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What is acceptable risk?
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If you are looking for hands and great analysis, I suggest Kit's Corner. This is (to Ray's annoyance I guess :) ) is about COVID-19, risks and my 5 cents on upcoming NABC.


I am not a doctor, not an epidemiologist and not an infectious disease expert. I am however a well trained, experienced scientist with background in statistics, medicine and population genetics. Currently I work in a ~30 people start-up, whose founders one is a doctor and the other is aStanford professor. We develop statistical + machine learning framework for novel diagnostic approach (applicable to wide range of conditions, but the first product is going to be infectious disease classifier). My husband is a PhD in biochemistry, works for Gilead - a 12,000 people company that is a leading company in making anti-virals, my father in law is a doctorand his wife is a nurse, she managesa clinic in Israel. My sister is a nurse in Toronto. I am well bellow 50, so is my husband, my kid is 4.5 years old and attends daycare.

I am not thepanicking type, and generally believe that what does not kill you makes your immune system stronger. As for COVID-19 I read the daily WHO reports, CDC website and some scientific articles that are being released. I avoid mass media (in general I have very low opinion of news outlets), when I do read press releases I like to track the source rather than read the journalists interpretation. Hopkins recently published nice resource for tracking the situation

I have no stake in whether Columbus gets cancelled or not - I was not going to attend anyway, I do not make money playing bridge, and I am not in contention for National open titles (yet Wink).

COVID-19 and Flu comparison

On this site and otherwise people compare this to the flu. The problem with that comparison is that it is apples to oranges. Flu will kill, and so far this season killed, more people than COVID-19 - this is not something in dispute. This however does not make COVID-19 less dangerous for you. It is different. Flu kills children, and very elderly. It is to some degree preventable, and to some degree treatable and it is seasonal. We know infection rate and hospitalization rate for flu. We also do not quarantine anyone with flu, nor do we put them under medical supervision. People that are hospitalized with flu have ~10% mortality rate - but we only hospitalize people with severe symptoms that require continuous support. Mild or moderate ones go home. We do not have any way of knowing how many people have COVID-19, we donot know if it is spread by the asymptomatic carriers (although we suspect yes). So comparingthe proportion of severe versus mild is, in my opinion, not really useful.

A more rationalcomparison, again imo, is to compare outcomes of people that have severe symptoms from either virus - at least these numbers are closer to being accurate, since both require hospitalization. Is severe flu as dangerous as severeCOVID19?

The numbers from China so far were reported for example in New England Journal of Medicine: 1099 laboratory confirmed, hospitalized cases of which 173 were characterized as severe - these are the patients that can be compared to the hospitalization of flu. Out of the 173, 67 ended up in on ventilator, 15 dead. "Of 975 CT scans that were performed at the time of admission, 86.2% revealed abnormal results." (this includes moderate). The mean duration of hospital stay was 14 days. All of these numbers are significantly worse than the ones for people that undergo hospitalization for the flu.

A WHO report on ~50 thousand cases ( suggest not a pretty picture either. 13.8% have severe disease, 6.1% - i.e. close to half of the people with severe disease, are critical. Critical means ventilation, multiple organ failure or septic shock.

To me, these numbersshow that COVID-19, once contracted is a more serious condition than flu, especially for older people (age dependency comes from data not discussed here, but widely accepted). However, we indeed have no idea how long it is around, how many have it and how many already got through it. So your chances of contracting it generally less than flu, but I dare to say that the chances for average ACBL member of spending several weeks in treatment, reaching ICU or dying look higher for COVID-19 than your run of the mill influenza. Although this year is not run of the mill.

Scientific community response

I am, as stated previously a scientist. For better or worse, I was involved in many diverse fields of research over the years, and met many scientists - from truly exceptionally smart and innovative to mediocre and complacent. The former is by far the majority though, and the latter are a minority - such was my luck. Scientists are people driven and motivated by emotions and imagination like the rest of us, but they are also trained to put those aside and examine data. The good ones do that rigorously, and try to prove themselves wrong. What most scientists are not - they are not prone topanic, and they do not seek evening news ratings. They do not like to cancel meetings, work around the clock and be responsible for media coverage. They definitely do not have some secret agenda of scaring everyone into some sort of isolation or control.

Another thing that i learned from my scientific career is that, however hard it is to admit, usually I am neither the smartest nor the most informed person in the room. You see, I do data analysis, I switch fields and projects every few years. That makes it interesting for me. However the most informed person in the room is usually someone who studied that field for all of their long, and for most part far from glorious, scientific career. Who imagined this scenario (and several dozen others) apriori and tried already to figure out what to do, what does it mean, and what can go wrong. When my interpretation of facts differs widely from that person, in my experience they are right more often than wrong - even if I can not see it at that moment. So I listen, and I am willing to give them a long rope to prove their point. My general assumption that when I would do differently than Kit, he is going to win the hand and I won't. Science, like bridge is not a democracy.

