produces something which has a publicly reviewed design known to be better than what they currently have is a gimme <OriansJ>a money back if we don't get certified in x days will more than cover their fears about not having enough. <OriansJ>but again too much fly-by-night flags right off the bat. <OriansJ>I've been on both sides of these sorts of discussions and anyone who says the requirements are not reasonable usually are lying or just cheap. (A CMS audit costs over $1M to conduct and it has to be done yearly) <OriansJ>You just literally can't afford to have CMS data in a business making less than $1M/year. <xentrac>it sounds like you're telling me things that you should be telling him, because I don't know what a CMS is <xentrac>but at the moment I believe he knows more than you do about NIOSH's certification process for N95 mask manufacturing <xentrac>so given the choice between believing you or believing him, I'd believe him <xentrac>also, a more fundamental piece of evidence that the problem is organizational rather than technical is that mainland China, Taiwan, Hong Kong, and South Korea have been able to ramp up their mask manufacturing to meet the challenge and stop the pandemic, and the US hasn't even begun <fossy>OriansJ: does m2-planet support variable names in // CONSTANT <OriansJ>fossy: absolutely not. Only integers or sizeof(type) anything else and you are probably doing the wrong thing. <fossy>debian's guile-2.2 package hangs on the make configure script, not at any specific point... <fossy>void linux's guile 2.0 dosen't, but guix's static 2.2.4 does... 