In this particular case I see several things that are going on:

Gilead - the large international company that collectively knows everything there is to know about viruses in general and this one in particular, and is trying very hard to find something that works, suspended unnecessary travel, offered everyone 50+ to work from home if at all possible and cancelled personnel participation in meetings unless approved on case by case basis.

Inflammatix - small start up with few experts on the subject and more people on visa/greencard than those with US passport - everyone who is somewhat unwell, with or without confirmed infection is asked to work from home. If you get fever do not show up at least a week after all symptoms are gone, if you have a confirmed case of COVID-19, at least two after you are symptom free and further testing will be considered. We do not have anyone with COVID so far, and hope to keep it that way.

Stanford - famous, well regarded university with top notch Medical School - among the most prestigious in the world. Cancelled all classes and large gatherings of >100 (? I am not 100% percent sure if it is 100 or 150) people. Classes moved online till the end of semester.

CROI - fairly large (several thousand), multiday international conference on retroviruses and infectious diseases, cancelled and moved online. Numerous other scientific and medical conferences followed suit, and either cancelled or moved online. I am not counting or looking at other fields, just medical/Life sciences conferences.

Note that all of theseorganizationshave in mind population which is mostly <50 years old, and do not imply sitting for hours in close contact within a confined space exchanging physical objects between all participants and mandating movements where everyone meets everyone. So it looks to me like the smartest person in the room prefers to err on the side of caution.

My father in law and his wife - not easily scared people. He was one of the doctors that went to Chernobyl at the time to screen people. Cancelled long planned trip to US at the end of March, with some financial damage. He is in his 60s I believe, she is a bit younger, but not far. Both still work full time and generally healthy.

Responses in other countries:

China - a country not prone to panic with centralized regime, at the epicenter of this spread quarantined tens of millions. Now the disease spread is going down - after the country been on hold for a very long time with very difficult economic consequences. Had to build emergency hospitals and add beds practically over night. Very organized and compliant population.

Italy - a European country which major income is tourism. Quarantine of millions, after they were not able to contain it otherwise. I am sure this is not fun for their government, let alone people.

Israel - a country that basically ignored SARS, MERS, swine flue and any other virus in terms of public response. Mandatory 14 days quarantine for everyone coming back from abroad. Any country. Some internal talks about asking all medical personnel to postpone personal travel abroad. Takes quarantine very seriously, including legal consequences for breaking it. Great economic burden.

Again, maybe they are all just panicking, and don't know what they are doing. Maybe it is all a PR. But my guess is that the majority of the people in charge of public health truly think this is necessary and had to convince quite a lot of people in that necessity.

Me versus us

"Everyone should decide for themselves" is the mantra of people who push for NABC to go forward. While I generally believe in private freedom, I find this statement extremely inaccurate in infectious disease scenarios. No one decides for themselves only - invariably you decide for others. When you decide to vaccinate your children or not - you make the decision to lower herd immunity and expose vulnerable populations to measlesor not. In time, with such an approach, a nearly extinct disease is resurrected. When you decide to travel or not toNABC and come in contact with clearly susceptible population, you decide on what is acceptable risk to you of someone else getting really sick, not just you.

When ACBL decides to hold or not to hold NABC it will decide how much money that risk is worth, how much it values prudence and safety over financial consequences. Anything they decide would be scrutinized and criticized. However the risk they need to consider is not a particular person that may get sick, that risk may in itself be quite low - but if any one there gets sick. And I think that this is not such a far fetched scenario. Lets take the 1 in 10,000 number that an interested math teacher threw out of his pocket on this forum - lets say 1,000 people attend. What are the chances that no one gets sick with this virus? You are all bridge players and know how to do that math - the back of the envelope comes to ~0.90. If I was ACBL,having 10% chance of at least someone getting really sick is not a pretty prospect - with or without financial liability. Compound this by the population demographics, NABC play dynamics and environment - these numbers are not getting better.

So while everyone decides for themselves whether to stock on toilet paper and water (I did not), I understand why scientific conferences are cancelled, and public events are postponed. In my opinion, however inconvenient and disappointing it is - if I was in ACBL place, yes I would cancel. Not because I would be afraid to get sick, but because there is a high enough chance of someone getting really sick, and I am not arrogant enough to think that I know better than the people who made it their life study. I also do not consider card game as an essential travel. It is a game.


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